|
VANCOMYCIN 1.75GM PREMIX IVPB
|
Facility
|
IP
|
$181.59
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$174.33 |
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.64
|
| Rate for Payer: Cash Price |
$90.80
|
| Rate for Payer: Cigna Commercial |
$150.72
|
| Rate for Payer: First Health Commercial |
$172.51
|
| Rate for Payer: Humana Commercial |
$154.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.80
|
| Rate for Payer: Ohio Health Group HMO |
$136.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.29
|
| Rate for Payer: PHCS Commercial |
$174.33
|
| Rate for Payer: United Healthcare All Payer |
$159.80
|
|
|
VANCOMYCIN 2GM PREMIX IVPB
|
Facility
|
OP
|
$203.45
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$195.31 |
| Rate for Payer: Aetna Commercial |
$156.66
|
| Rate for Payer: Anthem Medicaid |
$69.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.69
|
| Rate for Payer: Cash Price |
$101.72
|
| Rate for Payer: Cigna Commercial |
$168.86
|
| Rate for Payer: First Health Commercial |
$193.28
|
| Rate for Payer: Humana Commercial |
$172.93
|
| Rate for Payer: Humana KY Medicaid |
$69.97
|
| Rate for Payer: Kentucky WC Medicaid |
$70.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.04
|
| Rate for Payer: Ohio Health Group HMO |
$152.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.07
|
| Rate for Payer: PHCS Commercial |
$195.31
|
| Rate for Payer: United Healthcare All Payer |
$179.04
|
|
|
VANCOMYCIN 2GM PREMIX IVPB
|
Facility
|
IP
|
$203.45
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$195.31 |
| Rate for Payer: Aetna Commercial |
$156.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.69
|
| Rate for Payer: Cash Price |
$101.72
|
| Rate for Payer: Cigna Commercial |
$168.86
|
| Rate for Payer: First Health Commercial |
$193.28
|
| Rate for Payer: Humana Commercial |
$172.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.04
|
| Rate for Payer: Ohio Health Group HMO |
$152.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.07
|
| Rate for Payer: PHCS Commercial |
$195.31
|
| Rate for Payer: United Healthcare All Payer |
$179.04
|
|
|
VANCOMYCIN 500MG (1.25GMIVPB)
|
Facility
|
OP
|
$137.89
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$132.37 |
| Rate for Payer: Aetna Commercial |
$106.18
|
| Rate for Payer: Anthem Medicaid |
$47.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.55
|
| Rate for Payer: Cash Price |
$68.94
|
| Rate for Payer: Cigna Commercial |
$114.45
|
| Rate for Payer: First Health Commercial |
$131.00
|
| Rate for Payer: Humana Commercial |
$117.21
|
| Rate for Payer: Humana KY Medicaid |
$47.42
|
| Rate for Payer: Kentucky WC Medicaid |
$47.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.34
|
| Rate for Payer: Ohio Health Group HMO |
$103.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.75
|
| Rate for Payer: PHCS Commercial |
$132.37
|
| Rate for Payer: United Healthcare All Payer |
$121.34
|
|
|
VANCOMYCIN 500MG (1.25GMIVPB)
|
Facility
|
IP
|
$137.89
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$132.37 |
| Rate for Payer: Aetna Commercial |
$106.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.55
|
| Rate for Payer: Cash Price |
$68.94
|
| Rate for Payer: Cigna Commercial |
$114.45
|
| Rate for Payer: First Health Commercial |
$131.00
|
| Rate for Payer: Humana Commercial |
$117.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.34
|
| Rate for Payer: Ohio Health Group HMO |
$103.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.75
|
| Rate for Payer: PHCS Commercial |
$132.37
|
| Rate for Payer: United Healthcare All Payer |
$121.34
|
|
|
VANCOMYCIN 500mg(1.5gm PreMix)
|
Facility
|
IP
|
$125.35
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
25004449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.77
|
| Rate for Payer: Cash Price |
$62.67
|
| Rate for Payer: Cigna Commercial |
$104.04
|
| Rate for Payer: First Health Commercial |
$119.08
|
| Rate for Payer: Humana Commercial |
$106.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.31
|
| Rate for Payer: Ohio Health Group HMO |
$94.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.86
|
| Rate for Payer: PHCS Commercial |
$120.34
|
| Rate for Payer: United Healthcare All Payer |
$110.31
|
|
|
VANCOMYCIN 500mg(1.5gm PreMix)
|
Facility
|
OP
|
$125.35
