|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$35.21
|
|
|
Service Code
|
NDC 65219018601
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$31.69 |
| Rate for Payer: Aetna Commercial |
$29.93
|
| Rate for Payer: Aetna Medicare |
$9.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.00
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS MAPPO |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$28.95
|
| Rate for Payer: BCN Medicare Advantage |
$8.80
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cofinity Commercial |
$30.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$31.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.41
|
| Rate for Payer: Mclaren Medicaid |
$6.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.24
|
| Rate for Payer: Meridian Medicaid |
$6.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.93
|
| Rate for Payer: Nomi Health Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.41
|
| Rate for Payer: PACE Senior Care Partners |
$8.36
|
| Rate for Payer: PACE SWMI |
$8.80
|
| Rate for Payer: PHP Commercial |
$29.93
|
| Rate for Payer: PHP Medicare Advantage |
$8.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.63
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.51
|
| Rate for Payer: Railroad Medicare Medicare |
$8.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Core |
$29.40
|
| Rate for Payer: UHC Exchange |
$8.80
|
| Rate for Payer: UHC Medicaid |
$6.21
|
| Rate for Payer: UHC Medicare Advantage |
$8.80
|
| Rate for Payer: UHCCP Medicaid |
$6.21
|
| Rate for Payer: VA VA |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.41
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$35.21
|
|
|
Service Code
|
NDC 65219018601
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$31.69 |
| Rate for Payer: Aetna Commercial |
$29.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.08
|
| Rate for Payer: BCN Commercial |
$29.08
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cofinity Commercial |
$30.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.17
|
| Rate for Payer: Healthscope Commercial |
$31.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.93
|
| Rate for Payer: Nomi Health Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.41
|
| Rate for Payer: PHP Commercial |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Core |
$29.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.41
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
NDC 00143950910
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.96
|
| Rate for Payer: BCBS Complete |
$7.68
|
| Rate for Payer: BCBS MAPPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.10
|
| Rate for Payer: BCN Commercial |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.37
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$37.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.11
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.89
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.26
|
| Rate for Payer: Nomi Health Commercial |
$34.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.11
|
| Rate for Payer: PACE Senior Care Partners |
$9.85
|
| Rate for Payer: PACE SWMI |
$10.37
|
| Rate for Payer: PHP Commercial |
$35.26
|
| Rate for Payer: PHP Medicare Advantage |
$10.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.09
|
| Rate for Payer: Priority Health Medicare |
$10.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.87
|
| Rate for Payer: Railroad Medicare Medicare |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.50
|
| Rate for Payer: UHC Core |
$34.64
|
| Rate for Payer: UHC Exchange |
$10.37
|
| Rate for Payer: UHC Medicaid |
$7.31
|
| Rate for Payer: UHC Medicare Advantage |
$10.37
|
| Rate for Payer: UHCCP Medicaid |
$7.31
|
| Rate for Payer: VA VA |
$10.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.11
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$40.95
|
|
|
Service Code
|
NDC 25021068405
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Aetna Commercial |
$34.81
|
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.80
|
| Rate for Payer: BCBS Complete |
$7.58
|
| Rate for Payer: BCBS MAPPO |
$10.24
|
| Rate for Payer: BCBS Trust/PPO |
$33.66
|
| Rate for Payer: BCN Commercial |
$33.66
|
| Rate for Payer: BCN Medicare Advantage |
$10.24
|
| Rate for Payer: Cash Price |
$32.76
|
| Rate for Payer: Cofinity Commercial |
$35.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$36.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.71
|
| Rate for Payer: Mclaren Medicaid |
$7.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.75
|
| Rate for Payer: Meridian Medicaid |
$7.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.81
|
| Rate for Payer: Nomi Health Commercial |
$33.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.71
|
| Rate for Payer: PACE Senior Care Partners |
$9.73
|
| Rate for Payer: PACE SWMI |
$10.24
|
| Rate for Payer: PHP Commercial |
$34.81
|
| Rate for Payer: PHP Medicare Advantage |
$10.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.63
|
| Rate for Payer: Priority Health Medicare |
$10.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.50
|
| Rate for Payer: Railroad Medicare Medicare |
$10.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.04
|
| Rate for Payer: UHC Core |
$34.19
|
| Rate for Payer: UHC Exchange |
$10.24
|
| Rate for Payer: UHC Medicaid |
$7.22
|
| Rate for Payer: UHC Medicare Advantage |
$10.24
|
| Rate for Payer: UHCCP Medicaid |
$7.22
|
| Rate for Payer: VA VA |
$10.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.71
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$38.63
|
|
|
Service Code
|
NDC 00409205115
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna Medicare |
$10.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.07
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.76
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Mclaren Medicaid |
$6.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.14
