|
ZINC SULFATE 220 MG 220MG/1CAP
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
25001755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ZINC SULFATE 220 MG 220MG/1CAP
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
25001755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ZINC SULFATE 220 MG TABLET
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 10006073027
|
| Hospital Charge Code |
25004000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINC SULFATE 220 MG TABLET
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 10006073027
|
| Hospital Charge Code |
25004000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINC SULFATE 25MG/5ML
|
Facility
|
OP
|
$345.75
|
|
|
Service Code
|
NDC 517800525
|
| Hospital Charge Code |
25003635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.72 |
| Max. Negotiated Rate |
$331.92 |
| Rate for Payer: Aetna Commercial |
$266.23
|
| Rate for Payer: Anthem Medicaid |
$118.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.69
|
| Rate for Payer: Cash Price |
$172.88
|
| Rate for Payer: Cigna Commercial |
$286.97
|
| Rate for Payer: First Health Commercial |
$328.46
|
| Rate for Payer: Humana Commercial |
$293.89
|
| Rate for Payer: Humana KY Medicaid |
$118.90
|
| Rate for Payer: Kentucky WC Medicaid |
$120.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.26
|
| Rate for Payer: Ohio Health Group HMO |
$259.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.57
|
| Rate for Payer: PHCS Commercial |
$331.92
|
| Rate for Payer: United Healthcare All Payer |
$304.26
|
|
|
ZINC SULFATE 25MG/5ML
|
Facility
|
IP
|
$345.75
|
|
|
Service Code
|
NDC 517800525
|
| Hospital Charge Code |
25003635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.72 |
| Max. Negotiated Rate |
$331.92 |
| Rate for Payer: Aetna Commercial |
$266.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.69
|
| Rate for Payer: Cash Price |
$172.88
|
| Rate for Payer: Cigna Commercial |
$286.97
|
| Rate for Payer: First Health Commercial |
$328.46
|
| Rate for Payer: Humana Commercial |
$293.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$283.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$255.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$304.26
|
| Rate for Payer: Ohio Health Group HMO |
$259.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.57
|
| Rate for Payer: PHCS Commercial |
$331.92
|
| Rate for Payer: United Healthcare All Payer |
$304.26
|
|
|
ZINC SULFATE 50 MG T 50MG/1TAB
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 30768000691
|
| Hospital Charge Code |
25001756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINC SULFATE 50 MG T 50MG/1TAB
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 30768000691
|
| Hospital Charge Code |
25001756
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
ZINECARD 250MG/25ML VIAL
|
Facility
|
IP
|
$1,494.72
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25003903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$448.42 |
| Max. Negotiated Rate |
$1,434.93 |
| Rate for Payer: Aetna Commercial |
$1,150.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.88
|
| Rate for Payer: Cash Price |
$747.36
|
| Rate for Payer: Cigna Commercial |
$1,240.62
|
| Rate for Payer: First Health Commercial |
$1,419.98
|
| Rate for Payer: Humana Commercial |
$1,270.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.36
|
| Rate for Payer: PHCS Commercial |
$1,434.93
|
| Rate for Payer: United Healthcare All Payer |
$1,315.35
|
|
|
ZINECARD 250MG/25ML VIAL
|
Facility
|
OP
|
$1,494.72
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25003903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$1,434.93 |
| Rate for Payer: Aetna Commercial |
$1,150.93
|
| Rate for Payer: Anthem Medicaid |
$514.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$44.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.32
|
| Rate for Payer: Cash Price |
$747.36
|
| Rate for Payer: Cash Price |
$747.36
|
| Rate for Payer: Cigna Commercial |
$1,240.62
|
| Rate for Payer: First Health Commercial |
$1,419.98
|
| Rate for Payer: Humana Commercial |
$1,270.51
|
| Rate for Payer: Humana KY Medicaid |
$514.03
|
| Rate for Payer: Humana Medicare Advantage |
$32.09
|
| Rate for Payer: Kentucky WC Medicaid |
$519.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.36
|
| Rate for Payer: PHCS Commercial |
$1,434.93
|
| Rate for Payer: United Healthcare All Payer |
$1,315.35
|
|
|
ZINECARD 250MG [500MG VIAL]
|
Facility
|
OP
|
$2,989.38
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25002033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$2,869.80 |
| Rate for Payer: Aetna Commercial |
$2,301.82
|
