|
ZARXIO EAMCG(480MCG/0.8MLSYR)
|
Facility
|
OP
|
$2,392.44
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$2,296.74 |
| Rate for Payer: Aetna Commercial |
$1,842.18
|
| Rate for Payer: Anthem Medicaid |
$822.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,866.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$1,196.22
|
| Rate for Payer: Cash Price |
$1,196.22
|
| Rate for Payer: Cigna Commercial |
$1,985.73
|
| Rate for Payer: First Health Commercial |
$2,272.82
|
| Rate for Payer: Humana Commercial |
$2,033.57
|
| Rate for Payer: Humana KY Medicaid |
$822.76
|
| Rate for Payer: Humana Medicare Advantage |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$831.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,961.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,765.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$839.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,105.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$478.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.66
|
| Rate for Payer: PHCS Commercial |
$2,296.74
|
| Rate for Payer: United Healthcare All Payer |
$2,105.35
|
|
|
ZARXIO EAMCG(480MCG/0.8MLSYR)
|
Facility
|
IP
|
$2,392.44
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$311.02 |
| Max. Negotiated Rate |
$2,296.74 |
| Rate for Payer: Aetna Commercial |
$1,842.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,866.10
|
| Rate for Payer: Cash Price |
$1,196.22
|
| Rate for Payer: Cigna Commercial |
$1,985.73
|
| Rate for Payer: First Health Commercial |
$2,272.82
|
| Rate for Payer: Humana Commercial |
$2,033.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,961.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,765.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,105.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$478.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.66
|
| Rate for Payer: PHCS Commercial |
$2,296.74
|
| Rate for Payer: United Healthcare All Payer |
$2,105.35
|
|
|
ZEBETA 5MG TAB
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
25001748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: First Health Commercial |
$8.70
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.06
|
| Rate for Payer: Ohio Health Group HMO |
$6.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.79
|
| Rate for Payer: United Healthcare All Payer |
$8.06
|
|
|
ZEBETA 5MG TAB
|
Facility
|
OP
|
$9.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
25001748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: First Health Commercial |
$8.70
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Humana KY Medicaid |
$3.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.06
|
| Rate for Payer: Ohio Health Group HMO |
$6.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.79
|
| Rate for Payer: United Healthcare All Payer |
$8.06
|
|
|
ZELANTE DVT ANGIOJET CATH
|
Facility
|
OP
|
$13,574.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,764.72 |
| Max. Negotiated Rate |
$13,031.76 |
| Rate for Payer: Aetna Commercial |
$10,452.56
|
| Rate for Payer: Anthem Medicaid |
$4,668.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,588.30
|
| Rate for Payer: Cash Price |
$6,787.38
|
| Rate for Payer: Cigna Commercial |
$11,267.04
|
| Rate for Payer: First Health Commercial |
$12,896.01
|
| Rate for Payer: Humana Commercial |
$11,538.54
|
| Rate for Payer: Humana KY Medicaid |
$4,668.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,131.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,018.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,072.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,762.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,945.78
|
| Rate for Payer: Ohio Health Group HMO |
$10,181.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,714.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,764.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,208.17
|
| Rate for Payer: PHCS Commercial |
$13,031.76
|
| Rate for Payer: United Healthcare All Payer |
$11,945.78
|
|
|
ZELANTE DVT ANGIOJET CATH
|
Facility
|
IP
|
$13,574.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,764.72 |
| Max. Negotiated Rate |
$13,031.76 |
| Rate for Payer: Aetna Commercial |
$10,452.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,588.30
|
| Rate for Payer: Cash Price |
$6,787.38
|
| Rate for Payer: Cigna Commercial |
$11,267.04
|
| Rate for Payer: First Health Commercial |
$12,896.01
|
| Rate for Payer: Humana Commercial |
$11,538.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,131.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,018.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,072.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,945.78
|
| Rate for Payer: Ohio Health Group HMO |
$10,181.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,714.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,764.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,208.17
|
| Rate for Payer: PHCS Commercial |
$13,031.76
|
| Rate for Payer: United Healthcare All Payer |
$11,945.78
|
|
|
ZEMAIRA 10MG (1000MG VL)
|
Facility
|
OP
|
$3,215.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$3,086.88 |
| Rate for Payer: Aetna Commercial |
$2,475.94
|
| Rate for Payer: Anthem Medicaid |
