VIGAMOX 0.5%(MOXIFOX HCL) SOL
|
Facility
|
IP
|
$1.50
|
|
Service Code
|
NDC 68180042201
|
Hospital Charge Code |
25003575
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.20 |
Max. Negotiated Rate |
$1.44 |
Rate for Payer: Aetna Commercial |
$1.16
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1.17
|
Rate for Payer: Cash Price |
$0.75
|
Rate for Payer: Cigna Commercial |
$1.24
|
Rate for Payer: First Health Commercial |
$1.42
|
Rate for Payer: Humana Commercial |
$1.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$0.45
|
Rate for Payer: Ohio Health Choice Commercial |
$1.32
|
Rate for Payer: Ohio Health Group HMO |
$1.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$0.30
|
Rate for Payer: Ohio Health Group PPO No Differential |
$0.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.47
|
Rate for Payer: PHCS Commercial |
$1.44
|
Rate for Payer: United Healthcare All Payer |
$1.32
|
|
VIMPAT 100MG TABLET
|
Facility
|
IP
|
$78.41
|
|
Service Code
|
NDC 131247835
|
Hospital Charge Code |
25001670
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$10.19 |
Max. Negotiated Rate |
$75.27 |
Rate for Payer: Aetna Commercial |
$60.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$61.16
|
Rate for Payer: Cash Price |
$39.20
|
Rate for Payer: Cigna Commercial |
$65.08
|
Rate for Payer: First Health Commercial |
$74.49
|
Rate for Payer: Humana Commercial |
$66.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$64.30
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.52
|
Rate for Payer: Ohio Health Choice Commercial |
$69.00
|
Rate for Payer: Ohio Health Group HMO |
$58.81
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.68
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.31
|
Rate for Payer: PHCS Commercial |
$75.27
|
Rate for Payer: United Healthcare All Payer |
$69.00
|
|
VIMPAT 100MG TABLET
|
Facility
|
OP
|
$78.41
|
|
Service Code
|
NDC 131247835
|
Hospital Charge Code |
25001670
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$10.19 |
Max. Negotiated Rate |
$75.27 |
Rate for Payer: Aetna Commercial |
$60.38
|
Rate for Payer: Anthem Medicaid |
$26.97
|
Rate for Payer: Anthem POS/PPO/Traditional |
$61.16
|
Rate for Payer: Cash Price |
$39.20
|
Rate for Payer: Cigna Commercial |
$65.08
|
Rate for Payer: First Health Commercial |
$74.49
|
Rate for Payer: Humana Commercial |
$66.65
|
Rate for Payer: Humana KY Medicaid |
$26.97
|
Rate for Payer: Kentucky WC Medicaid |
$27.24
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$64.30
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.52
|
Rate for Payer: Molina Healthcare Medicaid |
$27.51
|
Rate for Payer: Ohio Health Choice Commercial |
$69.00
|
Rate for Payer: Ohio Health Group HMO |
$58.81
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.68
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.31
|
Rate for Payer: PHCS Commercial |
$75.27
|
Rate for Payer: United Healthcare All Payer |
$69.00
|
|
VIMPAT 150MG TABLET
|
Facility
|
IP
|
$79.50
|
|
Service Code
|
NDC 131247935
|
Hospital Charge Code |
25001671
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$10.34 |
Max. Negotiated Rate |
$76.32 |
Rate for Payer: Aetna Commercial |
$61.22
|
Rate for Payer: Anthem POS/PPO/Traditional |
$62.01
|
Rate for Payer: Cash Price |
$39.75
|
Rate for Payer: Cigna Commercial |
$65.98
|
Rate for Payer: First Health Commercial |
$75.52
|
Rate for Payer: Humana Commercial |
$67.58
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$65.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.67
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.85
|
Rate for Payer: Ohio Health Choice Commercial |
$69.96
|
Rate for Payer: Ohio Health Group HMO |
$59.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.64
|
Rate for Payer: PHCS Commercial |
$76.32
|
Rate for Payer: United Healthcare All Payer |
$69.96
|
|
VIMPAT 150MG TABLET
|
Facility
|
OP
|
$79.50
|
|
Service Code
|
NDC 131247935
|
Hospital Charge Code |
25001671
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$10.34 |
Max. Negotiated Rate |
$76.32 |
Rate for Payer: Aetna Commercial |
$61.22
|
Rate for Payer: Anthem Medicaid |
$27.34
|
Rate for Payer: Anthem POS/PPO/Traditional |
$62.01
|
Rate for Payer: Cash Price |
$39.75
|
Rate for Payer: Cigna Commercial |
$65.98
|
Rate for Payer: First Health Commercial |