| Rate for Payer: Anthem Medicaid |
$1,028.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,331.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$44.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.32
|
| Rate for Payer: Cash Price |
$1,494.69
|
| Rate for Payer: Cash Price |
$1,494.69
|
| Rate for Payer: Cigna Commercial |
$2,481.19
|
| Rate for Payer: First Health Commercial |
$2,839.91
|
| Rate for Payer: Humana Commercial |
$2,540.97
|
| Rate for Payer: Humana KY Medicaid |
$1,028.05
|
| Rate for Payer: Humana Medicare Advantage |
$32.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,630.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,391.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,062.67
|
| Rate for Payer: PHCS Commercial |
$2,869.80
|
| Rate for Payer: United Healthcare All Payer |
$2,630.65
|
|
|
ZINECARD 250MG [500MG VIAL]
|
Facility
|
IP
|
$2,989.38
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
25002033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$896.81 |
| Max. Negotiated Rate |
$2,869.80 |
| Rate for Payer: Aetna Commercial |
$2,301.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,331.72
|
| Rate for Payer: Cash Price |
$1,494.69
|
| Rate for Payer: Cigna Commercial |
$2,481.19
|
| Rate for Payer: First Health Commercial |
$2,839.91
|
| Rate for Payer: Humana Commercial |
$2,540.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$896.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,630.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,391.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,062.67
|
| Rate for Payer: PHCS Commercial |
$2,869.80
|
| Rate for Payer: United Healthcare All Payer |
$2,630.65
|
|
|
ZINPLAVA 10mg (1,000mg Vial)
|
Facility
|
IP
|
$20,710.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
25004165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,213.00 |
| Max. Negotiated Rate |
$19,881.60 |
| Rate for Payer: Aetna Commercial |
$15,946.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,153.80
|
| Rate for Payer: Cash Price |
$10,355.00
|
| Rate for Payer: Cigna Commercial |
$17,189.30
|
| Rate for Payer: First Health Commercial |
$19,674.50
|
| Rate for Payer: Humana Commercial |
$17,603.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,982.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,283.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,213.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,224.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,017.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,289.90
|
| Rate for Payer: PHCS Commercial |
$19,881.60
|
| Rate for Payer: United Healthcare All Payer |
$18,224.80
|
|
|
ZINPLAVA 10mg (1,000mg Vial)
|
Facility
|
OP
|
$20,710.00
|
|
|
Service Code
|
HCPCS J0565
|
| Hospital Charge Code |
25004165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$19,881.60 |
| Rate for Payer: Aetna Commercial |
$15,946.70
|
| Rate for Payer: Anthem Medicaid |
$7,122.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,153.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$55.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.77
|
| Rate for Payer: Cash Price |
$10,355.00
|
| Rate for Payer: Cash Price |
$10,355.00
|
| Rate for Payer: Cigna Commercial |
$17,189.30
|
| Rate for Payer: First Health Commercial |
$19,674.50
|
| Rate for Payer: Humana Commercial |
$17,603.50
|
| Rate for Payer: Humana KY Medicaid |
$7,122.17
|
| Rate for Payer: Humana Medicare Advantage |
$39.83
|
| Rate for Payer: Kentucky WC Medicaid |
$7,194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,982.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,283.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,265.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,224.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,017.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,289.90
|
| Rate for Payer: PHCS Commercial |
$19,881.60
|
| Rate for Payer: United Healthcare All Payer |
$18,224.80
|
|
|
ZIPPERED BODY GIRDLE LG WHITE
|
Facility
|
IP
|
$1,217.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$365.18 |
| Max. Negotiated Rate |
$1,168.56 |
| Rate for Payer: Aetna Commercial |
$937.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$949.46
|
| Rate for Payer: Cash Price |
$608.62
|
| Rate for Payer: Cigna Commercial |
$1,010.32
|
| Rate for Payer: First Health Commercial |
$1,156.39
|
| Rate for Payer: Humana Commercial |
$1,034.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$998.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$898.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,071.18
|
| Rate for Payer: Ohio Health Group HMO |
