|
CLIMARA (ESTRADIOL) .05MG/1EA
|
Facility
|
IP
|
$35.56
|
|
|
Service Code
|
NDC 378335016
|
| Hospital Charge Code |
25000429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Aetna Commercial |
$27.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.74
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cigna Commercial |
$29.51
|
| Rate for Payer: First Health Commercial |
$33.78
|
| Rate for Payer: Humana Commercial |
$30.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.29
|
| Rate for Payer: Ohio Health Group HMO |
$26.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.02
|
| Rate for Payer: PHCS Commercial |
$34.14
|
| Rate for Payer: United Healthcare All Payer |
$31.29
|
|
|
CLIMARA (ESTRADIOL) .05MG/1EA
|
Facility
|
OP
|
$35.56
|
|
|
Service Code
|
NDC 378335016
|
| Hospital Charge Code |
25000429
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$34.14 |
| Rate for Payer: Aetna Commercial |
$27.38
|
| Rate for Payer: Anthem Medicaid |
$12.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.74
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cigna Commercial |
$29.51
|
| Rate for Payer: First Health Commercial |
$33.78
|
| Rate for Payer: Humana Commercial |
$30.23
|
| Rate for Payer: Humana KY Medicaid |
$12.23
|
| Rate for Payer: Kentucky WC Medicaid |
$12.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.29
|
| Rate for Payer: Ohio Health Group HMO |
$26.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.02
|
| Rate for Payer: PHCS Commercial |
$34.14
|
| Rate for Payer: United Healthcare All Payer |
$31.29
|
|
|
[C]LIMBITROL (CHLORD/AMIT)1TAB
|
Facility
|
IP
|
$61.23
|
|
|
Service Code
|
NDC 378021101
|
| Hospital Charge Code |
25000103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$58.78 |
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.76
|
| Rate for Payer: Cash Price |
$30.61
|
| Rate for Payer: Cigna Commercial |
$50.82
|
| Rate for Payer: First Health Commercial |
$58.17
|
| Rate for Payer: Humana Commercial |
$52.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.88
|
| Rate for Payer: Ohio Health Group HMO |
$45.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.98
|
| Rate for Payer: PHCS Commercial |
$58.78
|
| Rate for Payer: United Healthcare All Payer |
$53.88
|
|
|
[C]LIMBITROL (CHLORD/AMIT)1TAB
|
Facility
|
OP
|
$61.23
|
|
|
Service Code
|
NDC 378021101
|
| Hospital Charge Code |
25000103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$58.78 |
| Rate for Payer: Aetna Commercial |
$47.15
|
| Rate for Payer: Anthem Medicaid |
$21.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.76
|
| Rate for Payer: Cash Price |
$30.61
|
| Rate for Payer: Cigna Commercial |
$50.82
|
| Rate for Payer: First Health Commercial |
$58.17
|
| Rate for Payer: Humana Commercial |
$52.05
|
| Rate for Payer: Humana KY Medicaid |
$21.06
|
| Rate for Payer: Kentucky WC Medicaid |
$21.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.88
|
| Rate for Payer: Ohio Health Group HMO |
$45.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.98
|
| Rate for Payer: PHCS Commercial |
$58.78
|
| Rate for Payer: United Healthcare All Payer |
$53.88
|
|
|
CLINDAMYCIN 1% LOTION(60ML)
|
Facility
|
OP
|
$11.04
|
|
|
Service Code
|
NDC 59762374401
|
| Hospital Charge Code |
25003726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Anthem Medicaid |
$3.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.61
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cigna Commercial |
$9.16
|
| Rate for Payer: First Health Commercial |
$10.49
|
| Rate for Payer: Humana Commercial |
$9.38
|
| Rate for Payer: Humana KY Medicaid |
$3.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.72
|
| Rate for Payer: Ohio Health Group HMO |
$8.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Payer |
$9.72
|
|
|
CLINDAMYCIN 1% LOTION(60ML)
|
Facility
|
IP
|
$11.04
|
|
|
Service Code
|
NDC 59762374401
|
| Hospital Charge Code |
25003726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.61
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: Cigna Commercial |
$9.16
|
| Rate for Payer: First Health Commercial |
$10.49
|
| Rate for Payer: Humana Commercial |
$9.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.72
|
| Rate for Payer: Ohio Health Group HMO |
$8.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$10.60
|
| Rate for Payer: United Healthcare All Payer |
$9.72
|
|
|
CLINDAMYCIN(GENERIC)300MG/50ML
|
Facility
|
IP
|
$114.08
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25004210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$109.52 |