$75.52
|
Rate for Payer: Humana Commercial |
$67.58
|
Rate for Payer: Humana KY Medicaid |
$27.34
|
Rate for Payer: Kentucky WC Medicaid |
$27.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$65.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.67
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.85
|
Rate for Payer: Molina Healthcare Medicaid |
$27.89
|
Rate for Payer: Ohio Health Choice Commercial |
$69.96
|
Rate for Payer: Ohio Health Group HMO |
$59.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.64
|
Rate for Payer: PHCS Commercial |
$76.32
|
Rate for Payer: United Healthcare All Payer |
$69.96
|
|
VIMPAT 1MG (200MG/20ML VIAL)
|
Facility
|
IP
|
$167.50
|
|
Service Code
|
HCPCS C9254
|
Hospital Charge Code |
25001814
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$21.78 |
Max. Negotiated Rate |
$160.80 |
Rate for Payer: Aetna Commercial |
$128.98
|
Rate for Payer: Anthem POS/PPO/Traditional |
$130.65
|
Rate for Payer: Cash Price |
$83.75
|
Rate for Payer: Cigna Commercial |
$139.02
|
Rate for Payer: First Health Commercial |
$159.12
|
Rate for Payer: Humana Commercial |
$142.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$137.35
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$50.25
|
Rate for Payer: Ohio Health Choice Commercial |
$147.40
|
Rate for Payer: Ohio Health Group HMO |
$125.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$33.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$21.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.92
|
Rate for Payer: PHCS Commercial |
$160.80
|
Rate for Payer: United Healthcare All Payer |
$147.40
|
|
VIMPAT 1MG (200MG/20ML VIAL)
|
Facility
|
OP
|
$167.50
|
|
Service Code
|
HCPCS C9254
|
Hospital Charge Code |
25001814
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$21.78 |
Max. Negotiated Rate |
$160.80 |
Rate for Payer: Aetna Commercial |
$128.98
|
Rate for Payer: Anthem Medicaid |
$57.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$130.65
|
Rate for Payer: Cash Price |
$83.75
|
Rate for Payer: Cigna Commercial |
$139.02
|
Rate for Payer: First Health Commercial |
$159.12
|
Rate for Payer: Humana Commercial |
$142.38
|
Rate for Payer: Humana KY Medicaid |
$57.60
|
Rate for Payer: Kentucky WC Medicaid |
$58.19
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$137.35
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$50.25
|
Rate for Payer: Molina Healthcare Medicaid |
$58.76
|
Rate for Payer: Ohio Health Choice Commercial |
$147.40
|
Rate for Payer: Ohio Health Group HMO |
$125.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$33.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$21.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.92
|
Rate for Payer: PHCS Commercial |
$160.80
|
Rate for Payer: United Healthcare All Payer |
$147.40
|
|
VIMPAT 200MG TABLET
|
Facility
|
IP
|
$79.51
|
|
Service Code
|
NDC 131248035
|
Hospital Charge Code |
25001672
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$10.34 |
Max. Negotiated Rate |
$76.33 |
Rate for Payer: Aetna Commercial |
$61.22
|
Rate for Payer: Anthem POS/PPO/Traditional |
$62.02
|
Rate for Payer: Cash Price |
$39.76
|
Rate for Payer: Cigna Commercial |
$65.99
|
Rate for Payer: First Health Commercial |
$75.53
|
Rate for Payer: Humana Commercial |
$67.58
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$65.20
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.68
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.85
|
Rate for Payer: Ohio Health Choice Commercial |
$69.97
|
Rate for Payer: Ohio Health Group HMO |
$59.63
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.65
|
Rate for Payer: PHCS Commercial |
$76.33
|
Rate for Payer: United Healthcare All Payer |
$69.97
|
|
VIMPAT 200MG TABLET
|
Facility
|
OP
|
$79.51
|
|
Service Code
|
NDC 131248035
|
Hospital Charge Code |
25001672
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$10.34 |
Max. Negotiated Rate |
$76.33 |
Rate for Payer: Aetna Commercial |
$61.22
|
Rate for Payer: Anthem Medicaid |
$27.34
|
Rate for Payer: Anthem POS/PPO/Traditional |
$62.02
|
Rate for Payer: Cash Price |
$39.76
|
Rate for Payer: Cigna Commercial |
$65.99
|
Rate for Payer: First Health Commercial |
$75.53
|
Rate for Payer: Humana Commercial |
$67.58
|
Rate for Payer: Humana KY Medicaid |
$27.34
|
Rate for Payer: Kentucky WC Medicaid |
