|
ZINECARD 250MG [500MG VIAL]
|
Facility
|
OP
|
$2,989.38
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25002033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.01 |
| Max. Negotiated Rate |
$2,869.80 |
| Rate for Payer: Aetna Commercial |
$2,301.82
|
| Rate for Payer: Anthem Medicaid |
$1,028.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$108.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,331.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$151.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.81
|
| Rate for Payer: Cash Price |
$1,494.69
|
| 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: Humana KY Medicaid |
$1,028.05
|
| Rate for Payer: Humana Medicare Advantage |
$108.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.51
|
| 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 |
$129.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.67
|
| 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
|
|
|
ZINPLAVA 10mg (1,000mg Vial)
|
Facility
|
IP
|
$20,710.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
25004165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$19,881.60 |
| Rate for Payer: Aetna Commercial |
$15,946.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,153.80
|
| Rate for Payer: Cash Price |
$10,355.00
|
| Rate for Payer: Cigna Commercial |
$17,189.30
|
| Rate for Payer: First Health Commercial |
$19,674.50
|
| Rate for Payer: Humana Commercial |
$17,603.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,982.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,283.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,213.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,224.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,692.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,420.10
|
| Rate for Payer: PHCS Commercial |
$19,881.60
|
| Rate for Payer: United Healthcare All Payer |
$18,224.80
|
|
|
ZINPLAVA 10mg (1,000mg Vial)
|
Facility
|
OP
|
$20,710.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
25004165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$19,881.60 |
| Rate for Payer: Aetna Commercial |
$15,946.70
|
| Rate for Payer: Anthem Medicaid |
$7,122.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,153.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$55.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.81
|
| Rate for Payer: Cash Price |
$10,355.00
|
| Rate for Payer: Cash Price |
$10,355.00
|
| Rate for Payer: Cigna Commercial |
$17,189.30
|
| Rate for Payer: First Health Commercial |
$19,674.50
|
| Rate for Payer: Humana Commercial |
$17,603.50
|
| Rate for Payer: Humana KY Medicaid |
$7,122.17
|
| Rate for Payer: Humana Medicare Advantage |
$39.86
|
| Rate for Payer: Kentucky WC Medicaid |
$7,194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,982.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,283.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,265.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,224.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,692.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,420.10
|
| Rate for Payer: PHCS Commercial |
$19,881.60
|
| Rate for Payer: United Healthcare All Payer |
$18,224.80
|
|
|
ZIP WIRE ANGLED .035*260CM
|
Facility
|
OP
|
$793.67
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.18 |
| Max. Negotiated Rate |
$761.92 |
| Rate for Payer: Aetna Commercial |
$611.13
|
| Rate for Payer: Anthem Medicaid |
$272.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.06
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$753.99
|
| Rate for Payer: Humana Commercial |
$674.62
|
| Rate for Payer: Humana KY Medicaid |
$272.94
|
| Rate for Payer: Kentucky WC Medicaid |
$275.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.43
|
| Rate for Payer: Ohio Health Group HMO |
$595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.04
|
| Rate for Payer: PHCS Commercial |
$761.92
|
| Rate for Payer: United Healthcare All Payer |
$698.43
|
|
|
ZIP WIRE ANGLED .035*260CM
|
Facility
|
IP
|
$793.67
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.18 |
| Max. Negotiated Rate |
$761.92 |
| Rate for Payer: Aetna Commercial |
$611.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.06
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$753.99
|
| Rate for Payer: Humana Commercial |
$674.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.43
|
| Rate for Payer: Ohio Health Group HMO |
$595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.04
|
| Rate for Payer: PHCS Commercial |
$761.92
|
| Rate for Payer: United Healthcare All Payer |
$698.43
|
|
|
ZIP WIRE STRAIGHT .035*260CM
|
Facility
|
IP
|
$793.67
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.18 |
| Max. Negotiated Rate |
$761.92 |
| Rate for Payer: Aetna Commercial |
$611.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.06
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$753.99
|
| Rate for Payer: Humana Commercial |
$674.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.43
|
| Rate for Payer: Ohio Health Group HMO |
$595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.04
|
| Rate for Payer: PHCS Commercial |
$761.92
|
| Rate for Payer: United Healthcare All Payer |
$698.43
|
|
|
ZIP WIRE STRAIGHT .035*260CM
|
Facility
|
OP
|
$793.67
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.18 |
| Max. Negotiated Rate |
$761.92 |
| Rate for Payer: Aetna Commercial |
$611.13
|
| Rate for Payer: Anthem Medicaid |
$272.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$619.06
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cigna Commercial |