$1,105.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$1,607.75
|
| Rate for Payer: Cash Price |
$1,607.75
|
| Rate for Payer: Cigna Commercial |
$2,668.86
|
| Rate for Payer: First Health Commercial |
$3,054.72
|
| Rate for Payer: Humana Commercial |
$2,733.18
|
| Rate for Payer: Humana KY Medicaid |
$1,105.81
|
| Rate for Payer: Humana Medicare Advantage |
$4.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,117.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,128.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.80
|
| Rate for Payer: PHCS Commercial |
$3,086.88
|
| Rate for Payer: United Healthcare All Payer |
$2,829.64
|
|
|
ZEMAIRA 10MG (1000MG VL)
|
Facility
|
IP
|
$3,215.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$418.02 |
| Max. Negotiated Rate |
$3,086.88 |
| Rate for Payer: Aetna Commercial |
$2,475.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.09
|
| Rate for Payer: Cash Price |
$1,607.75
|
| Rate for Payer: Cigna Commercial |
$2,668.86
|
| Rate for Payer: First Health Commercial |
$3,054.72
|
| Rate for Payer: Humana Commercial |
$2,733.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.80
|
| Rate for Payer: PHCS Commercial |
$3,086.88
|
| Rate for Payer: United Healthcare All Payer |
$2,829.64
|
|
|
ZEMDRI 5MG (500MG SDV)
|
Facility
|
IP
|
$1,885.16
|
|
|
Service Code
|
HCPCS J0291
|
| Hospital Charge Code |
25001817
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.07 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Aetna Commercial |
$1,451.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.42
|
| Rate for Payer: Cash Price |
$942.58
|
| Rate for Payer: Cigna Commercial |
$1,564.68
|
| Rate for Payer: First Health Commercial |
$1,790.90
|
| Rate for Payer: Humana Commercial |
$1,602.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.40
|
| Rate for Payer: PHCS Commercial |
$1,809.75
|
| Rate for Payer: United Healthcare All Payer |
$1,658.94
|
|
|
ZEMDRI 5MG (500MG SDV)
|
Facility
|
OP
|
$1,885.16
|
|
|
Service Code
|
HCPCS J0291
|
| Hospital Charge Code |
25001817
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Aetna Commercial |
$1,451.57
|
| Rate for Payer: Anthem Medicaid |
$648.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.86
|
| Rate for Payer: Cash Price |
$942.58
|
| Rate for Payer: Cash Price |
$942.58
|
| Rate for Payer: Cigna Commercial |
$1,564.68
|
| Rate for Payer: First Health Commercial |
$1,790.90
|
| Rate for Payer: Humana Commercial |
$1,602.39
|
| Rate for Payer: Humana KY Medicaid |
$648.31
|
| Rate for Payer: Humana Medicare Advantage |
$3.60
|
| Rate for Payer: Kentucky WC Medicaid |
$654.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.40
|
| Rate for Payer: PHCS Commercial |
$1,809.75
|
| Rate for Payer: United Healthcare All Payer |
$1,658.94
|
|
|
ZEMPLAR PARICALCITOL 1 MCG CAP
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 49483068703
|
| Hospital Charge Code |
25001749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
ZEMPLAR PARICALCITOL 1 MCG CAP
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 49483068703
|
| Hospital Charge Code |
25001749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
ZEMPLAR(PARICALOTOL)1MCG5MCGML
|
Facility
|
IP
|
$122.15
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
25003632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$117.26 |
| Rate for Payer: Aetna Commercial |
$94.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.28
|
| Rate for Payer: Cash Price |
$61.08
|
| Rate for Payer: Cigna Commercial |
$101.38
|
| Rate for Payer: First Health Commercial |
$116.04
|
| Rate for Payer: Humana Commercial |
$103.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.49
|
| Rate for Payer: Ohio Health Group HMO |
$91.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.87
|
| Rate for Payer: PHCS Commercial |
$117.26
|
| Rate for Payer: United Healthcare All Payer |
$107.49
|
|
|
ZEMPLAR(PARICALOTOL)1MCG5MCGML
|
Facility
|
OP
|
$122.15
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
25003632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$117.26 |
| Rate for Payer: Aetna Commercial |
$94.06
|
| Rate for Payer: Anthem Medicaid |
$42.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.28
|
| Rate for Payer: Cash Price |
$61.08
|
| Rate for Payer: Cigna Commercial |
$101.38
|
| Rate for Payer: First Health Commercial |
$116.04
|
| Rate for Payer: Humana Commercial |
$103.83
|
| Rate for Payer: Humana KY Medicaid |
$42.01
|
| Rate for Payer: Kentucky WC Medicaid |
$42.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.49
|
| Rate for Payer: Ohio Health Group HMO |
$91.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.87
|
| Rate for Payer: PHCS Commercial |
$117.26
|
| Rate for Payer: United Healthcare All Payer |
$107.49
|
|
|
ZEMURON 100MG/10ML VIAL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
NDC 67457022810
|
| Hospital Charge Code |
25003634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
ZEMURON 100MG/10ML VIAL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
NDC 67457022810
|
| Hospital Charge Code |
25003634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$39.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$39.20
|
| Rate for Payer: Kentucky WC Medicaid |
$39.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