$27.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$65.20
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.68
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$23.85
|
Rate for Payer: Molina Healthcare Medicaid |
$27.89
|
Rate for Payer: Ohio Health Choice Commercial |
$69.97
|
Rate for Payer: Ohio Health Group HMO |
$59.63
|
Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.65
|
Rate for Payer: PHCS Commercial |
$76.33
|
Rate for Payer: United Healthcare All Payer |
$69.97
|
|
VINBLASTINE 1MG(FROM 10MG MDV)
|
Facility
|
OP
|
$29.30
|
|
Service Code
|
HCPCS J9360
|
Hospital Charge Code |
25004298
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.81 |
Max. Negotiated Rate |
$28.13 |
Rate for Payer: Aetna Commercial |
$22.56
|
Rate for Payer: Anthem Medicaid |
$10.08
|
Rate for Payer: Anthem POS/PPO/Traditional |
$22.85
|
Rate for Payer: Cash Price |
$14.65
|
Rate for Payer: Cigna Commercial |
$24.32
|
Rate for Payer: First Health Commercial |
$27.84
|
Rate for Payer: Humana Commercial |
$24.90
|
Rate for Payer: Humana KY Medicaid |
$10.08
|
Rate for Payer: Kentucky WC Medicaid |
$10.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$24.03
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8.79
|
Rate for Payer: Molina Healthcare Medicaid |
$10.28
|
Rate for Payer: Ohio Health Choice Commercial |
$25.78
|
Rate for Payer: Ohio Health Group HMO |
$21.98
|
Rate for Payer: Ohio Health Group PPO Differential |
$5.86
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.08
|
Rate for Payer: PHCS Commercial |
$28.13
|
Rate for Payer: United Healthcare All Payer |
$25.78
|
|
VINBLASTINE 1MG(FROM 10MG MDV)
|
Facility
|
IP
|
$29.30
|
|
Service Code
|
HCPCS J9360
|
Hospital Charge Code |
25004298
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$3.81 |
Max. Negotiated Rate |
$28.13 |
Rate for Payer: Aetna Commercial |
$22.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$22.85
|
Rate for Payer: Cash Price |
$14.65
|
Rate for Payer: Cigna Commercial |
$24.32
|
Rate for Payer: First Health Commercial |
$27.84
|
Rate for Payer: Humana Commercial |
$24.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$24.03
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8.79
|
Rate for Payer: Ohio Health Choice Commercial |
$25.78
|
Rate for Payer: Ohio Health Group HMO |
$21.98
|
Rate for Payer: Ohio Health Group PPO Differential |
$5.86
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.08
|
Rate for Payer: PHCS Commercial |
$28.13
|
Rate for Payer: United Healthcare All Payer |
$25.78
|
|
VINCRISTINE SULFATE 1 MG INJ
|
Facility
|
OP
|
$96.74
|
|
Service Code
|
HCPCS J9370
|
Hospital Charge Code |
25002690
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.58 |
Max. Negotiated Rate |
$92.87 |
Rate for Payer: Aetna Commercial |
$74.49
|
Rate for Payer: Anthem Medicaid |
$33.27
|
Rate for Payer: Anthem POS/PPO/Traditional |
$75.46
|
Rate for Payer: Cash Price |
$48.37
|
Rate for Payer: Cigna Commercial |
$80.29
|
Rate for Payer: First Health Commercial |
$91.90
|
Rate for Payer: Humana Commercial |
$82.23
|
Rate for Payer: Humana KY Medicaid |
$33.27
|
Rate for Payer: Kentucky WC Medicaid |
$33.61
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$79.33
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.39
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$29.02
|
Rate for Payer: Molina Healthcare Medicaid |
$33.94
|
Rate for Payer: Ohio Health Choice Commercial |
$85.13
|
Rate for Payer: Ohio Health Group HMO |
$72.56
|
Rate for Payer: Ohio Health Group PPO Differential |
$19.35
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.99
|
Rate for Payer: PHCS Commercial |
$92.87
|
Rate for Payer: United Healthcare All Payer |
$85.13
|
|
VINCRISTINE SULFATE 1 MG INJ
|
Facility
|
IP
|
$96.74
|
|
Service Code
|
HCPCS J9370
|
Hospital Charge Code |
25002690
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.58 |
Max. Negotiated Rate |
$92.87 |
Rate for Payer: Aetna Commercial |
$74.49
|
Rate for Payer: Anthem POS/PPO/Traditional |
$75.46
|
Rate for Payer: Cash Price |
$48.37
|
Rate for Payer: Cigna Commercial |
$80.29
|
Rate for Payer: First Health Commercial |
$91.90
|
Rate for Payer: Humana Commercial |
$82.23
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$79.33
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.39
