|
CLINDAMYCIN(GENERIC)900MG/50ML
|
Facility
|
IP
|
$121.50
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
25004212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.45 |
| 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 |
$97.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.83
|
| 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 |
$36.45 |
| Max. Negotiated Rate |
$116.64 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Anthem Medicaid |
$41.78
|
| 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: Humana KY Medicaid |
$41.78
|
| 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 |
$36.45
|
| 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 |
$97.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.83
|
| Rate for Payer: PHCS Commercial |
$116.64
|
| Rate for Payer: United Healthcare All Payer |
$106.92
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Professional
|
Both
|
$80.03
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$48.02 |
| 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 |
$40.02
|
| Rate for Payer: Cash Price |
$40.02
|
| 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 |
$48.02
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$28.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$1.67
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
IP
|
$80.03
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0114
|
|
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
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
OP
|
$80.03
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0114
|
|
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
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
OP
|
$80.03
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
636T0114
|
|
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
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
IP
|
$80.03
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
636T0114
|
|
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
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003928
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.40 |
| 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
|
IP
|
$80.03
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600114
|
|
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
|
|
|
CLINDAMYCIN PHOSPHATE300MG INJ
|
Facility
|
OP
|
$80.03
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
63600114
|
|
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
|
|
|
CLINIMIX 4.25% 10% (1000ML)
|
Facility
|
OP
|
$102.97
|
|
|
Service Code
|
NDC 338113403
|
| Hospital Charge Code |
25002947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.89 |
| 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 |
$82.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.05
|
| 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 |
$30.89 |
| 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 |
$82.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.05
|
| Rate for Payer: PHCS Commercial |
$98.85
|
| Rate for Payer: United Healthcare All Payer |
$90.61
|
|
|
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 |
$64.03 |
| 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 |
$170.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.27
|
| Rate for Payer: PHCS Commercial |
$204.90
|
| Rate for Payer: United Healthcare All Payer |
$187.83
|
|
|
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 |
$64.03 |
| 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 |
$170.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.27
|
| 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 |
$32.42 |
| 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 |
$86.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.58
|
| 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 |
$32.42 |
| 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 |
$86.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.58
|
| 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 |
$33.47 |
| Max. Negotiated Rate |
$107.09 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Anthem Medicaid |
$38.36
|
| 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 |
$33.47
|
| 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 |
$89.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.97
|
| Rate for Payer: PHCS Commercial |
$107.09
|
| Rate for Payer: United Healthcare All Payer |
$98.16
|
|
|
CLINIMIX E 4.25% 10% (1000ML)
|
Facility
|
IP
|
$111.55
|
|
|
Service Code
|
NDC 338114503
|
| Hospital Charge Code |
25002951
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$107.09 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| 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: 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 |
$33.47
|
| 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 |
$89.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.97
|
| Rate for Payer: PHCS Commercial |
$107.09
|
| Rate for Payer: United Healthcare All Payer |
$98.16
|
|
|
CLINIMIX E 4.25% 10% (2000ML)
|
Facility
|
IP
|
$219.18
|
|
|
Service Code
|
NDC 338111504
|
| Hospital Charge Code |
25002952
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$210.41 |
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.96
|
| Rate for Payer: Cash Price |
$109.59
|
| Rate for Payer: Cigna Commercial |