$912.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$839.90
|
| Rate for Payer: PHCS Commercial |
$1,168.56
|
| Rate for Payer: United Healthcare All Payer |
$1,071.18
|
|
|
ZIPPERED BODY GIRDLE LG WHITE
|
Facility
|
OP
|
$1,217.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$365.18 |
| Max. Negotiated Rate |
$1,168.56 |
| Rate for Payer: Aetna Commercial |
$937.28
|
| Rate for Payer: Anthem Medicaid |
$418.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$949.46
|
| Rate for Payer: Cash Price |
$608.62
|
| Rate for Payer: Cigna Commercial |
$1,010.32
|
| Rate for Payer: First Health Commercial |
$1,156.39
|
| Rate for Payer: Humana Commercial |
$1,034.66
|
| Rate for Payer: Humana KY Medicaid |
$418.61
|
| Rate for Payer: Kentucky WC Medicaid |
$422.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$998.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$898.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,071.18
|
| Rate for Payer: Ohio Health Group HMO |
$912.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$839.90
|
| Rate for Payer: PHCS Commercial |
$1,168.56
|
| Rate for Payer: United Healthcare All Payer |
$1,071.18
|
|
|
ZIP WIRE ANGLED .035*260CM
|
Facility
|
OP
|
$815.19
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.56 |
| Max. Negotiated Rate |
$782.58 |
| Rate for Payer: Aetna Commercial |
$627.70
|
| Rate for Payer: Anthem Medicaid |
$280.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.85
|
| Rate for Payer: Cash Price |
$407.60
|
| Rate for Payer: Cigna Commercial |
$676.61
|
| Rate for Payer: First Health Commercial |
$774.43
|
| Rate for Payer: Humana Commercial |
$692.91
|
| Rate for Payer: Humana KY Medicaid |
$280.34
|
| Rate for Payer: Kentucky WC Medicaid |
$283.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.37
|
| Rate for Payer: Ohio Health Group HMO |
$611.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.48
|
| Rate for Payer: PHCS Commercial |
$782.58
|
| Rate for Payer: United Healthcare All Payer |
$717.37
|
|
|
ZIP WIRE ANGLED .035*260CM
|
Facility
|
IP
|
$815.19
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.56 |
| Max. Negotiated Rate |
$782.58 |
| Rate for Payer: Aetna Commercial |
$627.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.85
|
| Rate for Payer: Cash Price |
$407.60
|
| Rate for Payer: Cigna Commercial |
$676.61
|
| Rate for Payer: First Health Commercial |
$774.43
|
| Rate for Payer: Humana Commercial |
$692.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.37
|
| Rate for Payer: Ohio Health Group HMO |
$611.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.48
|
| Rate for Payer: PHCS Commercial |
$782.58
|
| Rate for Payer: United Healthcare All Payer |
$717.37
|
|
|
ZIP WIRE STRAIGHT .035*260CM
|
Facility
|
IP
|
$815.19
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.56 |
| Max. Negotiated Rate |
$782.58 |
| Rate for Payer: Aetna Commercial |
$627.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.85
|
| Rate for Payer: Cash Price |
$407.60
|
| Rate for Payer: Cigna Commercial |
$676.61
|
| Rate for Payer: First Health Commercial |
$774.43
|
| Rate for Payer: Humana Commercial |
$692.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.37
|
| Rate for Payer: Ohio Health Group HMO |
$611.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.48
|
| Rate for Payer: PHCS Commercial |
$782.58
|
| Rate for Payer: United Healthcare All Payer |
$717.37
|
|
|
ZIP WIRE STRAIGHT .035*260CM
|
Facility
|
OP
|
$815.19
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.56 |
| Max. Negotiated Rate |
$782.58 |
| Rate for Payer: Aetna Commercial |
$627.70
|
| Rate for Payer: Anthem Medicaid |
$280.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.85
|
| Rate for Payer: Cash Price |
$407.60
|
| Rate for Payer: Cigna Commercial |
$676.61
|
| Rate for Payer: First Health Commercial |
$774.43
|
| Rate for Payer: Humana Commercial |
$692.91
|
| Rate for Payer: Humana KY Medicaid |
$280.34
|
| Rate for Payer: Kentucky WC Medicaid |
$283.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.37
|
| Rate for Payer: Ohio Health Group HMO |
$611.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.48
|
| Rate for Payer: PHCS Commercial |
$782.58
|
| Rate for Payer: United Healthcare All Payer |
$717.37
|
|
|
ZIRABEV 10MG (100 MG VIAL)
|
Facility
|
OP
|
$3,343.03
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
25003978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$3,209.31 |
| Rate for Payer: Aetna Commercial |
$2,574.13
|
| Rate for Payer: Anthem Medicaid |
$1,149.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,607.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$1,671.52
|
| Rate for Payer: Cash Price |
