|
ZENITH AAA ILIAC PLG ZIP-16-30
|
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
|
|
|
ZENITH AAA ILIAC PLG ZIP-16-30
|
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-20-30
|
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
|
|
|
ZENITH AAA ILIAC PLG ZIP-20-30
|
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 PLUGZIP-24-30
|
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 PLUGZIP-24-30
|
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
|
|
|
ZERBAXA 75mg (1.5gm SDV)
|
Facility
OP
|
$832.91
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
25003946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$799.59 |
| Rate for Payer: Aetna Commercial |
$641.34
|
| Rate for Payer: Anthem Medicaid |
$286.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$649.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.95
|
| Rate for Payer: Cash Price |
$416.46
|
| Rate for Payer: Cash Price |
$416.46
|
| Rate for Payer: Cigna Commercial |
$691.32
|
| Rate for Payer: First Health Commercial |
$791.26
|
| Rate for Payer: Humana Commercial |
$707.97
|
| Rate for Payer: Humana KY Medicaid |
$286.44
|
| Rate for Payer: Humana Medicare Advantage |
$7.37
|
| Rate for Payer: Kentucky WC Medicaid |
$289.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$682.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$614.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$732.96
|
| Rate for Payer: Ohio Health Group HMO |
$624.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.20
|
| Rate for Payer: PHCS Commercial |
$799.59
|
| Rate for Payer: United Healthcare All Payer |
$732.96
|
|
|
ZERBAXA 75mg (1.5gm SDV)
|
Facility
IP
|
$832.91
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
25003946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.28 |
| Max. Negotiated Rate |
$799.59 |
| Rate for Payer: Aetna Commercial |
$641.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$649.67
|
| Rate for Payer: Cash Price |
$416.46
|
| Rate for Payer: Cigna Commercial |
$691.32
|
| Rate for Payer: First Health Commercial |
$791.26
|
| Rate for Payer: Humana Commercial |
$707.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$682.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$614.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$732.96
|
| Rate for Payer: Ohio Health Group HMO |
$624.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.20
|
| Rate for Payer: PHCS Commercial |
$799.59
|
|
|
ZETIA (EZETIMIBIE) 10 MG TAB
|
Facility
OP
|
$4.37
|
|
| Hospital Charge Code |
25001750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ZETIA (EZETIMIBIE) 10 MG TAB
|
Facility
IP
|
$4.37
|
|
| Hospital Charge Code |
25001750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.20
|
|
|
ZIAC (BISOPROLOL) 10 10MG/1TAB
|
Facility
OP
|
$4.52
|
|
| Hospital Charge Code |
25001751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
ZIAC (BISOPROLOL) 10 10MG/1TAB
|
Facility
IP
|
$4.52
|
|
| Hospital Charge Code |
25001751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
|
|
ZIAC (BISOPROLOL) 2 2.5MG/1TAB
|
Facility
OP
|
$4.39
|
|
| Hospital Charge Code |
25001752
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| 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 |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ZIAC (BISOPROLOL) 2 2.5MG/1TAB
|
Facility
IP
|
$4.39
|
|
| Hospital Charge Code |
25001752
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| 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 |
$4.21
|
|
|
ZIAC (BISOPROLOL) 5 M 5MG/TAB
|
Facility
OP
|
$4.52
|
|
| Hospital Charge Code |
25001753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
ZIAC (BISOPROLOL) 5 M 5MG/TAB
|
Facility
IP
|
$4.52
|
|
| Hospital Charge Code |
25001753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
|
|
ZIEXTENZO 0.5mg (6mg PFS)
|
Facility
IP
|
$20,609.03
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
25004107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,679.17 |
| Max. Negotiated Rate |
$19,784.67 |
| Rate for Payer: Aetna Commercial |
$15,868.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,075.04
|
| Rate for Payer: Cash Price |
$10,304.51
|
| Rate for Payer: Cigna Commercial |
$17,105.49
|
| Rate for Payer: First Health Commercial |
$19,578.58
|
| Rate for Payer: Humana Commercial |
$17,517.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,899.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,209.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,182.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,135.95
|
| Rate for Payer: Ohio Health Group HMO |
$15,456.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,121.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,679.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,388.80
|
| Rate for Payer: PHCS Commercial |
$19,784.67
|
|
|
ZIEXTENZO 0.5mg (6mg PFS)
|
Facility
OP
|
$20,609.03
|
|
|
Service Code
|
HCPCS Q5120
|
| Hospital Charge Code |
25004107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$346.76 |
| Max. Negotiated Rate |
$19,784.67 |
| Rate for Payer: Aetna Commercial |
$15,868.95
|
| Rate for Payer: Anthem Medicaid |
$7,087.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$346.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,075.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$485.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$468.12
|
| Rate for Payer: Cash Price |
$10,304.51
|
| Rate for Payer: Cash Price |
$10,304.51
|
| Rate for Payer: Cigna Commercial |
$17,105.49
|
| Rate for Payer: First Health Commercial |
$19,578.58
|
| Rate for Payer: Humana Commercial |
$17,517.68
|
| Rate for Payer: Humana KY Medicaid |
$7,087.45
|
| Rate for Payer: Humana Medicare Advantage |
$346.76
|
| Rate for Payer: Kentucky WC Medicaid |
$7,159.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,899.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,209.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,229.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,135.95
