|
Y-PLATE 5TH MET LT
|
Facility
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
Y-PLATE 5TH MET LT
|
Facility
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
|
|
Y-PLATE 5TH MET RT
|
Facility
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
Y-PLATE 5TH MET RT
|
Facility
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
|
|
Y-TEC PROCEDURE PACK STD
|
Facility
OP
|
$2,029.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$1,562.33
|
| Rate for Payer: Anthem Medicaid |
$697.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.62
|
| Rate for Payer: Cash Price |
$1,014.50
|
| Rate for Payer: Cigna Commercial |
$1,684.07
|
| Rate for Payer: First Health Commercial |
$1,927.55
|
| Rate for Payer: Humana Commercial |
$1,724.65
|
| Rate for Payer: Humana KY Medicaid |
$697.77
|
| Rate for Payer: Kentucky WC Medicaid |
$704.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$711.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.99
|
| Rate for Payer: PHCS Commercial |
$1,947.84
|
| Rate for Payer: United Healthcare All Payer |
$1,785.52
|
|
|
Y-TEC PROCEDURE PACK STD
|
Facility
IP
|
$2,029.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$1,562.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.62
|
| Rate for Payer: Cash Price |
$1,014.50
|
| Rate for Payer: Cigna Commercial |
$1,684.07
|
| Rate for Payer: First Health Commercial |
$1,927.55
|
| Rate for Payer: Humana Commercial |
$1,724.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.99
|
| Rate for Payer: PHCS Commercial |
$1,947.84
|
|
|
YTTRIU 90 IBRITUMO TIUX PR DOS
|
Facility
OP
|
$63,605.00
|
|
|
Service Code
|
HCPCS A9543
|
| Hospital Charge Code |
34000058
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$8,268.65 |
| Max. Negotiated Rate |
$91,667.21 |
| Rate for Payer: Aetna Commercial |
$48,975.85
|
| Rate for Payer: Anthem Medicaid |
$21,873.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65,476.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,611.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91,667.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$88,393.39
|
| Rate for Payer: Cash Price |
$31,802.50
|
| Rate for Payer: Cash Price |
$31,802.50
|
| Rate for Payer: Cigna Commercial |
$52,792.15
|
| Rate for Payer: First Health Commercial |
$60,424.75
|
| Rate for Payer: Humana Commercial |
$54,064.25
|
| Rate for Payer: Humana KY Medicaid |
$21,873.76
|
| Rate for Payer: Humana Medicare Advantage |
$65,476.58
|
| Rate for Payer: Kentucky WC Medicaid |
$22,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,156.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46,940.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78,571.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,312.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$55,972.40
|
| Rate for Payer: Ohio Health Group HMO |
$47,703.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,721.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,268.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,717.55
|
| Rate for Payer: PHCS Commercial |
$61,060.80
|
| Rate for Payer: United Healthcare All Payer |
$55,972.40
|
|
|
YTTRIU 90 IBRITUMO TIUX PR DOS
|
Facility
IP
|
$63,605.00
|
|
|
Service Code
|
HCPCS A9543
|
| Hospital Charge Code |
34000058
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$8,268.65 |
| Max. Negotiated Rate |
$61,060.80 |
| Rate for Payer: Aetna Commercial |
$48,975.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,611.90
|
| Rate for Payer: Cash Price |
$31,802.50
|
| Rate for Payer: Cigna Commercial |
$52,792.15
|
| Rate for Payer: First Health Commercial |
$60,424.75
|
| Rate for Payer: Humana Commercial |
$54,064.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,156.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46,940.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,081.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$55,972.40
|
| Rate for Payer: Ohio Health Group HMO |
$47,703.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,721.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,268.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,717.55
|
| Rate for Payer: PHCS Commercial |
$61,060.80
|
|
|
ZADITOR 0.025% DROPS 5ML
|
Facility
OP
|
$0.11
|
|
| Hospital Charge Code |
25001737
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem Medicaid |
$0.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.09
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Humana KY Medicaid |
