|
ZARXIO EAMCG (300MCG/0.5MLSYR)
|
Facility
|
OP
|
$1,495.26
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1,435.45 |
| Rate for Payer: Aetna Commercial |
$1,151.35
|
| Rate for Payer: Anthem Medicaid |
$514.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$747.63
|
| 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: Humana KY Medicaid |
$514.22
|
| Rate for Payer: Humana Medicare Advantage |
$0.37
|
| Rate for Payer: Kentucky WC Medicaid |
$519.45
|
| 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 |
$0.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.54
|
| 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
|
|
|
ZARXIO EAMCG(480MCG/0.8MLSYR)
|
Facility
|
OP
|
$2,392.44
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$2,296.74 |
| Rate for Payer: Aetna Commercial |
$1,842.18
|
| Rate for Payer: Anthem Medicaid |
$822.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,866.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$1,196.22
|
| Rate for Payer: Cash Price |
$1,196.22
|
| Rate for Payer: Cigna Commercial |
$1,985.73
|
| Rate for Payer: First Health Commercial |
$2,272.82
|
| Rate for Payer: Humana Commercial |
$2,033.57
|
| Rate for Payer: Humana KY Medicaid |
$822.76
|
| Rate for Payer: Humana Medicare Advantage |
$0.37
|
| Rate for Payer: Kentucky WC Medicaid |
$831.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,961.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,765.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$839.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,105.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,913.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,081.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.78
|
| Rate for Payer: PHCS Commercial |
$2,296.74
|
| Rate for Payer: United Healthcare All Payer |
$2,105.35
|
|
|
ZARXIO EAMCG(480MCG/0.8MLSYR)
|
Facility
|
IP
|
$2,392.44
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
25002724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$717.73 |
| Max. Negotiated Rate |
$2,296.74 |
| Rate for Payer: Aetna Commercial |
$1,842.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,866.10
|
| Rate for Payer: Cash Price |
$1,196.22
|
| Rate for Payer: Cigna Commercial |
$1,985.73
|
| Rate for Payer: First Health Commercial |
$2,272.82
|
| Rate for Payer: Humana Commercial |
$2,033.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,961.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,765.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,105.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,913.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,081.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.78
|
| Rate for Payer: PHCS Commercial |
$2,296.74
|
| Rate for Payer: United Healthcare All Payer |
$2,105.35
|
|
|
ZEBETA 5MG TAB
|
Facility
|
OP
|
$9.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
25001748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: First Health Commercial |
$8.70
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Humana KY Medicaid |
$3.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.06
|
| Rate for Payer: Ohio Health Group HMO |
$6.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.32
|
| Rate for Payer: PHCS Commercial |
$8.79
|
| Rate for Payer: United Healthcare All Payer |
$8.06
|
|
|
ZEBETA 5MG TAB
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
25001748
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: First Health Commercial |
$8.70
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.06
|
| Rate for Payer: Ohio Health Group HMO |
$6.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.32
|
| Rate for Payer: PHCS Commercial |
$8.79
|
| Rate for Payer: United Healthcare All Payer |
$8.06
|
|
|
ZELANTE DVT ANGIOJET CATH
|
Facility
|
OP
|
$13,831.05
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,149.31 |
| Max. Negotiated Rate |
$13,277.81 |
| Rate for Payer: Aetna Commercial |
$10,649.91
|
| Rate for Payer: Anthem Medicaid |
$4,756.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,788.22
|
| Rate for Payer: Cash Price |
$6,915.52
|
| Rate for Payer: Cigna Commercial |
$11,479.77
|
| Rate for Payer: First Health Commercial |
$13,139.50
|
| Rate for Payer: Humana Commercial |
$11,756.39
|
| Rate for Payer: Humana KY Medicaid |
$4,756.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,804.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,341.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,207.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,149.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,851.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,171.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,373.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,064.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,033.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,543.42
|
| Rate for Payer: PHCS Commercial |
$13,277.81
|
| Rate for Payer: United Healthcare All Payer |
$12,171.32
|
|
|
ZELANTE DVT ANGIOJET CATH
|
Facility
|
IP
|
$13,831.05
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,149.31 |
| Max. Negotiated Rate |
$13,277.81 |
| Rate for Payer: Aetna Commercial |
$10,649.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,788.22
|
| Rate for Payer: Cash Price |
$6,915.52
|
| Rate for Payer: Cigna Commercial |
$11,479.77
|
| Rate for Payer: First Health Commercial |
$13,139.50
|
| Rate for Payer: Humana Commercial |
$11,756.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,341.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,207.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,149.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,171.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,373.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,064.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,033.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,543.42
|
