ZIP WIRE STRAIGHT .035*260CM
|
Facility
OP
|
$793.67
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
27000056
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$9,415.68 |
Rate for Payer: Aetna Commercial |
$611.13
|
Rate for Payer: Anthem Medicaid |
$272.94
|
Rate for Payer: Anthem POS/PPO/Traditional |
$619.06
|
Rate for Payer: Cash Price |
$396.84
|
Rate for Payer: Cigna Commercial |
$658.75
|
Rate for Payer: First Health Commercial |
$753.99
|
Rate for Payer: Humana Commercial |
$674.62
|
Rate for Payer: Humana KY Medicaid |
$272.94
|
Rate for Payer: Kentucky WC Medicaid |
$275.72
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$650.81
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$238.10
|
Rate for Payer: Molina Healthcare Medicaid |
$278.42
|
Rate for Payer: Ohio Health Choice Commercial |
$698.43
|
Rate for Payer: Ohio Health Group HMO |
$595.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$158.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$103.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.04
|
Rate for Payer: PHCS Commercial |
$761.92
|
Rate for Payer: United Healthcare All Payer |
$698.43
|
|
ZIP WIRE STRAIGHT .035*260CM
|
Facility
IP
|
$793.67
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
27000056
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$9,415.68 |
Rate for Payer: Aetna Commercial |
$611.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$619.06
|
Rate for Payer: Cash Price |
$396.84
|
Rate for Payer: Cigna Commercial |
$658.75
|
Rate for Payer: First Health Commercial |
$753.99
|
Rate for Payer: Humana Commercial |
$674.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$650.81
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$238.10
|
Rate for Payer: Ohio Health Choice Commercial |
$698.43
|
Rate for Payer: Ohio Health Group HMO |
$595.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$158.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$103.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.04
|
Rate for Payer: PHCS Commercial |
$761.92
|
|
ZIRABEV 10MG (100 MG VIAL)
|
Facility
IP
|
$3,220.35
|
|
Service Code
|
HCPCS Q5118
|
Hospital Charge Code |
25003978
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$418.65 |
Max. Negotiated Rate |
$3,091.54 |
Rate for Payer: Aetna Commercial |
$2,479.67
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,511.87
|
Rate for Payer: Cash Price |
$1,610.17
|
Rate for Payer: Cigna Commercial |
$2,672.89
|
Rate for Payer: First Health Commercial |
$3,059.33
|
Rate for Payer: Humana Commercial |
$2,737.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,640.69
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,376.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$966.10
|
Rate for Payer: Ohio Health Choice Commercial |
$2,833.91
|
Rate for Payer: Ohio Health Group HMO |
$2,415.26
|
Rate for Payer: Ohio Health Group PPO Differential |
$644.07
|
Rate for Payer: Ohio Health Group PPO No Differential |
$418.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$998.31
|
Rate for Payer: PHCS Commercial |
$3,091.54
|
|
ZIRABEV 10MG (100 MG VIAL)
|
Facility
OP
|
$3,220.35
|
|
Service Code
|
HCPCS Q5118
|
Hospital Charge Code |
25003978
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$21.51 |
Max. Negotiated Rate |
$3,091.54 |
Rate for Payer: Aetna Commercial |
$2,479.67
|
Rate for Payer: Anthem Medicaid |
$1,107.48
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$21.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,511.87
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.12
|
Rate for Payer: CareSource Just4Me Medicare |
$29.04
|
Rate for Payer: Cash Price |
$1,610.17
|
Rate for Payer: Cash Price |
$1,610.17
|
Rate for Payer: Cigna Commercial |
$2,672.89
|
Rate for Payer: First Health Commercial |
$3,059.33
|
Rate for Payer: Humana Commercial |
$2,737.30
|
Rate for Payer: Humana KY Medicaid |
$1,107.48
|
Rate for Payer: Humana Medicare Advantage |
$21.51
|
Rate for Payer: Kentucky WC Medicaid |
$1,118.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,640.69
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,376.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$25.81
|
Rate for Payer: Molina Healthcare Medicaid |
$1,129.70
|
