|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$45.99
|
|
|
Service Code
|
NDC 00168009930
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$41.39 |
| Rate for Payer: Aetna Commercial |
$39.09
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.89
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cofinity Commercial |
$32.19
|
| Rate for Payer: Cofinity Commercial |
$39.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.79
|
| Rate for Payer: Healthscope Commercial |
$41.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.09
|
| Rate for Payer: PHP Commercial |
$39.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.89
|
| Rate for Payer: Priority Health SBD |
$28.97
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$123.80
|
|
|
Service Code
|
NDC 51672129802
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$111.42 |
| Rate for Payer: Aetna Commercial |
$105.23
|
| Rate for Payer: Aetna Medicare |
$61.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.47
|
| Rate for Payer: BCBS Complete |
$49.52
|
| Rate for Payer: Cash Price |
$99.04
|
| Rate for Payer: Cofinity Commercial |
$106.47
|
| Rate for Payer: Cofinity Commercial |
$86.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.04
|
| Rate for Payer: Healthscope Commercial |
$111.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.23
|
| Rate for Payer: PHP Commercial |
$105.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.47
|
| Rate for Payer: Priority Health SBD |
$77.99
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$45.99
|
|
|
Service Code
|
NDC 00168009930
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$41.39 |
| Rate for Payer: Aetna Commercial |
$39.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.89
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cofinity Commercial |
$32.19
|
| Rate for Payer: Cofinity Commercial |
$39.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.79
|
| Rate for Payer: Healthscope Commercial |
$41.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.09
|
| Rate for Payer: PHP Commercial |
$39.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.89
|
| Rate for Payer: Priority Health SBD |
$28.97
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Commercial |
$12.04
|
| Rate for Payer: Aetna Commercial |
$13.22
|
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$12.21
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$13.22
|
| Rate for Payer: PHP Commercial |
$12.04
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health SBD |
$10.99
|
| Rate for Payer: Priority Health SBD |
$8.92
|
| Rate for Payer: Priority Health SBD |
$9.80
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: Priority Health SBD |
$13.04
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.55
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna Commercial |
$13.22
|
| Rate for Payer: Aetna Commercial |
$12.04
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.21
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PHP Commercial |
$13.22
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$12.04
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health SBD |
$9.80
|
| Rate for Payer: Priority Health SBD |
$10.99
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: Priority Health SBD |
$8.92
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: Aetna Commercial |
$21.79
|
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.17
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Commercial |
$7.72
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.73
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$12.21
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$18.91
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Healthscope Commercial |
$11.36
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.82
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$22.97
|
| Rate for Payer: PHP Commercial |
$17.82
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$21.79
|
| Rate for Payer: PHP Commercial |
$10.73
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: PHP Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.20
|
| Rate for Payer: Priority Health SBD |
$17.02
|
| Rate for Payer: Priority Health SBD |
$10.99
|
| Rate for Payer: Priority Health SBD |
$16.15
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: Priority Health SBD |
$7.95
|
| Rate for Payer: Priority Health SBD |
$6.95
|
| Rate for Payer: Priority Health SBD |
$7.13
|
| Rate for Payer: Priority Health SBD |
$13.21
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Aetna Commercial |
$21.79
|
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Commercial |
$9.73
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$18.91
|
| Rate for Payer: Cofinity Commercial |
$7.72
|
| Rate for Payer: Cofinity Commercial |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$12.21
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Healthscope Commercial |
$11.36
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Healthscope Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$23.07
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.66
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PHP Commercial |
$21.79
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: PHP Commercial |
$10.73
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$17.82
|
| Rate for Payer: PHP Commercial |
$22.97
|
| Rate for Payer: PHP Commercial |
$17.66
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health SBD |
$6.95
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: Priority Health SBD |
$7.13
|
| Rate for Payer: Priority Health SBD |
$13.21
|
| Rate for Payer: Priority Health SBD |
$17.02
|
| Rate for Payer: Priority Health SBD |
$10.99
|
| Rate for Payer: Priority Health SBD |
$7.95
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: Priority Health SBD |
$16.15
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$2,079.75
|
|
|
Service Code
|
NDC 70377006113
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,310.24 |
| Max. Negotiated Rate |
$1,871.78 |
| Rate for Payer: Aetna Commercial |
$1,767.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.84
|
| Rate for Payer: Cash Price |
$1,663.80
|
| Rate for Payer: Cofinity Commercial |
$1,455.83
|
| Rate for Payer: Cofinity Commercial |
$1,788.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,455.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,663.80
|
| Rate for Payer: Healthscope Commercial |
$1,871.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,767.79
|
| Rate for Payer: PHP Commercial |
$1,767.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.84
|
| Rate for Payer: Priority Health SBD |
$1,310.24
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.39 |
| Max. Negotiated Rate |
$346.27 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health SBD |
$242.39
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$346.27 |
| Rate for Payer: Aetna Commercial |
$327.04
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.09
|
| Rate for Payer: BCBS Complete |
$153.90
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$269.32
