|
LIDOCAINE 1% PF VIAL (2mL)
|
Facility
|
OP
|
$75.22
|
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$72.21 |
| Rate for Payer: Aetna Commercial |
$57.92
|
| Rate for Payer: Anthem Medicaid |
$25.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.67
|
| Rate for Payer: Cash Price |
$37.61
|
| Rate for Payer: Cigna Commercial |
$62.43
|
| Rate for Payer: First Health Commercial |
$71.46
|
| Rate for Payer: Humana Commercial |
$63.94
|
| Rate for Payer: Humana KY Medicaid |
$25.87
|
| Rate for Payer: Kentucky WC Medicaid |
$26.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.19
|
| Rate for Payer: Ohio Health Group HMO |
$56.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.32
|
| Rate for Payer: PHCS Commercial |
$72.21
|
| Rate for Payer: United Healthcare All Payer |
$66.19
|
|
|
LIDOCAINE 1% PF VIAL (2mL)
|
Facility
|
IP
|
$75.22
|
|
| Hospital Charge Code |
636T0103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$72.21 |
| Rate for Payer: Aetna Commercial |
$57.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.67
|
| Rate for Payer: Cash Price |
$37.61
|
| Rate for Payer: Cigna Commercial |
$62.43
|
| Rate for Payer: First Health Commercial |
$71.46
|
| Rate for Payer: Humana Commercial |
$63.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.19
|
| Rate for Payer: Ohio Health Group HMO |
$56.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.32
|
| Rate for Payer: PHCS Commercial |
$72.21
|
| Rate for Payer: United Healthcare All Payer |
$66.19
|
|
|
LIDOCAINE 1% PF VIAL (2mL)
|
Professional
|
Both
|
$75.22
|
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$75.22 |
| Rate for Payer: Buckeye Medicare Advantage |
$75.22
|
| Rate for Payer: Cash Price |
$37.61
|
| Rate for Payer: Multiplan PHCS |
$45.13
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.65
|
| Rate for Payer: UHCCP Medicaid |
$26.33
|
|
|
LIDOCAINE 1% PF VIAL (2mL)
|
Facility
|
IP
|
$78.22
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003625
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$60.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.01
|
| Rate for Payer: Cash Price |
$39.11
|
| Rate for Payer: Cigna Commercial |
$64.92
|
| Rate for Payer: First Health Commercial |
$74.31
|
| Rate for Payer: Humana Commercial |
$66.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.83
|
| Rate for Payer: Ohio Health Group HMO |
$58.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.25
|
| Rate for Payer: PHCS Commercial |
$75.09
|
| Rate for Payer: United Healthcare All Payer |
$68.83
|
|
|
LIDOCAINE 1% PF VIAL (5mL)
|
Facility
|
OP
|
$79.93
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$76.73 |
| Rate for Payer: Aetna Commercial |
$61.55
|
| Rate for Payer: Anthem Medicaid |
$27.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.35
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Cigna Commercial |
$66.34
|
| Rate for Payer: First Health Commercial |
$75.93
|
| Rate for Payer: Humana Commercial |
$67.94
|
| Rate for Payer: Humana KY Medicaid |
$27.49
|
| Rate for Payer: Kentucky WC Medicaid |
$27.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.34
|
| Rate for Payer: Ohio Health Group HMO |
$59.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$76.73
|
| Rate for Payer: United Healthcare All Payer |
$70.34
|
|
|
LIDOCAINE 1% PF VIAL (5mL)
|
Facility
|
OP
|
$76.93
|
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$59.24
|
| Rate for Payer: Anthem Medicaid |
$26.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.01
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: First Health Commercial |
$73.08
|
| Rate for Payer: Humana Commercial |
$65.39
|
| Rate for Payer: Humana KY Medicaid |
$26.46
|
| Rate for Payer: Kentucky WC Medicaid |
$26.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.70
|
| Rate for Payer: Ohio Health Group HMO |
$57.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.85
|
| Rate for Payer: PHCS Commercial |
$73.85
|
| Rate for Payer: United Healthcare All Payer |
$67.70
|
|
|
LIDOCAINE 1% PF VIAL (5mL)
|
Professional
|
Both
|
$76.93
|
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$76.93 |
| Rate for Payer: Buckeye Medicare Advantage |
$76.93
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Multiplan PHCS |
$46.16
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.85
|
| Rate for Payer: UHCCP Medicaid |
$26.93
|
|
|
LIDOCAINE 1% PF VIAL (5mL)
|
Facility
|
IP
|
$79.93
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$76.73 |
| Rate for Payer: Aetna Commercial |
$61.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.35
