|
ZEBETA 5MG TAB
|
Facility
IP
|
$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 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: 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: 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
|
|
|
ZELANTE DVT ANGIOJET CATH
|
Facility
IP
|
$13,574.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$38,842.08 |
| Rate for Payer: Aetna Commercial |
$10,452.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,588.30
|
| Rate for Payer: Cash Price |
$6,787.38
|
| Rate for Payer: Cigna Commercial |
$11,267.04
|
| Rate for Payer: First Health Commercial |
$12,896.01
|
| Rate for Payer: Humana Commercial |
$11,538.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,131.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,018.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,072.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,945.78
|
| Rate for Payer: Ohio Health Group HMO |
$10,181.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,714.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,764.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,208.17
|
| Rate for Payer: PHCS Commercial |
$13,031.76
|
|
|
ZELANTE DVT ANGIOJET CATH
|
Facility
OP
|
$13,574.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$38,842.08 |
| Rate for Payer: Aetna Commercial |
$10,452.56
|
| Rate for Payer: Anthem Medicaid |
$4,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,588.30
|
| Rate for Payer: Cash Price |
$6,787.38
|
| Rate for Payer: Cigna Commercial |
$11,267.04
|
| Rate for Payer: First Health Commercial |
$12,896.01
|
| Rate for Payer: Humana Commercial |
$11,538.54
|
| Rate for Payer: Humana KY Medicaid |
$4,668.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,131.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,018.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,072.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,762.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,945.78
|
| Rate for Payer: Ohio Health Group HMO |
$10,181.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,714.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,764.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,208.17
|
| Rate for Payer: PHCS Commercial |
$13,031.76
|
| Rate for Payer: United Healthcare All Payer |
$11,945.78
|
|
|
ZEMAIRA 10MG (1000MG VL)
|
Facility
IP
|
$2,940.00
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$2,822.40 |
| Rate for Payer: Aetna Commercial |
$2,263.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.20
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cigna Commercial |
$2,440.20
|
| Rate for Payer: First Health Commercial |
$2,793.00
|
| Rate for Payer: Humana Commercial |
$2,499.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,410.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,169.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,587.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$911.40
|
| Rate for Payer: PHCS Commercial |
$2,822.40
|
|
|
ZEMAIRA 10MG (1000MG VL)
|
Facility
OP
|
$2,940.00
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$2,822.40 |
| Rate for Payer: Aetna Commercial |
$2,263.80
|
| Rate for Payer: Anthem Medicaid |
$1,011.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cigna Commercial |
$2,440.20
|
| Rate for Payer: First Health Commercial |
$2,793.00
|
| Rate for Payer: Humana Commercial |
$2,499.00
|
| Rate for Payer: Humana KY Medicaid |
$1,011.07
|
| Rate for Payer: Humana Medicare Advantage |
$4.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,021.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,410.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,169.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,031.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,587.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$911.40
|
| Rate for Payer: PHCS Commercial |
$2,822.40
|
| Rate for Payer: United Healthcare All Payer |
$2,587.20
|
|
|
ZEMDRI 5MG (500MG SDV)
|
Facility
OP
|
$1,815.98
|
|
|
Service Code
|
HCPCS J0291
|
| Hospital Charge Code |
25001817
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$1,743.34 |
| Rate for Payer: Aetna Commercial |
$1,398.30
|
| Rate for Payer: Anthem Medicaid |
$624.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.86
|
| Rate for Payer: Cash Price |
$907.99
|
| Rate for Payer: Cash Price |
$907.99
|
| Rate for Payer: Cigna Commercial |
$1,507.26
|
| Rate for Payer: First Health Commercial |
$1,725.18
|
| Rate for Payer: Humana Commercial |
$1,543.58
|
| Rate for Payer: Humana KY Medicaid |
$624.52
|
| Rate for Payer: Humana Medicare Advantage |
$3.60
|
| Rate for Payer: Kentucky WC Medicaid |
$630.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.95
|
| Rate for Payer: PHCS Commercial |
$1,743.34
|
| Rate for Payer: United Healthcare All Payer |
$1,598.06
|
|
|
ZEMDRI 5MG (500MG SDV)
|
Facility
IP
|
$1,815.98
|
|
|
Service Code
|
HCPCS J0291
|
| Hospital Charge Code |
25001817
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.08 |
| Max. Negotiated Rate |
$1,743.34 |
| Rate for Payer: Aetna Commercial |
$1,398.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.46
|
| Rate for Payer: Cash Price |
$907.99
|
| Rate for Payer: Cigna Commercial |
$1,507.26
|
| Rate for Payer: First Health Commercial |
$1,725.18
|
| Rate for Payer: Humana Commercial |
$1,543.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.95
|
| Rate for Payer: PHCS Commercial |
$1,743.34
|
|
|
