|
KELLER TIMMERMANS SHEATH 24.0
|
Facility
|
OP
|
$3,717.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,115.25 |
| Max. Negotiated Rate |
$3,568.80 |
| Rate for Payer: Aetna Commercial |
$2,862.47
|
| Rate for Payer: Anthem Medicaid |
$1,278.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.65
|
| Rate for Payer: Cash Price |
$1,858.75
|
| Rate for Payer: Cigna Commercial |
$3,085.53
|
| Rate for Payer: First Health Commercial |
$3,531.62
|
| Rate for Payer: Humana Commercial |
$3,159.88
|
| Rate for Payer: Humana KY Medicaid |
$1,278.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.07
|
| Rate for Payer: PHCS Commercial |
$3,568.80
|
| Rate for Payer: United Healthcare All Payer |
$3,271.40
|
|
|
KELLER TIMMERMANS SHEATH 24.0
|
Facility
|
IP
|
$3,717.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,115.25 |
| Max. Negotiated Rate |
$3,568.80 |
| Rate for Payer: Aetna Commercial |
$2,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.65
|
| Rate for Payer: Cash Price |
$1,858.75
|
| Rate for Payer: Cigna Commercial |
$3,085.53
|
| Rate for Payer: First Health Commercial |
$3,531.62
|
| Rate for Payer: Humana Commercial |
$3,159.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.07
|
| Rate for Payer: PHCS Commercial |
$3,568.80
|
| Rate for Payer: United Healthcare All Payer |
$3,271.40
|
|
|
KENALOG 10 MG (40 MG VIAL)
|
Professional
|
Both
|
$28.97
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Ambetter Exchange |
$0.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Healthspan PPO |
$2.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Multiplan PHCS |
$17.38
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.12
|
| Rate for Payer: UHCCP Medicaid |
$10.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.86
|
|
|
KENALOG 10 MG (40 MG VIAL)
|
Facility
|
OP
|
$28.97
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636T0064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Anthem Medicaid |
$9.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.60
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cigna Commercial |
$24.05
|
| Rate for Payer: First Health Commercial |
$27.52
|
| Rate for Payer: Humana Commercial |
$24.62
|
| Rate for Payer: Humana KY Medicaid |
$9.96
|
| Rate for Payer: Kentucky WC Medicaid |
$10.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.49
|
| Rate for Payer: Ohio Health Group HMO |
$21.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.99
|
| Rate for Payer: PHCS Commercial |
$27.81
|
| Rate for Payer: United Healthcare All Payer |
$25.49
|
|
|
KENALOG 10 MG (40 MG VIAL)
|
Facility
|
OP
|
$115.89
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
25002400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Anthem Medicaid |
$39.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.39
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cigna Commercial |
$96.19
|
| Rate for Payer: First Health Commercial |
$110.10
|
| Rate for Payer: Humana Commercial |
$98.51
|
| Rate for Payer: Humana KY Medicaid |
$39.85
|
| Rate for Payer: Kentucky WC Medicaid |
$40.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.98
|
| Rate for Payer: Ohio Health Group HMO |
$86.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.96
|
| Rate for Payer: PHCS Commercial |
$111.25
|
| Rate for Payer: United Healthcare All Payer |
$101.98
|
|
|
KENALOG 10 MG (40 MG VIAL)
|
Professional
|
Both
|
$111.36
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
25002400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$66.82 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Ambetter Exchange |
$0.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$55.68
|
| Rate for Payer: Cash Price |
$55.68
|
| Rate for Payer: Healthspan PPO |
$2.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Multiplan PHCS |
$66.82
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.12
|
| Rate for Payer: UHCCP Medicaid |
$38.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.86
|
|
|
KENALOG 10 MG (40 MG VIAL)
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.60
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cigna Commercial |
$24.05
|
| Rate for Payer: First Health Commercial |
$27.52
|
| Rate for Payer: Humana Commercial |
$24.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.49
|
| Rate for Payer: Ohio Health Group HMO |
$21.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.99
|
| Rate for Payer: PHCS Commercial |
$27.81
|
| Rate for Payer: United Healthcare All Payer |
$25.49
|
|
|
KENALOG 10 MG (40 MG VIAL)
|
Facility
|
OP
|
$28.97
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Anthem Medicaid |
$9.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.60
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cigna Commercial |
$24.05
|
| Rate for Payer: First Health Commercial |
$27.52
|
| Rate for Payer: Humana Commercial |
$24.62
|
| Rate for Payer: Humana KY Medicaid |
$9.96
|
| Rate for Payer: Kentucky WC Medicaid |
$10.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.49
|
| Rate for Payer: Ohio Health Group HMO |
$21.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.99
|