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
25004449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Anthem Medicaid |
$43.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.88
|
| Rate for Payer: Cash Price |
$62.67
|
| Rate for Payer: Cash Price |
$62.67
|
| Rate for Payer: Cigna Commercial |
$104.04
|
| Rate for Payer: First Health Commercial |
$119.08
|
| Rate for Payer: Humana Commercial |
$106.55
|
| Rate for Payer: Humana KY Medicaid |
$43.11
|
| Rate for Payer: Humana Medicare Advantage |
$6.58
|
| Rate for Payer: Kentucky WC Medicaid |
$43.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.31
|
| Rate for Payer: Ohio Health Group HMO |
$94.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.86
|
| Rate for Payer: PHCS Commercial |
$120.34
|
| Rate for Payer: United Healthcare All Payer |
$110.31
|
|
|
VANCOMYCIN 500MG[1GM/250ML IV]
|
Facility
|
IP
|
$116.03
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.39 |
| Rate for Payer: Aetna Commercial |
$89.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.50
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cigna Commercial |
$96.30
|
| Rate for Payer: First Health Commercial |
$110.23
|
| Rate for Payer: Humana Commercial |
$98.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.11
|
| Rate for Payer: Ohio Health Group HMO |
$87.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.97
|
| Rate for Payer: PHCS Commercial |
$111.39
|
| Rate for Payer: United Healthcare All Payer |
$102.11
|
|
|
VANCOMYCIN 500MG[1GM/250ML IV]
|
Facility
|
OP
|
$116.03
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.39 |
| Rate for Payer: Aetna Commercial |
$89.34
|
| Rate for Payer: Anthem Medicaid |
$39.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.50
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cigna Commercial |
$96.30
|
| Rate for Payer: First Health Commercial |
$110.23
|
| Rate for Payer: Humana Commercial |
$98.63
|
| Rate for Payer: Humana KY Medicaid |
$39.90
|
| Rate for Payer: Kentucky WC Medicaid |
$40.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.11
|
| Rate for Payer: Ohio Health Group HMO |
$87.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.97
|
| Rate for Payer: PHCS Commercial |
$111.39
|
| Rate for Payer: United Healthcare All Payer |
$102.11
|
|
|
VANCOMYCIN 500MG 1GR POWDER
|
Facility
|
OP
|
$87.42
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$83.92 |
| Rate for Payer: Aetna Commercial |
$67.31
|
| Rate for Payer: Anthem Medicaid |
$30.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.19
|
| Rate for Payer: Cash Price |
$43.71
|
| Rate for Payer: Cigna Commercial |
$72.56
|
| Rate for Payer: First Health Commercial |
$83.05
|
| Rate for Payer: Humana Commercial |
$74.31
|
| Rate for Payer: Humana KY Medicaid |
$30.06
|
| Rate for Payer: Kentucky WC Medicaid |
$30.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.93
|
| Rate for Payer: Ohio Health Group HMO |
$65.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.10
|
| Rate for Payer: PHCS Commercial |
$83.92
|
| Rate for Payer: United Healthcare All Payer |
$76.93
|
|
|
VANCOMYCIN 500MG 1GR POWDER
|
Facility
|
IP
|
$87.42
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$83.92 |
| Rate for Payer: Aetna Commercial |
$67.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.19
|
| Rate for Payer: Cash Price |
$43.71
|
| Rate for Payer: Cigna Commercial |
$72.56
|
| Rate for Payer: First Health Commercial |
$83.05
|
| Rate for Payer: Humana Commercial |
$74.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.93
|
| Rate for Payer: Ohio Health Group HMO |
$65.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.10
|
| Rate for Payer: PHCS Commercial |
$83.92
|
| Rate for Payer: United Healthcare All Payer |
$76.93
|
|
|
VANCOMYCIN 500MG/255ML
|
Facility
|
OP
|
$72.32
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25003893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$69.43 |
| Rate for Payer: Aetna Commercial |
$55.69
|
| Rate for Payer: Anthem Medicaid |
$24.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.41
|
| Rate for Payer: Cash Price |
$36.16
|
| Rate for Payer: Cigna Commercial |
$60.03
|
| Rate for Payer: First Health Commercial |
$68.70
|
| Rate for Payer: Humana Commercial |
$61.47
|
| Rate for Payer: Humana KY Medicaid |
