|
CLAVICULECTOMY; TOTAL
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 23125
|
| Hospital Charge Code |
76100446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.24 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,863.40
|
| Rate for Payer: Anthem Medicaid |
$832.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,887.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cigna Commercial |
$2,008.60
|
| Rate for Payer: First Health Commercial |
$2,299.00
|
| Rate for Payer: Humana Commercial |
$2,057.00
|
| Rate for Payer: Humana KY Medicaid |
$832.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$840.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,984.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,785.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$848.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,129.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,815.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,105.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,669.80
|
| Rate for Payer: PHCS Commercial |
$2,323.20
|
| Rate for Payer: United Healthcare All Payer |
$2,129.60
|
|
|
CLAVICULECTOMY; TOTAL(P
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 23125
|
| Hospital Charge Code |
761P0446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.74 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,032.58
|
| Rate for Payer: Ambetter Exchange |
$678.22
|
| Rate for Payer: Anthem Medicaid |
$519.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$678.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$678.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$813.86
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cigna Commercial |
$1,128.27
|
| Rate for Payer: Healthspan PPO |
$935.29
|
| Rate for Payer: Humana Medicaid |
$519.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$873.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$678.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.13
|
| Rate for Payer: Molina Healthcare Passport |
$519.74
|
| Rate for Payer: Multiplan PHCS |
$1,452.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$881.69
|
| Rate for Payer: UHCCP Medicaid |
$847.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$524.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$678.22
|
|
|
CLEANER 6F 135CM
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
CLEANER 6F 135CM
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
CLEAN OUT MASTOID CAVITY
|
Facility
|
IP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
76102415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,955.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.12
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
CLEAN OUT MASTOID CAVITY
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
76102415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem Medicaid |
$773.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Humana KY Medicaid |
$773.09
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$788.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,955.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.12
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
CLEAN OUT MASTOID CAVITY
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
76102415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$1,348.80 |
| Rate for Payer: Aetna Commercial |
$194.36
|
| Rate for Payer: Ambetter Exchange |
$126.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.08
|
| Rate for Payer: Anthem Medicaid |
$61.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.04
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$300.09
|
| Rate for Payer: Healthspan PPO |
$265.45
|
| Rate for Payer: Humana Medicaid |
$61.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.64
|
| Rate for Payer: Molina Healthcare Passport |
$61.41
|
| Rate for Payer: Multiplan PHCS |
$1,348.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.71
|
| Rate for Payer: UHCCP Medicaid |
$73.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.70
|
|
|
CLEAN OUT MASTOID CAVITY(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
761P2415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.41 |
| Max. Negotiated Rate |
$300.09 |
| Rate for Payer: Aetna Commercial |
$194.36
|
| Rate for Payer: Ambetter Exchange |
$126.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.08
|
| Rate for Payer: Anthem Medicaid |
$61.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.04
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$300.09
|
| Rate for Payer: Healthspan PPO |
$265.45
|
| Rate for Payer: Humana Medicaid |
$61.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.64
|
| Rate for Payer: Molina Healthcare Passport |
$61.41
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.71
|
| Rate for Payer: UHCCP Medicaid |
$73.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.70
|
|
|
CLEAN OUT MASTOID CAVITY(T
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
761T2415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$1,702.08 |
| Rate for Payer: Aetna Commercial |
$1,365.21
|
| Rate for Payer: Anthem Medicaid |
$609.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$1,471.59
|
| Rate for Payer: First Health Commercial |
$1,684.35
|
| Rate for Payer: Humana Commercial |
$1,507.05
|
| Rate for Payer: Humana KY Medicaid |
$609.73
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$615.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,542.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,223.37
|
| Rate for Payer: PHCS Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare All Payer |
$1,560.24
|
|
|
CLEAN OUT MASTOID CAVITY(T
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
761T2415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$531.90 |
| Max. Negotiated Rate |
$1,702.08 |
| Rate for Payer: Aetna Commercial |
$1,365.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.94
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$1,471.59
|
| Rate for Payer: First Health Commercial |
$1,684.35
|
| Rate for Payer: Humana Commercial |
$1,507.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,542.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,223.37
|
| Rate for Payer: PHCS Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare All Payer |
$1,560.24
|
|
|
CLEAN ROUTINE
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
22200120
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem Medicaid |
$11.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.96
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Humana KY Medicaid |
$11.00
|
| Rate for Payer: Kentucky WC Medicaid |
$11.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.08
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
CLEAN ROUTINE
|
Professional
|
Both
|
$32.00
|
|
| Hospital Charge Code |
22200120
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Multiplan PHCS |
$19.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.40
