|
ZOCOR (SIMVASTATIN) 20MG TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 68180047902
|
| Hospital Charge Code |
25001759
|
|
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
|
|
|
ZOCOR (SIMVASTATIN) 20MG TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 68180047902
|
| Hospital Charge Code |
25001759
|
|
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) 40MG TAB
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 60687021001
|
| Hospital Charge Code |
25001760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ZOCOR (SIMVASTATIN) 40MG TAB
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 60687021001
|
| Hospital Charge Code |
25001760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ZOCOR (SIMVASTATIN) 5MG TAB
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 16729015615
|
| Hospital Charge Code |
25001761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ZOCOR (SIMVASTATIN) 5MG TAB
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 16729015615
|
| Hospital Charge Code |
25001761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ZO ENYMATIC PEEL
|
Professional
|
Both
|
$72.00
|
|
| Hospital Charge Code |
22200201
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$72.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Multiplan PHCS |
$43.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.40
|
| Rate for Payer: UHCCP Medicaid |
$25.20
|
|
|
ZO FIRMING SERUM
|
Professional
|
Both
|
$235.00
|
|
| Hospital Charge Code |
22200202
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
IP
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$11.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.88
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: First Health Commercial |
$14.47
|
| Rate for Payer: Humana Commercial |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.40
|
| Rate for Payer: Ohio Health Group HMO |
$11.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.72
|
| Rate for Payer: PHCS Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Payer |
$13.40
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
OP
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
636T0046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$11.73
|
| Rate for Payer: Anthem Medicaid |
$5.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.88
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: First Health Commercial |
$14.47
|
| Rate for Payer: Humana Commercial |
$12.95
|
| Rate for Payer: Humana KY Medicaid |
$5.24
|
| Rate for Payer: Kentucky WC Medicaid |
$5.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.40
|
| Rate for Payer: Ohio Health Group HMO |
$11.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.72
|
| Rate for Payer: PHCS Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Payer |
$13.40
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Professional
|
Both
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.23
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Healthspan PPO |
$0.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.14
|
| Rate for Payer: Multiplan PHCS |
$9.14
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.66
|
| Rate for Payer: UHCCP Medicaid |
$5.33
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25002285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$60.92 |
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: Anthem Medicaid |
$21.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.50
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Cigna Commercial |
$52.67
|
| Rate for Payer: First Health Commercial |
$60.29
|
| Rate for Payer: Humana Commercial |
$53.94
|
| Rate for Payer: Humana KY Medicaid |
$21.82
|
| Rate for Payer: Kentucky WC Medicaid |
$22.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.84
|
| Rate for Payer: Ohio Health Group HMO |
$47.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.67
|
| Rate for Payer: PHCS Commercial |
$60.92
|
| Rate for Payer: United Healthcare All Payer |
$55.84
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
OP
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$11.73
|
| Rate for Payer: Anthem Medicaid |
$5.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.88
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: First Health Commercial |
$14.47
|
| Rate for Payer: Humana Commercial |
$12.95
|
| Rate for Payer: Humana KY Medicaid |
$5.24
|
| Rate for Payer: Kentucky WC Medicaid |
$5.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.40
|
| Rate for Payer: Ohio Health Group HMO |
$11.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.72
|
| Rate for Payer: PHCS Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Payer |
$13.40
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
IP
|
$15.23
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
636T0046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$11.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.88
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cigna Commercial |
$12.64
|
| Rate for Payer: First Health Commercial |
$14.47
|
| Rate for Payer: Humana Commercial |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.40
|
| Rate for Payer: Ohio Health Group HMO |
$11.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.72
|
| Rate for Payer: PHCS Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Payer |
$13.40
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25002285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$60.92 |
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.50
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Cigna Commercial |
$52.67
|
| Rate for Payer: First Health Commercial |
$60.29
|
| Rate for Payer: Humana Commercial |
$53.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.84
|
| Rate for Payer: Ohio Health Group HMO |
$47.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.67
|
| Rate for Payer: PHCS Commercial |
$60.92
|
| Rate for Payer: United Healthcare All Payer |
$55.84
|
|
|
ZOFRAN EQ 2MG/2.5MLORALSOL2.5
|
Facility
|
IP
|
$12.20
|
|
|
Service Code
|
NDC 54006447
|
| Hospital Charge Code |
25001765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Aetna Commercial |
$9.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.52
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cigna Commercial |
$10.13
|
| Rate for Payer: First Health Commercial |
$11.59
|
| Rate for Payer: Humana Commercial |
$10.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.74
|
| Rate for Payer: Ohio Health Group HMO |
$9.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.78
|
| Rate for Payer: PHCS Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Payer |
$10.74
|
|
|
ZOFRAN EQ 2MG/2.5MLORALSOL2.5
|
Facility
|
OP
|
$12.20
|
|
|
Service Code
|
NDC 54006447
|
| Hospital Charge Code |
25001765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Aetna Commercial |
$9.39
|
| Rate for Payer: Anthem Medicaid |
$4.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.52
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cigna Commercial |
$10.13
|
| Rate for Payer: First Health Commercial |
$11.59
|
| Rate for Payer: Humana Commercial |
$10.37
|
| Rate for Payer: Humana KY Medicaid |
$4.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.74
|
| Rate for Payer: Ohio Health Group HMO |
$9.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.78
|
| Rate for Payer: PHCS Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Payer |
$10.74
|
|
|
ZOFRAN ODT 4 MG TABLET
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
NDC 68001024617
|
| Hospital Charge Code |
25001766
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
ZOFRAN ODT 4 MG TABLET
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
NDC 68001024617
|
| Hospital Charge Code |
25001766
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
ZOFRAN ODT 8 MG TAB
|
Facility
|
IP
|
$9.13
|
|
|
Service Code
|
NDC 68001024717
|
| Hospital Charge Code |
25003639
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Aetna Commercial |
$7.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.12
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cigna Commercial |
$7.58
|
| Rate for Payer: First Health Commercial |
$8.67
|
| Rate for Payer: Humana Commercial |
$7.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.03
|
| Rate for Payer: Ohio Health Group HMO |
$6.85
|
| 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 |
$2.83
|
| Rate for Payer: PHCS Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Payer |
$8.03
|
|
|
ZOFRAN ODT 8 MG TAB
|
Facility
|
OP
|
$9.13
|
|
|
Service Code
|
NDC 68001024717
|
| Hospital Charge Code |
25003639
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Aetna Commercial |
$7.03
|
| Rate for Payer: Anthem Medicaid |
$3.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.12
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cigna Commercial |
$7.58
|
| Rate for Payer: First Health Commercial |
$8.67
|
| Rate for Payer: Humana Commercial |
$7.76
|
| Rate for Payer: Humana KY Medicaid |
$3.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.03
|
| Rate for Payer: Ohio Health Group HMO |
$6.85
|
| 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 |
$2.83
|
| Rate for Payer: PHCS Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Payer |
$8.03
|
|
|
ZOFRAN (ONDANSETRON) 4MG/1TAB
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 68084022001
|
| Hospital Charge Code |
25001764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
|
|
ZOFRAN (ONDANSETRON) 4MG/1TAB
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 68084022001
|
| Hospital Charge Code |
25001764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
ZOFRAN (ONDANSETRON H 8MG/1TAB
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 57237007630
|
| Hospital Charge Code |
25001763
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| 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 |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| 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 |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ZOFRAN (ONDANSETRON H 8MG/1TAB
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 57237007630
|
| Hospital Charge Code |
25001763
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| 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 |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| 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 |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