| Rate for Payer: PHCS Commercial |
$13,277.81
|
| Rate for Payer: United Healthcare All Payer |
$12,171.32
|
|
|
ZEMAIRA 10MG (1000MG VL)
|
Facility
|
IP
|
$3,324.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$997.35 |
| Max. Negotiated Rate |
$3,191.52 |
| Rate for Payer: Aetna Commercial |
$2,559.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,593.11
|
| Rate for Payer: Cash Price |
$1,662.25
|
| Rate for Payer: Cigna Commercial |
$2,759.34
|
| Rate for Payer: First Health Commercial |
$3,158.28
|
| Rate for Payer: Humana Commercial |
$2,825.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,726.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,453.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$997.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,925.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,493.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,659.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,892.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.91
|
| Rate for Payer: PHCS Commercial |
$3,191.52
|
| Rate for Payer: United Healthcare All Payer |
$2,925.56
|
|
|
ZEMAIRA 10MG (1000MG VL)
|
Facility
|
OP
|
$3,324.50
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
25001849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$3,191.52 |
| Rate for Payer: Aetna Commercial |
$2,559.86
|
| Rate for Payer: Anthem Medicaid |
$1,143.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,593.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.01
|
| Rate for Payer: Cash Price |
$1,662.25
|
| Rate for Payer: Cash Price |
$1,662.25
|
| Rate for Payer: Cigna Commercial |
$2,759.34
|
| Rate for Payer: First Health Commercial |
$3,158.28
|
| Rate for Payer: Humana Commercial |
$2,825.82
|
| Rate for Payer: Humana KY Medicaid |
$1,143.30
|
| Rate for Payer: Humana Medicare Advantage |
$5.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,154.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,726.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,453.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,166.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,925.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,493.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,659.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,892.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.91
|
| Rate for Payer: PHCS Commercial |
$3,191.52
|
| Rate for Payer: United Healthcare All Payer |
$2,925.56
|
|
|
ZEMDRI 5MG (500MG SDV)
|
Facility
|
IP
|
$1,885.16
|
|
|
Service Code
|
HCPCS J0291
|
| Hospital Charge Code |
25001817
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$565.55 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Aetna Commercial |
$1,451.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.42
|
| Rate for Payer: Cash Price |
$942.58
|
| Rate for Payer: Cigna Commercial |
$1,564.68
|
| Rate for Payer: First Health Commercial |
$1,790.90
|
| Rate for Payer: Humana Commercial |
$1,602.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.76
|
| Rate for Payer: PHCS Commercial |
$1,809.75
|
| Rate for Payer: United Healthcare All Payer |
$1,658.94
|
|
|
ZEMDRI 5MG (500MG SDV)
|
Facility
|
OP
|
$1,885.16
|
|
|
Service Code
|
HCPCS J0291
|
| Hospital Charge Code |
25001817
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$1,809.75 |
| Rate for Payer: Aetna Commercial |
$1,451.57
|
| Rate for Payer: Anthem Medicaid |
$648.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.82
|
| Rate for Payer: Cash Price |
$942.58
|
| Rate for Payer: Cash Price |
$942.58
|
| Rate for Payer: Cigna Commercial |
$1,564.68
|
| Rate for Payer: First Health Commercial |
$1,790.90
|
| Rate for Payer: Humana Commercial |
$1,602.39
|
| Rate for Payer: Humana KY Medicaid |
$648.31
|
| Rate for Payer: Humana Medicare Advantage |
$3.57
|
| Rate for Payer: Kentucky WC Medicaid |
$654.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.76
|
| Rate for Payer: PHCS Commercial |
$1,809.75
|
| Rate for Payer: United Healthcare All Payer |
$1,658.94
|
|
|
ZEMPLAR PARICALCITOL 1 MCG CAP
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 49483068703
|
| Hospital Charge Code |
25001749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.21
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
ZEMPLAR PARICALCITOL 1 MCG CAP
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 49483068703
|
| Hospital Charge Code |
25001749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.21
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
ZEMPLAR(PARICALOTOL)1MCG5MCGML
|
Facility
|
IP
|
$122.15
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
25003632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.65 |
| Max. Negotiated Rate |
$117.26 |
| Rate for Payer: Aetna Commercial |
$94.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.28
|
| Rate for Payer: Cash Price |
$61.08
|
| Rate for Payer: Cigna Commercial |
$101.38
|
| Rate for Payer: First Health Commercial |
$116.04
|
| Rate for Payer: Humana Commercial |
$103.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.49
|
| Rate for Payer: Ohio Health Group HMO |
$91.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.28
|
| Rate for Payer: PHCS Commercial |
$117.26
|
| Rate for Payer: United Healthcare All Payer |
$107.49
|
|
|
ZEMPLAR(PARICALOTOL)1MCG5MCGML
|
Facility
|
OP
|
$122.15
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
25003632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.65 |
| Max. Negotiated Rate |
$117.26 |
| Rate for Payer: Aetna Commercial |
$94.06
|
| Rate for Payer: Anthem Medicaid |
$42.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.28
|
| Rate for Payer: Cash Price |
$61.08
|
| Rate for Payer: Cigna Commercial |
$101.38
|
| Rate for Payer: First Health Commercial |
$116.04
|
| Rate for Payer: Humana Commercial |
$103.83
|
| Rate for Payer: Humana KY Medicaid |
$42.01
|
| Rate for Payer: Kentucky WC Medicaid |