$0.04
|
| Rate for Payer: Kentucky WC Medicaid |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.10
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Payer |
$0.10
|
|
|
ZADITOR 0.025% DROPS 5ML
|
Facility
IP
|
$0.11
|
|
| Hospital Charge Code |
25001737
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.09
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.10
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.11
|
|
|
ZALTRAP 1MG[100MG/4ML VIAL]
|
Facility
OP
|
$8,400.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
25002695
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$8,064.00 |
| Rate for Payer: Aetna Commercial |
$6,468.00
|
| Rate for Payer: Anthem Medicaid |
$2,888.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,552.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.83
|
| Rate for Payer: Cash Price |
$4,200.00
|
| Rate for Payer: Cash Price |
$4,200.00
|
| Rate for Payer: Cigna Commercial |
$6,972.00
|
| Rate for Payer: First Health Commercial |
$7,980.00
|
| Rate for Payer: Humana Commercial |
$7,140.00
|
| Rate for Payer: Humana KY Medicaid |
$2,888.76
|
| Rate for Payer: Humana Medicare Advantage |
$7.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,918.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,888.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,199.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,946.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,392.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,092.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,604.00
|
| Rate for Payer: PHCS Commercial |
$8,064.00
|
| Rate for Payer: United Healthcare All Payer |
$7,392.00
|
|
|
ZALTRAP 1MG[100MG/4ML VIAL]
|
Facility
IP
|
$8,400.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
25002695
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,092.00 |
| Max. Negotiated Rate |
$8,064.00 |
| Rate for Payer: Aetna Commercial |
$6,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,552.00
|
| Rate for Payer: Cash Price |
$4,200.00
|
| Rate for Payer: Cigna Commercial |
$6,972.00
|
| Rate for Payer: First Health Commercial |
$7,980.00
|
| Rate for Payer: Humana Commercial |
$7,140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,888.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,199.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,392.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,092.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,604.00
|
| Rate for Payer: PHCS Commercial |
$8,064.00
|
|
|
ZANAFLEX (TIZANIDINE) 2MG TAB
|
Facility
OP
|
$4.18
|
|
| Hospital Charge Code |
25001738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Aetna Commercial |
$3.22
|
| Rate for Payer: Anthem Medicaid |
$1.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cigna Commercial |
$3.47
|
| Rate for Payer: First Health Commercial |
$3.97
|
| Rate for Payer: Humana Commercial |
$3.55
|
| Rate for Payer: Humana KY Medicaid |
$1.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.68
|
| Rate for Payer: Ohio Health Group HMO |
$3.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.30
|
| Rate for Payer: PHCS Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Payer |
$3.68
|
|
|
ZANAFLEX (TIZANIDINE) 2MG TAB
|
Facility
IP
|
$4.18
|
|
| Hospital Charge Code |
25001738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Aetna Commercial |
$3.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cigna Commercial |
$3.47
|
| Rate for Payer: First Health Commercial |
$3.97
|
| Rate for Payer: Humana Commercial |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.68
|
| Rate for Payer: Ohio Health Group HMO |
$3.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.30
|
| Rate for Payer: PHCS Commercial |
$4.01
|
|
|
ZANAFLEX (TIZANIDINE) 4 MG TAB
|
Facility
OP
|
$4.76
|
|
| Hospital Charge Code |
25001739
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
ZANAFLEX (TIZANIDINE) 4 MG TAB
|
Facility
IP
|
$4.76
|
|
| Hospital Charge Code |
25001739
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.57
|
|
|
ZAROXOLYN (METOLAZO 2.5MG/1TAB
|
Facility
OP
|
$4.30
|
|
| Hospital Charge Code |
25001744
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
ZAROXOLYN (METOLAZO 2.5MG/1TAB
|
Facility
IP
|
$4.30
|
|
| Hospital Charge Code |
25001744
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.13
|
|
|
ZAROXOLYN (METOLAZONE 5MG/1TAB
|
Facility
IP
|
$4.40
|
|
| Hospital Charge Code |