Rate for Payer: Ohio Health Choice Commercial |
$2,833.91
|
Rate for Payer: Ohio Health Group HMO |
$2,415.26
|
Rate for Payer: Ohio Health Group PPO Differential |
$644.07
|
Rate for Payer: Ohio Health Group PPO No Differential |
$418.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$998.31
|
Rate for Payer: PHCS Commercial |
$3,091.54
|
Rate for Payer: United Healthcare All Payer |
$2,833.91
|
|
ZIRABEV 10MG (400 MG VIAL)
|
Facility
OP
|
$12,881.40
|
|
Service Code
|
HCPCS Q5118
|
Hospital Charge Code |
25003977
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$21.51 |
Max. Negotiated Rate |
$12,366.14 |
Rate for Payer: Aetna Commercial |
$9,918.68
|
Rate for Payer: Anthem Medicaid |
$4,429.91
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$21.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,047.49
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.12
|
Rate for Payer: CareSource Just4Me Medicare |
$29.04
|
Rate for Payer: Cash Price |
$6,440.70
|
Rate for Payer: Cash Price |
$6,440.70
|
Rate for Payer: Cigna Commercial |
$10,691.56
|
Rate for Payer: First Health Commercial |
$12,237.33
|
Rate for Payer: Humana Commercial |
$10,949.19
|
Rate for Payer: Humana KY Medicaid |
$4,429.91
|
Rate for Payer: Humana Medicare Advantage |
$21.51
|
Rate for Payer: Kentucky WC Medicaid |
$4,475.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,562.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,506.47
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$25.81
|
Rate for Payer: Molina Healthcare Medicaid |
$4,518.80
|
Rate for Payer: Ohio Health Choice Commercial |
$11,335.63
|
Rate for Payer: Ohio Health Group HMO |
$9,661.05
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.28
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,674.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,993.23
|
Rate for Payer: PHCS Commercial |
$12,366.14
|
Rate for Payer: United Healthcare All Payer |
$11,335.63
|
|
ZIRABEV 10MG (400 MG VIAL)
|
Facility
IP
|
$12,881.40
|
|
Service Code
|
HCPCS Q5118
|
Hospital Charge Code |
25003977
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1,674.58 |
Max. Negotiated Rate |
$12,366.14 |
Rate for Payer: Aetna Commercial |
$9,918.68
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,047.49
|
Rate for Payer: Cash Price |
$6,440.70
|
Rate for Payer: Cigna Commercial |
$10,691.56
|
Rate for Payer: First Health Commercial |
$12,237.33
|
Rate for Payer: Humana Commercial |
$10,949.19
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,562.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,506.47
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,864.42
|
Rate for Payer: Ohio Health Choice Commercial |
$11,335.63
|
Rate for Payer: Ohio Health Group HMO |
$9,661.05
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.28
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,674.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,993.23
|
Rate for Payer: PHCS Commercial |
$12,366.14
|
|
ZITHROMAX 500 MG D5W 250ML PB
|
Facility
IP
|
$112.25
|
|
Service Code
|
HCPCS J0456
|
Hospital Charge Code |
25001876
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.59 |
Max. Negotiated Rate |
$107.76 |
Rate for Payer: Aetna Commercial |
$86.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
Rate for Payer: Cash Price |
$56.12
|
Rate for Payer: Cigna Commercial |
$93.17
|
Rate for Payer: First Health Commercial |
$106.64
|
Rate for Payer: Humana Commercial |
$95.41
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
Rate for Payer: Ohio Health Group HMO |
$84.19
|
Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
Rate for Payer: PHCS Commercial |
$107.76
|
|
ZITHROMAX 500 MG D5W 250ML PB
|
Facility
OP
|
$112.25
|
|
Service Code
|
HCPCS J0456
|
Hospital Charge Code |
25001876
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$14.59 |
Max. Negotiated Rate |
$107.76 |
Rate for Payer: Aetna Commercial |
$86.43
|
Rate for Payer: Anthem Medicaid |
$38.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
Rate for Payer: Cash Price |
$56.12
|
Rate for Payer: Cigna Commercial |
$93.17
|
Rate for Payer: First Health Commercial |
$106.64
|
Rate for Payer: Humana Commercial |
$95.41
|
Rate for Payer: Humana KY Medicaid |
$38.60
|
Rate for Payer: Kentucky WC Medicaid |
