|
ZENITH AAA ILIAC LEG EXT 24*55
|
Facility
|
OP
|
$9,584.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,875.38 |
| Max. Negotiated Rate |
$9,201.22 |
| Rate for Payer: Aetna Commercial |
$7,380.14
|
| Rate for Payer: Anthem Medicaid |
$3,296.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,475.99
|
| Rate for Payer: Cash Price |
$4,792.30
|
| Rate for Payer: Cigna Commercial |
$7,955.22
|
| Rate for Payer: First Health Commercial |
$9,105.37
|
| Rate for Payer: Humana Commercial |
$8,146.91
|
| Rate for Payer: Humana KY Medicaid |
$3,296.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,329.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,859.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,073.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,362.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,434.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,188.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,667.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,338.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,613.37
|
| Rate for Payer: PHCS Commercial |
$9,201.22
|
| Rate for Payer: United Healthcare All Payer |
$8,434.45
|
|
|
ZENITH AAA ILIAC LEG EXT 24*55
|
Facility
|
IP
|
$9,584.60
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,875.38 |
| Max. Negotiated Rate |
$9,201.22 |
| Rate for Payer: Aetna Commercial |
$7,380.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,475.99
|
| Rate for Payer: Cash Price |
$4,792.30
|
| Rate for Payer: Cigna Commercial |
$7,955.22
|
| Rate for Payer: First Health Commercial |
$9,105.37
|
| Rate for Payer: Humana Commercial |
$8,146.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,859.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,073.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,875.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,434.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,188.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,667.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,338.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,613.37
|
| Rate for Payer: PHCS Commercial |
$9,201.22
|
| Rate for Payer: United Healthcare All Payer |
$8,434.45
|
|
|
ZENITH AAA ILIAC PLG ZIP-14-30
|
Facility
|
IP
|
$9,686.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,906.04 |
| Max. Negotiated Rate |
$9,299.33 |
| Rate for Payer: Aetna Commercial |
$7,458.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,555.70
|
| Rate for Payer: Cash Price |
$4,843.40
|
| Rate for Payer: Cigna Commercial |
$8,040.04
|
| Rate for Payer: First Health Commercial |
$9,202.46
|
| Rate for Payer: Humana Commercial |
$8,233.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,749.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,427.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,683.89
|
| Rate for Payer: PHCS Commercial |
$9,299.33
|
| Rate for Payer: United Healthcare All Payer |
$8,524.38
|
|
|
ZENITH AAA ILIAC PLG ZIP-14-30
|
Facility
|
OP
|
$9,686.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,906.04 |
| Max. Negotiated Rate |
$9,299.33 |
| Rate for Payer: Aetna Commercial |
$7,458.84
|
| Rate for Payer: Anthem Medicaid |
$3,331.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,555.70
|
| Rate for Payer: Cash Price |
$4,843.40
|
| Rate for Payer: Cigna Commercial |
$8,040.04
|
| Rate for Payer: First Health Commercial |
$9,202.46
|
| Rate for Payer: Humana Commercial |
$8,233.78
|
| Rate for Payer: Humana KY Medicaid |
$3,331.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,749.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,427.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,683.89
|
| Rate for Payer: PHCS Commercial |
$9,299.33
|
| Rate for Payer: United Healthcare All Payer |
$8,524.38
|
|
|
ZENITH AAA ILIAC PLG ZIP-16-30
|
Facility
|
OP
|
$9,686.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,906.04 |
| Max. Negotiated Rate |
$9,299.33 |
| Rate for Payer: Aetna Commercial |
$7,458.84
|
| Rate for Payer: Anthem Medicaid |
$3,331.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,555.70
|
| Rate for Payer: Cash Price |
$4,843.40
|
| Rate for Payer: Cigna Commercial |
$8,040.04
|
| Rate for Payer: First Health Commercial |
$9,202.46
|
| Rate for Payer: Humana Commercial |
$8,233.78
|
| Rate for Payer: Humana KY Medicaid |
$3,331.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,749.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,427.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,683.89
|
| Rate for Payer: PHCS Commercial |
$9,299.33
|
| Rate for Payer: United Healthcare All Payer |
$8,524.38
|
|
|