$42.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.49
|
| Rate for Payer: Ohio Health Group HMO |
$91.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.28
|
| Rate for Payer: PHCS Commercial |
$117.26
|
| Rate for Payer: United Healthcare All Payer |
$107.49
|
|
|
ZEMURON 100MG/10ML VIAL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
NDC 67457022810
|
| Hospital Charge Code |
25003634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$39.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$39.20
|
| Rate for Payer: Kentucky WC Medicaid |
$39.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
ZEMURON 100MG/10ML VIAL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
NDC 67457022810
|
| Hospital Charge Code |
25003634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
ZEMURON (ROCURONIU) 5 50MG/5ML
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003633
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
ZEMURON (ROCURONIU) 5 50MG/5ML
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003633
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$38.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$38.86
|
| Rate for Payer: Kentucky WC Medicaid |
$39.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
ZENITH AAA COMP KIT ZAK-100C
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
ZENITH AAA COMP KIT ZAK-100C
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
ZENITH AAA ILIAC LEG EXT 16*55
|
Facility
|
IP
|
$10,843.67
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,253.10 |
| Max. Negotiated Rate |
$10,409.92 |
| Rate for Payer: Aetna Commercial |
$8,349.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,458.06
|
| Rate for Payer: Cash Price |
$5,421.84
|
| Rate for Payer: Cigna Commercial |
$9,000.25
|
| Rate for Payer: First Health Commercial |
$10,301.49
|
| Rate for Payer: Humana Commercial |
$9,217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,891.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,002.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,253.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,542.43
|
| Rate for Payer: Ohio Health Group HMO |
$8,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,674.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,433.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,482.13
|
| Rate for Payer: PHCS Commercial |
$10,409.92
|
| Rate for Payer: United Healthcare All Payer |
$9,542.43
|
|
|
ZENITH AAA ILIAC LEG EXT 16*55
|
Facility
|
OP
|
$10,843.67
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,253.10 |
| Max. Negotiated Rate |
$10,409.92 |
| Rate for Payer: Aetna Commercial |
$8,349.63
|
| Rate for Payer: Anthem Medicaid |
$3,729.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,458.06
|
| Rate for Payer: Cash Price |
$5,421.84
|
| Rate for Payer: Cigna Commercial |
$9,000.25
|
| Rate for Payer: First Health Commercial |
$10,301.49
|
| Rate for Payer: Humana Commercial |
$9,217.12
|
| Rate for Payer: Humana KY Medicaid |
$3,729.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,767.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,891.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,002.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,253.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,803.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,542.43
|
| Rate for Payer: Ohio Health Group HMO |
$8,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,674.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,433.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,482.13
|
| Rate for Payer: PHCS Commercial |
$10,409.92
|
| Rate for Payer: United Healthcare All Payer |
$9,542.43
|
|
|
ZENITH AAA ILIAC LEG EXT 18*55
|
Facility
|
IP
|
$11,287.74
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,386.32 |
| Max. Negotiated Rate |
$10,836.23 |
| Rate for Payer: Aetna Commercial |
$8,691.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,804.44
|
| Rate for Payer: Cash Price |
$5,643.87
|
| Rate for Payer: Cigna Commercial |
$9,368.82
|
| Rate for Payer: First Health Commercial |
$10,723.35
|
| Rate for Payer: Humana Commercial |
$9,594.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,255.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,330.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,386.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,933.21
|
| Rate for Payer: Ohio Health Group HMO |
$8,465.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,030.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,820.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,788.54
|
| Rate for Payer: PHCS Commercial |
$10,836.23
|
| Rate for Payer: United Healthcare All Payer |
$9,933.21
|
|
|
ZENITH AAA ILIAC LEG EXT 18*55
|
Facility
|
OP
|
$11,287.74
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,386.32 |
| Max. Negotiated Rate |
$10,836.23 |
| Rate for Payer: Aetna Commercial |
$8,691.56
|
| Rate for Payer: Anthem Medicaid |
$3,881.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,804.44
|
| Rate for Payer: Cash Price |
$5,643.87
|
| Rate for Payer: Cigna Commercial |
$9,368.82
|
| Rate for Payer: First Health Commercial |
$10,723.35
|
| Rate for Payer: Humana Commercial |
$9,594.58
|
| Rate for Payer: Humana KY Medicaid |
$3,881.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,921.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,255.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,330.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,386.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,959.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,933.21
|
| Rate for Payer: Ohio Health Group HMO |
$8,465.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,030.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,820.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,788.54
|
| Rate for Payer: PHCS Commercial |
$10,836.23
|
| Rate for Payer: United Healthcare All Payer |
$9,933.21
|
|
