|
ZR 12/14 TAPER FEM HD 28MM +8
|
Facility
IP
|
$5,175.00
|
|
|
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 |
$3,984.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.50
|
| Rate for Payer: Cash Price |
$2,587.50
|
| Rate for Payer: Cigna Commercial |
$4,295.25
|
| Rate for Payer: First Health Commercial |
$4,916.25
|
| Rate for Payer: Humana Commercial |
$4,398.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,819.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,554.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
| Rate for Payer: PHCS Commercial |
$4,968.00
|
|
|
ZR 12/14 TAPER FEM HD 28MM +8
|
Facility
OP
|
$5,175.00
|
|
|
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 |
$3,984.75
|
| Rate for Payer: Anthem Medicaid |
$1,779.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.50
|
| Rate for Payer: Cash Price |
$2,587.50
|
| Rate for Payer: Cigna Commercial |
$4,295.25
|
| Rate for Payer: First Health Commercial |
$4,916.25
|
| Rate for Payer: Humana Commercial |
$4,398.75
|
| Rate for Payer: Humana KY Medicaid |
$1,779.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,819.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,815.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,554.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
| Rate for Payer: PHCS Commercial |
$4,968.00
|
| Rate for Payer: United Healthcare All Payer |
$4,554.00
|
|
|
ZYLOPRIM (ALLOPURIN 100MG/1TAB
|
Facility
IP
|
$4.51
|
|
| Hospital Charge Code |
25001782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
|
|
ZYLOPRIM (ALLOPURIN 100MG/1TAB
|
Facility
OP
|
$4.51
|
|
| Hospital Charge Code |
25001782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
ZYNRELEF 1MG/0.03MG (7ML SDV)
|
Facility
IP
|
$746.92
|
|
|
Service Code
|
HCPCS C9088
|
| Hospital Charge Code |
25004171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.10 |
| Max. Negotiated Rate |
$717.04 |
| Rate for Payer: Aetna Commercial |
$575.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.60
|
| Rate for Payer: Cash Price |
$373.46
|
| Rate for Payer: Cigna Commercial |
$619.94
|
| Rate for Payer: First Health Commercial |
$709.57
|
| Rate for Payer: Humana Commercial |
$634.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.29
|
| Rate for Payer: Ohio Health Group HMO |
$560.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.55
|
| Rate for Payer: PHCS Commercial |
$717.04
|
|
|
ZYNRELEF 1MG/0.03MG (7ML SDV)
|
Facility
OP
|
$746.92
|
|
|
Service Code
|
HCPCS C9088
|
| Hospital Charge Code |
25004171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$717.04 |
| Rate for Payer: Aetna Commercial |
$575.13
|
| Rate for Payer: Anthem Medicaid |
$256.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.98
|
| Rate for Payer: Cash Price |
$373.46
|
| Rate for Payer: Cash Price |
$373.46
|
| Rate for Payer: Cigna Commercial |
$619.94
|
| Rate for Payer: First Health Commercial |
$709.57
|
| Rate for Payer: Humana Commercial |
$634.88
|
| Rate for Payer: Humana KY Medicaid |
$256.87
|
| Rate for Payer: Humana Medicare Advantage |
$0.73
|
| Rate for Payer: Kentucky WC Medicaid |
$259.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.29
|
| Rate for Payer: Ohio Health Group HMO |
$560.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.55
|
| Rate for Payer: PHCS Commercial |
$717.04
|
| Rate for Payer: United Healthcare All Payer |
$657.29
|
|
|
ZYNRELF 1MG/0.03MG (14ML SDV)
|
Facility
OP
|
$1,474.57
|
|
|
Service Code
|
HCPCS C9088
|
| Hospital Charge Code |
25004172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1,415.59 |
| Rate for Payer: Aetna Commercial |
$1,135.42
|
| Rate for Payer: Anthem Medicaid |
$507.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.98
|
| Rate for Payer: Cash Price |
$737.28
|
| Rate for Payer: Cash Price |
$737.28
|
| Rate for Payer: Cigna Commercial |
$1,223.89
|
| Rate for Payer: First Health Commercial |
$1,400.84
|
| Rate for Payer: Humana Commercial |
$1,253.38
|
| Rate for Payer: Humana KY Medicaid |
$507.10
|
| Rate for Payer: Humana Medicare Advantage |
$0.73
|
| Rate for Payer: Kentucky WC Medicaid |
$512.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,297.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,105.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.12
|
| Rate for Payer: PHCS Commercial |
$1,415.59
|
| Rate for Payer: United Healthcare All Payer |
$1,297.62
|
|
|
ZYNRELF 1MG/0.03MG (14ML SDV)
|
Facility
IP
|
$1,474.57
|
|
|
Service Code
|
HCPCS C9088
|
| Hospital Charge Code |
25004172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.69 |
| Max. Negotiated Rate |
$1,415.59 |
| Rate for Payer: Aetna Commercial |
$1,135.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.16
|
| Rate for Payer: Cash Price |
$737.28
|
| Rate for Payer: Cigna Commercial |
$1,223.89
|
| Rate for Payer: First Health Commercial |
$1,400.84
|
| Rate for Payer: Humana Commercial |
$1,253.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,297.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,105.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.12
|
| Rate for Payer: PHCS Commercial |
$1,415.59
|
|
|
ZYPREXA 10MG TABLET
|
Facility
OP
|
$4.45
|
|
| Hospital Charge Code |
25003645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| 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 |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
ZYPREXA 10MG TABLET
|
Facility
IP
|
$4.45
|
|
| Hospital Charge Code |
25003645
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| 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 |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
|
|
ZYPREXA (OLANZAPINE) 5 MG TAB
|
Facility
OP
|
$4.33
|
|