| Rate for Payer: PHCS Commercial |
$27.81
|
| Rate for Payer: United Healthcare All Payer |
$25.49
|
|
|
KENALOG 10 MG (40 MG VIAL)
|
Facility
|
IP
|
$115.89
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
25002400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$111.25 |
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.39
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cigna Commercial |
$96.19
|
| Rate for Payer: First Health Commercial |
$110.10
|
| Rate for Payer: Humana Commercial |
$98.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.98
|
| Rate for Payer: Ohio Health Group HMO |
$86.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.96
|
| Rate for Payer: PHCS Commercial |
$111.25
|
| Rate for Payer: United Healthcare All Payer |
$101.98
|
|
|
KENALOG 10 MG (40 MG VIAL)
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636T0064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.60
|
| Rate for Payer: Cash Price |
$14.48
|
| Rate for Payer: Cigna Commercial |
$24.05
|
| Rate for Payer: First Health Commercial |
$27.52
|
| Rate for Payer: Humana Commercial |
$24.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.49
|
| Rate for Payer: Ohio Health Group HMO |
$21.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.99
|
| Rate for Payer: PHCS Commercial |
$27.81
|
| Rate for Payer: United Healthcare All Payer |
$25.49
|
|
|
KENALOG 10MG(from 200mg MDV)
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
25004578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
KENALOG 10MG(from 200mg MDV)
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
25004578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
KENALOG 10mg (from 400mg MDV)
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636T0149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Anthem Medicaid |
$1.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.26
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna Commercial |
$2.41
|
| Rate for Payer: First Health Commercial |
$2.75
|
| Rate for Payer: Humana Commercial |
$2.46
|
| Rate for Payer: Humana KY Medicaid |
$1.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.55
|
| Rate for Payer: Ohio Health Group HMO |
$2.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.00
|
| Rate for Payer: PHCS Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Payer |
$2.55
|
|
|
KENALOG 10mg (from 400mg MDV)
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.26
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna Commercial |
$2.41
|
| Rate for Payer: First Health Commercial |
$2.75
|
| Rate for Payer: Humana Commercial |
$2.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.55
|
| Rate for Payer: Ohio Health Group HMO |
$2.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.00
|
| Rate for Payer: PHCS Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Payer |
$2.55
|
|
|
KENALOG 10mg (from 400mg MDV)
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Anthem Medicaid |
$1.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.26
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna Commercial |
$2.41
|
| Rate for Payer: First Health Commercial |
$2.75
|
| Rate for Payer: Humana Commercial |
$2.46
|
| Rate for Payer: Humana KY Medicaid |
$1.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.55
|
| Rate for Payer: Ohio Health Group HMO |
$2.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.00
|
| Rate for Payer: PHCS Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Payer |
$2.55
|
|
|
KENALOG 10mg (from 400mg MDV)
|
Facility
|
IP
|
$2.90
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636T0149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.26
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna Commercial |
$2.41
|
| Rate for Payer: First Health Commercial |
$2.75
|
| Rate for Payer: Humana Commercial |
$2.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.55
|
| Rate for Payer: Ohio Health Group HMO |
$2.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.00
|
| Rate for Payer: PHCS Commercial |
$2.78
|
| Rate for Payer: United Healthcare All Payer |
$2.55
|
|
|
KENALOG 10mg (from 400mg MDV)
|
Professional
|
Both
|
$2.90
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.01 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Ambetter Exchange |
$0.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Healthspan PPO |
$2.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Multiplan PHCS |
$1.74
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.12
|
| Rate for Payer: UHCCP Medicaid |
$1.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.86
|
|
|
KENALOG 10mg (from 50mg MDV)
|
Professional
|
Both
|
$15.68
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Ambetter Exchange |
$0.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.03
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Healthspan PPO |
$2.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Multiplan PHCS |
$9.41
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.12
|
| Rate for Payer: UHCCP Medicaid |
$5.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.86
|
|
|
KENALOG 10mg (from 50mg MDV)
