|
ZITHROMAX 500 MG D5W 250ML PB
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
ZITHROMAX 500MG VIAL
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
25001877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
ZITHROMAX 500MG VIAL
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
25001877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem Medicaid |
$38.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Humana KY Medicaid |
$38.52
|
| Rate for Payer: Kentucky WC Medicaid |
$38.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
ZITHROMAX(AZITH)100MG/5ML 15ML
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
NDC 59762311001
|
| Hospital Charge Code |
25003638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$18.23
|
| Rate for Payer: Anthem Medicaid |
$8.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.46
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cigna Commercial |
$19.65
|
| Rate for Payer: First Health Commercial |
$22.49
|
| Rate for Payer: Humana Commercial |
$20.12
|
| Rate for Payer: Humana KY Medicaid |
$8.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.83
|
| Rate for Payer: Ohio Health Group HMO |
$17.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.33
|
| Rate for Payer: PHCS Commercial |
$22.72
|
| Rate for Payer: United Healthcare All Payer |
$20.83
|
|
|
ZITHROMAX(AZITH)100MG/5ML 15ML
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
NDC 59762311001
|
| Hospital Charge Code |
25003638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$18.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.46
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cigna Commercial |
$19.65
|
| Rate for Payer: First Health Commercial |
$22.49
|
| Rate for Payer: Humana Commercial |
$20.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.83
|
| Rate for Payer: Ohio Health Group HMO |
$17.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.33
|
| Rate for Payer: PHCS Commercial |
$22.72
|
| Rate for Payer: United Healthcare All Payer |
$20.83
|
|
|
ZITHROMAX(AZITH)200MG/5ML 15ML
|
Facility
|
OP
|
$11.33
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
25003636
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Anthem Medicaid |
$3.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.84
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.40
|
| Rate for Payer: First Health Commercial |
$10.76
|
| Rate for Payer: Humana Commercial |
$9.63
|
| Rate for Payer: Humana KY Medicaid |
$3.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.97
|
| Rate for Payer: Ohio Health Group HMO |
$8.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.82
|
| Rate for Payer: PHCS Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Payer |
$9.97
|
|
|
ZITHROMAX(AZITH)200MG/5ML 15ML
|
Facility
|
IP
|
$11.33
|
|
|
Service Code
|
NDC 59762314001
|
| Hospital Charge Code |
25003636
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.84
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.40
|
| Rate for Payer: First Health Commercial |
$10.76
|
| Rate for Payer: Humana Commercial |
$9.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.97
|
| Rate for Payer: Ohio Health Group HMO |
$8.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.82
|
| Rate for Payer: PHCS Commercial |
$10.88
|
| Rate for Payer: United Healthcare All Payer |
$9.97
|
|
|
ZITHROMAX (AZITHROM 250MG/1CAP
|
Facility
|
OP
|
$9.56
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$7.36
|
| Rate for Payer: Anthem Medicaid |
$3.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.46
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: First Health Commercial |
$9.08
|
| Rate for Payer: Humana Commercial |
$8.13
|
| Rate for Payer: Humana KY Medicaid |
$3.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.41
|
| Rate for Payer: Ohio Health Group HMO |
$7.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.60
|
| Rate for Payer: PHCS Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Payer |
$8.41
|
|
|
ZITHROMAX (AZITHROM 250MG/1CAP
|
Facility
|
IP
|
$9.56
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25002525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$7.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.46
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna Commercial |
$7.93
|
| Rate for Payer: First Health Commercial |
$9.08
|
| Rate for Payer: Humana Commercial |
$8.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.41
|
| Rate for Payer: Ohio Health Group HMO |
$7.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.60
|
| Rate for Payer: PHCS Commercial |
$9.18
|
| Rate for Payer: United Healthcare All Payer |
$8.41
|
|
|
ZMR PRSS-FT HUM STEM 10.5*110
|
Facility
|
IP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZMR PRSS-FT HUM STEM 10.5*110
|
Facility
|
OP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem Medicaid |
