|
VIMPAT 100MG TABLET
|
Facility
|
OP
|
$78.87
|
|
|
Service Code
|
NDC 131247835
|
| Hospital Charge Code |
25001670
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna Commercial |
$60.73
|
| Rate for Payer: Anthem Medicaid |
$27.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.52
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: First Health Commercial |
$74.93
|
| Rate for Payer: Humana Commercial |
$67.04
|
| Rate for Payer: Humana KY Medicaid |
$27.12
|
| Rate for Payer: Kentucky WC Medicaid |
$27.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.41
|
| Rate for Payer: Ohio Health Group HMO |
$59.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.42
|
| Rate for Payer: PHCS Commercial |
$75.72
|
| Rate for Payer: United Healthcare All Payer |
$69.41
|
|
|
VIMPAT 100MG TABLET
|
Facility
|
IP
|
$78.87
|
|
|
Service Code
|
NDC 131247835
|
| Hospital Charge Code |
25001670
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna Commercial |
$60.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.52
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna Commercial |
$65.46
|
| Rate for Payer: First Health Commercial |
$74.93
|
| Rate for Payer: Humana Commercial |
$67.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.41
|
| Rate for Payer: Ohio Health Group HMO |
$59.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.42
|
| Rate for Payer: PHCS Commercial |
$75.72
|
| Rate for Payer: United Healthcare All Payer |
$69.41
|
|
|
VIMPAT 150MG TABLET
|
Facility
|
OP
|
$79.99
|
|
|
Service Code
|
NDC 131247935
|
| Hospital Charge Code |
25001671
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna Commercial |
$61.59
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.39
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Cigna Commercial |
$66.39
|
| Rate for Payer: First Health Commercial |
$75.99
|
| Rate for Payer: Humana Commercial |
$67.99
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.39
|
| Rate for Payer: Ohio Health Group HMO |
$59.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.19
|
| Rate for Payer: PHCS Commercial |
$76.79
|
| Rate for Payer: United Healthcare All Payer |
$70.39
|
|
|
VIMPAT 150MG TABLET
|
Facility
|
IP
|
$79.99
|
|
|
Service Code
|
NDC 131247935
|
| Hospital Charge Code |
25001671
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna Commercial |
$61.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.39
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Cigna Commercial |
$66.39
|
| Rate for Payer: First Health Commercial |
$75.99
|
| Rate for Payer: Humana Commercial |
$67.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.39
|
| Rate for Payer: Ohio Health Group HMO |
$59.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.19
|
| Rate for Payer: PHCS Commercial |
$76.79
|
| Rate for Payer: United Healthcare All Payer |
$70.39
|
|
|
VIMPAT 1MG (200MG/20ML VIAL)
|
Facility
|
IP
|
$167.50
|
|
|
Service Code
|
HCPCS C9254
|
| Hospital Charge Code |
25001814
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$160.80 |
| Rate for Payer: Aetna Commercial |
$128.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.65
|
| Rate for Payer: Cash Price |
$83.75
|
| Rate for Payer: Cigna Commercial |
$139.03
|
| 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 |
$123.61
|
| 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 |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.58
|
| 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 |
$50.25 |
| Max. Negotiated Rate |
$160.80 |
| Rate for Payer: Aetna Commercial |
$128.97
|
| 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 |
$139.03
|
| 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 |
$123.61
|
| 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 |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.58
|
| Rate for Payer: PHCS Commercial |
$160.80
|
| Rate for Payer: United Healthcare All Payer |
$147.40
|
|
|
VIMPAT 200MG TABLET
|
Facility
|
IP
|
$79.99
|
|
|
Service Code
|
NDC 131248035
|
| Hospital Charge Code |
25001672
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna Commercial |
$61.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.39
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Cigna Commercial |
$66.39
|
| Rate for Payer: First Health Commercial |
$75.99
|
| Rate for Payer: Humana Commercial |
$67.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.39
|
| Rate for Payer: Ohio Health Group HMO |
$59.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.19
|
| Rate for Payer: PHCS Commercial |
$76.79
|
| Rate for Payer: United Healthcare All Payer |
$70.39
|
|
|
VIMPAT 200MG TABLET
|
Facility
|
OP
|
$79.99
|
|
|
Service Code
|
NDC 131248035
|
| Hospital Charge Code |
25001672
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna Commercial |
$61.59
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.39
