|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
OP
|
$75.94
|
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$58.47
|
| Rate for Payer: Anthem Medicaid |
$26.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.23
|
| Rate for Payer: Cash Price |
$37.97
|
| Rate for Payer: Cigna Commercial |
$63.03
|
| Rate for Payer: First Health Commercial |
$72.14
|
| Rate for Payer: Humana Commercial |
$64.55
|
| Rate for Payer: Humana KY Medicaid |
$26.12
|
| Rate for Payer: Kentucky WC Medicaid |
$26.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.83
|
| Rate for Payer: Ohio Health Group HMO |
$56.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.54
|
| Rate for Payer: PHCS Commercial |
$72.90
|
| Rate for Payer: United Healthcare All Payer |
$66.83
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
IP
|
$75.94
|
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$58.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.23
|
| Rate for Payer: Cash Price |
$37.97
|
| Rate for Payer: Cigna Commercial |
$63.03
|
| Rate for Payer: First Health Commercial |
$72.14
|
| Rate for Payer: Humana Commercial |
$64.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.83
|
| Rate for Payer: Ohio Health Group HMO |
$56.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.54
|
| Rate for Payer: PHCS Commercial |
$72.90
|
| Rate for Payer: United Healthcare All Payer |
$66.83
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Professional
|
Both
|
$75.94
|
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.58 |
| Max. Negotiated Rate |
$75.94 |
| Rate for Payer: Buckeye Medicare Advantage |
$75.94
|
| Rate for Payer: Cash Price |
$37.97
|
| Rate for Payer: Multiplan PHCS |
$45.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.16
|
| Rate for Payer: UHCCP Medicaid |
$26.58
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
IP
|
$75.94
|
|
| Hospital Charge Code |
636T0086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$58.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.23
|
| Rate for Payer: Cash Price |
$37.97
|
| Rate for Payer: Cigna Commercial |
$63.03
|
| Rate for Payer: First Health Commercial |
$72.14
|
| Rate for Payer: Humana Commercial |
$64.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.83
|
| Rate for Payer: Ohio Health Group HMO |
$56.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.54
|
| Rate for Payer: PHCS Commercial |
$72.90
|
| Rate for Payer: United Healthcare All Payer |
$66.83
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
IP
|
$79.51
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25002942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$76.33 |
| Rate for Payer: Aetna Commercial |
$61.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.02
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cigna Commercial |
$65.99
|
| Rate for Payer: First Health Commercial |
$75.53
|
| Rate for Payer: Humana Commercial |
$67.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.97
|
| Rate for Payer: Ohio Health Group HMO |
$59.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.65
|
| Rate for Payer: PHCS Commercial |
$76.33
|
| Rate for Payer: United Healthcare All Payer |
$69.97
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
OP
|
$75.94
|
|
| Hospital Charge Code |
636T0086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$58.47
|
| Rate for Payer: Anthem Medicaid |
$26.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.23
|
| Rate for Payer: Cash Price |
$37.97
|
| Rate for Payer: Cigna Commercial |
$63.03
|
| Rate for Payer: First Health Commercial |
$72.14
|
| Rate for Payer: Humana Commercial |
$64.55
|
| Rate for Payer: Humana KY Medicaid |
$26.12
|
| Rate for Payer: Kentucky WC Medicaid |
$26.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.83
|
| Rate for Payer: Ohio Health Group HMO |
$56.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.54
|
| Rate for Payer: PHCS Commercial |
$72.90
|
| Rate for Payer: United Healthcare All Payer |
$66.83
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
OP
|
$79.51
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25002942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$76.33 |
| Rate for Payer: Aetna Commercial |
$61.22
|
| Rate for Payer: Anthem Medicaid |
$27.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.57
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cigna Commercial |
$65.99
|
| Rate for Payer: First Health Commercial |
$75.53
|
| Rate for Payer: Humana Commercial |
$67.58
|
| Rate for Payer: Humana KY Medicaid |
$27.34
|