$7,825.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Humana KY Medicaid |
$7,825.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZOCOR (SIMVASTATIN) 10MG/1TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 68180047802
|
| Hospital Charge Code |
25001758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ZOCOR (SIMVASTATIN) 10MG/1TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 68180047802
|
| Hospital Charge Code |
25001758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ZOCOR (SIMVASTATIN) 20MG TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 68180047902
|
| Hospital Charge Code |
25001759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ZOCOR (SIMVASTATIN) 20MG TAB
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 68180047902
|
| Hospital Charge Code |
25001759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
ZOCOR (SIMVASTATIN) 40MG TAB
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 60687021001
|
| Hospital Charge Code |
25001760
|
|
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
|
|
|
ZOCOR (SIMVASTATIN) 40MG TAB
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 60687021001
|
| Hospital Charge Code |
25001760
|
|
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
|
|
|
ZOCOR (SIMVASTATIN) 5MG TAB
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 16729015615
|
| Hospital Charge Code |
25001761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ZOCOR (SIMVASTATIN) 5MG TAB
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 16729015615
|
| Hospital Charge Code |
25001761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ZO ENYMATIC PEEL
|
Professional
|
Both
|
$72.00
|
|
| Hospital Charge Code |
22200201
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Multiplan PHCS |
$43.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.40
|
| Rate for Payer: UHCCP Medicaid |
$25.20
|
|
|
ZO FIRMING SERUM
|
Professional
|
Both
|
$235.00
|
|
| Hospital Charge Code |
22200202
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25002285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$60.92 |
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.50
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Cigna Commercial |
$52.67
|
| Rate for Payer: First Health Commercial |
$60.29
|
| Rate for Payer: Humana Commercial |
$53.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.84
|
| Rate for Payer: Ohio Health Group HMO |
$47.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.79
|
| Rate for Payer: PHCS Commercial |
$60.92
|
| Rate for Payer: United Healthcare All Payer |
$55.84
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
IP
|
$15.87
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna Commercial |
$12.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.38
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Cigna Commercial |
$13.17
|
| Rate for Payer: First Health Commercial |
$15.08
|
| Rate for Payer: Humana Commercial |
$13.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.97
|
| Rate for Payer: Ohio Health Group HMO |
$11.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.95
|
| Rate for Payer: PHCS Commercial |
$15.24
|
| Rate for Payer: United Healthcare All Payer |
$13.97
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25002285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$60.92 |
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: Anthem Medicaid |
$21.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.50
|
| Rate for Payer: Cash Price |
$31.73
|
| Rate for Payer: Cigna Commercial |
$52.67
|
| Rate for Payer: First Health Commercial |
$60.29
|
| Rate for Payer: Humana Commercial |
$53.94
|
| Rate for Payer: Humana KY Medicaid |
$21.82
|
| Rate for Payer: Kentucky WC Medicaid |
$22.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.84
|
| Rate for Payer: Ohio Health Group HMO |
$47.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.79
|
| Rate for Payer: PHCS Commercial |
$60.92
|
| Rate for Payer: United Healthcare All Payer |
$55.84
|
|
|
ZOFRAN 1MG (4MG/2ML VL)
|
Facility
|
OP
|
$15.87
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600046
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna Commercial |
$12.22
|
| Rate for Payer: Anthem Medicaid |
$5.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.38
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Cigna Commercial |
$13.17
|
| Rate for Payer: First Health Commercial |
$15.08
|
| Rate for Payer: Humana Commercial |
$13.49
|
| Rate for Payer: Humana KY Medicaid |
$5.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.97
|
| Rate for Payer: Ohio Health Group HMO |
$11.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.95
|
| Rate for Payer: PHCS Commercial |
$15.24
|
| Rate for Payer: United Healthcare All Payer |
$13.97
|
|