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Cigna Commercial |
$66.34
|
| Rate for Payer: First Health Commercial |
$75.93
|
| Rate for Payer: Humana Commercial |
$67.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.34
|
| Rate for Payer: Ohio Health Group HMO |
$59.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$76.73
|
| Rate for Payer: United Healthcare All Payer |
$70.34
|
|
|
LIDOCAINE 1% PF VIAL (5mL)
|
Facility
|
OP
|
$76.93
|
|
| Hospital Charge Code |
636T0102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$59.24
|
| Rate for Payer: Anthem Medicaid |
$26.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.01
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: First Health Commercial |
$73.08
|
| Rate for Payer: Humana Commercial |
$65.39
|
| Rate for Payer: Humana KY Medicaid |
$26.46
|
| Rate for Payer: Kentucky WC Medicaid |
$26.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.70
|
| Rate for Payer: Ohio Health Group HMO |
$57.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.85
|
| Rate for Payer: PHCS Commercial |
$73.85
|
| Rate for Payer: United Healthcare All Payer |
$67.70
|
|
|
LIDOCAINE 1% PF VIAL (5mL)
|
Facility
|
IP
|
$76.93
|
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$59.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.01
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: First Health Commercial |
$73.08
|
| Rate for Payer: Humana Commercial |
$65.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.70
|
| Rate for Payer: Ohio Health Group HMO |
$57.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.85
|
| Rate for Payer: PHCS Commercial |
$73.85
|
| Rate for Payer: United Healthcare All Payer |
$67.70
|
|
|
LIDOCAINE 1% PF VIAL (5mL)
|
Facility
|
IP
|
$76.93
|
|
| Hospital Charge Code |
636T0102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$59.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.01
|
| Rate for Payer: Cash Price |
$38.47
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: First Health Commercial |
$73.08
|
| Rate for Payer: Humana Commercial |
$65.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.70
|
| Rate for Payer: Ohio Health Group HMO |
$57.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.85
|
| Rate for Payer: PHCS Commercial |
$73.85
|
| Rate for Payer: United Healthcare All Payer |
$67.70
|
|
|
LIDOCAINE 1% TEARTO 300MG/10ML
|
Facility
|
IP
|
$79.27
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$76.10 |
| Rate for Payer: Aetna Commercial |
$61.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Cash Price |
$39.63
|
| Rate for Payer: Cigna Commercial |
$65.79
|
| Rate for Payer: First Health Commercial |
$75.31
|
| Rate for Payer: Humana Commercial |
$67.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.76
|
| Rate for Payer: Ohio Health Group HMO |
$59.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.57
|
| Rate for Payer: PHCS Commercial |
$76.10
|
| Rate for Payer: United Healthcare All Payer |
$69.76
|
|
|
LIDOCAINE 1% TEARTO 300MG/10ML
|
Facility
|
OP
|
$79.27
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$76.10 |
| Rate for Payer: Aetna Commercial |
$61.04
|
| Rate for Payer: Anthem Medicaid |
$27.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Cash Price |
$39.63
|
| Rate for Payer: Cigna Commercial |
$65.79
|
| Rate for Payer: First Health Commercial |
$75.31
|
| Rate for Payer: Humana Commercial |
$67.38
|
| Rate for Payer: Humana KY Medicaid |
$27.26
|
| Rate for Payer: Kentucky WC Medicaid |
$27.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.76
|
| Rate for Payer: Ohio Health Group HMO |
$59.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.57
|
| Rate for Payer: PHCS Commercial |
$76.10
|
| Rate for Payer: United Healthcare All Payer |
$69.76
|
|
|
LIDOCAINE 1% VIAL (10ML)
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
LIDOCAINE 1% VIAL (10ML)
|
Facility
|
OP
|
$78.44
|
|
|
Service Code
|
NDC 63323020103
|
| Hospital Charge Code |
25003166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$75.30 |
| Rate for Payer: Aetna Commercial |
$60.40
|
| Rate for Payer: Anthem Medicaid |
$26.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.18
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cigna Commercial |
$65.11
|
| Rate for Payer: First Health Commercial |
$74.52
|
| Rate for Payer: Humana Commercial |
$66.67
|
| Rate for Payer: Humana KY Medicaid |
$26.98
|
| Rate for Payer: Kentucky WC Medicaid |
$27.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.03
|