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$29.02
|
Rate for Payer: Ohio Health Choice Commercial |
$85.13
|
Rate for Payer: Ohio Health Group HMO |
$72.56
|
Rate for Payer: Ohio Health Group PPO Differential |
$19.35
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.99
|
Rate for Payer: PHCS Commercial |
$92.87
|
Rate for Payer: United Healthcare All Payer |
$85.13
|
|
VINCRISTINE SULFATE 2MG/2ML VL
|
Facility
|
IP
|
$83.93
|
|
Service Code
|
HCPCS J9370
|
Hospital Charge Code |
25003916
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.91 |
Max. Negotiated Rate |
$80.57 |
Rate for Payer: Aetna Commercial |
$64.63
|
Rate for Payer: Anthem POS/PPO/Traditional |
$65.47
|
Rate for Payer: Cash Price |
$41.97
|
Rate for Payer: Cigna Commercial |
$69.66
|
Rate for Payer: First Health Commercial |
$79.73
|
Rate for Payer: Humana Commercial |
$71.34
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$68.82
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.94
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$25.18
|
Rate for Payer: Ohio Health Choice Commercial |
$73.86
|
Rate for Payer: Ohio Health Group HMO |
$62.95
|
Rate for Payer: Ohio Health Group PPO Differential |
$16.79
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.02
|
Rate for Payer: PHCS Commercial |
$80.57
|
Rate for Payer: United Healthcare All Payer |
$73.86
|
|
VINCRISTINE SULFATE 2MG/2ML VL
|
Facility
|
OP
|
$83.93
|
|
Service Code
|
HCPCS J9370
|
Hospital Charge Code |
25003916
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$10.91 |
Max. Negotiated Rate |
$80.57 |
Rate for Payer: Aetna Commercial |
$64.63
|
Rate for Payer: Anthem Medicaid |
$28.86
|
Rate for Payer: Anthem POS/PPO/Traditional |
$65.47
|
Rate for Payer: Cash Price |
$41.97
|
Rate for Payer: Cigna Commercial |
$69.66
|
Rate for Payer: First Health Commercial |
$79.73
|
Rate for Payer: Humana Commercial |
$71.34
|
Rate for Payer: Humana KY Medicaid |
$28.86
|
Rate for Payer: Kentucky WC Medicaid |
$29.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$68.82
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.94
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$25.18
|
Rate for Payer: Molina Healthcare Medicaid |
$29.44
|
Rate for Payer: Ohio Health Choice Commercial |
$73.86
|
Rate for Payer: Ohio Health Group HMO |
$62.95
|
Rate for Payer: Ohio Health Group PPO Differential |
$16.79
|
Rate for Payer: Ohio Health Group PPO No Differential |
$10.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.02
|
Rate for Payer: PHCS Commercial |
$80.57
|
Rate for Payer: United Healthcare All Payer |
$73.86
|
|
VINORELBINE 10MG/ML VIAL
|
Facility
|
OP
|
$136.25
|
|
Service Code
|
HCPCS J9390
|
Hospital Charge Code |
25002691
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$17.71 |
Max. Negotiated Rate |
$130.80 |
Rate for Payer: Aetna Commercial |
$104.91
|
Rate for Payer: Anthem Medicaid |
$46.86
|
Rate for Payer: Anthem POS/PPO/Traditional |
$106.28
|
Rate for Payer: Cash Price |
$68.12
|
Rate for Payer: Cigna Commercial |
$113.09
|
Rate for Payer: First Health Commercial |
$129.44
|
Rate for Payer: Humana Commercial |
$115.81
|
Rate for Payer: Humana KY Medicaid |
$46.86
|
Rate for Payer: Kentucky WC Medicaid |
$47.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$111.72
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.55
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$40.88
|
Rate for Payer: Molina Healthcare Medicaid |
$47.80
|
Rate for Payer: Ohio Health Choice Commercial |
$119.90
|
Rate for Payer: Ohio Health Group HMO |
$102.19
|
Rate for Payer: Ohio Health Group PPO Differential |
$27.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$17.71
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.24
|
Rate for Payer: PHCS Commercial |
$130.80
|
Rate for Payer: United Healthcare All Payer |
$119.90
|
|
VINORELBINE 10MG/ML VIAL
|
Facility
|
IP
|
$136.25
|
|
Service Code
|
HCPCS J9390
|
Hospital Charge Code |
25002691
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$17.71 |
Max. Negotiated Rate |
$130.80 |
Rate for Payer: Aetna Commercial |
$104.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$106.28
|
Rate for Payer: Cash Price |
$68.12
|
Rate for Payer: Cigna Commercial |
$113.09
|
Rate for Payer: First Health Commercial |
$129.44
|