ZENITH AAA ILIAC PLG ZIP-16-30
|
Facility
|
IP
|
$9,686.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,906.04 |
| Max. Negotiated Rate |
$9,299.33 |
| Rate for Payer: Aetna Commercial |
$7,458.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,555.70
|
| Rate for Payer: Cash Price |
$4,843.40
|
| Rate for Payer: Cigna Commercial |
$8,040.04
|
| Rate for Payer: First Health Commercial |
$9,202.46
|
| Rate for Payer: Humana Commercial |
$8,233.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,749.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,427.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,683.89
|
| Rate for Payer: PHCS Commercial |
$9,299.33
|
| Rate for Payer: United Healthcare All Payer |
$8,524.38
|
|
|
ZENITH AAA ILIAC PLG ZIP-20-30
|
Facility
|
IP
|
$9,686.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,906.04 |
| Max. Negotiated Rate |
$9,299.33 |
| Rate for Payer: Aetna Commercial |
$7,458.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,555.70
|
| Rate for Payer: Cash Price |
$4,843.40
|
| Rate for Payer: Cigna Commercial |
$8,040.04
|
| Rate for Payer: First Health Commercial |
$9,202.46
|
| Rate for Payer: Humana Commercial |
$8,233.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,749.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,427.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,683.89
|
| Rate for Payer: PHCS Commercial |
$9,299.33
|
| Rate for Payer: United Healthcare All Payer |
$8,524.38
|
|
|
ZENITH AAA ILIAC PLG ZIP-20-30
|
Facility
|
OP
|
$9,686.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,906.04 |
| Max. Negotiated Rate |
$9,299.33 |
| Rate for Payer: Aetna Commercial |
$7,458.84
|
| Rate for Payer: Anthem Medicaid |
$3,331.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,555.70
|
| Rate for Payer: Cash Price |
$4,843.40
|
| Rate for Payer: Cigna Commercial |
$8,040.04
|
| Rate for Payer: First Health Commercial |
$9,202.46
|
| Rate for Payer: Humana Commercial |
$8,233.78
|
| Rate for Payer: Humana KY Medicaid |
$3,331.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,749.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,427.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,683.89
|
| Rate for Payer: PHCS Commercial |
$9,299.33
|
| Rate for Payer: United Healthcare All Payer |
$8,524.38
|
|
|
ZENITH AAA ILIAC PLUGZIP-24-30
|
Facility
|
OP
|
$9,686.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,906.04 |
| Max. Negotiated Rate |
$9,299.33 |
| Rate for Payer: Aetna Commercial |
$7,458.84
|
| Rate for Payer: Anthem Medicaid |
$3,331.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,555.70
|
| Rate for Payer: Cash Price |
$4,843.40
|
| Rate for Payer: Cigna Commercial |
$8,040.04
|
| Rate for Payer: First Health Commercial |
$9,202.46
|
| Rate for Payer: Humana Commercial |
$8,233.78
|
| Rate for Payer: Humana KY Medicaid |
$3,331.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,365.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,398.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,749.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,427.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,683.89
|
| Rate for Payer: PHCS Commercial |
$9,299.33
|
| Rate for Payer: United Healthcare All Payer |
$8,524.38
|
|
|
ZENITH AAA ILIAC PLUGZIP-24-30
|
Facility
|
IP
|
$9,686.80
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,906.04 |
| Max. Negotiated Rate |
$9,299.33 |
| Rate for Payer: Aetna Commercial |
$7,458.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,555.70
|
| Rate for Payer: Cash Price |
$4,843.40
|
| Rate for Payer: Cigna Commercial |
$8,040.04
|
| Rate for Payer: First Health Commercial |
$9,202.46
|
| Rate for Payer: Humana Commercial |
$8,233.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,943.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,906.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,524.38
|
| Rate for Payer: Ohio Health Group HMO |
$7,265.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,749.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,427.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,683.89
|
| Rate for Payer: PHCS Commercial |
$9,299.33
|
| Rate for Payer: United Healthcare All Payer |
$8,524.38
|
|
|
ZENPEP 10/32/42K CAPSULE
|
Facility
|
OP
|
$12.21
|
|
|
Service Code
|
NDC 73562011001
|
| Hospital Charge Code |
25004561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$11.72 |
| Rate for Payer: Aetna Commercial |
$9.40
|
| Rate for Payer: Anthem Medicaid |
$4.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.52
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cigna Commercial |
$10.13
|