$24.87
|
| Rate for Payer: Kentucky WC Medicaid |
$25.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.64
|
| Rate for Payer: Ohio Health Group HMO |
$54.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.42
|
| Rate for Payer: PHCS Commercial |
$69.43
|
| Rate for Payer: United Healthcare All Payer |
$63.64
|
|
|
VANCOMYCIN 500MG/255ML
|
Facility
|
IP
|
$72.32
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25003893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$69.43 |
| Rate for Payer: Aetna Commercial |
$55.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.41
|
| Rate for Payer: Cash Price |
$36.16
|
| Rate for Payer: Cigna Commercial |
$60.03
|
| Rate for Payer: First Health Commercial |
$68.70
|
| Rate for Payer: Humana Commercial |
$61.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.64
|
| Rate for Payer: Ohio Health Group HMO |
$54.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.42
|
| Rate for Payer: PHCS Commercial |
$69.43
|
| Rate for Payer: United Healthcare All Payer |
$63.64
|
|
|
VANCOMYCIN 500mg (500mgPreMix)
|
Facility
|
OP
|
$49.05
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25004452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$47.09 |
| Rate for Payer: Aetna Commercial |
$37.77
|
| Rate for Payer: Anthem Medicaid |
$16.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.26
|
| Rate for Payer: Cash Price |
$24.52
|
| Rate for Payer: Cigna Commercial |
$40.71
|
| Rate for Payer: First Health Commercial |
$46.60
|
| Rate for Payer: Humana Commercial |
$41.69
|
| Rate for Payer: Humana KY Medicaid |
$16.87
|
| Rate for Payer: Kentucky WC Medicaid |
$17.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.16
|
| Rate for Payer: Ohio Health Group HMO |
$36.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.21
|
| Rate for Payer: PHCS Commercial |
$47.09
|
| Rate for Payer: United Healthcare All Payer |
$43.16
|
|
|
VANCOMYCIN 500mg (500mgPreMix)
|
Facility
|
IP
|
$49.05
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25004452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$47.09 |
| Rate for Payer: Aetna Commercial |
$37.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$38.26
|
| Rate for Payer: Cash Price |
$24.52
|
| Rate for Payer: Cigna Commercial |
$40.71
|
| Rate for Payer: First Health Commercial |
$46.60
|
| Rate for Payer: Humana Commercial |
$41.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.16
|
| Rate for Payer: Ohio Health Group HMO |
$36.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.21
|
| Rate for Payer: PHCS Commercial |
$47.09
|
| Rate for Payer: United Healthcare All Payer |
$43.16
|
|
|
VANCOMYCIN 500mg (750mgPreMix)
|
Facility
|
OP
|
$65.40
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
25004453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem Medicaid |
$22.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.88
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Humana KY Medicaid |
$22.49
|
| Rate for Payer: Humana Medicare Advantage |
$6.58
|
| Rate for Payer: Kentucky WC Medicaid |
$22.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.27
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
|
|
VANCOMYCIN 500mg (750mgPreMix)
|
Facility
|
IP
|
$65.40
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
25004453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.27
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
|
|
VANCOMYCIN 500MG VIAL
|
Facility
|
IP
|
$25.16
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25003894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.14
|
| Rate for Payer: Ohio Health Group HMO |
$18.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.80
|
| Rate for Payer: PHCS Commercial |
$24.15
|
| Rate for Payer: United Healthcare All Payer |
$22.14
|
| Rate for Payer: Aetna Commercial |
$19.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.62
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cigna Commercial |
$20.88
|
| Rate for Payer: First Health Commercial |
$23.90
|
| Rate for Payer: Humana Commercial |
$21.39
|
|
|
VANCOMYCIN 500MG VIAL
|
Facility
|
OP
|
$25.16
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25003894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna Commercial |
$19.37
|
| Rate for Payer: Anthem Medicaid |