Rate for Payer: Humana Commercial |
$115.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$111.72
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.55
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$40.88
|
Rate for Payer: Ohio Health Choice Commercial |
$119.90
|
Rate for Payer: Ohio Health Group HMO |
$102.19
|
Rate for Payer: Ohio Health Group PPO Differential |
$27.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$17.71
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.24
|
Rate for Payer: PHCS Commercial |
$130.80
|
Rate for Payer: United Healthcare All Payer |
$119.90
|
|
VINORELBINE 50MG/5ML VIAL
|
Facility
|
IP
|
$490.50
|
|
Service Code
|
HCPCS J9390
|
Hospital Charge Code |
25003917
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$63.76 |
Max. Negotiated Rate |
$470.88 |
Rate for Payer: Aetna Commercial |
$377.68
|
Rate for Payer: Anthem POS/PPO/Traditional |
$382.59
|
Rate for Payer: Cash Price |
$245.25
|
Rate for Payer: Cigna Commercial |
$407.12
|
Rate for Payer: First Health Commercial |
$465.98
|
Rate for Payer: Humana Commercial |
$416.92
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$402.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$147.15
|
Rate for Payer: Ohio Health Choice Commercial |
$431.64
|
Rate for Payer: Ohio Health Group HMO |
$367.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$98.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$63.76
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.06
|
Rate for Payer: PHCS Commercial |
$470.88
|
Rate for Payer: United Healthcare All Payer |
$431.64
|
|
VINORELBINE 50MG/5ML VIAL
|
Facility
|
OP
|
$490.50
|
|
Service Code
|
HCPCS J9390
|
Hospital Charge Code |
25003917
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$63.76 |
Max. Negotiated Rate |
$470.88 |
Rate for Payer: Aetna Commercial |
$377.68
|
Rate for Payer: Anthem Medicaid |
$168.68
|
Rate for Payer: Anthem POS/PPO/Traditional |
$382.59
|
Rate for Payer: Cash Price |
$245.25
|
Rate for Payer: Cigna Commercial |
$407.12
|
Rate for Payer: First Health Commercial |
$465.98
|
Rate for Payer: Humana Commercial |
$416.92
|
Rate for Payer: Humana KY Medicaid |
$168.68
|
Rate for Payer: Kentucky WC Medicaid |
$170.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$402.21
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$361.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$147.15
|
Rate for Payer: Molina Healthcare Medicaid |
$172.07
|
Rate for Payer: Ohio Health Choice Commercial |
$431.64
|
Rate for Payer: Ohio Health Group HMO |
$367.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$98.10
|
Rate for Payer: Ohio Health Group PPO No Differential |
$63.76
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.06
|
Rate for Payer: PHCS Commercial |
$470.88
|
Rate for Payer: United Healthcare All Payer |
$431.64
|
|
VIPERWIRE
|
Facility
|
IP
|
$2,085.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
27000056
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$271.05 |
Max. Negotiated Rate |
$2,001.60 |
Rate for Payer: Aetna Commercial |
$1,605.45
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,626.30
|
Rate for Payer: Cash Price |
$1,042.50
|
Rate for Payer: Cigna Commercial |
$1,730.55
|
Rate for Payer: First Health Commercial |
$1,980.75
|
Rate for Payer: Humana Commercial |
$1,772.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$625.50
|
Rate for Payer: Ohio Health Choice Commercial |
$1,834.80
|
Rate for Payer: Ohio Health Group HMO |
$1,563.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$417.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$271.05
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.35
|
Rate for Payer: PHCS Commercial |
$2,001.60
|
Rate for Payer: United Healthcare All Payer |
$1,834.80
|
|
VIPERWIRE
|
Facility
|
OP
|
$2,085.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
27000056
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$271.05 |
Max. Negotiated Rate |
$2,001.60 |
Rate for Payer: Aetna Commercial |
$1,605.45
|
Rate for Payer: Anthem Medicaid |
$717.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,626.30
|
Rate for Payer: Cash Price |
$1,042.50
|
Rate for Payer: Cigna Commercial |
$1,730.55
|
Rate for Payer: First Health Commercial |
$1,980.75
|
Rate for Payer: Humana Commercial |
$1,772.25
|
