|
ZIMMER PRSS-FT HUM STEM 14*110
|
Facility
IP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
|
|
ZINC CHLORIDE 10mg SDV
|
Facility
IP
|
$125.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$120.66 |
| Rate for Payer: Aetna Commercial |
$96.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.04
|
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Cigna Commercial |
$104.32
|
| Rate for Payer: First Health Commercial |
$119.41
|
| Rate for Payer: Humana Commercial |
$106.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.61
|
| Rate for Payer: Ohio Health Group HMO |
$94.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.96
|
| Rate for Payer: PHCS Commercial |
$120.66
|
|
|
ZINC CHLORIDE 10mg SDV
|
Facility
OP
|
$125.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$120.66 |
| Rate for Payer: Aetna Commercial |
$96.78
|
| Rate for Payer: Anthem Medicaid |
$43.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.04
|
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Cigna Commercial |
$104.32
|
| Rate for Payer: First Health Commercial |
$119.41
|
| Rate for Payer: Humana Commercial |
$106.84
|
| Rate for Payer: Humana KY Medicaid |
$43.22
|
| Rate for Payer: Kentucky WC Medicaid |
$43.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.61
|
| Rate for Payer: Ohio Health Group HMO |
$94.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.96
|
| Rate for Payer: PHCS Commercial |
$120.66
|
| Rate for Payer: United Healthcare All Payer |
$110.61
|
|
|
ZINC OXIDE PASTE 113 gm
|
Facility
OP
|
$3.51
|
|
| Hospital Charge Code |
25004446
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem Medicaid |
$1.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Humana KY Medicaid |
$1.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.09
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
ZINC OXIDE PASTE 113 gm
|
Facility
IP
|
$3.51
|
|
| Hospital Charge Code |
25004446
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.09
|
| Rate for Payer: PHCS Commercial |
$3.37
|
|
|
ZINC OXIDE PASTE 4 gm
|
Facility
IP
|
$4.34
|
|
| Hospital Charge Code |
25004458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
|
|
ZINC OXIDE PASTE 4 gm
|
Facility
OP
|
$4.34
|
|
| Hospital Charge Code |
25004458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
ZINC OXIDE PASTE 57 gm
|
Facility
IP
|
$5.14
|
|
| Hospital Charge Code |
25004457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna Commercial |
$4.27
|
| Rate for Payer: First Health Commercial |
$4.88
|
| Rate for Payer: Humana Commercial |
$4.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.59
|
| Rate for Payer: PHCS Commercial |
$4.93
|
|
|
ZINC OXIDE PASTE 57 gm
|
Facility
OP
|
$5.14
|
|
| Hospital Charge Code |
25004457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Anthem Medicaid |
$1.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna Commercial |
$4.27
|
| Rate for Payer: First Health Commercial |
$4.88
|
| Rate for Payer: Humana Commercial |
$4.37
|
| Rate for Payer: Humana KY Medicaid |
$1.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.59
|
| Rate for Payer: PHCS Commercial |
$4.93
|
| Rate for Payer: United Healthcare All Payer |
$4.52
|
|
|
ZINC SULFATE 10 MG/10 ML VIAL
|
Facility
IP
|
$178.70
|
|
| Hospital Charge Code |
25003990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$171.55 |
| Rate for Payer: Aetna Commercial |
$137.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.39
|
| Rate for Payer: Cash Price |
$89.35
|
| Rate for Payer: Cigna Commercial |
$148.32
|
| Rate for Payer: First Health Commercial |
$169.76
|
| Rate for Payer: Humana Commercial |
$151.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$131.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.26
|
| Rate for Payer: Ohio Health Group HMO |
$134.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.40
|
| Rate for Payer: PHCS Commercial |
$171.55
|
|
|
ZINC SULFATE 10 MG/10 ML VIAL
|
Facility
OP
|
$178.70
|
|
| Hospital Charge Code |
25003990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$171.55 |
| Rate for Payer: Aetna Commercial |
$137.60
|
| Rate for Payer: Anthem Medicaid |
$61.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.39
|
| Rate for Payer: Cash Price |
$89.35
|
| Rate for Payer: Cigna Commercial |
$148.32
|
| Rate for Payer: First Health Commercial |
$169.76
|
| Rate for Payer: Humana Commercial |
$151.90
|
| Rate for Payer: Humana KY Medicaid |
$61.45
|
| Rate for Payer: Kentucky WC Medicaid |
$62.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$131.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.26