$181.92
|
| Rate for Payer: First Health Commercial |
$208.22
|
| Rate for Payer: Humana Commercial |
$186.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.88
|
| Rate for Payer: Ohio Health Group HMO |
$164.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.23
|
| Rate for Payer: PHCS Commercial |
$210.41
|
| Rate for Payer: United Healthcare All Payer |
$192.88
|
|
|
CLINIMIX E 4.25% 10% (2000ML)
|
Facility
|
OP
|
$219.18
|
|
|
Service Code
|
NDC 338111504
|
| Hospital Charge Code |
25002952
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$210.41 |
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Anthem Medicaid |
$75.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.96
|
| Rate for Payer: Cash Price |
$109.59
|
| Rate for Payer: Cigna Commercial |
$181.92
|
| Rate for Payer: First Health Commercial |
$208.22
|
| Rate for Payer: Humana Commercial |
$186.30
|
| Rate for Payer: Humana KY Medicaid |
$75.38
|
| Rate for Payer: Kentucky WC Medicaid |
$76.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$179.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$192.88
|
| Rate for Payer: Ohio Health Group HMO |
$164.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.23
|
| Rate for Payer: PHCS Commercial |
$210.41
|
| Rate for Payer: United Healthcare All Payer |
$192.88
|
|
|
CLINIMIX E 5%/15% (1000 ML)
|
Facility
|
IP
|
$108.91
|
|
|
Service Code
|
NDC 338114703
|
| Hospital Charge Code |
25002954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.67 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Aetna Commercial |
$83.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.95
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna Commercial |
$90.40
|
| Rate for Payer: First Health Commercial |
$103.46
|
| Rate for Payer: Humana Commercial |
$92.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.84
|
| Rate for Payer: Ohio Health Group HMO |
$81.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.15
|
| Rate for Payer: PHCS Commercial |
$104.55
|
| Rate for Payer: United Healthcare All Payer |
$95.84
|
|
|
CLINIMIX E 5%/15% (1000 ML)
|
Facility
|
OP
|
$108.91
|
|
|
Service Code
|
NDC 338114703
|
| Hospital Charge Code |
25002954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.67 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Aetna Commercial |
$83.86
|
| Rate for Payer: Anthem Medicaid |
$37.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.95
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna Commercial |
$90.40
|
| Rate for Payer: First Health Commercial |
$103.46
|
| Rate for Payer: Humana Commercial |
$92.57
|
| Rate for Payer: Humana KY Medicaid |
$37.45
|
| Rate for Payer: Kentucky WC Medicaid |
$37.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.84
|
| Rate for Payer: Ohio Health Group HMO |
$81.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.15
|
| Rate for Payer: PHCS Commercial |
$104.55
|
| Rate for Payer: United Healthcare All Payer |
$95.84
|
|
|
CLINIMIX E 5% 15% (2000ML)
|
Facility
|
OP
|
$223.66
|
|
|
Service Code
|
NDC 338112304
|
| Hospital Charge Code |
25002953
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$214.71 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Anthem Medicaid |
$76.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.45
|
| Rate for Payer: Cash Price |
$111.83
|
| Rate for Payer: Cigna Commercial |
$185.64
|
| Rate for Payer: First Health Commercial |
$212.48
|
| Rate for Payer: Humana Commercial |
$190.11
|
| Rate for Payer: Humana KY Medicaid |
$76.92
|
| Rate for Payer: Kentucky WC Medicaid |
$77.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$183.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$196.82
|
| Rate for Payer: Ohio Health Group HMO |
$167.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.33
|
| Rate for Payer: PHCS Commercial |
$214.71
|
| Rate for Payer: United Healthcare All Payer |
$196.82
|
|
|
CLINIMIX E 5% 15% (2000ML)
|
Facility
|
IP
|
$223.66
|
|
|
Service Code
|
NDC 338112304
|
| Hospital Charge Code |
25002953
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$214.71 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$174.45
|
| Rate for Payer: Cash Price |
$111.83
|
| Rate for Payer: Cigna Commercial |
$185.64
|
| Rate for Payer: First Health Commercial |
$212.48
|
| Rate for Payer: Humana Commercial |
$190.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$183.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$196.82
|
| Rate for Payer: Ohio Health Group HMO |
$167.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.33
|
| Rate for Payer: PHCS Commercial |
$214.71
|
| Rate for Payer: United Healthcare All Payer |
$196.82
|
|
|
CLIPS LIGATING TI 20 SILVER ME
|
Facility
|
IP
|
$165.65
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$159.02 |
| Rate for Payer: Aetna Commercial |
$127.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.21
|
| Rate for Payer: Cash Price |
$82.82
|
| Rate for Payer: Cigna Commercial |
$137.49
|
| Rate for Payer: First Health Commercial |
$157.37
|
| Rate for Payer: Humana Commercial |
$140.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.77
|
| Rate for Payer: Ohio Health Group HMO |
$124.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.30
|
| Rate for Payer: PHCS Commercial |
$159.02
|
| Rate for Payer: United Healthcare All Payer |
$145.77
|
|