25001746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
|
|
ZAROXOLYN (METOLAZONE 5MG/1TAB
|
Facility
OP
|
$4.40
|
|
| Hospital Charge Code |
25001746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ZARXIO EAMCG (300MCG/0.5MLSYR)
|
Facility
IP
|
$1,440.39
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$1,382.77 |
| Rate for Payer: Aetna Commercial |
$1,109.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.50
|
| Rate for Payer: Cash Price |
$720.20
|
| Rate for Payer: Cigna Commercial |
$1,195.52
|
| Rate for Payer: First Health Commercial |
$1,368.37
|
| Rate for Payer: Humana Commercial |
$1,224.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,181.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,063.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.52
|
| Rate for Payer: PHCS Commercial |
$1,382.77
|
|
|
ZARXIO EAMCG (300MCG/0.5MLSYR)
|
Facility
OP
|
$1,440.39
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1,382.77 |
| Rate for Payer: Aetna Commercial |
$1,109.10
|
| Rate for Payer: Anthem Medicaid |
$495.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$720.20
|
| Rate for Payer: Cash Price |
$720.20
|
| Rate for Payer: Cigna Commercial |
$1,195.52
|
| Rate for Payer: First Health Commercial |
$1,368.37
|
| Rate for Payer: Humana Commercial |
$1,224.33
|
| Rate for Payer: Humana KY Medicaid |
$495.35
|
| Rate for Payer: Humana Medicare Advantage |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$500.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,181.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,063.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.52
|
| Rate for Payer: PHCS Commercial |
$1,382.77
|
| Rate for Payer: United Healthcare All Payer |
$1,267.54
|
|
|
ZARXIO EAMCG(480MCG/0.8MLSYR)
|
Facility
OP
|
$2,304.65
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$2,212.46 |
| Rate for Payer: Aetna Commercial |
$1,774.58
|
| Rate for Payer: Anthem Medicaid |
$792.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,797.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$1,152.33
|
| Rate for Payer: Cash Price |
$1,152.33
|
| Rate for Payer: Cigna Commercial |
$1,912.86
|
| Rate for Payer: First Health Commercial |
$2,189.42
|
| Rate for Payer: Humana Commercial |
$1,958.95
|
| Rate for Payer: Humana KY Medicaid |
$792.57
|
| Rate for Payer: Humana Medicare Advantage |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$800.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,889.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,700.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$808.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,028.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,728.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$714.44
|
| Rate for Payer: PHCS Commercial |
$2,212.46
|
| Rate for Payer: United Healthcare All Payer |
$2,028.09
|
|
|
ZARXIO EAMCG(480MCG/0.8MLSYR)
|
Facility
IP
|
$2,304.65
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$2,212.46 |
| Rate for Payer: Aetna Commercial |
$1,774.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,797.63
|
| Rate for Payer: Cash Price |
$1,152.33
|
| Rate for Payer: Cigna Commercial |
$1,912.86
|
| Rate for Payer: First Health Commercial |
$2,189.42
|
| Rate for Payer: Humana Commercial |
$1,958.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,889.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,700.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$691.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,028.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,728.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$714.44
|
| Rate for Payer: PHCS Commercial |
$2,212.46
|
|
|
ZEBETA 5MG TAB
|
Facility
OP
|
$8.86
|
|
| Hospital Charge Code |
25001748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna Commercial |
$6.82
|
| Rate for Payer: Anthem Medicaid |
$3.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.91
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cigna Commercial |
$7.35
|
| Rate for Payer: First Health Commercial |
$8.42
|
| Rate for Payer: Humana Commercial |
$7.53
|
| Rate for Payer: Humana KY Medicaid |
$3.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.80
|
| Rate for Payer: Ohio Health Group HMO |
$6.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.75
|
| Rate for Payer: PHCS Commercial |
$8.51
|
| Rate for Payer: United Healthcare All Payer |
$7.80
|
|