$39.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
Rate for Payer: Molina Healthcare Medicaid |
$39.38
|
Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
Rate for Payer: Ohio Health Group HMO |
$84.19
|
Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
Rate for Payer: PHCS Commercial |
$107.76
|
Rate for Payer: United Healthcare All Payer |
$98.78
|
|
ZITHROMAX 500MG VIAL
|
Facility
OP
|
$107.00
|
|
Service Code
|
HCPCS J0456
|
Hospital Charge Code |
25001877
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$13.91 |
Max. Negotiated Rate |
$102.72 |
Rate for Payer: Aetna Commercial |
$82.39
|
Rate for Payer: Anthem Medicaid |
$36.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$83.46
|
Rate for Payer: Cash Price |
$53.50
|
Rate for Payer: Cigna Commercial |
$88.81
|
Rate for Payer: First Health Commercial |
$101.65
|
Rate for Payer: Humana Commercial |
$90.95
|
Rate for Payer: Humana KY Medicaid |
$36.80
|
Rate for Payer: Kentucky WC Medicaid |
$37.17
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
Rate for Payer: Molina Healthcare Medicaid |
$37.54
|
Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
Rate for Payer: Ohio Health Group HMO |
$80.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$21.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$13.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.17
|
Rate for Payer: PHCS Commercial |
$102.72
|
Rate for Payer: United Healthcare All Payer |
$94.16
|
|
ZITHROMAX 500MG VIAL
|
Facility
IP
|
$107.00
|
|
Service Code
|
HCPCS J0456
|
Hospital Charge Code |
25001877
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$13.91 |
Max. Negotiated Rate |
$102.72 |
Rate for Payer: Aetna Commercial |
$82.39
|
Rate for Payer: Anthem POS/PPO/Traditional |
$83.46
|
Rate for Payer: Cash Price |
$53.50
|
Rate for Payer: Cigna Commercial |
$88.81
|
Rate for Payer: First Health Commercial |
$101.65
|
Rate for Payer: Humana Commercial |
$90.95
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
Rate for Payer: Ohio Health Group HMO |
$80.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$21.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$13.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.17
|
Rate for Payer: PHCS Commercial |
$102.72
|
|
ZITHROMAX(AZITH)100MG/5ML 15ML
|
Facility
IP
|
$21.67
|
|
Hospital Charge Code |
25003638
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$2.82 |
Max. Negotiated Rate |
$20.80 |
Rate for Payer: Aetna Commercial |
$16.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16.90
|
Rate for Payer: Cash Price |
$10.84
|
Rate for Payer: Cigna Commercial |
$17.99
|
Rate for Payer: First Health Commercial |
$20.59
|
Rate for Payer: Humana Commercial |
$18.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17.77
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.50
|
Rate for Payer: Ohio Health Choice Commercial |
$19.07
|
Rate for Payer: Ohio Health Group HMO |
$16.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.33
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.72
|
Rate for Payer: PHCS Commercial |
$20.80
|
|
ZITHROMAX(AZITH)100MG/5ML 15ML
|
Facility
OP
|
$21.67
|
|
Hospital Charge Code |
25003638
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$2.82 |
Max. Negotiated Rate |
$20.80 |
Rate for Payer: Aetna Commercial |
$16.69
|
Rate for Payer: Anthem Medicaid |
$7.45
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16.90
|
Rate for Payer: Cash Price |
$10.84
|
Rate for Payer: Cigna Commercial |
$17.99
|
Rate for Payer: First Health Commercial |
$20.59
|
Rate for Payer: Humana Commercial |
$18.42
|
Rate for Payer: Humana KY Medicaid |
$7.45
|
Rate for Payer: Kentucky WC Medicaid |
$7.53
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17.77
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.50
|
Rate for Payer: Molina Healthcare Medicaid |
$7.60
|
Rate for Payer: Ohio Health Choice Commercial |
$19.07
|
Rate for Payer: Ohio Health Group HMO |
$16.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.33
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.72
|
Rate for Payer: PHCS Commercial |
$20.80
|
Rate for Payer: United Healthcare All Payer |
$19.07
|
|
ZITHROMAX(AZITH)200MG/5ML 15ML
|
Facility
IP
|
$11.03
|
|
Hospital Charge Code |
25003636
