|
TRIAL OXF UNI PH3 SZ D LM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAL OXF UNI PH3 SZ D RM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAL OXF UNI PH3 SZ D RM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAL OXF UNI PH3 SZ E LM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAL OXF UNI PH3 SZ E LM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAL OXF UNI PH3 SZ E RM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAL OXF UNI PH3 SZ E RM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAL OXF UNI PH3 SZ F LM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAL OXF UNI PH3 SZ F LM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TRIAMCINOIONE 0.5% CRM (15GM)
|
Facility
|
OP
|
$5.38
|
|
|
Service Code
|
NDC 33342032815
|
| Hospital Charge Code |
25001586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna Commercial |
$4.14
|
| Rate for Payer: Anthem Medicaid |
$1.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.20
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cigna Commercial |
$4.47
|
| Rate for Payer: First Health Commercial |
$5.11
|
| Rate for Payer: Humana Commercial |
$4.57
|
| Rate for Payer: Humana KY Medicaid |
$1.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.73
|
| Rate for Payer: Ohio Health Group HMO |
$4.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.67
|
| Rate for Payer: PHCS Commercial |
$5.16
|
| Rate for Payer: United Healthcare All Payer |
$4.73
|
|
|
TRIAMCINOIONE 0.5% CRM (15GM)
|
Facility
|
IP
|
$5.38
|
|
|
Service Code
|
NDC 33342032815
|
| Hospital Charge Code |
25001586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna Commercial |
$4.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.20
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cigna Commercial |
$4.47
|
| Rate for Payer: First Health Commercial |
$5.11
|
| Rate for Payer: Humana Commercial |
$4.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.73
|
| Rate for Payer: Ohio Health Group HMO |
$4.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.67
|
| Rate for Payer: PHCS Commercial |
$5.16
|
| Rate for Payer: United Healthcare All Payer |
$4.73
|
|
|
TRIAMCINOLE ACETONIDE.1%OT15GM
|
Facility
|
IP
|
$3.56
|
|
|
Service Code
|
NDC 51672128401
|
| Hospital Charge Code |
25001587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.78
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna Commercial |
$2.95
|
| Rate for Payer: First Health Commercial |
$3.38
|
| Rate for Payer: Humana Commercial |
$3.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.13
|
| Rate for Payer: Ohio Health Group HMO |
$2.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.10
|
| Rate for Payer: PHCS Commercial |
$3.42
|
| Rate for Payer: United Healthcare All Payer |
$3.13
|
|
|
TRIAMCINOLE ACETONIDE.1%OT15GM
|
Facility
|
OP
|
$3.56
|
|
|
Service Code
|
NDC 51672128401
|
| Hospital Charge Code |
25001587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Anthem Medicaid |
$1.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.78
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna Commercial |
$2.95
|
| Rate for Payer: First Health Commercial |
$3.38
|
| Rate for Payer: Humana Commercial |
$3.03
|
| Rate for Payer: Humana KY Medicaid |
$1.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.13
|
| Rate for Payer: Ohio Health Group HMO |
$2.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.10
|
| Rate for Payer: PHCS Commercial |
$3.42
|
| Rate for Payer: United Healthcare All Payer |
$3.13
|
|
|
TRIAMCINOLONE 0.025% CRM 80 GM
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 45802006335
|
| Hospital Charge Code |
25001588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem Medicaid |
$1.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Humana KY Medicaid |
$1.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.09
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
TRIAMCINOLONE 0.025% CRM 80 GM
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
NDC 45802006335
|
| Hospital Charge Code |
25001588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.09
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
TRIAMCINOLONE 0.1% CREAM 1LB
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
NDC 33342032915
|
| Hospital Charge Code |
25001590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.09
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
TRIAMCINOLONE 0.1% CREAM 1LB
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 33342032915
|
| Hospital Charge Code |
25001590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem Medicaid |
$1.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Humana KY Medicaid |
$1.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.09
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
TRIAMCINOLONE 0.1% CREAM(30GM)
|
Facility
|
OP
|
$2.71
|
|
|
Service Code
|
NDC 51672128202
|
| Hospital Charge Code |
25003534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Anthem Medicaid |
$0.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.25
|
| Rate for Payer: First Health Commercial |
$2.57
|
| Rate for Payer: Humana Commercial |
$2.30
|
| Rate for Payer: Humana KY Medicaid |
$0.93
|
| Rate for Payer: Kentucky WC Medicaid |
$0.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.38
|
| Rate for Payer: Ohio Health Group HMO |
$2.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.84