|
| Rate for Payer: Ohio Health Group HMO |
$15,456.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,121.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,679.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,388.80
|
| Rate for Payer: PHCS Commercial |
$19,784.67
|
| Rate for Payer: United Healthcare All Payer |
$18,135.95
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Facility
IP
|
$102.16
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
636T0182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.68
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cigna Commercial |
$84.79
|
| Rate for Payer: First Health Commercial |
$97.05
|
| Rate for Payer: Humana Commercial |
$86.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.90
|
| Rate for Payer: Ohio Health Group HMO |
$76.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.67
|
| Rate for Payer: PHCS Commercial |
$98.07
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Facility
OP
|
$3,334.43
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
25004333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$3,201.05 |
| Rate for Payer: Aetna Commercial |
$2,567.51
|
| Rate for Payer: Anthem Medicaid |
$1,146.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,600.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.68
|
| Rate for Payer: Cash Price |
$1,667.21
|
| Rate for Payer: Cash Price |
$1,667.21
|
| Rate for Payer: Cigna Commercial |
$2,767.58
|
| Rate for Payer: First Health Commercial |
$3,167.71
|
| Rate for Payer: Humana Commercial |
$2,834.27
|
| Rate for Payer: Humana KY Medicaid |
$1,146.71
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,158.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,734.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,460.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,169.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,934.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,500.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,033.67
|
| Rate for Payer: PHCS Commercial |
$3,201.05
|
| Rate for Payer: United Healthcare All Payer |
$2,934.30
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Facility
IP
|
$102.16
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
63600182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.68
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cigna Commercial |
$84.79
|
| Rate for Payer: First Health Commercial |
$97.05
|
| Rate for Payer: Humana Commercial |
$86.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.90
|
| Rate for Payer: Ohio Health Group HMO |
$76.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.67
|
| Rate for Payer: PHCS Commercial |
$98.07
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Facility
OP
|
$102.16
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
63600182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Anthem Medicaid |
$35.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.68
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cigna Commercial |
$84.79
|
| Rate for Payer: First Health Commercial |
$97.05
|
| Rate for Payer: Humana Commercial |
$86.84
|
| Rate for Payer: Humana KY Medicaid |
$35.13
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Kentucky WC Medicaid |
$35.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.90
|
| Rate for Payer: Ohio Health Group HMO |
$76.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.67
|
| Rate for Payer: PHCS Commercial |
$98.07
|
| Rate for Payer: United Healthcare All Payer |
$89.90
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Facility
IP
|
$3,334.43
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
25004333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$433.48 |
| Max. Negotiated Rate |
$3,201.05 |
| Rate for Payer: Aetna Commercial |
$2,567.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,600.86
|
| Rate for Payer: Cash Price |
$1,667.21
|
| Rate for Payer: Cigna Commercial |
$2,767.58
|
| Rate for Payer: First Health Commercial |
$3,167.71
|
| Rate for Payer: Humana Commercial |
$2,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,734.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,460.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,934.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,500.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,033.67
|
| Rate for Payer: PHCS Commercial |
$3,201.05
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Professional
|
$102.16
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
63600182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.11 |
| Max. Negotiated Rate |
$102.16 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.54
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$17.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.11
|
| Rate for Payer: Multiplan PHCS |
$61.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.25
|
| Rate for Payer: UHCCP Medicaid |
$35.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.11
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Facility
OP
|
$102.16
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
636T0182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Anthem Medicaid |
$35.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.68
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cigna Commercial |
$84.79
|
| Rate for Payer: First Health Commercial |
$97.05
|
| Rate for Payer: Humana Commercial |
$86.84
|
| Rate for Payer: Humana KY Medicaid |
$35.13
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Kentucky WC Medicaid |
$35.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.90
|
| Rate for Payer: Ohio Health Group HMO |
$76.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.67
|
| Rate for Payer: PHCS Commercial |
$98.07
|
| Rate for Payer: United Healthcare All Payer |
$89.90
|
|