Rate for Payer: Humana KY Medicaid |
$717.03
|
Rate for Payer: Kentucky WC Medicaid |
$724.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$625.50
|
Rate for Payer: Molina Healthcare Medicaid |
$731.42
|
Rate for Payer: Ohio Health Choice Commercial |
$1,834.80
|
Rate for Payer: Ohio Health Group HMO |
$1,563.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$417.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$271.05
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.35
|
Rate for Payer: PHCS Commercial |
$2,001.60
|
Rate for Payer: United Healthcare All Payer |
$1,834.80
|
|
VIPERWIRE .012 200CM
|
Facility
|
OP
|
$1,945.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
27000056
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$252.85 |
Max. Negotiated Rate |
$1,867.20 |
Rate for Payer: Aetna Commercial |
$1,497.65
|
Rate for Payer: Anthem Medicaid |
$668.89
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.10
|
Rate for Payer: Cash Price |
$972.50
|
Rate for Payer: Cigna Commercial |
$1,614.35
|
Rate for Payer: First Health Commercial |
$1,847.75
|
Rate for Payer: Humana Commercial |
$1,653.25
|
Rate for Payer: Humana KY Medicaid |
$668.89
|
Rate for Payer: Kentucky WC Medicaid |
$675.69
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,594.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.41
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$583.50
|
Rate for Payer: Molina Healthcare Medicaid |
$682.31
|
Rate for Payer: Ohio Health Choice Commercial |
$1,711.60
|
Rate for Payer: Ohio Health Group HMO |
$1,458.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$389.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$252.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.95
|
Rate for Payer: PHCS Commercial |
$1,867.20
|
Rate for Payer: United Healthcare All Payer |
$1,711.60
|
|
VIPERWIRE .012 200CM
|
Facility
|
IP
|
$1,945.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
27000056
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$252.85 |
Max. Negotiated Rate |
$1,867.20 |
Rate for Payer: Aetna Commercial |
$1,497.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.10
|
Rate for Payer: Cash Price |
$972.50
|
Rate for Payer: Cigna Commercial |
$1,614.35
|
Rate for Payer: First Health Commercial |
$1,847.75
|
Rate for Payer: Humana Commercial |
$1,653.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,594.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.41
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$583.50
|
Rate for Payer: Ohio Health Choice Commercial |
$1,711.60
|
Rate for Payer: Ohio Health Group HMO |
$1,458.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$389.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$252.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.95
|
Rate for Payer: PHCS Commercial |
$1,867.20
|
Rate for Payer: United Healthcare All Payer |
$1,711.60
|
|
VIPERWIRE .014 335CM
|
Facility
|
IP
|
$2,050.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
27000056
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$266.50 |
Max. Negotiated Rate |
$1,968.00 |
Rate for Payer: Aetna Commercial |
$1,578.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
Rate for Payer: Cash Price |
$1,025.00
|
Rate for Payer: Cigna Commercial |
$1,701.50
|
Rate for Payer: First Health Commercial |
$1,947.50
|
Rate for Payer: Humana Commercial |
$1,742.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
Rate for Payer: PHCS Commercial |
$1,968.00
|
Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
VIPERWIRE .014 335CM
|
Facility
|
OP
|
$2,050.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
27000056
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$266.50 |
Max. Negotiated Rate |
$1,968.00 |
Rate for Payer: Aetna Commercial |
$1,578.50
|
Rate for Payer: Anthem Medicaid |
$705.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
Rate for Payer: Cash Price |
$1,025.00
|
Rate for Payer: Cigna Commercial |
$1,701.50
|
Rate for Payer: First Health Commercial |
$1,947.50
|
Rate for Payer: Humana Commercial |
$1,742.50
|
Rate for Payer: Humana KY Medicaid |
$705.00
|
Rate for Payer: Kentucky WC Medicaid |
$712.17
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
Rate for Payer: PHCS Commercial |
$1,968.00
|
Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|