|
| Rate for Payer: Meridian Medicaid |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Nomi Health Commercial |
$31.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PACE Senior Care Partners |
$9.17
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.61
|
| Rate for Payer: Priority Health Medicare |
$9.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.89
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.99
|
| Rate for Payer: UHC Core |
$32.26
|
| Rate for Payer: UHC Exchange |
$9.66
|
| Rate for Payer: UHC Medicaid |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$9.66
|
| Rate for Payer: UHCCP Medicaid |
$6.81
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
NDC 00143950901
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.87 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: BCBS Trust/PPO |
$34.26
|
| Rate for Payer: BCN Commercial |
$34.26
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.26
|
| Rate for Payer: Nomi Health Commercial |
$34.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.11
|
| Rate for Payer: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.50
|
| Rate for Payer: UHC Core |
$34.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.11
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$38.65
|
|
|
Service Code
|
NDC 00409004005
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$34.78 |
| Rate for Payer: Aetna Commercial |
$32.85
|
| Rate for Payer: BCBS Trust/PPO |
$31.92
|
| Rate for Payer: BCN Commercial |
$31.92
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$33.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Healthscope Commercial |
$34.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: PHP Commercial |
$32.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.01
|
| Rate for Payer: UHC Core |
$32.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.99
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 00409205115
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.89 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: BCBS Trust/PPO |
$31.90
|
| Rate for Payer: BCN Commercial |
$31.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Nomi Health Commercial |
$31.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.99
|
| Rate for Payer: UHC Core |
$32.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$35.21
|
|
|
Service Code
|
NDC 65219018605
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$31.69 |
| Rate for Payer: Aetna Commercial |
$29.93
|
| Rate for Payer: Aetna Medicare |
$9.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.00
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS MAPPO |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$28.95
|
| Rate for Payer: BCN Medicare Advantage |
$8.80
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cofinity Commercial |
$30.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$31.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.41
|
| Rate for Payer: Mclaren Medicaid |
$6.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.24
|
| Rate for Payer: Meridian Medicaid |
$6.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.93
|
| Rate for Payer: Nomi Health Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.41
|
| Rate for Payer: PACE Senior Care Partners |
$8.36
|
| Rate for Payer: PACE SWMI |
$8.80
|
| Rate for Payer: PHP Commercial |
$29.93
|
| Rate for Payer: PHP Medicare Advantage |
$8.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.63
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.51
|
| Rate for Payer: Railroad Medicare Medicare |
$8.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.98
|
| Rate for Payer: UHC Core |
$29.40
|
| Rate for Payer: UHC Exchange |
$8.80
|
| Rate for Payer: UHC Medicaid |
$6.21
|
| Rate for Payer: UHC Medicare Advantage |
$8.80
|
| Rate for Payer: UHCCP Medicaid |
$6.21
|
| Rate for Payer: VA VA |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.41
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$38.63
|
|
|
Service Code
|
NDC 00409205105
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna Medicare |
$10.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.07
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.76
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Mclaren Medicaid |
$6.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.14
|
| Rate for Payer: Meridian Medicaid |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Nomi Health Commercial |
$31.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PACE Senior Care Partners |
$9.17
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.61
|
| Rate for Payer: Priority Health Medicare |
$9.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.89
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.99
|
| Rate for Payer: UHC Core |
$32.26
|
| Rate for Payer: UHC Exchange |
$9.66
|
| Rate for Payer: UHC Medicaid |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$9.66
|
| Rate for Payer: UHCCP Medicaid |
$6.81
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 69374098255
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.91
|
| Rate for Payer: BCN Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$45.50
|
|
|
Service Code
|
NDC 25021068220
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna Commercial |
$38.67
|
| Rate for Payer: BCBS Trust/PPO |
$37.58
|
| Rate for Payer: BCN Commercial |
$37.58
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$39.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.40
|
| Rate for Payer: Healthscope Commercial |
$40.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.67
|
| Rate for Payer: Nomi Health Commercial |
$37.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.12
|
| Rate for Payer: PHP Commercial |
$38.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.04
|
| Rate for Payer: UHC Core |
$37.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.12