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
|
|
CLEAN ROUTINE
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
22200120
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.96
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.08
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
CLEOCIN(CLINDAMYCIN 150MG/1CAP
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 42571025101
|
| Hospital Charge Code |
25000427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
CLEOCIN(CLINDAMYCIN 150MG/1CAP
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 42571025101
|
| Hospital Charge Code |
25000427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
OP
|
$80.03
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25002942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Anthem Medicaid |
$27.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.42
|
| Rate for Payer: Cash Price |
$40.02
|
| Rate for Payer: Cigna Commercial |
$66.42
|
| Rate for Payer: First Health Commercial |
$76.03
|
| Rate for Payer: Humana Commercial |
$68.03
|
| Rate for Payer: Humana KY Medicaid |
$27.52
|
| Rate for Payer: Kentucky WC Medicaid |
$27.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.43
|
| Rate for Payer: Ohio Health Group HMO |
$60.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.22
|
| Rate for Payer: PHCS Commercial |
$76.83
|
| Rate for Payer: United Healthcare All Payer |
$70.43
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
OP
|
$40.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$30.82
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.22
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Cigna Commercial |
$33.22
|
| Rate for Payer: First Health Commercial |
$38.02
|
| Rate for Payer: Humana Commercial |
$34.02
|
| Rate for Payer: Humana KY Medicaid |
$13.76
|
| Rate for Payer: Kentucky WC Medicaid |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.22
|
| Rate for Payer: Ohio Health Group HMO |
$30.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.61
|
| Rate for Payer: PHCS Commercial |
$38.42
|
| Rate for Payer: United Healthcare All Payer |
$35.22
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Professional
|
Both
|
$40.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$24.01 |
| Rate for Payer: Ambetter Exchange |
$1.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.00
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.67
|
| Rate for Payer: Multiplan PHCS |
$24.01
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$14.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$1.67
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
IP
|
$40.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$30.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.22
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Cigna Commercial |
$33.22
|
| Rate for Payer: First Health Commercial |
$38.02
|
| Rate for Payer: Humana Commercial |
$34.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.22
|
| Rate for Payer: Ohio Health Group HMO |
$30.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.61
|
| Rate for Payer: PHCS Commercial |
$38.42
|
| Rate for Payer: United Healthcare All Payer |
$35.22
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
IP
|
$80.03
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25002942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.42
|
| Rate for Payer: Cash Price |
$40.02
|
| Rate for Payer: Cigna Commercial |
$66.42
|
| Rate for Payer: First Health Commercial |
$76.03
|
| Rate for Payer: Humana Commercial |
$68.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.43
|
| Rate for Payer: Ohio Health Group HMO |
$60.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.22
|
| Rate for Payer: PHCS Commercial |
$76.83
|
| Rate for Payer: United Healthcare All Payer |
$70.43
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
IP
|
$40.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
636T0086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$30.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.22
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Cigna Commercial |
$33.22
|
| Rate for Payer: First Health Commercial |
$38.02
|
| Rate for Payer: Humana Commercial |
$34.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.22
|
| Rate for Payer: Ohio Health Group HMO |
$30.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.61
|
| Rate for Payer: PHCS Commercial |
$38.42
|
| Rate for Payer: United Healthcare All Payer |
$35.22
|
|
|
CLEOCIN (CLINDAMYCIN 600MG/4ML
|
Facility
|
OP
|
$40.02
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
636T0086
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$38.42 |
| Rate for Payer: Aetna Commercial |
$30.82
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.22
|
| Rate for Payer: Cash Price |
$20.01
|
| Rate for Payer: Cigna Commercial |
$33.22
|
| Rate for Payer: First Health Commercial |
$38.02
|
| Rate for Payer: Humana Commercial |
$34.02
|
| Rate for Payer: Humana KY Medicaid |
$13.76
|
| Rate for Payer: Kentucky WC Medicaid |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.22
|
| Rate for Payer: Ohio Health Group HMO |
$30.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.61
|
| Rate for Payer: PHCS Commercial |
$38.42
|
| Rate for Payer: United Healthcare All Payer |
$35.22
|
|
|
CLEOCIN[CLINDAMYCIN]VAGIN 40GM
|
Facility
|
OP
|
$74.61
|
|
|
Service Code
|
NDC 168027740
|
| Hospital Charge Code |
25000428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.38 |
| 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 |
$59.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.48
|
| Rate for Payer: PHCS Commercial |
$71.63
|
| Rate for Payer: United Healthcare All Payer |
$65.66
|
|
|
CLEOCIN[CLINDAMYCIN]VAGIN 40GM
|
Facility
|
IP
|
$74.61
|
|
|
Service Code
|
NDC 168027740
|
| Hospital Charge Code |
25000428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.38 |
| 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 |
$59.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.48
|
| Rate for Payer: PHCS Commercial |
$71.63
|
| Rate for Payer: United Healthcare All Payer |
$65.66
|
|
|
CLEOCIN PED 75MG/5MLSOL 100ML
|
Facility
|
OP
|
$9.63
|
|
|
Service Code
|
NDC 9076004
|
| Hospital Charge Code |
25002945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$9.24 |
| Rate for Payer: Aetna Commercial |
$7.42
|
| Rate for Payer: Anthem Medicaid |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.51
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cigna Commercial |
$7.99
|
| Rate for Payer: First Health Commercial |
$9.15
|
| Rate for Payer: Humana Commercial |
$8.19
|
| Rate for Payer: Humana KY Medicaid |
$3.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.47
|
| Rate for Payer: Ohio Health Group HMO |
$7.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.64
|
| Rate for Payer: PHCS Commercial |
$9.24
|
| Rate for Payer: United Healthcare All Payer |
$8.47
|
|