| Rate for Payer: Humana Medicare Advantage |
$1.90
|
| Rate for Payer: Kentucky WC Medicaid |
$27.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.97
|
| Rate for Payer: Ohio Health Group HMO |
$59.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.65
|
| Rate for Payer: PHCS Commercial |
$76.33
|
| Rate for Payer: United Healthcare All Payer |
$69.97
|
|
|
CLEOCIN[CLINDAMYCIN]VAGIN 40GM
|
Facility
|
IP
|
$74.61
|
|
|
Service Code
|
NDC 168027740
|
| Hospital Charge Code |
25000428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$57.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.20
|
| Rate for Payer: Cash Price |
$37.30
|
| Rate for Payer: Cigna Commercial |
$61.93
|
| Rate for Payer: First Health Commercial |
$70.88
|
| Rate for Payer: Humana Commercial |
$63.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.66
|
| Rate for Payer: Ohio Health Group HMO |
$55.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.13
|
| Rate for Payer: PHCS Commercial |
$71.63
|
| Rate for Payer: United Healthcare All Payer |
$65.66
|
|
|
CLEOCIN[CLINDAMYCIN]VAGIN 40GM
|
Facility
|
OP
|
$74.61
|
|
|
Service Code
|
NDC 168027740
|
| Hospital Charge Code |
25000428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$57.45
|
| Rate for Payer: Anthem Medicaid |
$25.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.20
|
| Rate for Payer: Cash Price |
$37.30
|
| Rate for Payer: Cigna Commercial |
$61.93
|
| Rate for Payer: First Health Commercial |
$70.88
|
| Rate for Payer: Humana Commercial |
$63.42
|
| Rate for Payer: Humana KY Medicaid |
$25.66
|
| Rate for Payer: Kentucky WC Medicaid |
$25.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.66
|
| Rate for Payer: Ohio Health Group HMO |
$55.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.13
|
| Rate for Payer: PHCS Commercial |
$71.63
|
| Rate for Payer: United Healthcare All Payer |
$65.66
|
|
|
CLEOCIN PED 75MG/5MLSOL 100ML
|
Facility
|
IP
|
$9.55
|
|
|
Service Code
|
NDC 9076004
|
| Hospital Charge Code |
25002945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.45
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: First Health Commercial |
$9.07
|
| Rate for Payer: Humana Commercial |
$8.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.40
|
| Rate for Payer: Ohio Health Group HMO |
$7.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$9.17
|
| Rate for Payer: United Healthcare All Payer |
$8.40
|
| Rate for Payer: Aetna Commercial |
$7.35
|
|
|
CLEOCIN PED 75MG/5MLSOL 100ML
|
Facility
|
OP
|
$9.55
|
|
|
Service Code
|
NDC 9076004
|
| Hospital Charge Code |
25002945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna Commercial |
$7.35
|
| Rate for Payer: Anthem Medicaid |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.45
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: First Health Commercial |
$9.07
|
| Rate for Payer: Humana Commercial |
$8.12
|
| Rate for Payer: Humana KY Medicaid |
$3.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.40
|
| Rate for Payer: Ohio Health Group HMO |
$7.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$9.17
|
| Rate for Payer: United Healthcare All Payer |
$8.40
|
|
|
CLEOCIN T(CLINDAMYCIN) 1% 30ML
|
Facility
|
OP
|
$6.61
|
|
|
Service Code
|
NDC 45802056201
|
| Hospital Charge Code |
25000426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Anthem Medicaid |
$2.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.16
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cigna Commercial |
$5.49
|
| Rate for Payer: First Health Commercial |
$6.28
|
| Rate for Payer: Humana Commercial |
$5.62
|
| Rate for Payer: Humana KY Medicaid |
$2.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.82
|
| Rate for Payer: Ohio Health Group HMO |
$4.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.05
|
| Rate for Payer: PHCS Commercial |
$6.35
|
| Rate for Payer: United Healthcare All Payer |
$5.82
|
|
|
CLEOCIN T(CLINDAMYCIN) 1% 30ML
|
Facility
|
IP
|
$6.61
|
|
|
Service Code
|
NDC 45802056201
|
| Hospital Charge Code |
25000426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.16
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cigna Commercial |
$5.49
|
| Rate for Payer: First Health Commercial |
$6.28
|
| Rate for Payer: Humana Commercial |
$5.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.82
|
| Rate for Payer: Ohio Health Group HMO |
$4.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.05
|
| Rate for Payer: PHCS Commercial |
$6.35
|
| Rate for Payer: United Healthcare All Payer |
$5.82
|
|
|
CLEOCIN T GEL 1% GEL (60GM)
|
Facility
|
OP
|
$9.04
|
|
