|
YERVOY 1mg (50mg Vial)
|
Facility
|
IP
|
$48,380.74
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
25003723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,514.22 |
| Max. Negotiated Rate |
$46,445.51 |
| Rate for Payer: Aetna Commercial |
$37,253.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37,736.98
|
| Rate for Payer: Cash Price |
$24,190.37
|
| Rate for Payer: Cigna Commercial |
$40,156.01
|
| Rate for Payer: First Health Commercial |
$45,961.70
|
| Rate for Payer: Humana Commercial |
$41,123.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39,672.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35,704.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,514.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$42,575.05
|
| Rate for Payer: Ohio Health Group HMO |
$36,285.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38,704.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42,091.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,382.71
|
| Rate for Payer: PHCS Commercial |
$46,445.51
|
| Rate for Payer: United Healthcare All Payer |
$42,575.05
|
|
|
YERVOY 1mg (50mg Vial)
|
Facility
|
OP
|
$48,380.74
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
25003723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.41 |
| Max. Negotiated Rate |
$46,445.51 |
| Rate for Payer: Aetna Commercial |
$37,253.17
|
| Rate for Payer: Anthem Medicaid |
$16,638.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37,736.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$256.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.60
|
| Rate for Payer: Cash Price |
$24,190.37
|
| Rate for Payer: Cash Price |
$24,190.37
|
| Rate for Payer: Cigna Commercial |
$40,156.01
|
| Rate for Payer: First Health Commercial |
$45,961.70
|
| Rate for Payer: Humana Commercial |
$41,123.63
|
| Rate for Payer: Humana KY Medicaid |
$16,638.14
|
| Rate for Payer: Humana Medicare Advantage |
$183.41
|
| Rate for Payer: Kentucky WC Medicaid |
$16,807.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39,672.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35,704.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,971.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$42,575.05
|
| Rate for Payer: Ohio Health Group HMO |
$36,285.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38,704.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42,091.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,382.71
|
| Rate for Payer: PHCS Commercial |
$46,445.51
|
| Rate for Payer: United Healthcare All Payer |
$42,575.05
|
|
|
YOKE OSS REINFORCED
|
Facility
|
IP
|
$8,829.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,648.86 |
| Max. Negotiated Rate |
$8,476.34 |
| Rate for Payer: Aetna Commercial |
$6,798.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,887.03
|
| Rate for Payer: Cash Price |
$4,414.76
|
| Rate for Payer: Cigna Commercial |
$7,328.50
|
| Rate for Payer: First Health Commercial |
$8,388.04
|
| Rate for Payer: Humana Commercial |
$7,505.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,240.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,516.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,648.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,769.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,622.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,063.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,681.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,092.37
|
| Rate for Payer: PHCS Commercial |
$8,476.34
|
| Rate for Payer: United Healthcare All Payer |
$7,769.98
|
|
|
YOKE OSS REINFORCED
|
Facility
|
OP
|
$8,829.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,648.86 |
| Max. Negotiated Rate |
$8,476.34 |
| Rate for Payer: Aetna Commercial |
$6,798.73
|
| Rate for Payer: Anthem Medicaid |
$3,036.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,887.03
|
| Rate for Payer: Cash Price |
$4,414.76
|
| Rate for Payer: Cigna Commercial |
$7,328.50
|
| Rate for Payer: First Health Commercial |
$8,388.04
|
| Rate for Payer: Humana Commercial |
$7,505.09
|
| Rate for Payer: Humana KY Medicaid |
$3,036.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,067.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,240.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,516.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,648.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,769.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,622.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,063.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,681.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,092.37
|
| Rate for Payer: PHCS Commercial |
$8,476.34
|
| Rate for Payer: United Healthcare All Payer |
$7,769.98
|
|
|
Y-PLATE 5TH MET LT
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
Y-PLATE 5TH MET LT
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
Y-PLATE 5TH MET RT
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
Y-PLATE 5TH MET RT
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
Y-TEC PROCEDURE PACK STD
|
Facility
|
OP
|
$2,037.20
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem Medicaid |
$700.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Humana KY Medicaid |
$700.59
|
| Rate for Payer: Kentucky WC Medicaid |
$707.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
Y-TEC PROCEDURE PACK STD
|
Facility
|
IP
|
$2,037.20
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
YTTRIU 90 IBRITUMO TIUX PR DOS
|
Facility
|
IP
|
$63,605.00
|
|
|
Service Code
|
HCPCS A9543
|
| Hospital Charge Code |
34000058
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$19,081.50 |
| Max. Negotiated Rate |
$61,060.80 |
| Rate for Payer: Aetna Commercial |
$48,975.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,611.90
|
| Rate for Payer: Cash Price |
$31,802.50
|
| Rate for Payer: Cigna Commercial |
$52,792.15
|
| Rate for Payer: First Health Commercial |
$60,424.75
|
| Rate for Payer: Humana Commercial |
$54,064.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,156.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46,940.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,081.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$55,972.40
|
| Rate for Payer: Ohio Health Group HMO |
$47,703.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50,884.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55,336.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43,887.45
|
| Rate for Payer: PHCS Commercial |
$61,060.80
|
| Rate for Payer: United Healthcare All Payer |
$55,972.40
|
|
|
YTTRIU 90 IBRITUMO TIUX PR DOS
|
Facility
|
OP
|
$63,605.00
|
|
|
Service Code
|
HCPCS A9543
|
| Hospital Charge Code |
34000058
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$21,873.76 |
| Max. Negotiated Rate |
$79,554.37 |
| Rate for Payer: Aetna Commercial |
$48,975.85
|
| Rate for Payer: Anthem Medicaid |
$21,873.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$56,824.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,611.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$79,554.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$76,713.14