|
| Rate for Payer: Cofinity Commercial |
$330.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$346.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: PHP Commercial |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health SBD |
$242.39
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.60
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: Priority Health SBD |
$1.55
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 60687045011
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.60
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: Priority Health SBD |
$1.55
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$427.70
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna Commercial |
$363.55
|
| Rate for Payer: Aetna Medicare |
$213.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.00
|
| Rate for Payer: BCBS Complete |
$171.08
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$299.39
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.55
|
| Rate for Payer: PHP Commercial |
$363.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health SBD |
$269.45
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$290.70
|
|
|
Service Code
|
NDC 00904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.28 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: Aetna Medicare |
$145.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: BCBS Complete |
$116.28
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: PHP Commercial |
$247.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health SBD |
$183.14
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health SBD |
$2.43
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna Commercial |
$363.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.00
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$299.39
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.55
|
| Rate for Payer: PHP Commercial |
$363.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health SBD |
$269.45
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$2,079.75
|
|
|
Service Code
|
NDC 70377006113
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$831.90 |
| Max. Negotiated Rate |
$1,871.78 |
| Rate for Payer: Aetna Commercial |
$1,767.79
|
| Rate for Payer: Aetna Medicare |
$1,039.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.84
|
| Rate for Payer: BCBS Complete |
$831.90
|
| Rate for Payer: Cash Price |
$1,663.80
|
| Rate for Payer: Cofinity Commercial |
$1,455.83
|
| Rate for Payer: Cofinity Commercial |
$1,788.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,455.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,663.80
|
| Rate for Payer: Healthscope Commercial |
$1,871.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,767.79
|
| Rate for Payer: PHP Commercial |
$1,767.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.84
|
| Rate for Payer: Priority Health SBD |
$1,310.24
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health SBD |
$2.43
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.83 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| Rate for Payer: Priority Health SBD |
$154.83
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$245.76
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.30 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna Medicare |
$122.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: BCBS Complete |
$98.30
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| Rate for Payer: Priority Health SBD |
$154.83
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 00904711061
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.14 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: PHP Commercial |
$247.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health SBD |
$183.14
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$16.30
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: Priority Health SBD |
$10.27
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$16.30
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Commercial |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.98
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Commercial |
$11.41
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Healthscope Commercial |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: PHP Commercial |
$7.82
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$5.80
|
| Rate for Payer: Priority Health SBD |
$10.27
|
| Rate for Payer: Priority Health SBD |
$18.14
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42.50
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Commercial |
$260.55
|
| Rate for Payer: Aetna Commercial |
$272.00
|
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$245.22
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Cofinity Commercial |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$109.90
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Commercial |
$214.57
|
| Rate for Payer: Cofinity Commercial |
$263.62
|
| Rate for Payer: Cofinity Commercial |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$29.75
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Healthscope Commercial |
$275.88
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$36.12
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$272.00
|
| Rate for Payer: PHP Commercial |
$260.55
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.05
|
| Rate for Payer: Priority Health SBD |
$201.60
|
| Rate for Payer: Priority Health SBD |
$98.91
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Priority Health SBD |
$193.11
|
| Rate for Payer: Priority Health SBD |
$26.77
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Commercial |
$260.55
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Commercial |
$272.00
|
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Aetna Medicare |
$153.26
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: Aetna Medicare |
$54.50
|
| Rate for Payer: Aetna Medicare |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Complete |
$62.80
|
| Rate for Payer: BCBS Complete |
$122.61
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$245.22
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cofinity Commercial |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Commercial |
$214.57
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Cofinity Commercial |
$29.75
|
| Rate for Payer: Cofinity Commercial |
$263.62
|
| Rate for Payer: Cofinity Commercial |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$109.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$275.88
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.55
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$272.00
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$36.12
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Commercial |
$260.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health SBD |
$26.77
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: Priority Health SBD |
$193.11
|
| Rate for Payer: Priority Health SBD |
$98.91
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: Priority Health SBD |
$201.60
|
|
