|
LACTATED RINGERS IRRIGA 3000ML
|
Facility
|
OP
|
$87.54
|
|
|
Service Code
|
NDC 990782808
|
| Hospital Charge Code |
25003154
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$84.04 |
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Anthem Medicaid |
$30.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.28
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$72.66
|
| Rate for Payer: First Health Commercial |
$83.16
|
| Rate for Payer: Humana Commercial |
$74.41
|
| Rate for Payer: Humana KY Medicaid |
$30.11
|
| Rate for Payer: Kentucky WC Medicaid |
$30.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.04
|
| Rate for Payer: Ohio Health Group HMO |
$65.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.40
|
| Rate for Payer: PHCS Commercial |
$84.04
|
| Rate for Payer: United Healthcare All Payer |
$77.04
|
|
|
LACTATED RINGERS IRRIGA 3000ML
|
Facility
|
IP
|
$87.54
|
|
|
Service Code
|
NDC 990782808
|
| Hospital Charge Code |
25003154
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$84.04 |
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.28
|
| Rate for Payer: Cash Price |
$43.77
|
| Rate for Payer: Cigna Commercial |
$72.66
|
| Rate for Payer: First Health Commercial |
$83.16
|
| Rate for Payer: Humana Commercial |
$74.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.04
|
| Rate for Payer: Ohio Health Group HMO |
$65.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.40
|
| Rate for Payer: PHCS Commercial |
$84.04
|
| Rate for Payer: United Healthcare All Payer |
$77.04
|
|
|
LACTATE (LACTIC ACID)
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
CPT 83605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.62
|
| Rate for Payer: Humana Medicare Advantage |
$11.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.88
|
|
|
LACTATE (LD) (LDH) ENZYME
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
30000435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$6.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.04
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$6.04
|
| Rate for Payer: Humana Medicare Advantage |
$6.04
|
| Rate for Payer: Kentucky WC Medicaid |
$6.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
LACTATE (LD) (LDH) ENZYME
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
30000435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
LACTIC ACID VENOUS
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
30000434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
LACTIC ACID VENOUS
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
30000434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem Medicaid |
$11.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.57
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Humana KY Medicaid |
$11.57
|
| Rate for Payer: Humana Medicare Advantage |
$11.57
|
| Rate for Payer: Kentucky WC Medicaid |
$11.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
LACTULOSE ENEMA SOL 1000ML
|
Facility
|
OP
|
$33.38
|
|
|
Service Code
|
NDC 121087316
|
| Hospital Charge Code |
25003155
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Anthem Medicaid |
$11.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.04
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cigna Commercial |
$27.71
|
| Rate for Payer: First Health Commercial |
$31.71
|
| Rate for Payer: Humana Commercial |
$28.37
|
| Rate for Payer: Humana KY Medicaid |
$11.48
|
| Rate for Payer: Kentucky WC Medicaid |
$11.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.37
|
| Rate for Payer: Ohio Health Group HMO |
$25.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.03
|
| Rate for Payer: PHCS Commercial |
$32.04
|
| Rate for Payer: United Healthcare All Payer |
$29.37
|
|
|
LACTULOSE ENEMA SOL 1000ML
|
Facility
|
IP
|
$33.38
|
|
|
Service Code
|
NDC 121087316
|
| Hospital Charge Code |
25003155
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$25.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.04
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cigna Commercial |
$27.71
|
| Rate for Payer: First Health Commercial |
$31.71
|
| Rate for Payer: Humana Commercial |
$28.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.37
|
| Rate for Payer: Ohio Health Group HMO |
$25.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.03
|
| Rate for Payer: PHCS Commercial |
$32.04
|
| Rate for Payer: United Healthcare All Payer |
$29.37
|
|
|
LAG SCREW 10.5*95MM
|
Facility
|
IP
|
$3,882.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.75 |
| Max. Negotiated Rate |
$3,727.20 |
| Rate for Payer: Aetna Commercial |
$2,989.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.35
|
| Rate for Payer: Cash Price |
$1,941.25
|
| Rate for Payer: Cigna Commercial |
$3,222.47
|
| Rate for Payer: First Health Commercial |
$3,688.38
|
| Rate for Payer: Humana Commercial |
$3,300.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,183.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,416.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,911.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,377.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.93
|
| Rate for Payer: PHCS Commercial |
