|
LIDO 1% + EPI 1:100 K VL(50ML)
|
Facility
|
OP
|
$79.98
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
25002461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.38
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Cigna Commercial |
$66.38
|
| Rate for Payer: First Health Commercial |
$75.98
|
| Rate for Payer: Humana Commercial |
$67.98
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.38
|
| Rate for Payer: Ohio Health Group HMO |
$59.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.19
|
| Rate for Payer: PHCS Commercial |
$76.78
|
| Rate for Payer: United Healthcare All Payer |
$70.38
|
|
|
LIDO 1% + EPI 1:100 K VL(50ML)
|
Facility
|
OP
|
$79.98
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.38
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Cigna Commercial |
$66.38
|
| Rate for Payer: First Health Commercial |
$75.98
|
| Rate for Payer: Humana Commercial |
$67.98
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.38
|
| Rate for Payer: Ohio Health Group HMO |
$59.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.19
|
| Rate for Payer: PHCS Commercial |
$76.78
|
| Rate for Payer: United Healthcare All Payer |
$70.38
|
|
|
LIDOCAINE 1% 50mL MDV
|
Facility
|
IP
|
$114.02
|
|
|
Service Code
|
NDC 409427617
|
| Hospital Charge Code |
25004159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$109.46 |
| Rate for Payer: Aetna Commercial |
$87.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.94
|
| Rate for Payer: Cash Price |
$57.01
|
| Rate for Payer: Cigna Commercial |
$94.64
|
| Rate for Payer: First Health Commercial |
$108.32
|
| Rate for Payer: Humana Commercial |
$96.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.34
|
| Rate for Payer: Ohio Health Group HMO |
$85.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.67
|
| Rate for Payer: PHCS Commercial |
$109.46
|
| Rate for Payer: United Healthcare All Payer |
$100.34
|
|
|
LIDOCAINE 1% 50mL MDV
|
Facility
|
OP
|
$114.02
|
|
|
Service Code
|
NDC 409427617
|
| Hospital Charge Code |
25004159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$109.46 |
| Rate for Payer: Aetna Commercial |
$87.80
|
| Rate for Payer: Anthem Medicaid |
$39.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.94
|
| Rate for Payer: Cash Price |
$57.01
|
| Rate for Payer: Cigna Commercial |
$94.64
|
| Rate for Payer: First Health Commercial |
$108.32
|
| Rate for Payer: Humana Commercial |
$96.92
|
| Rate for Payer: Humana KY Medicaid |
$39.21
|
| Rate for Payer: Kentucky WC Medicaid |
$39.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.34
|
| Rate for Payer: Ohio Health Group HMO |
$85.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.67
|
| Rate for Payer: PHCS Commercial |
$109.46
|
| Rate for Payer: United Healthcare All Payer |
$100.34
|
|
|
LIDOCAINE 1% MDV VIAL (20ML)
|
Facility
|
IP
|
$79.39
|
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$76.21 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.92
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna Commercial |
$65.89
|
| Rate for Payer: First Health Commercial |
$75.42
|
| Rate for Payer: Humana Commercial |
$67.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.86
|
| Rate for Payer: Ohio Health Group HMO |
$59.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.78
|
| Rate for Payer: PHCS Commercial |
$76.21
|
| Rate for Payer: United Healthcare All Payer |
$69.86
|
|
|
LIDOCAINE 1% MDV VIAL (20ML)
|
Facility
|
OP
|
$79.39
|
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$76.21 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Anthem Medicaid |
$27.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.92
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna Commercial |
$65.89
|
| Rate for Payer: First Health Commercial |
$75.42
|
| Rate for Payer: Humana Commercial |
$67.48
|
| Rate for Payer: Humana KY Medicaid |
$27.30
|
| Rate for Payer: Kentucky WC Medicaid |
$27.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.86
|
| Rate for Payer: Ohio Health Group HMO |
$59.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.78
|
| Rate for Payer: PHCS Commercial |
$76.21
|
| Rate for Payer: United Healthcare All Payer |
$69.86
|
|
|
LIDOCAINE 1% MDV VIAL (20ML)
|
Facility
|
IP
|
$79.39
|
|
| Hospital Charge Code |
636T0104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$76.21 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.92
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna Commercial |
$65.89
|
| Rate for Payer: First Health Commercial |
$75.42
|
| Rate for Payer: Humana Commercial |
$67.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.86
|
| Rate for Payer: Ohio Health Group HMO |
$59.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.78
|
| Rate for Payer: PHCS Commercial |