$8.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.62
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cigna Commercial |
$20.88
|
| Rate for Payer: First Health Commercial |
$23.90
|
| Rate for Payer: Humana Commercial |
$21.39
|
| Rate for Payer: Humana KY Medicaid |
$8.65
|
| Rate for Payer: Kentucky WC Medicaid |
$8.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.14
|
| Rate for Payer: Ohio Health Group HMO |
$18.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.80
|
| Rate for Payer: PHCS Commercial |
$24.15
|
| Rate for Payer: United Healthcare All Payer |
$22.14
|
|
|
VANCOMYCIN 750 MG/257.5 ML
|
Facility
|
IP
|
$94.18
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25003895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$90.41 |
| Rate for Payer: Aetna Commercial |
$72.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.46
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cigna Commercial |
$78.17
|
| Rate for Payer: First Health Commercial |
$89.47
|
| Rate for Payer: Humana Commercial |
$80.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.88
|
| Rate for Payer: Ohio Health Group HMO |
$70.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.20
|
| Rate for Payer: PHCS Commercial |
$90.41
|
| Rate for Payer: United Healthcare All Payer |
$82.88
|
|
|
VANCOMYCIN 750 MG/257.5 ML
|
Facility
|
OP
|
$94.18
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25003895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$90.41 |
| Rate for Payer: Aetna Commercial |
$72.52
|
| Rate for Payer: Anthem Medicaid |
$32.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.46
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cigna Commercial |
$78.17
|
| Rate for Payer: First Health Commercial |
$89.47
|
| Rate for Payer: Humana Commercial |
$80.05
|
| Rate for Payer: Humana KY Medicaid |
$32.39
|
| Rate for Payer: Kentucky WC Medicaid |
$32.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.88
|
| Rate for Payer: Ohio Health Group HMO |
$70.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.20
|
| Rate for Payer: PHCS Commercial |
$90.41
|
| Rate for Payer: United Healthcare All Payer |
$82.88
|
|
|
VANCOMYCIN INTRVTRL 1MG/0.1 MJ
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
NDC 70436002082
|
| Hospital Charge Code |
25003554
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
|
|
VANCOMYCIN INTRVTRL 1MG/0.1 MJ
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
NDC 70436002082
|
| Hospital Charge Code |
25003554
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
VANCOMYCIN POWDER 500MG(10G V)
|
Facility
|
OP
|
$645.23
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.88 |
| Max. Negotiated Rate |
$619.42 |
| Rate for Payer: Aetna Commercial |
$496.83
|
| Rate for Payer: Anthem Medicaid |
$221.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.28
|
| Rate for Payer: Cash Price |
$322.62
|
| Rate for Payer: Cigna Commercial |
$535.54
|
| Rate for Payer: First Health Commercial |
$612.97
|
| Rate for Payer: Humana Commercial |
$548.45
|
| Rate for Payer: Humana KY Medicaid |
$221.89
|
| Rate for Payer: Kentucky WC Medicaid |
$224.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$529.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$226.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.80
|
| Rate for Payer: Ohio Health Group HMO |
$483.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.02
|
| Rate for Payer: PHCS Commercial |
$619.42
|
| Rate for Payer: United Healthcare All Payer |
$567.80
|
|
|
VANCOMYCIN POWDER 500MG(10G V)
|
Facility
|
IP
|
$645.23
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.88 |
| Max. Negotiated Rate |
$619.42 |
| Rate for Payer: Aetna Commercial |
$496.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.28
|
| Rate for Payer: Cash Price |
$322.62
|
| Rate for Payer: Cigna Commercial |
$535.54
|
| Rate for Payer: First Health Commercial |
$612.97
|
| Rate for Payer: Humana Commercial |
$548.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$529.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.80
|
| Rate for Payer: Ohio Health Group HMO |
$483.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.02
|
| Rate for Payer: PHCS Commercial |
$619.42
|
| Rate for Payer: United Healthcare All Payer |
$567.80
|
|