| Rate for Payer: Aetna Commercial |
$87.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.98
|
| Rate for Payer: Cash Price |
$57.04
|
| Rate for Payer: Cigna Commercial |
$94.69
|
| Rate for Payer: First Health Commercial |
$108.38
|
| Rate for Payer: Humana Commercial |
$96.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.39
|
| Rate for Payer: Ohio Health Group HMO |
$85.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.36
|
| Rate for Payer: PHCS Commercial |
$109.52
|
| Rate for Payer: United Healthcare All Payer |
$100.39
|
|
|
CLINDAMYCIN(GENERIC)300MG/50ML
|
Facility
|
OP
|
$114.08
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25004210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$109.52 |
| Rate for Payer: Aetna Commercial |
$87.84
|
| Rate for Payer: Anthem Medicaid |
$39.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.57
|
| Rate for Payer: Cash Price |
$57.04
|
| Rate for Payer: Cash Price |
$57.04
|
| Rate for Payer: Cigna Commercial |
$94.69
|
| Rate for Payer: First Health Commercial |
$108.38
|
| Rate for Payer: Humana Commercial |
$96.97
|
| Rate for Payer: Humana KY Medicaid |
$39.23
|
| Rate for Payer: Humana Medicare Advantage |
$1.90
|
| Rate for Payer: Kentucky WC Medicaid |
$39.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.39
|
| Rate for Payer: Ohio Health Group HMO |
$85.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.36
|
| Rate for Payer: PHCS Commercial |
$109.52
|
| Rate for Payer: United Healthcare All Payer |
$100.39
|
|
|
CLINDAMYCIN(GENERIC)600MG/50ML
|
Facility
|
IP
|
$118.87
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25004211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$114.12 |
| Rate for Payer: Aetna Commercial |
$91.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.72
|
| Rate for Payer: Cash Price |
$59.44
|
| Rate for Payer: Cigna Commercial |
$98.66
|
| Rate for Payer: First Health Commercial |
$112.93
|
| Rate for Payer: Humana Commercial |
$101.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.61
|
| Rate for Payer: Ohio Health Group HMO |
$89.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.85
|
| Rate for Payer: PHCS Commercial |
$114.12
|
| Rate for Payer: United Healthcare All Payer |
$104.61
|
|
|
CLINDAMYCIN(GENERIC)600MG/50ML
|
Facility
|
OP
|
$118.87
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25004211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$114.12 |
| Rate for Payer: Aetna Commercial |
$91.53
|
| Rate for Payer: Anthem Medicaid |
$40.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.57
|
| Rate for Payer: Cash Price |
$59.44
|
| Rate for Payer: Cash Price |
$59.44
|
| Rate for Payer: Cigna Commercial |
$98.66
|
| Rate for Payer: First Health Commercial |
$112.93
|
| Rate for Payer: Humana Commercial |
$101.04
|
| Rate for Payer: Humana KY Medicaid |
$40.88
|
| Rate for Payer: Humana Medicare Advantage |
$1.90
|
| Rate for Payer: Kentucky WC Medicaid |
$41.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.61
|
| Rate for Payer: Ohio Health Group HMO |
$89.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.85
|
| Rate for Payer: PHCS Commercial |
$114.12
|
| Rate for Payer: United Healthcare All Payer |
$104.61
|
|
|
CLINDAMYCIN(GENERIC)900MG/50ML
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25004212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$116.64 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.77
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna Commercial |
$100.84
|
| Rate for Payer: First Health Commercial |
$115.42
|
| Rate for Payer: Humana Commercial |
$103.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.92
|
| Rate for Payer: Ohio Health Group HMO |
$91.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.66
|
| Rate for Payer: PHCS Commercial |
$116.64
|
| Rate for Payer: United Healthcare All Payer |
$106.92
|
|
|
CLINDAMYCIN(GENERIC)900MG/50ML
|
Facility
|
OP
|
$121.50
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25004212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$116.64 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Anthem Medicaid |
$41.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.57
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna Commercial |
$100.84
|
| Rate for Payer: First Health Commercial |
$115.42
|
| Rate for Payer: Humana Commercial |
$103.28
|
| Rate for Payer: Humana KY Medicaid |
$41.78
|
| Rate for Payer: Humana Medicare Advantage |
$1.90
|
| Rate for Payer: Kentucky WC Medicaid |