$76.21
|
| Rate for Payer: United Healthcare All Payer |
$69.86
|
|
|
LIDOCAINE 1% MDV VIAL (20ML)
|
Facility
|
OP
|
$76.39
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$73.33 |
| Rate for Payer: Aetna Commercial |
$58.82
|
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Anthem Medicaid |
$26.27
|
| Rate for Payer: Anthem Medicaid |
$27.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.92
|
| Rate for Payer: Cash Price |
$38.20
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna Commercial |
$65.89
|
| Rate for Payer: Cigna Commercial |
$63.40
|
| Rate for Payer: First Health Commercial |
$75.42
|
| Rate for Payer: First Health Commercial |
$72.57
|
| Rate for Payer: Humana Commercial |
$64.93
|
| Rate for Payer: Humana Commercial |
$67.48
|
| Rate for Payer: Humana KY Medicaid |
$26.27
|
| Rate for Payer: Humana KY Medicaid |
$27.30
|
| Rate for Payer: Kentucky WC Medicaid |
$27.58
|
| Rate for Payer: Kentucky WC Medicaid |
$26.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.86
|
| Rate for Payer: Ohio Health Group HMO |
$57.29
|
| Rate for Payer: Ohio Health Group HMO |
$59.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.78
|
| Rate for Payer: PHCS Commercial |
$76.21
|
| Rate for Payer: PHCS Commercial |
$73.33
|
| Rate for Payer: United Healthcare All Payer |
$69.86
|
| Rate for Payer: United Healthcare All Payer |
$67.22
|
|
|
LIDOCAINE 1% MDV VIAL (20ML)
|
Professional
|
Both
|
$79.39
|
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.79 |
| Max. Negotiated Rate |
$55.57 |
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Multiplan PHCS |
$47.63
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.57
|
| Rate for Payer: UHCCP Medicaid |
$27.79
|
|
|
LIDOCAINE 1% MDV VIAL (20ML)
|
Facility
|
IP
|
$76.39
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$73.33 |
| Rate for Payer: Aetna Commercial |
$58.82
|
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.92
|
| Rate for Payer: Cash Price |
$38.20
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna Commercial |
$63.40
|
| Rate for Payer: Cigna Commercial |
$65.89
|
| Rate for Payer: First Health Commercial |
$75.42
|
| Rate for Payer: First Health Commercial |
$72.57
|
| Rate for Payer: Humana Commercial |
$67.48
|
| Rate for Payer: Humana Commercial |
$64.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.86
|
| Rate for Payer: Ohio Health Group HMO |
$57.29
|
| Rate for Payer: Ohio Health Group HMO |
$59.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.71
|
| Rate for Payer: PHCS Commercial |
$73.33
|
| Rate for Payer: PHCS Commercial |
$76.21
|
| Rate for Payer: United Healthcare All Payer |
$67.22
|
| Rate for Payer: United Healthcare All Payer |
$69.86
|
|
|
LIDOCAINE 1% MDV VIAL (20ML)
|
Facility
|
OP
|
$79.39
|
|
| Hospital Charge Code |
636T0104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$76.21 |
| Rate for Payer: Aetna Commercial |
$61.13
|
| Rate for Payer: Anthem Medicaid |
$27.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.92
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna Commercial |
$65.89
|
| Rate for Payer: First Health Commercial |
$75.42
|
| Rate for Payer: Humana Commercial |
$67.48
|
| Rate for Payer: Humana KY Medicaid |
$27.30
|
| Rate for Payer: Kentucky WC Medicaid |
$27.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.86
|
| Rate for Payer: Ohio Health Group HMO |
$59.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.78
|
| Rate for Payer: PHCS Commercial |
$76.21
|
| Rate for Payer: United Healthcare All Payer |
$69.86
|
|
|
LIDOCAINE 1MG(100MG/25ML) SYR
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25004247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Anthem Medicaid |
$0.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.66
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cigna Commercial |
$1.77
|
| Rate for Payer: First Health Commercial |
$2.02
|
| Rate for Payer: Humana Commercial |
$1.81
|
| Rate for Payer: Humana KY Medicaid |
$0.73
|
| Rate for Payer: Kentucky WC Medicaid |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.87
|
| Rate for Payer: Ohio Health Group HMO |
$1.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Payer |
$1.87
|
|
|
LIDOCAINE 1MG(100MG/25ML) SYR
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25004247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.66
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: Cigna Commercial |
$1.77
|
| Rate for Payer: First Health Commercial |
$2.02
|
| Rate for Payer: Humana Commercial |
$1.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.87
|
| Rate for Payer: Ohio Health Group HMO |
$1.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$2.04
|
| Rate for Payer: United Healthcare All Payer |
$1.87
|
|
|
