|
ZOLOFT (SERTRAZLINE) 25MG TAB
|
Facility
IP
|
$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 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: 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: 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
|
|
|
ZOMETA 1MG (4MG VIAL)
|
Facility
OP
|
$393.75
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
25002456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna Commercial |
$303.19
|
| Rate for Payer: Anthem Medicaid |
$135.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.12
|
| Rate for Payer: Cash Price |
$196.88
|
| Rate for Payer: Cigna Commercial |
$326.81
|
| Rate for Payer: First Health Commercial |
$374.06
|
| Rate for Payer: Humana Commercial |
$334.69
|
| Rate for Payer: Humana KY Medicaid |
$135.41
|
| Rate for Payer: Kentucky WC Medicaid |
$136.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$322.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.50
|
| Rate for Payer: Ohio Health Group HMO |
$295.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.06
|
| Rate for Payer: PHCS Commercial |
$378.00
|
| Rate for Payer: United Healthcare All Payer |
$346.50
|
|
|
ZOMETA 1MG (4MG VIAL)
|
Facility
IP
|
$393.75
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
25002456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna Commercial |
$303.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.12
|
| Rate for Payer: Cash Price |
$196.88
|
| Rate for Payer: Cigna Commercial |
$326.81
|
| Rate for Payer: First Health Commercial |
$374.06
|
| Rate for Payer: Humana Commercial |
$334.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$322.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.50
|
| Rate for Payer: Ohio Health Group HMO |
$295.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.06
|
| Rate for Payer: PHCS Commercial |
$378.00
|
|
|
ZONEGRAN 25MG CAPSULE
|
Facility
IP
|
$4.31
|
|
| Hospital Charge Code |
25001774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| 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 |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.14
|
|
|
ZONEGRAN 25MG CAPSULE
|
Facility
OP
|
$4.31
|
|
| Hospital Charge Code |
25001774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| 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 |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
ZONEGRAN 50MG EQUIVALENT CAP
|
Facility
OP
|
$4.34
|
|
| Hospital Charge Code |
25003641
|
|
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
|
|
|
ZONEGRAN 50MG EQUIVALENT CAP
|
Facility
IP
|
$4.34
|
|
| Hospital Charge Code |
25003641
|
|
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
|
|
|
ZONEGRAN (ZONISAMIDE)100MG CAP
|
Facility
OP
|
$4.59
|
|
| Hospital Charge Code |
25001773
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
ZONEGRAN (ZONISAMIDE)100MG CAP
|
Facility
IP
|
$4.59
|
|
| Hospital Charge Code |
25001773
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.41
|
|
|
ZO OIL CONTROL PADS
|
Professional
|
$62.00
|
|
| Hospital Charge Code |
22200162
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Multiplan PHCS |
$37.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.40
|
| Rate for Payer: UHCCP Medicaid |
$21.70
|
|
|
ZO RENEWAL CREAM
|
Professional
|
$106.00
|
|
| Hospital Charge Code |
22200166
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$106.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Multiplan PHCS |
$63.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.20
|
| Rate for Payer: UHCCP Medicaid |
$37.10
|
|
|
ZO RETINOL SKIN BRIGHTEN 0.5%
|
Professional
|
$104.00
|
|
| Hospital Charge Code |
22200165
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$104.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.80
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
|
|
ZOSTER(SHINGLES)VACC LIVESQINJ
|
Facility
IP
|
$621.53
|
|
|
Service Code
|
HCPCS 90736
|
| Hospital Charge Code |
77000049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$596.67 |
| Rate for Payer: Aetna Commercial |
$478.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$484.79
|
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Cigna Commercial |
$515.87
|
| Rate for Payer: First Health Commercial |
$590.45
|
| Rate for Payer: Humana Commercial |
$528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$509.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$458.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$546.95
|
| Rate for Payer: Ohio Health Group HMO |
$466.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.67
|
| Rate for Payer: PHCS Commercial |
$596.67
|
|
|
ZOSTER(SHINGLES)VACC LIVESQINJ
|
Facility
OP
|
$621.53
|
|
|
Service Code
|
HCPCS 90736
|
| Hospital Charge Code |
77000049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$596.67 |
| Rate for Payer: Aetna Commercial |
$478.58
|
| Rate for Payer: Anthem Medicaid |
$213.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$484.79
|
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Cigna Commercial |
$515.87
|
| Rate for Payer: First Health Commercial |
$590.45
|
| Rate for Payer: Humana Commercial |
$528.30
|
| Rate for Payer: Humana KY Medicaid |
$213.74
|
| Rate for Payer: Kentucky WC Medicaid |
$215.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$509.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$458.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$546.95
|
| Rate for Payer: Ohio Health Group HMO |
$466.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.67
|
| Rate for Payer: PHCS Commercial |
$596.67
|
| Rate for Payer: United Healthcare All Payer |
$546.95
|
|
|
ZOSTER(SHINGLES)VACC LIVESQINJ
|
Facility
IP
|
$621.53
|
|
|
Service Code
|
HCPCS 90736
|
| Hospital Charge Code |
770T0049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$596.67 |
| Rate for Payer: Aetna Commercial |
$478.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$484.79
|
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Cigna Commercial |
$515.87
|
| Rate for Payer: First Health Commercial |
$590.45
|
| Rate for Payer: Humana Commercial |
$528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$509.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$458.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$546.95
|
| Rate for Payer: Ohio Health Group HMO |