ZEMURON (ROCURONIU) 5 50MG/5ML
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
ZEMURON (ROCURONIU) 5 50MG/5ML
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$38.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$38.86
|
| Rate for Payer: Kentucky WC Medicaid |
$39.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
ZENITH AAA COMP KIT ZAK-100C
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
ZENITH AAA COMP KIT ZAK-100C
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
ZENITH AAA ILIAC LEG EXT 16*55
|
Facility
|
IP
|
$10,603.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.47 |
| Max. Negotiated Rate |
$10,179.50 |
| Rate for Payer: Aetna Commercial |
$8,164.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,270.85
|
| Rate for Payer: Cash Price |
$5,301.82
|
| Rate for Payer: Cigna Commercial |
$8,801.03
|
| Rate for Payer: First Health Commercial |
$10,073.47
|
| Rate for Payer: Humana Commercial |
$9,013.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,694.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,825.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,331.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,952.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.13
|
| Rate for Payer: PHCS Commercial |
$10,179.50
|
| Rate for Payer: United Healthcare All Payer |
$9,331.21
|
|
|
ZENITH AAA ILIAC LEG EXT 16*55
|
Facility
|
OP
|
$10,603.65
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.47 |
| Max. Negotiated Rate |
$10,179.50 |
| Rate for Payer: Aetna Commercial |
$8,164.81
|
| Rate for Payer: Anthem Medicaid |
$3,646.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,270.85
|
| Rate for Payer: Cash Price |
$5,301.82
|
| Rate for Payer: Cigna Commercial |
$8,801.03
|
| Rate for Payer: First Health Commercial |
$10,073.47
|
| Rate for Payer: Humana Commercial |
$9,013.10
|
| Rate for Payer: Humana KY Medicaid |
$3,646.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,683.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,694.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,825.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,181.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,719.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,331.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,952.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.13
|
| Rate for Payer: PHCS Commercial |
$10,179.50
|
| Rate for Payer: United Healthcare All Payer |
$9,331.21
|
|
|
ZENITH AAA ILIAC LEG EXT 18*55
|
Facility
|
OP
|
$11,045.30
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.89 |
| Max. Negotiated Rate |
$10,603.49 |
| Rate for Payer: Aetna Commercial |
$8,504.88
|
| Rate for Payer: Anthem Medicaid |
$3,798.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.33
|
| Rate for Payer: Cash Price |
$5,522.65
|
| Rate for Payer: Cigna Commercial |
$9,167.60
|
| Rate for Payer: First Health Commercial |
$10,493.04
|
| Rate for Payer: Humana Commercial |
$9,388.50
|
| Rate for Payer: Humana KY Medicaid |
$3,798.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,837.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,874.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,719.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,283.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,209.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,424.04
|
| Rate for Payer: PHCS Commercial |
$10,603.49
|
| Rate for Payer: United Healthcare All Payer |
$9,719.86
|
|
|
ZENITH AAA ILIAC LEG EXT 18*55
|
Facility
|
IP
|
$11,045.30
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.89 |
| Max. Negotiated Rate |
$10,603.49 |
| Rate for Payer: Aetna Commercial |
$8,504.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.33
|
| Rate for Payer: Cash Price |
$5,522.65
|
| Rate for Payer: Cigna Commercial |
$9,167.60
|
| Rate for Payer: First Health Commercial |
$10,493.04
|
| Rate for Payer: Humana Commercial |
$9,388.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,719.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,283.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,209.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,424.04
|
| Rate for Payer: PHCS Commercial |
$10,603.49
|
| Rate for Payer: United Healthcare All Payer |
$9,719.86
|
|
|
ZENITH AAA ILIAC LEG EXT 24*55
|
Facility
|
IP
|
$9,384.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.00 |
| Max. Negotiated Rate |
$9,009.22 |
| Rate for Payer: Aetna Commercial |
$7,226.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,319.99
|
| Rate for Payer: Cash Price |
$4,692.30
|
| Rate for Payer: Cigna Commercial |
$7,789.22
|
| Rate for Payer: First Health Commercial |
$8,915.37
|
| Rate for Payer: Humana Commercial |
$7,976.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,695.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,925.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,815.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,258.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,038.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,876.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.23
|
| Rate for Payer: PHCS Commercial |
$9,009.22
|
| Rate for Payer: United Healthcare All Payer |
$8,258.45
|
|