$3,727.20
|
| Rate for Payer: United Healthcare All Payer |
$3,416.60
|
|
|
LAG SCREW 10.5*95MM
|
Facility
|
OP
|
$3,882.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.75 |
| Max. Negotiated Rate |
$3,727.20 |
| Rate for Payer: Aetna Commercial |
$2,989.53
|
| Rate for Payer: Anthem Medicaid |
$1,335.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.35
|
| Rate for Payer: Cash Price |
$1,941.25
|
| Rate for Payer: Cigna Commercial |
$3,222.47
|
| Rate for Payer: First Health Commercial |
$3,688.38
|
| Rate for Payer: Humana Commercial |
$3,300.12
|
| Rate for Payer: Humana KY Medicaid |
$1,335.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,348.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,183.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,416.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,911.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,377.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.93
|
| Rate for Payer: PHCS Commercial |
$3,727.20
|
| Rate for Payer: United Healthcare All Payer |
$3,416.60
|
|
|
LAG SCREWS 4.0*40.0MM
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
LAG SCREWS 4.0*40.0MM
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
LAG SCREWS 4.0*45.0MM
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
LAG SCREWS 4.0*45.0MM
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
LAMBS QUARTERS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000764
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
LAMBS QUARTERS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000764
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
LAMICTAL (LAMOTRIGINE)100 MG T
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 904700861
|
| Hospital Charge Code |
25000831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
LAMICTAL (LAMOTRIGINE)100 MG T
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 904700861
|
| Hospital Charge Code |
25000831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
LAMICTAL (LAMOTRIGINE) 25 MG T
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 68084031801
|
| Hospital Charge Code |
25000830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
LAMICTAL (LAMOTRIGINE) 25 MG T
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 68084031801
|
| Hospital Charge Code |
25000830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
LAMICTAL (LAMOTRIGINE) 5MG TAB
|
Facility
|
IP
|
$26.52
|
|
|
Service Code
|
NDC 173052600
|
| Hospital Charge Code |
25003849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna Commercial |
$20.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.69
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: First Health Commercial |
$25.19
|
| Rate for Payer: Humana Commercial |
$22.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.34
|
| Rate for Payer: Ohio Health Group HMO |
$19.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.30
|
| Rate for Payer: PHCS Commercial |
$25.46
|
| Rate for Payer: United Healthcare All Payer |
$23.34
|
|
|
LAMICTAL (LAMOTRIGINE) 5MG TAB
|
Facility
|
OP
|
$26.52
|
|
|
Service Code
|
NDC 173052600
|
| Hospital Charge Code |
25003849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna Commercial |
$20.42
|
| Rate for Payer: Anthem Medicaid |
$9.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.69
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: First Health Commercial |
$25.19
|
| Rate for Payer: Humana Commercial |
$22.54
|
| Rate for Payer: Humana KY Medicaid |
$9.12
|
| Rate for Payer: Kentucky WC Medicaid |
$9.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.34
|
| Rate for Payer: Ohio Health Group HMO |
$19.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.30
|
| Rate for Payer: PHCS Commercial |
$25.46
|
| Rate for Payer: United Healthcare All Payer |
$23.34
|
|
|
LAMISIL (TERBINAFINE H)1%/30GM
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 24385052405
|
| Hospital Charge Code |
25000836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Anthem Medicaid |
$0.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna Commercial |
$0.25
|
| Rate for Payer: First Health Commercial |
$0.29
|
| Rate for Payer: Humana Commercial |
$0.26
|
| Rate for Payer: Humana KY Medicaid |
$0.10
|
| Rate for Payer: Kentucky WC Medicaid |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.26
|
| Rate for Payer: Ohio Health Group HMO |
$0.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.21
|
| Rate for Payer: PHCS Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Payer |
$0.26
|
|
|
LAMISIL (TERBINAFINE H)1%/30GM
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 24385052405
|
| Hospital Charge Code |
25000836
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.23
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cigna Commercial |
$0.25
|
| Rate for Payer: First Health Commercial |
$0.29
|
| Rate for Payer: Humana Commercial |
$0.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.26
|
| Rate for Payer: Ohio Health Group HMO |
$0.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.21
|
| Rate for Payer: PHCS Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Payer |
$0.26
|
|