|
| Rate for Payer: Cash Price |
$31,802.50
|
| Rate for Payer: Cash Price |
$31,802.50
|
| Rate for Payer: Cigna Commercial |
$52,792.15
|
| Rate for Payer: First Health Commercial |
$60,424.75
|
| Rate for Payer: Humana Commercial |
$54,064.25
|
| Rate for Payer: Humana KY Medicaid |
$21,873.76
|
| Rate for Payer: Humana Medicare Advantage |
$56,824.55
|
| Rate for Payer: Kentucky WC Medicaid |
$22,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,156.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46,940.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68,189.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,312.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$55,972.40
|
| Rate for Payer: Ohio Health Group HMO |
$47,703.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50,884.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55,336.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43,887.45
|
| Rate for Payer: PHCS Commercial |
$61,060.80
|
| Rate for Payer: United Healthcare All Payer |
$55,972.40
|
|
|
ZADITOR 0.025% DROPS 5ML
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 65401105
|
| Hospital Charge Code |
25001737
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem Medicaid |
$0.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.09
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Humana KY Medicaid |
$0.04
|
| Rate for Payer: Kentucky WC Medicaid |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.10
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.08
|
| Rate for Payer: PHCS Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Payer |
$0.10
|
|
|
ZADITOR 0.025% DROPS 5ML
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 65401105
|
| Hospital Charge Code |
25001737
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.09
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.10
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.08
|
| Rate for Payer: PHCS Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Payer |
$0.10
|
|
|
ZALTRAP 1MG[100MG/4ML VIAL]
|
Facility
|
OP
|
$8,720.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
25002695
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$8,371.20 |
| Rate for Payer: Aetna Commercial |
$6,714.40
|
| Rate for Payer: Anthem Medicaid |
$2,998.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,801.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.77
|
| Rate for Payer: Cash Price |
$4,360.00
|
| Rate for Payer: Cash Price |
$4,360.00
|
| Rate for Payer: Cigna Commercial |
$7,237.60
|
| Rate for Payer: First Health Commercial |
$8,284.00
|
| Rate for Payer: Humana Commercial |
$7,412.00
|
| Rate for Payer: Humana KY Medicaid |
$2,998.81
|
| Rate for Payer: Humana Medicare Advantage |
$7.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,029.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,150.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,435.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,058.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,673.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,586.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,016.80
|
| Rate for Payer: PHCS Commercial |
$8,371.20
|
| Rate for Payer: United Healthcare All Payer |
$7,673.60
|
|
|
ZALTRAP 1MG[100MG/4ML VIAL]
|
Facility
|
IP
|
$8,720.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
25002695
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,616.00 |
| Max. Negotiated Rate |
$8,371.20 |
| Rate for Payer: Aetna Commercial |
$6,714.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,801.60
|
| Rate for Payer: Cash Price |
$4,360.00
|
| Rate for Payer: Cigna Commercial |
$7,237.60
|
| Rate for Payer: First Health Commercial |
$8,284.00
|
| Rate for Payer: Humana Commercial |
$7,412.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,150.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,435.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,616.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,673.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,586.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,016.80
|
| Rate for Payer: PHCS Commercial |
$8,371.20
|
| Rate for Payer: United Healthcare All Payer |
$7,673.60
|
|
|
ZANAFLEX (TIZANIDINE) 2MG TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 55111017915
|
| Hospital Charge Code |
25001738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| 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 |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ZANAFLEX (TIZANIDINE) 2MG TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 55111017915
|
| Hospital Charge Code |
25001738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| 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 |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ZANAFLEX (TIZANIDINE) 4 MG TAB
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
NDC 50268076015
|
| Hospital Charge Code |
25001739
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
ZANAFLEX (TIZANIDINE) 4 MG TAB
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 50268076015
|
| Hospital Charge Code |
25001739
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.62
|
| Rate for Payer: Humana Commercial |
$4.13
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.28
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.35
|
| Rate for Payer: PHCS Commercial |
$4.67
|
| Rate for Payer: United Healthcare All Payer |
$4.28
|
|
|
ZAROXOLYN (METOLAZO 2.5MG/1TAB
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 72888005201
|
| Hospital Charge Code |
25001744
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| 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 |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ZAROXOLYN (METOLAZO 2.5MG/1TAB
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 72888005201
|
| Hospital Charge Code |
25001744
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| 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 |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ZAROXOLYN (METOLAZONE 5MG/1TAB
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 72888005301
|
| Hospital Charge Code |
25001746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
ZAROXOLYN (METOLAZONE 5MG/1TAB
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 72888005301
|
| Hospital Charge Code |
25001746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
ZARXIO EAMCG (300MCG/0.5MLSYR)
|
Facility
|
IP
|
$1,495.26
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$448.58 |
| Max. Negotiated Rate |
$1,435.45 |
| Rate for Payer: Aetna Commercial |
$1,151.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.30
|
| Rate for Payer: Cash Price |
$747.63
|
| Rate for Payer: Cigna Commercial |
$1,241.07
|
| Rate for Payer: First Health Commercial |
$1,420.50
|
| Rate for Payer: Humana Commercial |
$1,270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,226.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.73
|
| Rate for Payer: PHCS Commercial |
$1,435.45
|
| Rate for Payer: United Healthcare All Payer |
$1,315.83
|
|