| Rate for Payer: First Health Commercial |
$11.60
|
| Rate for Payer: Humana Commercial |
$10.38
|
| Rate for Payer: Humana KY Medicaid |
$4.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.01
|
| 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 |
$9.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.42
|
| Rate for Payer: PHCS Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Payer |
$10.74
|
|
|
ZENPEP 10/32/42K CAPSULE
|
Facility
|
IP
|
$12.21
|
|
|
Service Code
|
NDC 73562011001
|
| Hospital Charge Code |
25004561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$11.72 |
| Rate for Payer: Aetna Commercial |
$9.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.52
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: Cigna Commercial |
$10.13
|
| Rate for Payer: First Health Commercial |
$11.60
|
| Rate for Payer: Humana Commercial |
$10.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.01
|
| 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 |
$9.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.42
|
| Rate for Payer: PHCS Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Payer |
$10.74
|
|
|
ZENPEP 25/79/105K CAPSULE
|
Facility
|
OP
|
$27.21
|
|
|
Service Code
|
NDC 73562011601
|
| Hospital Charge Code |
25004562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$26.12 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Anthem Medicaid |
$9.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.22
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cigna Commercial |
$22.58
|
| Rate for Payer: First Health Commercial |
$25.85
|
| Rate for Payer: Humana Commercial |
$23.13
|
| Rate for Payer: Humana KY Medicaid |
$9.36
|
| Rate for Payer: Kentucky WC Medicaid |
$9.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.94
|
| Rate for Payer: Ohio Health Group HMO |
$20.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.77
|
| Rate for Payer: PHCS Commercial |
$26.12
|
| Rate for Payer: United Healthcare All Payer |
$23.94
|
|
|
ZENPEP 25/79/105K CAPSULE
|
Facility
|
IP
|
$27.21
|
|
|
Service Code
|
NDC 73562011601
|
| Hospital Charge Code |
25004562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$26.12 |
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.22
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cigna Commercial |
$22.58
|
| Rate for Payer: First Health Commercial |
$25.85
|
| Rate for Payer: Humana Commercial |
$23.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.94
|
| Rate for Payer: Ohio Health Group HMO |
$20.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.77
|
| Rate for Payer: PHCS Commercial |
$26.12
|
| Rate for Payer: United Healthcare All Payer |
$23.94
|
|
|
ZENPEP 3/10/14K CAPSULE
|
Facility
|
IP
|
$10.23
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25004566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.98
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.49
|
| Rate for Payer: First Health Commercial |
$9.72
|
| Rate for Payer: Humana Commercial |
$8.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.00
|
| Rate for Payer: Ohio Health Group HMO |
$7.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.06
|
| Rate for Payer: PHCS Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Payer |
$9.00
|
|
|
ZENPEP 3/10/14K CAPSULE
|
Facility
|
OP
|
$10.23
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25004566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem Medicaid |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.98
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.49
|
| Rate for Payer: First Health Commercial |
$9.72
|
| Rate for Payer: Humana Commercial |
$8.70
|
| Rate for Payer: Humana KY Medicaid |
$3.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.00
|
| Rate for Payer: Ohio Health Group HMO |
$7.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.06
|
| Rate for Payer: PHCS Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Payer |
$9.00
|
|
|
ZENPEP 40/126/168K CAPSULE
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
NDC 73562011401
|
| Hospital Charge Code |
25004563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$31.96 |
| Rate for Payer: Aetna Commercial |
$25.63
|
| Rate for Payer: Anthem Medicaid |
$11.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.97
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cigna Commercial |
$27.63
|
| Rate for Payer: First Health Commercial |
$31.63
|
| Rate for Payer: Humana Commercial |
$28.30
|
| Rate for Payer: Humana KY Medicaid |
$11.45
|
| Rate for Payer: Kentucky WC Medicaid |
$11.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.30
|
| Rate for Payer: Ohio Health Group HMO |