|
| Rate for Payer: PHCS Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Payer |
$2.38
|
|
|
TRIAMCINOLONE 0.1% CREAM(30GM)
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
NDC 51672128202
|
| Hospital Charge Code |
25003534
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna Commercial |
$2.25
|
| Rate for Payer: First Health Commercial |
$2.57
|
| Rate for Payer: Humana Commercial |
$2.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.38
|
| Rate for Payer: Ohio Health Group HMO |
$2.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.84
|
| Rate for Payer: PHCS Commercial |
$2.60
|
| Rate for Payer: United Healthcare All Payer |
$2.38
|
|
|
TRIAMCINOLONE 0.1% CREAM 80GM
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 168000480
|
| Hospital Charge Code |
25001589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna Commercial |
$0.32
|
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.35
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: First Health Commercial |
$0.98
|
| Rate for Payer: First Health Commercial |
$0.40
|
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.91
|
| Rate for Payer: Ohio Health Group HMO |
$0.32
|
| Rate for Payer: Ohio Health Group HMO |
$0.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.13
|
| Rate for Payer: PHCS Commercial |
$0.40
|
| Rate for Payer: PHCS Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Payer |
$0.37
|
| Rate for Payer: United Healthcare All Payer |
$0.91
|
|
|
TRIAMCINOLONE 0.1% CREAM 80GM
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 168000480
|
| Hospital Charge Code |
25001589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna Commercial |
$0.32
|
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Anthem Medicaid |
$0.14
|
| Rate for Payer: Anthem Medicaid |
$0.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: Cigna Commercial |
$0.35
|
| Rate for Payer: First Health Commercial |
$0.98
|
| Rate for Payer: First Health Commercial |
$0.40
|
| Rate for Payer: Humana Commercial |
$0.36
|
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Humana KY Medicaid |
$0.14
|
| Rate for Payer: Humana KY Medicaid |
$0.35
|
| Rate for Payer: Kentucky WC Medicaid |
$0.36
|
| Rate for Payer: Kentucky WC Medicaid |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.91
|
| Rate for Payer: Ohio Health Group HMO |
$0.32
|
| Rate for Payer: Ohio Health Group HMO |
$0.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.32
|
| Rate for Payer: PHCS Commercial |
$0.99
|
| Rate for Payer: PHCS Commercial |
$0.40
|
| Rate for Payer: United Healthcare All Payer |
$0.91
|
| Rate for Payer: United Healthcare All Payer |
$0.37
|
|
|
TRIAMCINOLONE 0.1% OINT 80GM
|
Facility
|
IP
|
$1.08
|
|
|
Service Code
|
NDC 168000680
|
| Hospital Charge Code |
25001591
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.84
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna Commercial |
$0.90
|
| Rate for Payer: First Health Commercial |
$1.03
|
| Rate for Payer: Humana Commercial |
$0.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.95
|
| Rate for Payer: Ohio Health Group HMO |
$0.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.33
|
| Rate for Payer: PHCS Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Payer |
$0.95
|
|
|
TRIAMCINOLONE 0.1% OINT 80GM
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
NDC 168000680
|
| Hospital Charge Code |
25001591
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.83
|
| Rate for Payer: Anthem Medicaid |
$0.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.84
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: Cigna Commercial |
$0.90
|
| Rate for Payer: First Health Commercial |
$1.03
|
| Rate for Payer: Humana Commercial |
$0.92
|
| Rate for Payer: Humana KY Medicaid |
$0.37
|
| Rate for Payer: Kentucky WC Medicaid |
$0.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.95
|
| Rate for Payer: Ohio Health Group HMO |
$0.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.33
|
| Rate for Payer: PHCS Commercial |
$1.04
|
| Rate for Payer: United Healthcare All Payer |
$0.95
|
|
|
TRIAMCINOLONE 0.5% OINT (15GM)
|
Facility
|
OP
|
$5.55
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
25003536
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Anthem Medicaid |
$1.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.33
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: First Health Commercial |
$5.27
|
| Rate for Payer: Humana Commercial |
$4.72
|
| Rate for Payer: Humana KY Medicaid |
$1.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.88
|
| Rate for Payer: Ohio Health Group HMO |
$4.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.72
|
| Rate for Payer: PHCS Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Payer |
$4.88
|
|
|
TRIAMCINOLONE 0.5% OINT (15GM)
|
Facility
|
IP
|
$5.55
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
25003536
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.33
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: First Health Commercial |
$5.27
|
| Rate for Payer: Humana Commercial |
$4.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.88
|
| Rate for Payer: Ohio Health Group HMO |
$4.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.72
|
| Rate for Payer: PHCS Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Payer |
$4.88
|
|