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.43 |
Max. Negotiated Rate |
$10.59 |
Rate for Payer: Aetna Commercial |
$8.49
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8.60
|
Rate for Payer: Cash Price |
$5.52
|
Rate for Payer: Cigna Commercial |
$9.15
|
Rate for Payer: First Health Commercial |
$10.48
|
Rate for Payer: Humana Commercial |
$9.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$9.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.14
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3.31
|
Rate for Payer: Ohio Health Choice Commercial |
$9.71
|
Rate for Payer: Ohio Health Group HMO |
$8.27
|
Rate for Payer: Ohio Health Group PPO Differential |
$2.21
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.43
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
Rate for Payer: PHCS Commercial |
$10.59
|
|
ZITHROMAX(AZITH)200MG/5ML 15ML
|
Facility
OP
|
$11.03
|
|
Hospital Charge Code |
25003636
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.43 |
Max. Negotiated Rate |
$10.59 |
Rate for Payer: Aetna Commercial |
$8.49
|
Rate for Payer: Anthem Medicaid |
$3.79
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8.60
|
Rate for Payer: Cash Price |
$5.52
|
Rate for Payer: Cigna Commercial |
$9.15
|
Rate for Payer: First Health Commercial |
$10.48
|
Rate for Payer: Humana Commercial |
$9.38
|
Rate for Payer: Humana KY Medicaid |
$3.79
|
Rate for Payer: Kentucky WC Medicaid |
$3.83
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$9.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.14
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3.31
|
Rate for Payer: Molina Healthcare Medicaid |
$3.87
|
Rate for Payer: Ohio Health Choice Commercial |
$9.71
|
Rate for Payer: Ohio Health Group HMO |
$8.27
|
Rate for Payer: Ohio Health Group PPO Differential |
$2.21
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.43
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
Rate for Payer: PHCS Commercial |
$10.59
|
Rate for Payer: United Healthcare All Payer |
$9.71
|
|
ZITHROMAX (AZITHROM 250MG/1CAP
|
Facility
OP
|
$9.26
|
|
Service Code
|
HCPCS J8499
|
Hospital Charge Code |
25002525
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.20 |
Max. Negotiated Rate |
$8.89 |
Rate for Payer: Aetna Commercial |
$7.13
|
Rate for Payer: Anthem Medicaid |
$3.18
|
Rate for Payer: Anthem POS/PPO/Traditional |
$7.22
|
Rate for Payer: Cash Price |
$4.63
|
Rate for Payer: Cigna Commercial |
$7.69
|
Rate for Payer: First Health Commercial |
$8.80
|
Rate for Payer: Humana Commercial |
$7.87
|
Rate for Payer: Humana KY Medicaid |
$3.18
|
Rate for Payer: Kentucky WC Medicaid |
$3.22
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7.59
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
Rate for Payer: Molina Healthcare Medicaid |
$3.25
|
Rate for Payer: Ohio Health Choice Commercial |
$8.15
|
Rate for Payer: Ohio Health Group HMO |
$6.94
|
Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
Rate for Payer: PHCS Commercial |
$8.89
|
Rate for Payer: United Healthcare All Payer |
$8.15
|
|
ZITHROMAX (AZITHROM 250MG/1CAP
|
Facility
IP
|
$9.26
|
|
Service Code
|
HCPCS J8499
|
Hospital Charge Code |
25002525
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.20 |
Max. Negotiated Rate |
$8.89 |
Rate for Payer: Aetna Commercial |
$7.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$7.22
|
Rate for Payer: Cash Price |
$4.63
|
Rate for Payer: Cigna Commercial |
$7.69
|
Rate for Payer: First Health Commercial |
$8.80
|
Rate for Payer: Humana Commercial |
$7.87
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7.59
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
Rate for Payer: Ohio Health Choice Commercial |
$8.15
|
Rate for Payer: Ohio Health Group HMO |
$6.94
|
Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
Rate for Payer: PHCS Commercial |
$8.89
|
|
ZMR PRSS-FT HUM STEM 10.5*110
|
Facility
OP
|
$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 Medicaid |
$7,593.50
|
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: Humana KY Medicaid |
$7,593.50
|
Rate for Payer: Kentucky WC Medicaid |
$7,670.79
|
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: Molina Healthcare Medicaid |
$7,745.86
|
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