|
Service Code
|
NDC 59762374302
|
| Hospital Charge Code |
25000425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Anthem Medicaid |
$3.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.05
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: First Health Commercial |
$8.59
|
| Rate for Payer: Humana Commercial |
$7.68
|
| Rate for Payer: Humana KY Medicaid |
$3.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.96
|
| Rate for Payer: Ohio Health Group HMO |
$6.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.80
|
| Rate for Payer: PHCS Commercial |
$8.68
|
| Rate for Payer: United Healthcare All Payer |
$7.96
|
|
|
CLEOCIN T GEL 1% GEL (60GM)
|
Facility
|
IP
|
$9.04
|
|
|
Service Code
|
NDC 59762374302
|
| Hospital Charge Code |
25000425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.05
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: First Health Commercial |
$8.59
|
| Rate for Payer: Humana Commercial |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.96
|
| Rate for Payer: Ohio Health Group HMO |
$6.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.80
|
| Rate for Payer: PHCS Commercial |
$8.68
|
| Rate for Payer: United Healthcare All Payer |
$7.96
|
|
|
[C]LIBRIUM(CHLORDIAZ 10MG/1CAP
|
Facility
|
OP
|
$60.15
|
|
|
Service Code
|
NDC 555003302
|
| Hospital Charge Code |
25000100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem Medicaid |
$20.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: First Health Commercial |
$57.14
|
| Rate for Payer: Humana Commercial |
$51.13
|
| Rate for Payer: Humana KY Medicaid |
$20.69
|
| Rate for Payer: Kentucky WC Medicaid |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.93
|
| Rate for Payer: Ohio Health Group HMO |
$45.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.65
|
| Rate for Payer: PHCS Commercial |
$57.74
|
| Rate for Payer: United Healthcare All Payer |
$52.93
|
|
|
[C]LIBRIUM(CHLORDIAZ 10MG/1CAP
|
Facility
|
IP
|
$60.15
|
|
|
Service Code
|
NDC 555003302
|
| Hospital Charge Code |
25000100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: First Health Commercial |
$57.14
|
| Rate for Payer: Humana Commercial |
$51.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.93
|
| Rate for Payer: Ohio Health Group HMO |
$45.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.65
|
| Rate for Payer: PHCS Commercial |
$57.74
|
| Rate for Payer: United Healthcare All Payer |
$52.93
|
|
|
[C]LIBRIUM(CHLORDIAZ 25MG/1CAP
|
Facility
|
OP
|
$60.17
|
|
|
Service Code
|
NDC 555015902
|
| Hospital Charge Code |
25000101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.76 |
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: Anthem Medicaid |
$20.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.93
|
| Rate for Payer: Cash Price |
$30.09
|
| Rate for Payer: Cigna Commercial |
$49.94
|
| Rate for Payer: First Health Commercial |
$57.16
|
| Rate for Payer: Humana Commercial |
$51.14
|
| Rate for Payer: Humana KY Medicaid |
$20.69
|
| Rate for Payer: Kentucky WC Medicaid |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.95
|
| Rate for Payer: Ohio Health Group HMO |
$45.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.65
|
| Rate for Payer: PHCS Commercial |
$57.76
|
| Rate for Payer: United Healthcare All Payer |
$52.95
|
|
|
[C]LIBRIUM(CHLORDIAZ 25MG/1CAP
|
Facility
|
IP
|
$60.17
|
|
|
Service Code
|
NDC 555015902
|
| Hospital Charge Code |
25000101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.76 |
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.93
|
| Rate for Payer: Cash Price |
$30.09
|
| Rate for Payer: Cigna Commercial |
$49.94
|
| Rate for Payer: First Health Commercial |
$57.16
|
| Rate for Payer: Humana Commercial |
$51.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.95
|
| Rate for Payer: Ohio Health Group HMO |
$45.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.65
|
| Rate for Payer: PHCS Commercial |
$57.76
|
| Rate for Payer: United Healthcare All Payer |
$52.95
|
|
|
[C]LIBRIUM(CHLORDIAZE 5MG/1CAP
|
Facility
|
IP
|
$60.19
|
|
|
Service Code
|
NDC 555015802
|
| Hospital Charge Code |
25000102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.78 |
| Rate for Payer: Aetna Commercial |
$46.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.95
|
| Rate for Payer: Cash Price |
$30.09
|
| Rate for Payer: Cigna Commercial |
$49.96
|
| Rate for Payer: First Health Commercial |
$57.18
|
| Rate for Payer: Humana Commercial |
$51.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.97
|
| Rate for Payer: Ohio Health Group HMO |