LIDOCAINE 1mg (2,000mg SOLN)
|
Facility
|
IP
|
$115.90
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
25002991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$111.26 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.40
|
| Rate for Payer: Cash Price |
$57.95
|
| Rate for Payer: Cigna Commercial |
$96.20
|
| Rate for Payer: First Health Commercial |
$110.11
|
| Rate for Payer: Humana Commercial |
$98.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.99
|
| Rate for Payer: Ohio Health Group HMO |
$86.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.97
|
| Rate for Payer: PHCS Commercial |
$111.26
|
| Rate for Payer: United Healthcare All Payer |
$101.99
|
|
|
LIDOCAINE 1mg (2,000mg SOLN)
|
Facility
|
OP
|
$115.90
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
25002991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$111.26 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Anthem Medicaid |
$39.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.40
|
| Rate for Payer: Cash Price |
$57.95
|
| Rate for Payer: Cigna Commercial |
$96.20
|
| Rate for Payer: First Health Commercial |
$110.11
|
| Rate for Payer: Humana Commercial |
$98.52
|
| Rate for Payer: Humana KY Medicaid |
$39.86
|
| Rate for Payer: Kentucky WC Medicaid |
$40.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.99
|
| Rate for Payer: Ohio Health Group HMO |
$86.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.97
|
| Rate for Payer: PHCS Commercial |
$111.26
|
| Rate for Payer: United Healthcare All Payer |
$101.99
|
|
|
LIDOCAINE 1mg (2,000mg VL)
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.04
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
LIDOCAINE 1mg (2,000mg VL)
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
636T0087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.04
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
LIDOCAINE 1mg (2,000mg VL)
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.04
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
LIDOCAINE 1mg (2,000mg VL)
|
Professional
|
Both
|
$0.06
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Multiplan PHCS |
$0.04
|
| Rate for Payer: UHCCP Medicaid |
$0.02
|
|
|
LIDOCAINE 1mg (2,000mg VL)
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
636T0087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.04
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
LIDOCAINE 1% PF VIAL (2mL)
|
Facility
|
OP
|
$78.22
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003625
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$60.23
|
| Rate for Payer: Anthem Medicaid |
$26.90
|
| 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: Humana KY Medicaid |
$26.90
|
| Rate for Payer: Kentucky WC Medicaid |
$27.17
|
| 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: Molina Healthcare Medicaid |
$27.44
|
| 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 |
$62.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.97
|
| Rate for Payer: PHCS Commercial |
$75.09
|
| Rate for Payer: United Healthcare All Payer |
$68.83
|
|
|
LIDOCAINE 1% PF VIAL (2mL)
|
Facility
|
IP
|
$78.22
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
25003625
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.47 |
| 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 |
$62.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.97
|
| Rate for Payer: PHCS Commercial |
$75.09
|
| Rate for Payer: United Healthcare All Payer |
$68.83
|
|
|
LIDOCAINE 1% PF VIAL (2mL)
|
Facility
|
OP
|
$78.22
|
|
| Hospital Charge Code |
636T0103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$60.23
|
| Rate for Payer: Anthem Medicaid |
$26.90
|
| 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: Humana KY Medicaid |
$26.90
|
| Rate for Payer: Kentucky WC Medicaid |
$27.17
|
| 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: Molina Healthcare Medicaid |
$27.44
|
| 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 |
$62.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.97
|
| Rate for Payer: PHCS Commercial |
$75.09
|
| Rate for Payer: United Healthcare All Payer |
$68.83
|
|
|
LIDOCAINE 1% PF VIAL (2mL)
|
Facility
|
IP
|
$78.22
|
|
| Hospital Charge Code |
636T0103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.47 |
| 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 |
$62.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.97
|
| Rate for Payer: PHCS Commercial |
$75.09
|
| Rate for Payer: United Healthcare All Payer |
$68.83
|
|
|
LIDOCAINE 1% PF VIAL (2mL)
|
Professional
|
Both
|
$78.22
|
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: Cash Price |
$39.11
|
| Rate for Payer: Multiplan PHCS |
$46.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.75
|
| Rate for Payer: UHCCP Medicaid |
$27.38
|
|
