|
ZO HYDRAFIRM EYE BRIGHTNNG RPR
|
Professional
|
Both
|
$140.00
|
|
| Hospital Charge Code |
22200203
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$140.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.00
|
| Rate for Payer: UHCCP Medicaid |
$49.00
|
|
|
ZO HYDRATING CREME
|
Professional
|
Both
|
$94.00
|
|
| Hospital Charge Code |
22200168
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$94.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Multiplan PHCS |
$56.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.80
|
| Rate for Payer: UHCCP Medicaid |
$32.90
|
|
|
ZOLADEX 3.6MG IMPLANT
|
Facility
|
OP
|
$5,410.87
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
25002624
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$609.01 |
| Max. Negotiated Rate |
$5,194.44 |
| Rate for Payer: Aetna Commercial |
$4,166.37
|
| Rate for Payer: Anthem Medicaid |
$1,860.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$609.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,220.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$852.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$822.16
|
| Rate for Payer: Cash Price |
$2,705.44
|
| Rate for Payer: Cash Price |
$2,705.44
|
| Rate for Payer: Cigna Commercial |
$4,491.02
|
| Rate for Payer: First Health Commercial |
$5,140.33
|
| Rate for Payer: Humana Commercial |
$4,599.24
|
| Rate for Payer: Humana KY Medicaid |
$1,860.80
|
| Rate for Payer: Humana Medicare Advantage |
$609.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,436.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,993.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,898.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,761.57
|
| Rate for Payer: Ohio Health Group HMO |
$4,058.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,082.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,677.37
|
| Rate for Payer: PHCS Commercial |
$5,194.44
|
| Rate for Payer: United Healthcare All Payer |
$4,761.57
|
|
|
ZOLADEX 3.6MG IMPLANT
|
Facility
|
IP
|
$5,410.87
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
25002624
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$703.41 |
| Max. Negotiated Rate |
$5,194.44 |
| Rate for Payer: Aetna Commercial |
$4,166.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,220.48
|
| Rate for Payer: Cash Price |
$2,705.44
|
| Rate for Payer: Cigna Commercial |
$4,491.02
|
| Rate for Payer: First Health Commercial |
$5,140.33
|
| Rate for Payer: Humana Commercial |
$4,599.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,436.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,993.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,623.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,761.57
|
| Rate for Payer: Ohio Health Group HMO |
$4,058.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,082.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,677.37
|
| Rate for Payer: PHCS Commercial |
$5,194.44
|
| Rate for Payer: United Healthcare All Payer |
$4,761.57
|
|
|
ZOLOFT (SERTRALIE)20MG/ML CONC
|
Facility
|
IP
|
$5.13
|
|
|
Service Code
|
NDC 59762006701
|
| Hospital Charge Code |
25003640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.26
|
| Rate for Payer: First Health Commercial |
$4.87
|
| Rate for Payer: Humana Commercial |
$4.36
|
| 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 |
$4.51
|
| Rate for Payer: Ohio Health Group HMO |
$3.85
|
| 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 |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ZOLOFT (SERTRALIE)20MG/ML CONC
|
Facility
|
OP
|
$5.13
|
|
|
Service Code
|
NDC 59762006701
|
| Hospital Charge Code |
25003640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Anthem Medicaid |
$1.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.26
|
| Rate for Payer: First Health Commercial |
$4.87
|
| Rate for Payer: Humana Commercial |
$4.36
|
| Rate for Payer: Humana KY Medicaid |
$1.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1.78
|
| 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 |
$4.51
|
| Rate for Payer: Ohio Health Group HMO |
$3.85
|
| 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 |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ZOLOFT (SERTRALINE) 100MG/1TAB
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 60687025301
|
| Hospital Charge Code |
25001768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
|
|
ZOLOFT (SERTRALINE) 100MG/1TAB
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 60687025301
|
| Hospital Charge Code |
25001768
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
ZOLOFT (SERTRALINE) 50MG/1TAB
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
25001767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
ZOLOFT (SERTRALINE) 50MG/1TAB
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 60687024201
|
| Hospital Charge Code |
25001767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
ZOLOFT (SERTRAZLINE) 25MG TAB
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 60687023101
|
| Hospital Charge Code |
25001769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
ZOLOFT (SERTRAZLINE) 25MG TAB
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 60687023101
|
| Hospital Charge Code |
25001769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
ZOMETA 1MG (4MG VIAL)
|
Facility
|
IP
|
$408.75
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
25002456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$392.40 |
| Rate for Payer: Aetna Commercial |
$314.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$318.82
|
| Rate for Payer: Cash Price |
