|
VANCOMYCIN (10mg) 500MG/10ML
|
Facility
|
OP
|
$78.95
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25002409
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Aetna Commercial |
$60.79
|
| Rate for Payer: Anthem Medicaid |
$27.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.58
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cigna Commercial |
$65.53
|
| Rate for Payer: First Health Commercial |
$75.00
|
| Rate for Payer: Humana Commercial |
$67.11
|
| Rate for Payer: Humana KY Medicaid |
$27.15
|
| Rate for Payer: Kentucky WC Medicaid |
$27.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.48
|
| Rate for Payer: Ohio Health Group HMO |
$59.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.48
|
| Rate for Payer: PHCS Commercial |
$75.79
|
| Rate for Payer: United Healthcare All Payer |
$69.48
|
|
|
VANCOMYCIN (10mg)500MG/255ML
|
Facility
|
OP
|
$72.32
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25003893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| 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 |
$57.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.90
|
| Rate for Payer: PHCS Commercial |
$69.43
|
| Rate for Payer: United Healthcare All Payer |
$63.64
|
|
|
VANCOMYCIN (10mg)500MG/255ML
|
Facility
|
IP
|
$72.32
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25003893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| 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 |
$57.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.90
|
| Rate for Payer: PHCS Commercial |
$69.43
|
| Rate for Payer: United Healthcare All Payer |
$63.64
|
|
|
VANCOMYCIN 10MG (500MG PREMIX)
|
Facility
|
OP
|
$49.05
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25004452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.71 |
| 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 |
$14.71
|
| 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 |
$39.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.84
|
| Rate for Payer: PHCS Commercial |
$47.09
|
| Rate for Payer: United Healthcare All Payer |
$43.16
|
|
|
VANCOMYCIN 10MG (500MG PREMIX)
|
Facility
|
IP
|
$49.05
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25004452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.71 |
| 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 |
$14.71
|
| 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 |
$39.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.84
|
| Rate for Payer: PHCS Commercial |
$47.09
|
| Rate for Payer: United Healthcare All Payer |
$43.16
|
|
|
VANCOMYCIN (10mg)500MG VIAL
|
Facility
|
IP
|
$25.16
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25003894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$24.15 |
| 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
|
| 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 |
$20.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.36
|
| Rate for Payer: PHCS Commercial |
$24.15
|
| Rate for Payer: United Healthcare All Payer |
$22.14
|
|
|
VANCOMYCIN (10mg)500MG VIAL
|
Facility
|
OP
|
$25.16
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25003894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| 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 |
$20.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.36
|
| Rate for Payer: PHCS Commercial |
$24.15
|
| Rate for Payer: United Healthcare All Payer |
$22.14
|
|
|
VANCOMYCIN 10MG (5G VIAL)
|
Facility
|
IP
|
$359.26
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25002418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$344.89 |
| Rate for Payer: Aetna Commercial |
$276.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.22
|
| Rate for Payer: Cash Price |
$179.63
|
| Rate for Payer: Cigna Commercial |
$298.19
|
| Rate for Payer: First Health Commercial |
$341.30
|
| Rate for Payer: Humana Commercial |
$305.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.15
|
| Rate for Payer: Ohio Health Group HMO |
$269.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.89
|
| Rate for Payer: PHCS Commercial |
$344.89
|
| Rate for Payer: United Healthcare All Payer |
$316.15
|
|
|
VANCOMYCIN 10MG (5G VIAL)
|
Facility
|
OP
|
$359.26
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25002418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$344.89 |
| Rate for Payer: Aetna Commercial |
$276.63
|
| Rate for Payer: Anthem Medicaid |
$123.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.22
|
| Rate for Payer: Cash Price |
$179.63
|
| Rate for Payer: Cigna Commercial |
$298.19
|
| Rate for Payer: First Health Commercial |
$341.30
|
| Rate for Payer: Humana Commercial |
$305.37
|
| Rate for Payer: Humana KY Medicaid |
$123.55
|
| Rate for Payer: Kentucky WC Medicaid |
$124.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.15
|
| Rate for Payer: Ohio Health Group HMO |
$269.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.89
|
| Rate for Payer: PHCS Commercial |
$344.89
|
| Rate for Payer: United Healthcare All Payer |
$316.15
|
|
|
VANCOMYCIN 10mg750 MG/257.5 ML
|
Facility
|
OP
|
$94.18
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25003895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.25 |
| 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 |
$75.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.98
|
| Rate for Payer: PHCS Commercial |
$90.41
|
| Rate for Payer: United Healthcare All Payer |
$82.88
|
|
|
VANCOMYCIN 10mg750 MG/257.5 ML
|
Facility
|
IP
|
$94.18
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25003895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.25 |
| 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 |
$75.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.98
|
| Rate for Payer: PHCS Commercial |
$90.41
|
| Rate for Payer: United Healthcare All Payer |
$82.88
|
|
|
VANCOMYCIN 125MG CAPSULE
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
NDC 68180016613
|
| Hospital Charge Code |
25003553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.19
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cigna Commercial |
$8.71
|
| Rate for Payer: First Health Commercial |
$9.97
|
| Rate for Payer: Humana Commercial |
$8.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.25
|
| Rate for Payer: PHCS Commercial |
$10.08
|
| Rate for Payer: United Healthcare All Payer |
$9.24
|
|
|
VANCOMYCIN 125MG CAPSULE
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
NDC 68180016613
|
| Hospital Charge Code |
25003553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Anthem Medicaid |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.19
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cigna Commercial |
$8.71
|
| Rate for Payer: First Health Commercial |
$9.97
|
| Rate for Payer: Humana Commercial |
$8.93
|
| Rate for Payer: Humana KY Medicaid |
$3.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.25
|
| Rate for Payer: PHCS Commercial |
$10.08
|
| Rate for Payer: United Healthcare All Payer |
$9.24
|
|
|
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 |
$23.70 |
| Max. Negotiated Rate |
$75.84 |
| 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
|
| 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 |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
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 |
$23.70 |
| 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 |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
VANCOMYCIN PWDR 10MG (10G V)
|
Facility
|
IP
|
$645.23
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25002417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.57 |
| 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 |
$516.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$445.21
|
| Rate for Payer: PHCS Commercial |
$619.42
|
| Rate for Payer: United Healthcare All Payer |
$567.80
|
|
|
VANCOMYCIN PWDR 10MG (10G V)
|
Facility
|
OP
|
$645.23
|
|
|
Service Code
|
HCPCS J3373
|
| Hospital Charge Code |
25002417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.57 |
| 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 |
$516.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$445.21
|
| Rate for Payer: PHCS Commercial |
$619.42
|
| Rate for Payer: United Healthcare All Payer |
$567.80
|
|
|
VANCOMYCIN TROUGH
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
30000052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$13.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.54
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Humana KY Medicaid |
$13.54
|
| Rate for Payer: Humana Medicare Advantage |
$13.54
|
| Rate for Payer: Kentucky WC Medicaid |
$13.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
VANCOMYCIN TROUGH
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
30000052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.22
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
VANDR DST FEM AUG 57.5X10 LL/R
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDR DST FEM AUG 57.5X10 LL/R
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDR DST FEM AUG 57.5X10 RL/L
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDR DST FEM AUG 57.5X10 RL/L
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDR DST FEM AUG 57.5X15 RL/L
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR DST FEM AUG 57.5X15 RL/L
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