|
| Rate for Payer: Ohio Health Group HMO |
$134.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.40
|
| Rate for Payer: PHCS Commercial |
$171.55
|
| Rate for Payer: United Healthcare All Payer |
$157.26
|
|
|
ZINC SULFATE 220 MG 220MG/1CAP
|
Facility
IP
|
$4.29
|
|
| Hospital Charge Code |
25001755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| 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 |
$4.12
|
|
|
ZINC SULFATE 220 MG 220MG/1CAP
|
Facility
OP
|
$4.29
|
|
| Hospital Charge Code |
25001755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| 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 |
$1.50
|
| 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 |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
ZINC SULFATE 220 MG TABLET
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
25004000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINC SULFATE 220 MG TABLET
|
Facility
IP
|
$0.04
|
|
| Hospital Charge Code |
25004000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.04
|
|
|
ZINC SULFATE 25MG/5ML
|
Facility
OP
|
$339.75
|
|
| Hospital Charge Code |
25003635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$326.16 |
| Rate for Payer: Aetna Commercial |
$261.61
|
| Rate for Payer: Anthem Medicaid |
$116.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.00
|
| Rate for Payer: Cash Price |
$169.88
|
| Rate for Payer: Cigna Commercial |
$281.99
|
| Rate for Payer: First Health Commercial |
$322.76
|
| Rate for Payer: Humana Commercial |
$288.79
|
| Rate for Payer: Humana KY Medicaid |
$116.84
|
| Rate for Payer: Kentucky WC Medicaid |
$118.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.98
|
| Rate for Payer: Ohio Health Group HMO |
$254.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.32
|
| Rate for Payer: PHCS Commercial |
$326.16
|
| Rate for Payer: United Healthcare All Payer |
$298.98
|
|
|
ZINC SULFATE 25MG/5ML
|
Facility
IP
|
$339.75
|
|
| Hospital Charge Code |
25003635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$326.16 |
| Rate for Payer: Aetna Commercial |
$261.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.00
|
| Rate for Payer: Cash Price |
$169.88
|
| Rate for Payer: Cigna Commercial |
$281.99
|
| Rate for Payer: First Health Commercial |
$322.76
|
| Rate for Payer: Humana Commercial |
$288.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.98
|
| Rate for Payer: Ohio Health Group HMO |
$254.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.32
|
| Rate for Payer: PHCS Commercial |
$326.16
|
|
|
ZINC SULFATE 50 MG T 50MG/1TAB
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
25001756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINC SULFATE 50 MG T 50MG/1TAB
|
Facility
IP
|
$0.04
|
|
| Hospital Charge Code |
25001756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.04
|
|
|
ZINECARD 250MG/25ML VIAL
|
Facility
IP
|
$1,439.87
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25003903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$1,382.28 |
| Rate for Payer: Aetna Commercial |
$1,108.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.10
|
| Rate for Payer: Cash Price |
$719.93
|
| Rate for Payer: Cigna Commercial |
$1,195.09
|
| Rate for Payer: First Health Commercial |
$1,367.88
|
| Rate for Payer: Humana Commercial |
$1,223.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,079.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.36
|
| Rate for Payer: PHCS Commercial |
$1,382.28
|
|
|
ZINECARD 250MG/25ML VIAL
|
Facility
OP
|
$1,439.87
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25003903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.01 |
| Max. Negotiated Rate |
$1,382.28 |
| Rate for Payer: Aetna Commercial |
$1,108.70
|
| Rate for Payer: Anthem Medicaid |
$495.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$108.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$151.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.81
|
| Rate for Payer: Cash Price |
$719.93
|
| Rate for Payer: Cash Price |
$719.93
|
| Rate for Payer: Cigna Commercial |
$1,195.09
|
| Rate for Payer: First Health Commercial |
$1,367.88
|
| Rate for Payer: Humana Commercial |
$1,223.89
|
| Rate for Payer: Humana KY Medicaid |
$495.17
|
| Rate for Payer: Humana Medicare Advantage |
$108.01
|
| Rate for Payer: Kentucky WC Medicaid |
$500.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,079.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.36
|
| Rate for Payer: PHCS Commercial |
$1,382.28
|
| Rate for Payer: United Healthcare All Payer |
$1,267.09
|
|
|
ZINECARD 250MG [500MG VIAL]