| Hospital Charge Code |
25001784
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| 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 |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| 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 |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
ZYPREXA (OLANZAPINE) 5 MG TAB
|
Facility
IP
|
$4.33
|
|
| Hospital Charge Code |
25001784
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| 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 |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| 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 |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.16
|
|
|
ZYPREXA ZYDIS 5MG TAB
|
Facility
OP
|
$4.96
|
|
| Hospital Charge Code |
25001785
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Anthem Medicaid |
$1.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.87
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.12
|
| Rate for Payer: First Health Commercial |
$4.71
|
| Rate for Payer: Humana Commercial |
$4.22
|
| Rate for Payer: Humana KY Medicaid |
$1.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
ZYPREXA ZYDIS 5MG TAB
|
Facility
IP
|
$4.96
|
|
| Hospital Charge Code |
25001785
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.87
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.12
|
| Rate for Payer: First Health Commercial |
$4.71
|
| Rate for Payer: Humana Commercial |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.76
|
|
|
ZYPREX (OLANZAPINE) 2.5MG TAB
|
Facility
IP
|
$4.30
|
|
| Hospital Charge Code |
25001783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| 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 |
$3.17
|
| 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 |
$4.13
|
|
|
ZYPREX (OLANZAPINE) 2.5MG TAB
|
Facility
OP
|
$4.30
|
|
| Hospital Charge Code |
25001783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| 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 |
$1.51
|
| 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 |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
ZYRTEC (CETIRIZINE) 5MG/5ML
|
Facility
OP
|
$4.23
|
|
| Hospital Charge Code |
25001787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: First Health Commercial |
$4.02
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.72
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Payer |
$3.72
|
|
|
ZYRTEC (CETIRIZINE) 5MG/5ML
|
Facility
IP
|
$4.23
|
|
| Hospital Charge Code |
25001787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: First Health Commercial |
$4.02
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.72
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.06
|
|
|
ZYRTEC-D (P-EPHED HC/CETIR)TAB
|
Facility
OP
|
$4.82
|
|
| Hospital Charge Code |
25001788
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Anthem Medicaid |
$1.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.76
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cigna Commercial |
$4.00
|
| Rate for Payer: First Health Commercial |
$4.58
|
| Rate for Payer: Humana Commercial |
$4.10
|
| Rate for Payer: Humana KY Medicaid |
$1.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.24
|
| Rate for Payer: Ohio Health Group HMO |
$3.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.63
|
| Rate for Payer: United Healthcare All Payer |
$4.24
|
|
|
ZYRTEC-D (P-EPHED HC/CETIR)TAB
|
Facility
IP
|
$4.82
|
|
| Hospital Charge Code |
25001788
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.76
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cigna Commercial |
$4.00
|
| Rate for Payer: First Health Commercial |
$4.58
|
| Rate for Payer: Humana Commercial |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.24
|
| Rate for Payer: Ohio Health Group HMO |
$3.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.63
|
|
|
ZYVOX 200MG[600MG/300ML IV SOL
|
Facility
IP
|
$116.00
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
25002217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
|
|
ZYVOX 200MG[600MG/300ML IV SOL
|
Facility
OP
|
$116.00
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
25002217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$39.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$39.89
|
| Rate for Payer: Kentucky WC Medicaid |
$40.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
ZYVOX (LINEZOLID) 600 MG TAB
|
Facility
OP
|
$21.17
|
|
| Hospital Charge Code |
25001790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$20.32 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Anthem Medicaid |
$7.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.51
|
| Rate for Payer: Cash Price |
$10.59
|
| Rate for Payer: Cigna Commercial |
$17.57
|
| Rate for Payer: First Health Commercial |
$20.11
|
| Rate for Payer: Humana Commercial |
$17.99
|
| Rate for Payer: Humana KY Medicaid |
$7.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.63
|
| Rate for Payer: Ohio Health Group HMO |
$15.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.56
|
| Rate for Payer: PHCS Commercial |
$20.32
|
| Rate for Payer: United Healthcare All Payer |
$18.63
|
|
|
ZYVOX (LINEZOLID) 600 MG TAB
|
Facility
IP
|
$21.17
|
|
| Hospital Charge Code |
25001790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$20.32 |
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.51
|
| Rate for Payer: Cash Price |
$10.59
|
| Rate for Payer: Cigna Commercial |
$17.57
|
| Rate for Payer: First Health Commercial |
$20.11
|
| Rate for Payer: Humana Commercial |
$17.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.63
|
| Rate for Payer: Ohio Health Group HMO |
$15.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.56
|
| Rate for Payer: PHCS Commercial |
$20.32
|
|
