|
ZYRTEC (CETIRIZINE) 5MG/5ML
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 51672407008
|
| Hospital Charge Code |
25001787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ZYRTEC (CETIRIZINE) 5MG/5ML
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 51672407008
|
| Hospital Charge Code |
25001787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ZYRTEC-D (P-EPHED HC/CETIR)TAB
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 50580072824
|
| Hospital Charge Code |
25001788
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
ZYRTEC-D (P-EPHED HC/CETIR)TAB
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 50580072824
|
| Hospital Charge Code |
25001788
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
ZYVOX 200MG (GEN) IV SOL
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
25002217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem Medicaid |
$41.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Humana KY Medicaid |
$41.61
|
| Rate for Payer: Kentucky WC Medicaid |
$42.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
ZYVOX 200MG (GEN) IV SOL
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
25002217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.16 |
| Rate for Payer: Aetna Commercial |
$93.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.38
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna Commercial |
$100.43
|
| Rate for Payer: First Health Commercial |
$114.95
|
| Rate for Payer: Humana Commercial |
$102.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.48
|
| Rate for Payer: Ohio Health Group HMO |
$90.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.49
|
| Rate for Payer: PHCS Commercial |
$116.16
|
| Rate for Payer: United Healthcare All Payer |
$106.48
|
|
|
ZYVOX (LINEZOLID) 600 MG TAB
|
Facility
|
OP
|
$23.17
|
|
|
Service Code
|
NDC 60687030921
|
| Hospital Charge Code |
25001790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Anthem Medicaid |
$7.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.07
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Cigna Commercial |
$19.23
|
| Rate for Payer: First Health Commercial |
$22.01
|
| Rate for Payer: Humana Commercial |
$19.69
|
| Rate for Payer: Humana KY Medicaid |
$7.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.39
|
| Rate for Payer: Ohio Health Group HMO |
$17.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.99
|
| Rate for Payer: PHCS Commercial |
$22.24
|
| Rate for Payer: United Healthcare All Payer |
$20.39
|
|
|
ZYVOX (LINEZOLID) 600 MG TAB
|
Facility
|
IP
|
$23.17
|
|
|
Service Code
|
NDC 60687030921
|
| Hospital Charge Code |
25001790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.07
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Cigna Commercial |
$19.23
|
| Rate for Payer: First Health Commercial |
$22.01
|
| Rate for Payer: Humana Commercial |
$19.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.39
|
| Rate for Payer: Ohio Health Group HMO |
$17.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.99
|
| Rate for Payer: PHCS Commercial |
$22.24
|
| Rate for Payer: United Healthcare All Payer |
$20.39
|
|