$42.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.92
|
| Rate for Payer: Ohio Health Group HMO |
$91.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.66
|
| Rate for Payer: PHCS Commercial |
$116.64
|
| Rate for Payer: United Healthcare All Payer |
$106.92
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
OP
|
$37.97
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$29.24
|
| Rate for Payer: Anthem Medicaid |
$13.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.57
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cigna Commercial |
$31.52
|
| Rate for Payer: First Health Commercial |
$36.07
|
| Rate for Payer: Humana Commercial |
$32.27
|
| Rate for Payer: Humana KY Medicaid |
$13.06
|
| Rate for Payer: Humana Medicare Advantage |
$1.90
|
| Rate for Payer: Kentucky WC Medicaid |
$13.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.41
|
| Rate for Payer: Ohio Health Group HMO |
$28.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.77
|
| Rate for Payer: PHCS Commercial |
$36.45
|
| Rate for Payer: United Healthcare All Payer |
$33.41
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
IP
|
$37.97
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$29.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.62
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cigna Commercial |
$31.52
|
| Rate for Payer: First Health Commercial |
$36.07
|
| Rate for Payer: Humana Commercial |
$32.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.41
|
| Rate for Payer: Ohio Health Group HMO |
$28.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.77
|
| Rate for Payer: PHCS Commercial |
$36.45
|
| Rate for Payer: United Healthcare All Payer |
$33.41
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2.00
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.40
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.54
|
| Rate for Payer: Anthem Medicaid |
$0.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.56
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna Commercial |
$1.66
|
| Rate for Payer: First Health Commercial |
$1.90
|
| Rate for Payer: Humana Commercial |
$1.70
|
| Rate for Payer: Humana KY Medicaid |
$0.69
|
| Rate for Payer: Kentucky WC Medicaid |
$0.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.76
|
| Rate for Payer: Ohio Health Group HMO |
$1.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.62
|
| Rate for Payer: PHCS Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Payer |
$1.76
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.56
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Cigna Commercial |
$1.66
|
| Rate for Payer: First Health Commercial |
$1.90
|
| Rate for Payer: Humana Commercial |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.76
|
| Rate for Payer: Ohio Health Group HMO |
$1.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.62
|
| Rate for Payer: PHCS Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Payer |
$1.76
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Professional
|
Both
|
$37.97
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$37.97 |
| Rate for Payer: Buckeye Medicare Advantage |
$37.97
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Multiplan PHCS |
$22.78
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$26.58
|
| Rate for Payer: UHCCP Medicaid |
$13.29
|
|
|
CLINIMIX 4.25% 10% (1000ML)
|
Facility
|
OP
|
$102.97
|
|
|
Service Code
|
NDC 338113403
|
| Hospital Charge Code |
25002947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$98.85 |
| Rate for Payer: Aetna Commercial |
$79.29
|
| Rate for Payer: Anthem Medicaid |
$35.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.32
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cigna Commercial |
$85.47
|
| Rate for Payer: First Health Commercial |
$97.82
|
| Rate for Payer: Humana Commercial |
$87.52
|
| Rate for Payer: Humana KY Medicaid |
$35.41
|
| Rate for Payer: Kentucky WC Medicaid |
$35.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.61
|
| Rate for Payer: Ohio Health Group HMO |
$77.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.92
|
| Rate for Payer: PHCS Commercial |
$98.85
|
| Rate for Payer: United Healthcare All Payer |
$90.61
|
|
|
CLINIMIX 4.25% 10% (1000ML)
|
Facility
|
IP
|
$102.97
|
|
|
Service Code
|
NDC 338113403
|
| Hospital Charge Code |
25002947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$98.85 |
| Rate for Payer: Aetna Commercial |
$79.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.32
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cigna Commercial |