$24.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.97
|
| Rate for Payer: PHCS Commercial |
$31.96
|
| Rate for Payer: United Healthcare All Payer |
$29.30
|
|
|
ZENPEP 40/126/168K CAPSULE
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
NDC 73562011401
|
| Hospital Charge Code |
25004563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$31.96 |
| Rate for Payer: Aetna Commercial |
$25.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.97
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cigna Commercial |
$27.63
|
| Rate for Payer: First Health Commercial |
$31.63
|
| Rate for Payer: Humana Commercial |
$28.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.30
|
| Rate for Payer: Ohio Health Group HMO |
$24.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.97
|
| Rate for Payer: PHCS Commercial |
$31.96
|
| Rate for Payer: United Healthcare All Payer |
$29.30
|
|
|
ZENPEP 5/17/24K CAPSULE
|
Facility
|
OP
|
$10.13
|
|
|
Service Code
|
NDC 73562011501
|
| Hospital Charge Code |
25004560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.72 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Anthem Medicaid |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.90
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cigna Commercial |
$8.41
|
| Rate for Payer: First Health Commercial |
$9.62
|
| Rate for Payer: Humana Commercial |
$8.61
|
| Rate for Payer: Humana KY Medicaid |
$3.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.91
|
| Rate for Payer: Ohio Health Group HMO |
$7.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.99
|
| Rate for Payer: PHCS Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Payer |
$8.91
|
|
|
ZENPEP 5/17/24K CAPSULE
|
Facility
|
IP
|
$10.13
|
|
|
Service Code
|
NDC 73562011501
|
| Hospital Charge Code |
25004560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$9.72 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.90
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cigna Commercial |
$8.41
|
| Rate for Payer: First Health Commercial |
$9.62
|
| Rate for Payer: Humana Commercial |
$8.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.91
|
| Rate for Payer: Ohio Health Group HMO |
$7.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.99
|
| Rate for Payer: PHCS Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Payer |
$8.91
|
|
|
ZERBAXA 75mg (1.5gm SDV)
|
Facility
|
IP
|
$950.26
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
25003946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.08 |
| Max. Negotiated Rate |
$912.25 |
| Rate for Payer: Aetna Commercial |
$731.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.20
|
| Rate for Payer: Cash Price |
$475.13
|
| Rate for Payer: Cigna Commercial |
$788.72
|
| Rate for Payer: First Health Commercial |
$902.75
|
| Rate for Payer: Humana Commercial |
$807.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.23
|
| Rate for Payer: Ohio Health Group HMO |
$712.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.68
|
| Rate for Payer: PHCS Commercial |
$912.25
|
| Rate for Payer: United Healthcare All Payer |
$836.23
|
|
|
ZERBAXA 75mg (1.5gm SDV)
|
Facility
|
OP
|
$950.26
|
|
|
Service Code
|
HCPCS J0695
|
| Hospital Charge Code |
25003946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$912.25 |
| Rate for Payer: Aetna Commercial |
$731.70
|
| Rate for Payer: Anthem Medicaid |
$326.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.33
|
| Rate for Payer: Cash Price |
$475.13
|
| Rate for Payer: Cash Price |
$475.13
|
| Rate for Payer: Cigna Commercial |
$788.72
|
| Rate for Payer: First Health Commercial |
$902.75
|
| Rate for Payer: Humana Commercial |
$807.72
|
| Rate for Payer: Humana KY Medicaid |
$326.79
|
| Rate for Payer: Humana Medicare Advantage |
$9.13
|
| Rate for Payer: Kentucky WC Medicaid |
$330.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.23
|
| Rate for Payer: Ohio Health Group HMO |
$712.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.68
|
| Rate for Payer: PHCS Commercial |
$912.25
|
| Rate for Payer: United Healthcare All Payer |
$836.23
|
|
|
ZETIA (EZETIMIBIE) 10 MG TAB
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 59651005290
|
| Hospital Charge Code |
25001750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
ZETIA (EZETIMIBIE) 10 MG TAB
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 59651005290
|
| Hospital Charge Code |
25001750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
ZIAC (BISOPROLOL) 10 10MG/1TAB
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 29300018901
|
| Hospital Charge Code |
25001751
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.19
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