|
Facility
|
IP
|
$15.68
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636T0150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$12.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.23
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cigna Commercial |
$13.01
|
| Rate for Payer: First Health Commercial |
$14.90
|
| Rate for Payer: Humana Commercial |
$13.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.80
|
| Rate for Payer: Ohio Health Group HMO |
$11.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.82
|
| Rate for Payer: PHCS Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Payer |
$13.80
|
|
|
KENALOG 10mg (from 50mg MDV)
|
Facility
|
OP
|
$78.42
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
25004102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$75.28 |
| Rate for Payer: Aetna Commercial |
$60.38
|
| Rate for Payer: Anthem Medicaid |
$26.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.17
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Cigna Commercial |
$65.09
|
| Rate for Payer: First Health Commercial |
$74.50
|
| Rate for Payer: Humana Commercial |
$66.66
|
| Rate for Payer: Humana KY Medicaid |
$26.97
|
| Rate for Payer: Kentucky WC Medicaid |
$27.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.01
|
| Rate for Payer: Ohio Health Group HMO |
$58.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.11
|
| Rate for Payer: PHCS Commercial |
$75.28
|
| Rate for Payer: United Healthcare All Payer |
$69.01
|
|
|
KENALOG 10mg (from 50mg MDV)
|
Facility
|
OP
|
$15.68
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
636T0150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$12.07
|
| Rate for Payer: Anthem Medicaid |
$5.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.23
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cigna Commercial |
$13.01
|
| Rate for Payer: First Health Commercial |
$14.90
|
| Rate for Payer: Humana Commercial |
$13.33
|
| Rate for Payer: Humana KY Medicaid |
$5.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.80
|
| Rate for Payer: Ohio Health Group HMO |
$11.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.82
|
| Rate for Payer: PHCS Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Payer |
$13.80
|
|
|
KENALOG 10mg (from 50mg MDV)
|
Facility
|
OP
|
$15.68
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$12.07
|
| Rate for Payer: Anthem Medicaid |
$5.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.23
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cigna Commercial |
$13.01
|
| Rate for Payer: First Health Commercial |
$14.90
|
| Rate for Payer: Humana Commercial |
$13.33
|
| Rate for Payer: Humana KY Medicaid |
$5.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.80
|
| Rate for Payer: Ohio Health Group HMO |
$11.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.82
|
| Rate for Payer: PHCS Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Payer |
$13.80
|
|
|
KENALOG 10mg (from 50mg MDV)
|
Facility
|
IP
|
$78.42
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
25004102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$75.28 |
| Rate for Payer: Aetna Commercial |
$60.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.17
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Cigna Commercial |
$65.09
|
| Rate for Payer: First Health Commercial |
$74.50
|
| Rate for Payer: Humana Commercial |
$66.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.01
|
| Rate for Payer: Ohio Health Group HMO |
$58.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.11
|
| Rate for Payer: PHCS Commercial |
$75.28
|
| Rate for Payer: United Healthcare All Payer |
$69.01
|
|
|
KENALOG 10mg (from 50mg MDV)
|
Facility
|
IP
|
$15.68
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
63600150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$12.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.23
|
| Rate for Payer: Cash Price |
$7.84
|
| Rate for Payer: Cigna Commercial |
$13.01
|
| Rate for Payer: First Health Commercial |
$14.90
|
| Rate for Payer: Humana Commercial |
$13.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.80
|
| Rate for Payer: Ohio Health Group HMO |
$11.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.82
|
| Rate for Payer: PHCS Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Payer |
$13.80
|
|
|
KENALOG 10MG(from 50mg MDV)
|
Facility
|
OP
|
$13.19
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
25004568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna Commercial |
$10.16
|
| Rate for Payer: Anthem Medicaid |
$4.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.29
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$10.95
|
| Rate for Payer: First Health Commercial |
$12.53
|
| Rate for Payer: Humana Commercial |
$11.21
|
| Rate for Payer: Humana KY Medicaid |
$4.54
|
| Rate for Payer: Kentucky WC Medicaid |
$4.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.61
|
| Rate for Payer: Ohio Health Group HMO |
$9.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.10
|
| Rate for Payer: PHCS Commercial |
$12.66
|
| Rate for Payer: United Healthcare All Payer |
$11.61
|
|