$85.47
|
| Rate for Payer: First Health Commercial |
$97.82
|
| Rate for Payer: Humana Commercial |
$87.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.61
|
| Rate for Payer: Ohio Health Group HMO |
$77.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.92
|
| Rate for Payer: PHCS Commercial |
$98.85
|
| Rate for Payer: United Healthcare All Payer |
$90.61
|
|
|
CLINIMIX 4.25%/10% (2000 ML)
|
Facility
|
OP
|
$213.44
|
|
|
Service Code
|
NDC 338109104
|
| Hospital Charge Code |
25002948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$204.90 |
| Rate for Payer: Aetna Commercial |
$164.35
|
| Rate for Payer: Anthem Medicaid |
$73.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.48
|
| Rate for Payer: Cash Price |
$106.72
|
| Rate for Payer: Cigna Commercial |
$177.16
|
| Rate for Payer: First Health Commercial |
$202.77
|
| Rate for Payer: Humana Commercial |
$181.42
|
| Rate for Payer: Humana KY Medicaid |
$73.40
|
| Rate for Payer: Kentucky WC Medicaid |
$74.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$74.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$187.83
|
| Rate for Payer: Ohio Health Group HMO |
$160.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.17
|
| Rate for Payer: PHCS Commercial |
$204.90
|
| Rate for Payer: United Healthcare All Payer |
$187.83
|
|
|
CLINIMIX 4.25%/10% (2000 ML)
|
Facility
|
IP
|
$213.44
|
|
|
Service Code
|
NDC 338109104
|
| Hospital Charge Code |
25002948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$204.90 |
| Rate for Payer: Aetna Commercial |
$164.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.48
|
| Rate for Payer: Cash Price |
$106.72
|
| Rate for Payer: Cigna Commercial |
$177.16
|
| Rate for Payer: First Health Commercial |
$202.77
|
| Rate for Payer: Humana Commercial |
$181.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$187.83
|
| Rate for Payer: Ohio Health Group HMO |
$160.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.17
|
| Rate for Payer: PHCS Commercial |
$204.90
|
| Rate for Payer: United Healthcare All Payer |
$187.83
|
|
|
CLINIMIX E 2.75% 5% (1000ML)
|
Facility
|
IP
|
$108.08
|
|
|
Service Code
|
NDC 338114203
|
| Hospital Charge Code |
25002949
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.76 |
| Rate for Payer: Aetna Commercial |
$83.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.30
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cigna Commercial |
$89.71
|
| Rate for Payer: First Health Commercial |
$102.68
|
| Rate for Payer: Humana Commercial |
$91.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.11
|
| Rate for Payer: Ohio Health Group HMO |
$81.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.50
|
| Rate for Payer: PHCS Commercial |
$103.76
|
| Rate for Payer: United Healthcare All Payer |
$95.11
|
|
|
CLINIMIX E 2.75% 5% (1000ML)
|
Facility
|
OP
|
$108.08
|
|
|
Service Code
|
NDC 338114203
|
| Hospital Charge Code |
25002949
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.76 |
| Rate for Payer: Aetna Commercial |
$83.22
|
| Rate for Payer: Anthem Medicaid |
$37.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.30
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cigna Commercial |
$89.71
|
| Rate for Payer: First Health Commercial |
$102.68
|
| Rate for Payer: Humana Commercial |
$91.87
|
| Rate for Payer: Humana KY Medicaid |
$37.17
|
| Rate for Payer: Kentucky WC Medicaid |
$37.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.11
|
| Rate for Payer: Ohio Health Group HMO |
$81.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.50
|
| Rate for Payer: PHCS Commercial |
$103.76
|
| Rate for Payer: United Healthcare All Payer |
$95.11
|
|
|
CLINIMIX E 4.25% 10% (1000ML)
|
Facility
|
OP
|
$111.55
|
|
|
Service Code
|
NDC 338114503
|
| Hospital Charge Code |
25002951
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$107.09 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.01
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cigna Commercial |
$92.59
|
| Rate for Payer: First Health Commercial |
$105.97
|
| Rate for Payer: Humana Commercial |
$94.82
|
| Rate for Payer: Humana KY Medicaid |
$38.36
|
| Rate for Payer: Kentucky WC Medicaid |
$38.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.16
|
| Rate for Payer: Ohio Health Group HMO |
$83.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.58
|
| Rate for Payer: PHCS Commercial |
$107.09
|
| Rate for Payer: United Healthcare All Payer |
$98.16
|
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Anthem Medicaid |
$38.36
|
|