$466.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.67
|
| Rate for Payer: PHCS Commercial |
$596.67
|
|
|
ZOSTER(SHINGLES)VACC LIVESQINJ
|
Facility
OP
|
$621.53
|
|
|
Service Code
|
HCPCS 90736
|
| Hospital Charge Code |
770T0049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$596.67 |
| Rate for Payer: Aetna Commercial |
$478.58
|
| Rate for Payer: Anthem Medicaid |
$213.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$484.79
|
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Cigna Commercial |
$515.87
|
| Rate for Payer: First Health Commercial |
$590.45
|
| Rate for Payer: Humana Commercial |
$528.30
|
| Rate for Payer: Humana KY Medicaid |
$213.74
|
| Rate for Payer: Kentucky WC Medicaid |
$215.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$509.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$458.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$546.95
|
| Rate for Payer: Ohio Health Group HMO |
$466.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.67
|
| Rate for Payer: PHCS Commercial |
$596.67
|
| Rate for Payer: United Healthcare All Payer |
$546.95
|
|
|
ZOSTER(SHINGLES)VACC LIVESQINJ
|
Professional
|
$621.53
|
|
|
Service Code
|
HCPCS 90736
|
| Hospital Charge Code |
77000049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.00 |
| Max. Negotiated Rate |
$621.53 |
| Rate for Payer: Buckeye Medicare Advantage |
$621.53
|
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Healthspan PPO |
$183.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$373.75
|
| Rate for Payer: Multiplan PHCS |
$372.92
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$435.07
|
| Rate for Payer: UHCCP Medicaid |
$217.54
|
|
|
ZO SULFUR MASK
|
Professional
|
$45.00
|
|
| Hospital Charge Code |
22200167
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
ZOSYN 1.125gm (13.5gm package)
|
Facility
OP
|
$210.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
25004167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$72.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$72.22
|
| Rate for Payer: Kentucky WC Medicaid |
$72.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.10
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ZOSYN 1.125gm (13.5gm package)
|
Facility
IP
|
$210.00
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
25004167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.10
|
| Rate for Payer: PHCS Commercial |
$201.60
|
|
|
ZOSYN 1.125 GM (3.375 GM SOLN)
|
Facility
OP
|
$35.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
25003756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$33.89 |
| Rate for Payer: Aetna Commercial |
$27.18
|
| Rate for Payer: Anthem Medicaid |
$12.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.53
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna Commercial |
$29.30
|
| Rate for Payer: First Health Commercial |
$33.54
|
| Rate for Payer: Humana Commercial |
$30.00
|
| Rate for Payer: Humana KY Medicaid |
$12.14
|
| Rate for Payer: Kentucky WC Medicaid |
$12.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.06
|
| Rate for Payer: Ohio Health Group HMO |
$26.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.94
|
| Rate for Payer: PHCS Commercial |
$33.89
|
| Rate for Payer: United Healthcare All Payer |
$31.06
|
|
|
ZOSYN 1.125 GM (3.375 GM SOLN)
|
Facility
IP
|
$35.30
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
25003756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$33.89 |
| Rate for Payer: Aetna Commercial |
$27.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.53
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna Commercial |
$29.30
|
| Rate for Payer: First Health Commercial |
$33.54
|
| Rate for Payer: Humana Commercial |
$30.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.06
|
| Rate for Payer: Ohio Health Group HMO |
$26.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.94
|
| Rate for Payer: PHCS Commercial |
$33.89
|
|
|
ZOSYN 1.125 GM (4.5GM SDV)
|
Facility
IP
|
$112.58
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
25002309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$108.08 |
| Rate for Payer: Aetna Commercial |
$86.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.81
|
| Rate for Payer: Cash Price |
$56.29
|
| Rate for Payer: Cigna Commercial |
$93.44
|
| Rate for Payer: First Health Commercial |
$106.95
|
| Rate for Payer: Humana Commercial |
$95.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.07
|
| Rate for Payer: Ohio Health Group HMO |
$84.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.90
|
| Rate for Payer: PHCS Commercial |
$108.08
|
|
|
ZOSYN 1.125 GM (4.5GM SDV)
|
Facility
OP
|
$112.58
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
25002309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$108.08 |
| Rate for Payer: Aetna Commercial |
$86.69
|
| Rate for Payer: Anthem Medicaid |
$38.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.81
|
| Rate for Payer: Cash Price |
$56.29
|
| Rate for Payer: Cigna Commercial |
$93.44
|
| Rate for Payer: First Health Commercial |
$106.95
|
| Rate for Payer: Humana Commercial |
$95.69
|
| Rate for Payer: Humana KY Medicaid |
$38.72
|
| Rate for Payer: Kentucky WC Medicaid |
$39.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.07
|
| Rate for Payer: Ohio Health Group HMO |
$84.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.90
|
| Rate for Payer: PHCS Commercial |
$108.08
|
| Rate for Payer: United Healthcare All Payer |
$99.07
|
|
|
ZOSYN 1.125 GM (4.5 GM SOLN)
|
Facility
OP
|
$173.38
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
25002313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$166.44 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Anthem Medicaid |
$59.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.24
|
| Rate for Payer: Cash Price |
$86.69
|
| Rate for Payer: Cigna Commercial |
$143.91
|
| Rate for Payer: First Health Commercial |
$164.71
|
| Rate for Payer: Humana Commercial |
$147.37
|
| Rate for Payer: Humana KY Medicaid |
$59.63
|
| Rate for Payer: Kentucky WC Medicaid |
$60.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.57
|
| Rate for Payer: Ohio Health Group HMO |
$130.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.75
|
| Rate for Payer: PHCS Commercial |
$166.44
|
| Rate for Payer: United Healthcare All Payer |
$152.57
|
|
