|
ZO FIRMING SERUM
|
Professional
|
$235.00
|
|
| Hospital Charge Code |
22200202
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
IP
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
636T0046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$11.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.88
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: First Health Commercial |
$14.47
|
| Rate for Payer: Humana Commercial |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.40
|
| Rate for Payer: Ohio Health Group HMO |
$11.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.72
|
| Rate for Payer: PHCS Commercial |
$14.62
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
OP
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$11.73
|
| Rate for Payer: Anthem Medicaid |
$5.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.88
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: First Health Commercial |
$14.47
|
| Rate for Payer: Humana Commercial |
$12.95
|
| Rate for Payer: Humana KY Medicaid |
$5.24
|
| Rate for Payer: Kentucky WC Medicaid |
$5.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.40
|
| Rate for Payer: Ohio Health Group HMO |
$11.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.72
|
| Rate for Payer: PHCS Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Payer |
$13.40
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
IP
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$11.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.88
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: First Health Commercial |
$14.47
|
| Rate for Payer: Humana Commercial |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.40
|
| Rate for Payer: Ohio Health Group HMO |
$11.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.72
|
| Rate for Payer: PHCS Commercial |
$14.62
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
OP
|
$60.46
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25002285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Anthem Medicaid |
$20.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.16
|
| Rate for Payer: Cash Price |
$30.23
|
| Rate for Payer: Cigna Commercial |
$50.18
|
| Rate for Payer: First Health Commercial |
$57.44
|
| Rate for Payer: Humana Commercial |
$51.39
|
| Rate for Payer: Humana KY Medicaid |
$20.79
|
| Rate for Payer: Kentucky WC Medicaid |
$21.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.20
|
| Rate for Payer: Ohio Health Group HMO |
$45.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.74
|
| Rate for Payer: PHCS Commercial |
$58.04
|
| Rate for Payer: United Healthcare All Payer |
$53.20
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Professional
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.13
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Healthspan PPO |
$0.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.11
|
| Rate for Payer: Multiplan PHCS |
$9.14
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.14
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.11
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
IP
|
$60.46
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25002285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.16
|
| Rate for Payer: Cash Price |
$30.23
|
| Rate for Payer: Cigna Commercial |
$50.18
|
| Rate for Payer: First Health Commercial |
$57.44
|
| Rate for Payer: Humana Commercial |
$51.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.20
|
| Rate for Payer: Ohio Health Group HMO |
$45.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.74
|
| Rate for Payer: PHCS Commercial |
$58.04
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
OP
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
636T0046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$11.73
|
| Rate for Payer: Anthem Medicaid |
$5.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.88
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: First Health Commercial |
$14.47
|
| Rate for Payer: Humana Commercial |
$12.95
|
| Rate for Payer: Humana KY Medicaid |
$5.24
|
| Rate for Payer: Kentucky WC Medicaid |
$5.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.40
|
| Rate for Payer: Ohio Health Group HMO |
$11.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.72
|
| Rate for Payer: PHCS Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Payer |
$13.40
|
|
|
ZOFRAN EQ 2MG/2.5MLORALSOL2.5
|
Facility
OP
|
$11.90
|
|
| Hospital Charge Code |
25001765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: Anthem Medicaid |
$4.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.28
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cigna Commercial |
$9.88
|
| Rate for Payer: First Health Commercial |
$11.30
|
| Rate for Payer: Humana Commercial |
$10.12
|
| Rate for Payer: Humana KY Medicaid |
$4.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.47
|
| Rate for Payer: Ohio Health Group HMO |
$8.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.69
|
| Rate for Payer: PHCS Commercial |
$11.42
|
| Rate for Payer: United Healthcare All Payer |
$10.47
|
|
|
ZOFRAN EQ 2MG/2.5MLORALSOL2.5
|
Facility
IP
|
$11.90
|
|
| Hospital Charge Code |
25001765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Aetna Commercial |
$9.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.28
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cigna Commercial |
$9.88
|
| Rate for Payer: First Health Commercial |
$11.30
|
| Rate for Payer: Humana Commercial |
$10.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.47
|
| Rate for Payer: Ohio Health Group HMO |
$8.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.69
|
| Rate for Payer: PHCS Commercial |
$11.42
|
|
|