$45.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.66
|
| Rate for Payer: PHCS Commercial |
$57.78
|
| Rate for Payer: United Healthcare All Payer |
$52.97
|
|
|
[C]LIBRIUM(CHLORDIAZE 5MG/1CAP
|
Facility
|
OP
|
$60.19
|
|
|
Service Code
|
NDC 555015802
|
| Hospital Charge Code |
25000102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.78 |
| Rate for Payer: Cigna Commercial |
$49.96
|
| Rate for Payer: First Health Commercial |
$57.18
|
| Rate for Payer: Humana Commercial |
$51.16
|
| Rate for Payer: Humana KY Medicaid |
$20.70
|
| Rate for Payer: Kentucky WC Medicaid |
$20.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.36
|
| Rate for Payer: Anthem Medicaid |
$20.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.95
|
| Rate for Payer: Cash Price |
$30.09
|
| Rate for Payer: Aetna Commercial |
$46.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.97
|
| Rate for Payer: Ohio Health Group HMO |
$45.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.66
|
| Rate for Payer: PHCS Commercial |
$57.78
|
| Rate for Payer: United Healthcare All Payer |
$52.97
|
|
|
CLIK X MRI ANCHOR
|
Facility
|
IP
|
$3,381.25
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.56 |
| Max. Negotiated Rate |
$3,246.00 |
| Rate for Payer: Aetna Commercial |
$2,603.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,637.38
|
| Rate for Payer: Cash Price |
$1,690.62
|
| Rate for Payer: Cigna Commercial |
$2,806.44
|
| Rate for Payer: First Health Commercial |
$3,212.19
|
| Rate for Payer: Humana Commercial |
$2,874.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,772.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,495.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,975.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,535.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$676.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.19
|
| Rate for Payer: PHCS Commercial |
$3,246.00
|
| Rate for Payer: United Healthcare All Payer |
$2,975.50
|
|
|
CLIK X MRI ANCHOR
|
Facility
|
OP
|
$3,381.25
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.56 |
| Max. Negotiated Rate |
$3,246.00 |
| Rate for Payer: Aetna Commercial |
$2,603.56
|
| Rate for Payer: Anthem Medicaid |
$1,162.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,637.38
|
| Rate for Payer: Cash Price |
$1,690.62
|
| Rate for Payer: Cigna Commercial |
$2,806.44
|
| Rate for Payer: First Health Commercial |
$3,212.19
|
| Rate for Payer: Humana Commercial |
$2,874.06
|
| Rate for Payer: Humana KY Medicaid |
$1,162.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,772.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,495.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,186.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,975.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,535.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$676.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.19
|
| Rate for Payer: PHCS Commercial |
$3,246.00
|
| Rate for Payer: United Healthcare All Payer |
$2,975.50
|
|
|
CLIMARA (ESTRADIOL) 0 .1MG/1EA
|
Facility
|
OP
|
$36.08
|
|
|
Service Code
|
NDC 50419045204
|
| Hospital Charge Code |
25000430
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$27.78
|
| Rate for Payer: Anthem Medicaid |
$12.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.14
|
| Rate for Payer: Cash Price |
$18.04
|
| Rate for Payer: Cigna Commercial |
$29.95
|
| Rate for Payer: First Health Commercial |
$34.28
|
| Rate for Payer: Humana Commercial |
$30.67
|
| Rate for Payer: Humana KY Medicaid |
$12.41
|
| Rate for Payer: Kentucky WC Medicaid |
$12.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.75
|
| Rate for Payer: Ohio Health Group HMO |
$27.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.18
|
| Rate for Payer: PHCS Commercial |
$34.64
|
| Rate for Payer: United Healthcare All Payer |
$31.75
|
|
|
CLIMARA (ESTRADIOL) 0 .1MG/1EA
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
NDC 50419045204
|
| Hospital Charge Code |
25000430
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$27.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.14
|
| Rate for Payer: Cash Price |
$18.04
|
| Rate for Payer: Cigna Commercial |
$29.95
|
| Rate for Payer: First Health Commercial |
$34.28
|
| Rate for Payer: Humana Commercial |
$30.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.75
|
| Rate for Payer: Ohio Health Group HMO |
$27.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.18
|
| Rate for Payer: PHCS Commercial |
$34.64
|
| Rate for Payer: United Healthcare All Payer |
$31.75
|
|