ZEMPLAR PARICALCITOL 1 MCG CAP
|
Facility
IP
|
$8.70
|
|
| Hospital Charge Code |
25001749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.79
|
| Rate for Payer: Cash Price |
$4.35
|
| Rate for Payer: Cigna Commercial |
$7.22
|
| Rate for Payer: First Health Commercial |
$8.26
|
| Rate for Payer: Humana Commercial |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.66
|
| Rate for Payer: Ohio Health Group HMO |
$6.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.70
|
| Rate for Payer: PHCS Commercial |
$8.35
|
|
|
ZEMPLAR PARICALCITOL 1 MCG CAP
|
Facility
OP
|
$8.70
|
|
| Hospital Charge Code |
25001749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: Anthem Medicaid |
$2.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.79
|
| Rate for Payer: Cash Price |
$4.35
|
| Rate for Payer: Cigna Commercial |
$7.22
|
| Rate for Payer: First Health Commercial |
$8.26
|
| Rate for Payer: Humana Commercial |
$7.40
|
| Rate for Payer: Humana KY Medicaid |
$2.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.66
|
| Rate for Payer: Ohio Health Group HMO |
$6.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.70
|
| Rate for Payer: PHCS Commercial |
$8.35
|
| Rate for Payer: United Healthcare All Payer |
$7.66
|
|
|
ZEMPLAR(PARICALOTOL)1MCG5MCGML
|
Facility
IP
|
$117.15
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
25003632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$112.46 |
| Rate for Payer: Aetna Commercial |
$90.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.38
|
| Rate for Payer: Cash Price |
$58.58
|
| Rate for Payer: Cigna Commercial |
$97.23
|
| Rate for Payer: First Health Commercial |
$111.29
|
| Rate for Payer: Humana Commercial |
$99.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.09
|
| Rate for Payer: Ohio Health Group HMO |
$87.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.32
|
| Rate for Payer: PHCS Commercial |
$112.46
|
|
|
ZEMPLAR(PARICALOTOL)1MCG5MCGML
|
Facility
OP
|
$117.15
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
25003632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$112.46 |
| Rate for Payer: Aetna Commercial |
$90.21
|
| Rate for Payer: Anthem Medicaid |
$40.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.38
|
| Rate for Payer: Cash Price |
$58.58
|
| Rate for Payer: Cigna Commercial |
$97.23
|
| Rate for Payer: First Health Commercial |
$111.29
|
| Rate for Payer: Humana Commercial |
$99.58
|
| Rate for Payer: Humana KY Medicaid |
$40.29
|
| Rate for Payer: Kentucky WC Medicaid |
$40.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.09
|
| Rate for Payer: Ohio Health Group HMO |
$87.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.32
|
| Rate for Payer: PHCS Commercial |
$112.46
|
| Rate for Payer: United Healthcare All Payer |
$103.09
|
|
|
ZEMURON 100MG/10ML VIAL
|
Facility
OP
|
$109.00
|
|
| Hospital Charge Code |
25003634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$37.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$37.49
|
| Rate for Payer: Kentucky WC Medicaid |
$37.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
ZEMURON 100MG/10ML VIAL
|
Facility
IP
|
$109.00
|
|
| Hospital Charge Code |
25003634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
|
|
ZEMURON (ROCURONIU) 5 50MG/5ML
|
Facility
IP
|
$108.00
|
|
| Hospital Charge Code |
25003633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.24
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
|
|
ZEMURON (ROCURONIU) 5 50MG/5ML
|
Facility
OP
|
$108.00
|
|
| Hospital Charge Code |
25003633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$37.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.24
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$37.14
|
| Rate for Payer: Kentucky WC Medicaid |
$37.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
ZENITH AAA COMP KIT ZAK-100C
|
Facility
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
ZENITH AAA COMP KIT ZAK-100C
|
Facility
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
|
|
ZENITH AAA ILIAC LEG EXT 16*55
|
Facility
OP
|
$10,603.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$8,164.81
|
| Rate for Payer: Anthem Medicaid |
$3,646.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,270.85
|
| Rate for Payer: Cash Price |
$5,301.82
|
| Rate for Payer: Cigna Commercial |
$8,801.03
|
| Rate for Payer: First Health Commercial |
$10,073.47
|
| Rate for Payer: Humana Commercial |
$9,013.10
|
| Rate for Payer: Humana KY Medicaid |
$3,646.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,683.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,694.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,825.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,181.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,719.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,331.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,952.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.13
|
| Rate for Payer: PHCS Commercial |
$10,179.50
|
| Rate for Payer: United Healthcare All Payer |
$9,331.21
|
|
|
ZENITH AAA ILIAC LEG EXT 16*55
|
Facility
IP
|
$10,603.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Cigna Commercial |
$8,801.03
|
| Rate for Payer: Aetna Commercial |
$8,164.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,270.85
|
| Rate for Payer: Cash Price |
$5,301.82
|
| Rate for Payer: First Health Commercial |
$10,073.47
|
| Rate for Payer: Humana Commercial |