$1,671.52
|
| Rate for Payer: Cigna Commercial |
$2,774.71
|
| Rate for Payer: First Health Commercial |
$3,175.88
|
| Rate for Payer: Humana Commercial |
$2,841.58
|
| Rate for Payer: Humana KY Medicaid |
$1,149.67
|
| Rate for Payer: Humana Medicare Advantage |
$23.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,161.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,741.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,941.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,507.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,674.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,908.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.69
|
| Rate for Payer: PHCS Commercial |
$3,209.31
|
| Rate for Payer: United Healthcare All Payer |
$2,941.87
|
|
|
ZIRABEV 10MG (100 MG VIAL)
|
Facility
|
IP
|
$3,343.03
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
25003978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,002.91 |
| Max. Negotiated Rate |
$3,209.31 |
| Rate for Payer: Aetna Commercial |
$2,574.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,607.56
|
| Rate for Payer: Cash Price |
$1,671.52
|
| Rate for Payer: Cigna Commercial |
$2,774.71
|
| Rate for Payer: First Health Commercial |
$3,175.88
|
| Rate for Payer: Humana Commercial |
$2,841.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,741.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,941.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,507.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,674.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,908.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.69
|
| Rate for Payer: PHCS Commercial |
$3,209.31
|
| Rate for Payer: United Healthcare All Payer |
$2,941.87
|
|
|
ZIRABEV 10MG (400 MG VIAL)
|
Facility
|
IP
|
$13,372.12
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
25003977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,011.64 |
| Max. Negotiated Rate |
$12,837.24 |
| Rate for Payer: Aetna Commercial |
$10,296.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.25
|
| Rate for Payer: Cash Price |
$6,686.06
|
| Rate for Payer: Cigna Commercial |
$11,098.86
|
| Rate for Payer: First Health Commercial |
$12,703.51
|
| Rate for Payer: Humana Commercial |
$11,366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.47
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,697.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,633.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,226.76
|
| Rate for Payer: PHCS Commercial |
$12,837.24
|
| Rate for Payer: United Healthcare All Payer |
$11,767.47
|
|
|
ZIRABEV 10MG (400 MG VIAL)
|
Facility
|
OP
|
$13,372.12
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
25003977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$12,837.24 |
| Rate for Payer: Aetna Commercial |
$10,296.53
|
| Rate for Payer: Anthem Medicaid |
$4,598.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.31
|
| Rate for Payer: Cash Price |
$6,686.06
|
| Rate for Payer: Cash Price |
$6,686.06
|
| Rate for Payer: Cigna Commercial |
$11,098.86
|
| Rate for Payer: First Health Commercial |
$12,703.51
|
| Rate for Payer: Humana Commercial |
$11,366.30
|
| Rate for Payer: Humana KY Medicaid |
$4,598.67
|
| Rate for Payer: Humana Medicare Advantage |
$23.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,645.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,690.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.47
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,697.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,633.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,226.76
|
| Rate for Payer: PHCS Commercial |
$12,837.24
|
| Rate for Payer: United Healthcare All Payer |
$11,767.47
|
|
|
ZITHROMAX 500 MG D5W 250ML PB
|
Facility
|
OP
|
$117.25
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
25001876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.17 |
| Max. Negotiated Rate |
$112.56 |
| Rate for Payer: Aetna Commercial |
$90.28
|
| Rate for Payer: Anthem Medicaid |
$40.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.45
|
| Rate for Payer: Cash Price |
$58.62
|
| Rate for Payer: Cigna Commercial |
$97.32
|
| Rate for Payer: First Health Commercial |
$111.39
|
| Rate for Payer: Humana Commercial |
$99.66
|
| Rate for Payer: Humana KY Medicaid |
$40.32
|
| Rate for Payer: Kentucky WC Medicaid |
$40.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.18
|
| Rate for Payer: Ohio Health Group HMO |
$87.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.90
|
| Rate for Payer: PHCS Commercial |
$112.56
|
| Rate for Payer: United Healthcare All Payer |
$103.18
|
|