|
Facility
IP
|
$2,879.68
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25002033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$2,764.49 |
| Rate for Payer: Aetna Commercial |
$2,217.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,246.15
|
| Rate for Payer: Cash Price |
$1,439.84
|
| Rate for Payer: Cigna Commercial |
$2,390.13
|
| Rate for Payer: First Health Commercial |
$2,735.70
|
| Rate for Payer: Humana Commercial |
$2,447.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,361.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,125.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$863.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,534.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,159.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$575.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.70
|
| Rate for Payer: PHCS Commercial |
$2,764.49
|
|
|
ZINECARD 250MG [500MG VIAL]
|
Facility
OP
|
$2,879.68
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25002033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.01 |
| Max. Negotiated Rate |
$2,764.49 |
| Rate for Payer: Aetna Commercial |
$2,217.35
|
| Rate for Payer: Anthem Medicaid |
$990.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$108.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,246.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$151.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.81
|
| Rate for Payer: Cash Price |
$1,439.84
|
| Rate for Payer: Cash Price |
$1,439.84
|
| Rate for Payer: Cigna Commercial |
$2,390.13
|
| Rate for Payer: First Health Commercial |
$2,735.70
|
| Rate for Payer: Humana Commercial |
$2,447.73
|
| Rate for Payer: Humana KY Medicaid |
$990.32
|
| Rate for Payer: Humana Medicare Advantage |
$108.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,361.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,125.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,010.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,534.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,159.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$575.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.70
|
| Rate for Payer: PHCS Commercial |
$2,764.49
|
| Rate for Payer: United Healthcare All Payer |
$2,534.12
|
|
|
ZINPLAVA 10mg (1,000mg Vial)
|
Facility
IP
|
$19,950.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
25004165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,593.50 |
| Max. Negotiated Rate |
$19,152.00 |
| Rate for Payer: Aetna Commercial |
$15,361.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,561.00
|
| Rate for Payer: Cash Price |
$9,975.00
|
| Rate for Payer: Cigna Commercial |
$16,558.50
|
| Rate for Payer: First Health Commercial |
$18,952.50
|
| Rate for Payer: Humana Commercial |
$16,957.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,359.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,723.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,985.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,556.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,990.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,184.50
|
| Rate for Payer: PHCS Commercial |
$19,152.00
|
|
|
ZINPLAVA 10mg (1,000mg Vial)
|
Facility
OP
|
$19,950.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
25004165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$19,152.00 |
| Rate for Payer: Aetna Commercial |
$15,361.50
|
| Rate for Payer: Anthem Medicaid |
$6,860.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,561.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$55.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.81
|
| Rate for Payer: Cash Price |
$9,975.00
|
| Rate for Payer: Cash Price |
$9,975.00
|
| Rate for Payer: Cigna Commercial |
$16,558.50
|
| Rate for Payer: First Health Commercial |
$18,952.50
|
| Rate for Payer: Humana Commercial |
$16,957.50
|
| Rate for Payer: Humana KY Medicaid |
$6,860.80
|
| Rate for Payer: Humana Medicare Advantage |
$39.86
|
| Rate for Payer: Kentucky WC Medicaid |
$6,930.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,359.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,723.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,998.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,556.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,990.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,593.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,184.50
|
| Rate for Payer: PHCS Commercial |
$19,152.00
|
| Rate for Payer: United Healthcare All Payer |
$17,556.00
|
|