|
Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
ZMR PRSS-FT HUM STEM 10.5*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
|
|
ZOCOR (SIMVASTATIN) 20MG TAB
|
Facility
OP
|
$4.18
|
|
Hospital Charge Code |
25001759
|
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
|
|
ZOCOR (SIMVASTATIN) 20MG TAB
|
Facility
IP
|
$4.18
|
|
Hospital Charge Code |
25001759
|
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
|
|
ZOCOR (SIMVASTATIN) 40MG TAB
|
Facility
IP
|
$4.27
|
|
Hospital Charge Code |
25001760
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$4.10 |
Rate for Payer: Aetna Commercial |
$3.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
Rate for Payer: Cash Price |
$2.13
|
Rate for Payer: Cigna Commercial |
$3.54
|
Rate for Payer: First Health Commercial |
$4.06
|
Rate for Payer: Humana Commercial |
$3.63
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
Rate for Payer: Ohio Health Group HMO |
$3.20
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
Rate for Payer: PHCS Commercial |
$4.10
|
|
ZOCOR (SIMVASTATIN) 40MG TAB
|
Facility
OP
|
$4.27
|
|
Hospital Charge Code |
25001760
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.56 |
Max. Negotiated Rate |
$4.10 |
Rate for Payer: Aetna Commercial |
$3.29
|
Rate for Payer: Anthem Medicaid |
$1.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
Rate for Payer: Cash Price |
$2.13
|
Rate for Payer: Cigna Commercial |
$3.54
|
Rate for Payer: First Health Commercial |
$4.06
|
Rate for Payer: Humana Commercial |
$3.63
|
Rate for Payer: Humana KY Medicaid |
$1.47
|
Rate for Payer: Kentucky WC Medicaid |
$1.48
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
Rate for Payer: Ohio Health Group HMO |
$3.20
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
Rate for Payer: PHCS Commercial |
$4.10
|
Rate for Payer: United Healthcare All Payer |
$3.76
|
|
ZOCOR (SIMVASTATIN) 5MG TAB
|
Facility
IP
|
$4.12
|
|
Hospital Charge Code |
25001761
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.54 |
Max. Negotiated Rate |
$3.96 |
Rate for Payer: Aetna Commercial |
$3.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.21
|
Rate for Payer: Cash Price |
$2.06
|
Rate for Payer: Cigna Commercial |
$3.42
|
Rate for Payer: First Health Commercial |
$3.91
|
Rate for Payer: Humana Commercial |
$3.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.38
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.04
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.24
|
Rate for Payer: Ohio Health Choice Commercial |
$3.63
|
Rate for Payer: Ohio Health Group HMO |
$3.09
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.54
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.28
|
Rate for Payer: PHCS Commercial |
$3.96
|
|
ZOCOR (SIMVASTATIN) 5MG TAB
|
Facility
OP
|
$4.12
|
|
Hospital Charge Code |
25001761
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.54 |
Max. Negotiated Rate |
$3.96 |
Rate for Payer: Aetna Commercial |
$3.17
|
Rate for Payer: Anthem Medicaid |
$1.42
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3.21
|
Rate for Payer: Cash Price |
$2.06
|
Rate for Payer: Cigna Commercial |
$3.42
|
Rate for Payer: First Health Commercial |
$3.91
|
Rate for Payer: Humana Commercial |
$3.50
|
Rate for Payer: Humana KY Medicaid |
$1.42
|
Rate for Payer: Kentucky WC Medicaid |
$1.43
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3.38
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.04
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1.24
|
Rate for Payer: Molina Healthcare Medicaid |
$1.45
|
Rate for Payer: Ohio Health Choice Commercial |
$3.63
|
Rate for Payer: Ohio Health Group HMO |
$3.09
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.54
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.28
|
Rate for Payer: PHCS Commercial |
$3.96
|
Rate for Payer: United Healthcare All Payer |
$3.63
|
|
ZO ENYMATIC PEEL
|
Professional
|
$72.00
|
|
Hospital Charge Code |
22200201
|
Hospital Revenue Code
|
222
|
Min. Negotiated Rate |
$25.20 |
Max. Negotiated Rate |
$72.00 |
Rate for Payer: Buckeye Medicare Advantage |
$72.00
|
Rate for Payer: Cash Price |
$36.00
|
Rate for Payer: Multiplan PHCS |
$43.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.40
|
Rate for Payer: UHCCP Medicaid |
$25.20
|
|