Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
DIANEAL LC 1.5%DEX 6LINJ
Low
$11
Average
$76
Median
$19
High
$401
Each hospital's average Molina rate, under the methodology and billing class chosen below.
30 hospitals; the 90th percentile is 22.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
30 hospital rates
iThe hospitals that file a Molina rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 2 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 3 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 4 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 5 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 6 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 7 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 8 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 9 | Fisher-Titus Medical Center Norwalk, OH facility · case rate · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 10 | GRITMAN MEDICAL CENTER INC Moscow, ID facility · fee schedule · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 11 | HCA HOUSTON HEALTHCARE CONROE CONROE, TX percent of total billed charges · outpatientfrom % of charges | 1 | $35 | $35 | — | — | — | $35 – $35 |
| 12 | HCA HOUSTON HEALTHCARE KINGWOOD KINGWOOD, TX percent of total billed charges · outpatientfrom % of charges | 1 | $61 | $61 | — | — | — | $61 – $61 |
| 13 | HCA Healthcare Live Oak Mental Health and Wellness Ladson, SC percent of total billed charges · outpatientfrom % of charges | 1 | $121 | $121 | $31 | 26% | — | $90 – $152 |
| 14 | HCA Healthcare Summerville Hospital SUMMERVILLE, SC percent of total billed charges · outpatientfrom % of charges | 1 | $121 | $121 | $31 | 26% | — | $90 – $152 |
| 15 | HCA Healthcare Trident Hospital SUMMERVILLE, SC percent of total billed charges · outpatientfrom % of charges | 1 | $121 | $121 | $31 | 26% | — | $90 – $152 |
| 16 | LODI COMMUNITY HOSPITAL Lodi, OH facility · case rate · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 17 | LUTHERAN HOSPITAL Cleveland, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 18 | MARYMOUNT HOSPITAL INC Garfield Heights, OH facility · case rate · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 19 | MEDINA HOSPITAL Medina, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 20 | NATIONWIDE CHILDREN'S HOSPITAL TOLEDO, LLC Toledo, OH facility · other · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 21 | Nationwide Children's Hospital Columbus, OH facility · other · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 22 | Santa Rosa Hospital - Westover Hills San Antonio, TX percent of total billed charges · outpatientfrom % of charges | 2 | $108 | $112 | $58 | 52% | — | $49 – $184 |
| 23 | Spohn Hospital Corpus Christi - Shoreline Corpus Christi, TX percent of total billed charges · outpatientfrom % of charges | 3 | $320 | $320 | — | — | — | $320 – $320 |
| 24 | Spohn Hospital Corpus Christi - South Corpus Christi, TX percent of total billed charges · outpatientfrom % of charges | 3 | $320 | $320 | — | — | — | $320 – $320 |
| 25 | Spohn Hospital Corpus Christi - South Corpus Christi, TX percent of total billed charges · outpatientfrom % of charges | 3 | $320 | $320 | — | — | — | $320 – $320 |
← Payers reporting HCPCS A4726 · Snapshot 20261112T181611Z-3fa9fb76