$658.75
|
| Rate for Payer: First Health Commercial |
$753.99
|
| Rate for Payer: Humana Commercial |
$674.62
|
| Rate for Payer: Humana KY Medicaid |
$272.94
|
| Rate for Payer: Kentucky WC Medicaid |
$275.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$650.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$585.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$698.43
|
| Rate for Payer: Ohio Health Group HMO |
$595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.04
|
| Rate for Payer: PHCS Commercial |
$761.92
|
| Rate for Payer: United Healthcare All Payer |
$698.43
|
|
|
ZIRABEV 10MG (100 MG VIAL)
|
Facility
|
IP
|
$3,343.03
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
25003978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$434.59 |
| Max. Negotiated Rate |
$3,209.31 |
| Rate for Payer: Aetna Commercial |
$2,574.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,607.56
|
| Rate for Payer: Cash Price |
$1,671.52
|
| Rate for Payer: Cigna Commercial |
$2,774.71
|
| Rate for Payer: First Health Commercial |
$3,175.88
|
| Rate for Payer: Humana Commercial |
$2,841.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,741.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,941.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,507.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,036.34
|
| Rate for Payer: PHCS Commercial |
$3,209.31
|
| Rate for Payer: United Healthcare All Payer |
$2,941.87
|
|
|
ZIRABEV 10MG (100 MG VIAL)
|
Facility
|
OP
|
$3,343.03
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
25003978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$3,209.31 |
| Rate for Payer: Aetna Commercial |
$2,574.13
|
| Rate for Payer: Anthem Medicaid |
$1,149.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,607.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.04
|
| Rate for Payer: Cash Price |
$1,671.52
|
| Rate for Payer: Cash Price |
$1,671.52
|
| Rate for Payer: Cigna Commercial |
$2,774.71
|
| Rate for Payer: First Health Commercial |
$3,175.88
|
| Rate for Payer: Humana Commercial |
$2,841.58
|
| Rate for Payer: Humana KY Medicaid |
$1,149.67
|
| Rate for Payer: Humana Medicare Advantage |
$21.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,161.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,741.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,941.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,507.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,036.34
|
| Rate for Payer: PHCS Commercial |
$3,209.31
|
| Rate for Payer: United Healthcare All Payer |
$2,941.87
|
|
|
ZIRABEV 10MG (400 MG VIAL)
|
Facility
|
OP
|
$13,372.12
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
25003977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$12,837.24 |
| Rate for Payer: Ohio Health Group HMO |
$10,029.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,674.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,738.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,145.36
|
| Rate for Payer: PHCS Commercial |
$12,837.24
|
| Rate for Payer: United Healthcare All Payer |
$11,767.47
|
| Rate for Payer: Aetna Commercial |
$10,296.53
|
| Rate for Payer: Anthem Medicaid |
$4,598.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.04
|
| Rate for Payer: Cash Price |
$6,686.06
|
| Rate for Payer: Cash Price |
$6,686.06
|
| Rate for Payer: Cigna Commercial |
$11,098.86
|
| Rate for Payer: First Health Commercial |
$12,703.51
|
| Rate for Payer: Humana Commercial |
$11,366.30
|
| Rate for Payer: Humana KY Medicaid |
$4,598.67
|
| Rate for Payer: Humana Medicare Advantage |
$21.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,645.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,690.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.47
|
|
|
ZIRABEV 10MG (400 MG VIAL)
|
Facility
|
IP
|
$13,372.12
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
25003977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,738.38 |
| Max. Negotiated Rate |
$12,837.24 |
| Rate for Payer: Aetna Commercial |
$10,296.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.25
|
| Rate for Payer: Cash Price |
$6,686.06
|
| Rate for Payer: Cigna Commercial |
$11,098.86
|
| Rate for Payer: First Health Commercial |
$12,703.51
|
| Rate for Payer: Humana Commercial |
$11,366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.47
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,674.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,738.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,145.36
|
| Rate for Payer: PHCS Commercial |
$12,837.24
|
| Rate for Payer: United Healthcare All Payer |
$11,767.47
|
|
|
ZITHROMAX 500 MG D5W 250ML PB
|
Facility
|
IP
|
$117.25
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
25001876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$112.56 |
| Rate for Payer: Aetna Commercial |
$90.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.46
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cigna Commercial |
$97.32
|
| Rate for Payer: First Health Commercial |
$111.39
|
| Rate for Payer: Humana Commercial |
$99.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.18
|
| Rate for Payer: Ohio Health Group HMO |
$87.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.35
|
| Rate for Payer: PHCS Commercial |
$112.56
|
| Rate for Payer: United Healthcare All Payer |
$103.18
|
|
|
ZITHROMAX 500 MG D5W 250ML PB
|
Facility
|
OP
|
$117.25
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
25001876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$112.56 |