ZOFRAN ODT 4 MG TABLET
|
Facility
OP
|
$4.79
|
|
| Hospital Charge Code |
25001766
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
ZOFRAN ODT 4 MG TABLET
|
Facility
IP
|
$4.79
|
|
| Hospital Charge Code |
25001766
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.60
|
|
|
ZOFRAN ODT 8 MG TAB
|
Facility
OP
|
$8.83
|
|
| Hospital Charge Code |
25003639
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Anthem Medicaid |
$3.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.89
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna Commercial |
$7.33
|
| Rate for Payer: First Health Commercial |
$8.39
|
| Rate for Payer: Humana Commercial |
$7.51
|
| Rate for Payer: Humana KY Medicaid |
$3.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.77
|
| Rate for Payer: Ohio Health Group HMO |
$6.62
|
| 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 |
$2.74
|
| Rate for Payer: PHCS Commercial |
$8.48
|
| Rate for Payer: United Healthcare All Payer |
$7.77
|
|
|
ZOFRAN ODT 8 MG TAB
|
Facility
IP
|
$8.83
|
|
| Hospital Charge Code |
25003639
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$8.48 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.89
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna Commercial |
$7.33
|
| Rate for Payer: First Health Commercial |
$8.39
|
| Rate for Payer: Humana Commercial |
$7.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.77
|
| Rate for Payer: Ohio Health Group HMO |
$6.62
|
| 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 |
$2.74
|
| Rate for Payer: PHCS Commercial |
$8.48
|
|
|
ZOFRAN (ONDANSETRON H 8MG/1TAB
|
Facility
OP
|
$4.28
|
|
| Hospital Charge Code |
25001763
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| 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 |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ZOFRAN (ONDANSETRON H 8MG/1TAB
|
Facility
IP
|
$4.28
|
|
| Hospital Charge Code |
25001763
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| 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 |
$4.11
|
|
|
ZO HYDRAFIRM EYE BRIGHTNNG RPR
|
Professional
|
$140.00
|
|
| Hospital Charge Code |
22200203
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$140.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.00
|
| Rate for Payer: UHCCP Medicaid |
$49.00
|
|
|
ZO HYDRATING CREME
|
Professional
|
$94.00
|
|
| Hospital Charge Code |
22200168
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Multiplan PHCS |
$56.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.80
|
| Rate for Payer: UHCCP Medicaid |
$32.90
|
|
|
ZOLADEX 3.6MG IMPLANT
|
Facility
IP
|
$4,968.81
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
25002624
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$645.95 |
| Max. Negotiated Rate |
$4,770.06 |
| Rate for Payer: Aetna Commercial |
$3,825.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,875.67
|
| Rate for Payer: Cash Price |
$2,484.41
|
| Rate for Payer: Cigna Commercial |
$4,124.11
|
| Rate for Payer: First Health Commercial |
$4,720.37
|
| Rate for Payer: Humana Commercial |
$4,223.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,074.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,666.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,490.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,372.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,726.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$993.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,540.33
|
| Rate for Payer: PHCS Commercial |
$4,770.06
|
|
|
ZOLADEX 3.6MG IMPLANT
|
Facility
OP
|
$4,968.81
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
25002624
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$609.01 |
| Max. Negotiated Rate |
$4,770.06 |
| Rate for Payer: Aetna Commercial |
$3,825.98
|
| Rate for Payer: Anthem Medicaid |
$1,708.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$609.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,875.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$852.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$822.16
|
| Rate for Payer: Cash Price |
$2,484.41
|
| Rate for Payer: Cash Price |
$2,484.41
|
| Rate for Payer: Cigna Commercial |
$4,124.11
|
| Rate for Payer: First Health Commercial |
$4,720.37
|
| Rate for Payer: Humana Commercial |
$4,223.49
|
| Rate for Payer: Humana KY Medicaid |
$1,708.77
|
| Rate for Payer: Humana Medicare Advantage |
$609.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,726.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,074.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,666.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,743.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,372.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,726.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$993.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,540.33
|
| Rate for Payer: PHCS Commercial |
$4,770.06
|
| Rate for Payer: United Healthcare All Payer |
$4,372.55
|
|
|
ZOLOFT (SERTRALIE)20MG/ML CONC
|
Facility
OP
|
$5.03
|
|
| Hospital Charge Code |
25003640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
ZOLOFT (SERTRALIE)20MG/ML CONC
|
Facility
IP
|
$5.03
|
|
| Hospital Charge Code |
25003640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.83
|
|
|
ZOLOFT (SERTRALINE) 100MG/1TAB
|
Facility
IP
|
$4.54
|
|
| Hospital Charge Code |
25001768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
|
|
ZOLOFT (SERTRALINE) 100MG/1TAB
|
Facility
OP
|
$4.54
|
|
| Hospital Charge Code |
25001768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
ZOLOFT (SERTRAZLINE) 25MG TAB
|
Facility
OP
|
$4.47
|
|
| Hospital Charge Code |
25001769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