$204.38
|
| Rate for Payer: Cigna Commercial |
$339.26
|
| Rate for Payer: First Health Commercial |
$388.31
|
| Rate for Payer: Humana Commercial |
$347.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$335.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.70
|
| Rate for Payer: Ohio Health Group HMO |
$306.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.71
|
| Rate for Payer: PHCS Commercial |
$392.40
|
| Rate for Payer: United Healthcare All Payer |
$359.70
|
|
|
ZOMETA 1MG (4MG VIAL)
|
Facility
|
OP
|
$408.75
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
25002456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$392.40 |
| Rate for Payer: Aetna Commercial |
$314.74
|
| Rate for Payer: Anthem Medicaid |
$140.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$318.82
|
| Rate for Payer: Cash Price |
$204.38
|
| Rate for Payer: Cigna Commercial |
$339.26
|
| Rate for Payer: First Health Commercial |
$388.31
|
| Rate for Payer: Humana Commercial |
$347.44
|
| Rate for Payer: Humana KY Medicaid |
$140.57
|
| Rate for Payer: Kentucky WC Medicaid |
$142.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$335.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.70
|
| Rate for Payer: Ohio Health Group HMO |
$306.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.71
|
| Rate for Payer: PHCS Commercial |
$392.40
|
| Rate for Payer: United Healthcare All Payer |
$359.70
|
|
|
ZONEGRAN 25MG CAPSULE
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 68001024200
|
| Hospital Charge Code |
25001774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| 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 |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
ZONEGRAN 25MG CAPSULE
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 68001024200
|
| Hospital Charge Code |
25001774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| 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 |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
ZONEGRAN 50MG EQUIVALENT CAP
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 68001024300
|
| Hospital Charge Code |
25003641
|
|
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
|
|
|
ZONEGRAN 50MG EQUIVALENT CAP
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 68001024300
|
| Hospital Charge Code |
25003641
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| 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
|
| Rate for Payer: Aetna Commercial |
$3.42
|
|
|
ZONEGRAN (ZONISAMIDE)100MG CAP
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 62756026002
|
| Hospital Charge Code |
25001773
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
ZONEGRAN (ZONISAMIDE)100MG CAP
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 62756026002
|
| Hospital Charge Code |
25001773
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
ZO OIL CONTROL PADS
|
Professional
|
Both
|
$62.00
|
|
| Hospital Charge Code |
22200162
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Multiplan PHCS |
$37.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.40
|
| Rate for Payer: UHCCP Medicaid |
$21.70
|
|
|
ZO RENEWAL CREAM
|
Professional
|
Both
|
$106.00
|
|
| Hospital Charge Code |
22200166
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$106.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Multiplan PHCS |
$63.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.20
|
| Rate for Payer: UHCCP Medicaid |
$37.10
|
|
|
ZO RETINOL SKIN BRIGHTEN 0.5%
|
Professional
|
Both
|
$104.00
|
|
| Hospital Charge Code |
22200165
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$104.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.80
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
|
|
ZOSTER(SHINGLES)VACC LIVESQINJ
|
Facility
|
OP
|
$621.53
|
|
|
Service Code
|
HCPCS 90736
|
| Hospital Charge Code |
77000049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$596.67 |
| Rate for Payer: Aetna Commercial |
$478.58
|
| Rate for Payer: Anthem Medicaid |
$213.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$484.79
|
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Cigna Commercial |
$515.87
|
| Rate for Payer: First Health Commercial |
$590.45
|
| Rate for Payer: Humana Commercial |
$528.30
|
| Rate for Payer: Humana KY Medicaid |
$213.74
|
| Rate for Payer: Kentucky WC Medicaid |
$215.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$509.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$458.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$546.95
|
| Rate for Payer: Ohio Health Group HMO |
$466.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.67
|
| Rate for Payer: PHCS Commercial |
$596.67
|
| Rate for Payer: United Healthcare All Payer |
$546.95
|
|
|
ZOSTER(SHINGLES)VACC LIVESQINJ
|
Facility
|
IP
|
$621.53
|
|
|
Service Code
|
HCPCS 90736
|
| Hospital Charge Code |
77000049
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$596.67 |
| Rate for Payer: Aetna Commercial |
$478.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$484.79
|
| Rate for Payer: Cash Price |
$310.76
|
| Rate for Payer: Cigna Commercial |
$515.87
|
| Rate for Payer: First Health Commercial |
$590.45
|
| Rate for Payer: Humana Commercial |
$528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$509.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$458.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$546.95
|
| Rate for Payer: Ohio Health Group HMO |
$466.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.67
|
| Rate for Payer: PHCS Commercial |
$596.67
|
| Rate for Payer: United Healthcare All Payer |
$546.95
|
|
