|
ZIMMER PRSS-FT HUM STEM 12*110
|
Facility
|
IP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,870.47 |
| Max. Negotiated Rate |
$21,197.34 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
|
ZIMMER PRSS-FT HUM STEM 12*110
|
Facility
|
OP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,870.47 |
| Max. Negotiated Rate |
$21,197.34 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem Medicaid |
$7,593.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Humana KY Medicaid |
$7,593.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,670.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
|
ZIMMER PRSS-FT HUM STEM 14*110
|
Facility
|
IP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,870.47 |
| Max. Negotiated Rate |
$21,197.34 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
|
ZIMMER PRSS-FT HUM STEM 14*110
|
Facility
|
OP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,870.47 |
| Max. Negotiated Rate |
$21,197.34 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem Medicaid |
$7,593.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Humana KY Medicaid |
$7,593.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,670.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
|
ZINC CHLORIDE 10mg SDV
|
Facility
|
OP
|
$130.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$125.46 |
| Rate for Payer: Aetna Commercial |
$100.63
|
| Rate for Payer: Anthem Medicaid |
$44.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.94
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cigna Commercial |
$108.47
|
| Rate for Payer: First Health Commercial |
$124.16
|
| Rate for Payer: Humana Commercial |
$111.09
|
| Rate for Payer: Humana KY Medicaid |
$44.94
|
| Rate for Payer: Kentucky WC Medicaid |
$45.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.01
|
| Rate for Payer: Ohio Health Group HMO |
$98.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.51
|
| Rate for Payer: PHCS Commercial |
$125.46
|
| Rate for Payer: United Healthcare All Payer |
$115.01
|
|
|
ZINC CHLORIDE 10mg SDV
|
Facility
|
IP
|
$130.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$125.46 |
| Rate for Payer: Aetna Commercial |
$100.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.94
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cigna Commercial |
$108.47
|
| Rate for Payer: First Health Commercial |
$124.16
|
| Rate for Payer: Humana Commercial |
$111.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.01
|
| Rate for Payer: Ohio Health Group HMO |
$98.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.51
|
| Rate for Payer: PHCS Commercial |
$125.46
|
| Rate for Payer: United Healthcare All Payer |
$115.01
|
|
|
ZINC OXIDE PASTE 113 gm
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 53329015644
|
| Hospital Charge Code |
25004446
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem Medicaid |
$1.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Humana KY Medicaid |
$1.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.09
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
ZINC OXIDE PASTE 113 gm
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
NDC 53329015644
|
| Hospital Charge Code |
25004446
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.09
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
ZINC OXIDE PASTE 4 gm
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 53329015683
|
| Hospital Charge Code |
25004458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| 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 |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ZINC OXIDE PASTE 4 gm
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 53329015683
|
| Hospital Charge Code |
25004458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| 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 |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ZINC OXIDE PASTE 57 gm
|
Facility
|
OP
|
$5.14
|
|
|
Service Code
|
NDC 53329015614
|
| Hospital Charge Code |
25004457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Anthem Medicaid |
$1.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna Commercial |
$4.27
|
| Rate for Payer: First Health Commercial |
$4.88
|
| Rate for Payer: Humana Commercial |
$4.37
|
| Rate for Payer: Humana KY Medicaid |
$1.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.59
|
| Rate for Payer: PHCS Commercial |
$4.93
|
| Rate for Payer: United Healthcare All Payer |
$4.52
|
|
|
ZINC OXIDE PASTE 57 gm
|
Facility
|
IP
|
$5.14
|
|
|
Service Code
|
NDC 53329015614
|
| Hospital Charge Code |
25004457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna Commercial |
$4.27
|
| Rate for Payer: First Health Commercial |
$4.88
|
| Rate for Payer: Humana Commercial |
$4.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.59
|
| Rate for Payer: PHCS Commercial |
$4.93
|
| Rate for Payer: United Healthcare All Payer |
$4.52
|
|
|
ZINC SULFATE 10 MG/10 ML VIAL
|
Facility
|
IP
|
$186.70
|
|
|
Service Code
|
NDC 517610125
|
| Hospital Charge Code |
25003990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$179.23 |
| Rate for Payer: Aetna Commercial |
$143.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.63
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cigna Commercial |
$154.96
|
| Rate for Payer: First Health Commercial |
$177.36
|
| Rate for Payer: Humana Commercial |
$158.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.30
|
| Rate for Payer: Ohio Health Group HMO |
$140.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.88
|
| Rate for Payer: PHCS Commercial |
$179.23
|
| Rate for Payer: United Healthcare All Payer |
$164.30
|
|
|
ZINC SULFATE 10 MG/10 ML VIAL
|
Facility
|
OP
|
$186.70
|
|
|
Service Code
|
NDC 517610125
|
| Hospital Charge Code |
25003990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$179.23 |
| Rate for Payer: Aetna Commercial |
$143.76
|