| Rate for Payer: Ohio Health Group HMO |
$58.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.32
|
| Rate for Payer: PHCS Commercial |
$75.30
|
| Rate for Payer: United Healthcare All Payer |
$69.03
|
|
|
LIDOCAINE 1% VIAL (10ML)
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
636T0088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
LIDOCAINE 1% VIAL (10ML)
|
Facility
|
IP
|
$78.44
|
|
|
Service Code
|
NDC 63323020103
|
| Hospital Charge Code |
25003166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$75.30 |
| Rate for Payer: Aetna Commercial |
$60.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.18
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cigna Commercial |
$65.11
|
| Rate for Payer: First Health Commercial |
$74.52
|
| Rate for Payer: Humana Commercial |
$66.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.03
|
| Rate for Payer: Ohio Health Group HMO |
$58.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.32
|
| Rate for Payer: PHCS Commercial |
$75.30
|
| Rate for Payer: United Healthcare All Payer |
$69.03
|
|
|
LIDOCAINE 1% VIAL (10ML)
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
636T0088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
LIDOCAINE 1% VIAL (10ML)
|
Professional
|
Both
|
$60.00
|
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
|
|
LIDOCAINE 1% VIAL (10ML)
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.60
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
LIDOCAINE 2% JELLY W/INJ 6ML
|
Facility
|
IP
|
$20.95
|
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$20.11 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.34
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna Commercial |
$17.39
|
| Rate for Payer: First Health Commercial |
$19.90
|
| Rate for Payer: Humana Commercial |
$17.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.44
|
| Rate for Payer: Ohio Health Group HMO |
$15.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$20.11
|
| Rate for Payer: United Healthcare All Payer |
$18.44
|
|
|
LIDOCAINE 2% JELLY W/INJ 6ML
|
Professional
|
Both
|
$20.95
|
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$20.95 |
| Rate for Payer: Buckeye Medicare Advantage |
$20.95
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Multiplan PHCS |
$12.57
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.66
|
| Rate for Payer: UHCCP Medicaid |
$7.33
|
|
|
LIDOCAINE 2% JELLY W/INJ 6ML
|
Facility
|
OP
|
$20.95
|
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$20.11 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Anthem Medicaid |
$7.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.34
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna Commercial |
$17.39
|
| Rate for Payer: First Health Commercial |
$19.90
|
| Rate for Payer: Humana Commercial |
$17.81
|
| Rate for Payer: Humana KY Medicaid |
$7.20
|
| Rate for Payer: Kentucky WC Medicaid |
$7.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.44
|
| Rate for Payer: Ohio Health Group HMO |
$15.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$20.11
|
| Rate for Payer: United Healthcare All Payer |
$18.44
|
|
|
LIDOCAINE 2% JELLY W/INJ 6ML
|
Facility
|
OP
|
$20.95
|
|
| Hospital Charge Code |
636T0089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$20.11 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Anthem Medicaid |
$7.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.34
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna Commercial |
$17.39
|
| Rate for Payer: First Health Commercial |
$19.90
|
| Rate for Payer: Humana Commercial |
$17.81
|
| Rate for Payer: Humana KY Medicaid |
$7.20
|
| Rate for Payer: Kentucky WC Medicaid |
$7.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.44
|
| Rate for Payer: Ohio Health Group HMO |
$15.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$20.11
|
| Rate for Payer: United Healthcare All Payer |
$18.44
|
|
|
LIDOCAINE 2% JELLY W/INJ 6ML
|
Facility
|
IP
|
$20.95
|
|
| Hospital Charge Code |
636T0089
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$20.11 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.34
|
| Rate for Payer: Cash Price |
$10.47
|
| Rate for Payer: Cigna Commercial |
$17.39
|
| Rate for Payer: First Health Commercial |
$19.90
|
| Rate for Payer: Humana Commercial |
$17.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.44
|
| Rate for Payer: Ohio Health Group HMO |
$15.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.49
|
| Rate for Payer: PHCS Commercial |
$20.11
|
| Rate for Payer: United Healthcare All Payer |
$18.44
|
|