$9,013.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,694.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,825.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,331.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,952.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.13
|
| Rate for Payer: PHCS Commercial |
$10,179.50
|
|
|
ZENITH AAA ILIAC LEG EXT 18*55
|
Facility
IP
|
$11,045.30
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$8,504.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.33
|
| Rate for Payer: Cash Price |
$5,522.65
|
| Rate for Payer: Cigna Commercial |
$9,167.60
|
| Rate for Payer: First Health Commercial |
$10,493.04
|
| Rate for Payer: Humana Commercial |
$9,388.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,719.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,283.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,209.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,424.04
|
| Rate for Payer: PHCS Commercial |
$10,603.49
|
|
|
ZENITH AAA ILIAC LEG EXT 18*55
|
Facility
OP
|
$11,045.30
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$8,504.88
|
| Rate for Payer: Anthem Medicaid |
$3,798.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.33
|
| Rate for Payer: Cash Price |
$5,522.65
|
| Rate for Payer: Cigna Commercial |
$9,167.60
|
| Rate for Payer: First Health Commercial |
$10,493.04
|
| Rate for Payer: Humana Commercial |
$9,388.50
|
| Rate for Payer: Humana KY Medicaid |
$3,798.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,837.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,874.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,719.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,283.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,209.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,424.04
|
| Rate for Payer: PHCS Commercial |
$10,603.49
|
| Rate for Payer: United Healthcare All Payer |
$9,719.86
|
|
|
ZENITH AAA ILIAC LEG EXT 24*55
|
Facility
IP
|
$9,384.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$7,226.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,319.99
|
| Rate for Payer: Cash Price |
$4,692.30
|
| Rate for Payer: Cigna Commercial |
$7,789.22
|
| Rate for Payer: First Health Commercial |
$8,915.37
|
| Rate for Payer: Humana Commercial |
$7,976.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,695.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,925.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,815.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,258.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,038.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.23
|
| Rate for Payer: PHCS Commercial |
$9,009.22
|
|
|
ZENITH AAA ILIAC LEG EXT 24*55
|
Facility
OP
|
$9,384.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$7,226.14
|
| Rate for Payer: Anthem Medicaid |
$3,227.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,319.99
|
| Rate for Payer: Cash Price |
$4,692.30
|
| Rate for Payer: Cigna Commercial |
$7,789.22
|
| Rate for Payer: First Health Commercial |
$8,915.37
|
| Rate for Payer: Humana Commercial |
$7,976.91
|
| Rate for Payer: Humana KY Medicaid |
$3,227.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,260.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,695.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,925.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,815.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,292.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,258.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,038.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.23
|
| Rate for Payer: PHCS Commercial |
$9,009.22
|
| Rate for Payer: United Healthcare All Payer |
$8,258.45
|
|
|
ZENITH AAA ILIAC PLG ZIP-14-30
|
Facility
IP
|
$9,486.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$7,304.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,399.70
|
| Rate for Payer: Cash Price |
$4,743.40
|
| Rate for Payer: Cigna Commercial |
$7,874.04
|
| Rate for Payer: First Health Commercial |
$9,012.46
|
| Rate for Payer: Humana Commercial |
$8,063.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,779.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,001.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,348.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,115.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,897.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.91
|
| Rate for Payer: PHCS Commercial |
$9,107.33
|
|
|
ZENITH AAA ILIAC PLG ZIP-14-30
|
Facility
OP
|
$9,486.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$7,304.84
|
| Rate for Payer: Anthem Medicaid |
$3,262.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,399.70
|
| Rate for Payer: Cash Price |
$4,743.40
|
| Rate for Payer: Cigna Commercial |
$7,874.04
|
| Rate for Payer: First Health Commercial |
$9,012.46
|
| Rate for Payer: Humana Commercial |
$8,063.78
|
| Rate for Payer: Humana KY Medicaid |
$3,262.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,295.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,779.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,001.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,327.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,348.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,115.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,897.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.91
|
| Rate for Payer: PHCS Commercial |
$9,107.33
|
| Rate for Payer: United Healthcare All Payer |
$8,348.38
|
|