| Rate for Payer: Anthem Medicaid |
$64.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.63
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cigna Commercial |
$154.96
|
| Rate for Payer: First Health Commercial |
$177.36
|
| Rate for Payer: Humana Commercial |
$158.70
|
| Rate for Payer: Humana KY Medicaid |
$64.21
|
| Rate for Payer: Kentucky WC Medicaid |
$64.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.30
|
| Rate for Payer: Ohio Health Group HMO |
$140.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.88
|
| Rate for Payer: PHCS Commercial |
$179.23
|
| Rate for Payer: United Healthcare All Payer |
$164.30
|
|
|
ZINC SULFATE 220 MG 220MG/1CAP
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
25001755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
| Rate for Payer: Aetna Commercial |
$3.38
|
|
|
ZINC SULFATE 220 MG 220MG/1CAP
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
25001755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ZINC SULFATE 220 MG TABLET
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 10006073027
|
| Hospital Charge Code |
25004000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINC SULFATE 220 MG TABLET
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 10006073027
|
| Hospital Charge Code |
25004000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINC SULFATE 25MG/5ML
|
Facility
|
IP
|
$345.75
|
|
|
Service Code
|
NDC 517800525
|
| Hospital Charge Code |
25003635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$331.92 |
| Rate for Payer: Aetna Commercial |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.68
|
| Rate for Payer: Cash Price |
$172.88
|
| Rate for Payer: Cigna Commercial |
$286.97
|
| Rate for Payer: First Health Commercial |
$328.46
|
| Rate for Payer: Humana Commercial |
$293.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.26
|
| Rate for Payer: Ohio Health Group HMO |
$259.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.18
|
| Rate for Payer: PHCS Commercial |
$331.92
|
| Rate for Payer: United Healthcare All Payer |
$304.26
|
|
|
ZINC SULFATE 25MG/5ML
|
Facility
|
OP
|
$345.75
|
|
|
Service Code
|
NDC 517800525
|
| Hospital Charge Code |
25003635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$331.92 |
| Rate for Payer: Aetna Commercial |
$266.23
|
| Rate for Payer: Anthem Medicaid |
$118.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.68
|
| Rate for Payer: Cash Price |
$172.88
|
| Rate for Payer: Cigna Commercial |
$286.97
|
| Rate for Payer: First Health Commercial |
$328.46
|
| Rate for Payer: Humana Commercial |
$293.89
|
| Rate for Payer: Humana KY Medicaid |
$118.90
|
| Rate for Payer: Kentucky WC Medicaid |
$120.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.26
|
| Rate for Payer: Ohio Health Group HMO |
$259.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.18
|
| Rate for Payer: PHCS Commercial |
$331.92
|
| Rate for Payer: United Healthcare All Payer |
$304.26
|
|
|
ZINC SULFATE 50 MG T 50MG/1TAB
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 30768000691
|
| Hospital Charge Code |
25001756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINC SULFATE 50 MG T 50MG/1TAB
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 30768000691
|
| Hospital Charge Code |
25001756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINECARD 250MG/25ML VIAL
|
Facility
|
OP
|
$1,494.72
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25003903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.01 |
| Max. Negotiated Rate |
$1,434.93 |
| Rate for Payer: Aetna Commercial |
$1,150.93
|
| Rate for Payer: Anthem Medicaid |
$514.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$108.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$151.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.81
|
| Rate for Payer: Cash Price |
$747.36
|
| Rate for Payer: Cash Price |
$747.36
|
| Rate for Payer: Cigna Commercial |
$1,240.62
|
| Rate for Payer: First Health Commercial |
$1,419.98
|
| Rate for Payer: Humana Commercial |
$1,270.51
|
| Rate for Payer: Humana KY Medicaid |
$514.03
|
| Rate for Payer: Humana Medicare Advantage |
$108.01
|
| Rate for Payer: Kentucky WC Medicaid |
$519.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.36
|
| Rate for Payer: PHCS Commercial |
$1,434.93
|
| Rate for Payer: United Healthcare All Payer |
$1,315.35
|
|
|
ZINECARD 250MG/25ML VIAL
|
Facility
|
IP
|
$1,494.72
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25003903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.31 |
| Max. Negotiated Rate |
$1,434.93 |
| Rate for Payer: Aetna Commercial |
$1,150.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.88
|
| Rate for Payer: Cash Price |
$747.36
|
| Rate for Payer: Cigna Commercial |
$1,240.62
|
| Rate for Payer: First Health Commercial |
$1,419.98
|
| Rate for Payer: Humana Commercial |
$1,270.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.36
|
| Rate for Payer: PHCS Commercial |
$1,434.93
|
| Rate for Payer: United Healthcare All Payer |
$1,315.35
|
|
|
ZINECARD 250MG [500MG VIAL]
|
Facility
|
IP
|
$2,989.38
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25002033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$388.62 |
| Max. Negotiated Rate |
$2,869.80 |
| Rate for Payer: Aetna Commercial |
$2,301.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,331.72
|
| Rate for Payer: Cash Price |
$1,494.69
|
| Rate for Payer: Cigna Commercial |
$2,481.19
|
| Rate for Payer: First Health Commercial |
$2,839.91
|
| Rate for Payer: Humana Commercial |
$2,540.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$896.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,630.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$597.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$926.71
|
| Rate for Payer: PHCS Commercial |
$2,869.80
|
| Rate for Payer: United Healthcare All Payer |
$2,630.65
|
|