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Cigna Commercial |
$66.39
|
| Rate for Payer: First Health Commercial |
$75.99
|
| Rate for Payer: Humana Commercial |
$67.99
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.39
|
| Rate for Payer: Ohio Health Group HMO |
$59.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.19
|
| Rate for Payer: PHCS Commercial |
$76.79
|
| Rate for Payer: United Healthcare All Payer |
$70.39
|
|
|
VINBLASTINE 1MG(FROM 10MG MDV)
|
Facility
|
IP
|
$29.30
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
25004298
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| 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 |
$24.91
|
| 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 |
$23.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.22
|
| Rate for Payer: PHCS Commercial |
$28.13
|
| Rate for Payer: United Healthcare All Payer |
$25.78
|
|
|
VINBLASTINE 1MG(FROM 10MG MDV)
|
Facility
|
OP
|
$29.30
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
25004298
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| 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 |
$24.91
|
| 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 |
$23.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.22
|
| 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 |
$29.02 |
| 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 |
$77.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.75
|
| 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 |
$29.02 |
| 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 |
$77.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.75
|
| Rate for Payer: PHCS Commercial |
$92.87
|
| Rate for Payer: United Healthcare All Payer |
$85.13
|
|
|
VINCRISTINE SULFATE 2MG/2ML VL
|
Facility
|
OP
|
$83.93
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
25003916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.18 |
| 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 |
$67.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.91
|
| Rate for Payer: PHCS Commercial |
$80.57
|
| Rate for Payer: United Healthcare All Payer |
$73.86
|
|
|
VINCRISTINE SULFATE 2MG/2ML VL
|
Facility
|
IP
|
$83.93
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
25003916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.18 |
| 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 |
$67.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.91
|
| 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 |
$40.88 |
| 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 |
$109.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.01
|
| 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 |
$40.88 |
| 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 |
$109.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.01
|
| Rate for Payer: PHCS Commercial |
$130.80
|
| Rate for Payer: United Healthcare All Payer |
$119.90
|
|
|
VINORELBINE 50MG/5ML VIAL
|
Facility
|
OP
|
$490.50
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
25003917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$470.88 |
| Rate for Payer: Aetna Commercial |
$377.69
|
| 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 |
$416.93
|
| 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 |
$392.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.44
|
| Rate for Payer: PHCS Commercial |
$470.88
|
| Rate for Payer: United Healthcare All Payer |
$431.64
|
|
|
VINORELBINE 50MG/5ML VIAL
|
Facility
|
IP
|
$490.50
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
25003917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$470.88 |
| Rate for Payer: Aetna Commercial |
$377.69
|
| 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 |
$416.93
|
| 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 |
$392.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.44
|
| Rate for Payer: PHCS Commercial |
$470.88
|
| Rate for Payer: United Healthcare All Payer |
$431.64
|
|
|
VIPERWIRE
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
VIPERWIRE
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem Medicaid |
$721.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Humana KY Medicaid |
$721.50
|
| Rate for Payer: Kentucky WC Medicaid |
$728.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
VIPERWIRE .012 200CM
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem Medicaid |
$669.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Humana KY Medicaid |
$669.23
|
| Rate for Payer: Kentucky WC Medicaid |
$676.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
VIPERWIRE .012 200CM
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
VIPERWIRE .014 335CM
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
VIPERWIRE .014 335CM
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
VIPERWIRE .017 335CM
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