| Rate for Payer: Aetna Commercial |
$90.28
|
| Rate for Payer: Anthem Medicaid |
$40.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.46
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cigna Commercial |
$97.32
|
| Rate for Payer: First Health Commercial |
$111.39
|
| Rate for Payer: Humana Commercial |
$99.66
|
| Rate for Payer: Humana KY Medicaid |
$40.32
|
| Rate for Payer: Kentucky WC Medicaid |
$40.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.18
|
| Rate for Payer: Ohio Health Group HMO |
$87.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.35
|
| Rate for Payer: PHCS Commercial |
$112.56
|
| Rate for Payer: United Healthcare All Payer |
$103.18
|
|
|
ZITHROMAX 500MG VIAL
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
25001877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.72
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
ZITHROMAX 500MG VIAL
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
25001877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem Medicaid |
$38.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Humana KY Medicaid |
$38.52
|
| Rate for Payer: Kentucky WC Medicaid |
$38.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.72
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
ZITHROMAX(AZITH)100MG/5ML 15ML
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
NDC 59762311001
|
| Hospital Charge Code |
25003638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$18.23
|
| Rate for Payer: Anthem Medicaid |
$8.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.46
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cigna Commercial |
$19.65
|
| Rate for Payer: First Health Commercial |
$22.49
|
| Rate for Payer: Humana Commercial |
$20.12
|
| Rate for Payer: Humana KY Medicaid |
$8.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.83
|
| Rate for Payer: Ohio Health Group HMO |
$17.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.34
|
| Rate for Payer: PHCS Commercial |
$22.72
|
| Rate for Payer: United Healthcare All Payer |
$20.83
|
|
|
ZITHROMAX(AZITH)100MG/5ML 15ML
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
NDC 59762311001
|
| Hospital Charge Code |
25003638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$18.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.46
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cigna Commercial |
$19.65
|
| Rate for Payer: First Health Commercial |
$22.49
|
| Rate for Payer: Humana Commercial |
$20.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.83
|
| Rate for Payer: Ohio Health Group HMO |
$17.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.34
|
| Rate for Payer: PHCS Commercial |
$22.72
|
| Rate for Payer: United Healthcare All Payer |
$20.83
|
|
|
ZITHROMAX(AZITH)200MG/5ML 15ML
|
Facility
|
IP
|
$11.33
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
25003636
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.84
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.40
|
| Rate for Payer: First Health Commercial |
$10.76
|
| Rate for Payer: Humana Commercial |
$9.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.97
|
| Rate for Payer: Ohio Health Group HMO |
$8.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.51
|
| Rate for Payer: PHCS Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Payer |
$9.97
|
|
|
ZITHROMAX(AZITH)200MG/5ML 15ML
|
Facility
|
OP
|
$11.33
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
25003636
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Anthem Medicaid |
$3.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.84
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.40
|
| Rate for Payer: First Health Commercial |
$10.76
|
| Rate for Payer: Humana Commercial |
$9.63
|
| Rate for Payer: Humana KY Medicaid |
$3.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.97
|
| Rate for Payer: Ohio Health Group HMO |
$8.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.51
|
| Rate for Payer: PHCS Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Payer |
$9.97
|
|
|
ZITHROMAX (AZITHROM 250MG/1CAP
|
Facility
|
OP
|
$9.56
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$7.36
|
| Rate for Payer: Anthem Medicaid |
$3.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.46
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: First Health Commercial |
$9.08
|
| Rate for Payer: Humana Commercial |
$8.13
|
| Rate for Payer: Humana KY Medicaid |
$3.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.41
|
| Rate for Payer: Ohio Health Group HMO |
$7.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Payer |
$8.41
|
|
|
ZITHROMAX (AZITHROM 250MG/1CAP
|
Facility
|
IP
|
$9.56
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$7.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.46
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: First Health Commercial |
$9.08
|
| Rate for Payer: Humana Commercial |
$8.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.41
|
| Rate for Payer: Ohio Health Group HMO |
$7.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Payer |
$8.41
|
|
|
ZMR PRSS-FT HUM STEM 10.5*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
|
|
|
ZMR PRSS-FT HUM STEM 10.5*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
|
|
|
ZOCOR (SIMVASTATIN) 10MG/1TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 68180047802
|
| Hospital Charge Code |
25001758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ZOCOR (SIMVASTATIN) 10MG/1TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 68180047802
|
| Hospital Charge Code |
25001758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