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
NDC 09900000869
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.82 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$79.29
|
| Rate for Payer: BCN Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$82.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.80
|
| Rate for Payer: Healthscope Commercial |
$86.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.60
|
| Rate for Payer: Nomi Health Commercial |
$78.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.00
|
| Rate for Payer: PHP Commercial |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.48
|
| Rate for Payer: UHC Core |
$80.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.00
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
NDC 09900000869
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$81.60
|
| Rate for Payer: Aetna Medicare |
$24.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.00
|
| Rate for Payer: BCBS Complete |
$17.77
|
| Rate for Payer: BCBS MAPPO |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.92
|
| Rate for Payer: BCN Commercial |
$78.92
|
| Rate for Payer: BCN Medicare Advantage |
$24.00
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$82.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$86.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.00
|
| Rate for Payer: Mclaren Medicaid |
$16.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.20
|
| Rate for Payer: Meridian Medicaid |
$17.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.60
|
| Rate for Payer: Nomi Health Commercial |
$78.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.00
|
| Rate for Payer: PACE Senior Care Partners |
$22.80
|
| Rate for Payer: PACE SWMI |
$24.00
|
| Rate for Payer: PHP Commercial |
$81.60
|
| Rate for Payer: PHP Medicare Advantage |
$24.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.52
|
| Rate for Payer: Priority Health Medicare |
$24.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.82
|
| Rate for Payer: Railroad Medicare Medicare |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.48
|
| Rate for Payer: UHC Core |
$80.16
|
| Rate for Payer: UHC Exchange |
$24.00
|
| Rate for Payer: UHC Medicaid |
$16.92
|
| Rate for Payer: UHC Medicare Advantage |
$24.00
|
| Rate for Payer: UHCCP Medicaid |
$16.92
|
| Rate for Payer: VA VA |
$24.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.00
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$67.70
|
|
|
Service Code
|
NDC 55150043801
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$57.55
|
| Rate for Payer: BCBS Trust/PPO |
$55.91
|
| Rate for Payer: BCN Commercial |
$55.91
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Cofinity Commercial |
$58.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.16
|
| Rate for Payer: Healthscope Commercial |
$60.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.55
|
| Rate for Payer: Nomi Health Commercial |
$55.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.77
|
| Rate for Payer: PHP Commercial |
$57.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.58
|
| Rate for Payer: UHC Core |
$56.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.77
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$53.50
|
|
|
Service Code
|
NDC 42023011310
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$48.15 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Medicare |
$13.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.72
|
| Rate for Payer: BCBS Complete |
$9.90
|
| Rate for Payer: BCBS MAPPO |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$43.98
|
| Rate for Payer: BCN Commercial |
$43.98
|
| Rate for Payer: BCN Medicare Advantage |
$13.38
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cofinity Commercial |
$46.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$48.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.12
|
| Rate for Payer: Mclaren Medicaid |
$9.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.04
|
| Rate for Payer: Meridian Medicaid |
$9.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Nomi Health Commercial |
$43.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.12
|
| Rate for Payer: PACE Senior Care Partners |
$12.71
|
| Rate for Payer: PACE SWMI |
$13.38
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.55
|
| Rate for Payer: Priority Health Medicare |
$13.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.24
|
| Rate for Payer: Railroad Medicare Medicare |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.08
|
| Rate for Payer: UHC Core |
$44.67
|
| Rate for Payer: UHC Exchange |
$13.38
|
| Rate for Payer: UHC Medicaid |
$9.43
|
| Rate for Payer: UHC Medicare Advantage |
$13.38
|
| Rate for Payer: UHCCP Medicaid |
$9.43
|
| Rate for Payer: VA VA |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.12
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$53.50
|
|
|
Service Code
|
NDC 42023011310
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$48.15 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: BCBS Trust/PPO |
$44.19
|
| Rate for Payer: BCN Commercial |
$44.19
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cofinity Commercial |
$46.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.80
|
| Rate for Payer: Healthscope Commercial |
$48.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Nomi Health Commercial |
$43.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.12
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.08
|
| Rate for Payer: UHC Core |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.12
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$45.50
|
|
|
Service Code
|
NDC 25021068220
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$40.95 |
| Rate for Payer: Aetna Commercial |
$38.67
|
| Rate for Payer: Aetna Medicare |
$11.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.42
|
| Rate for Payer: BCBS MAPPO |
$11.38
|
| Rate for Payer: BCBS Trust/PPO |
$37.41
|
| Rate for Payer: BCN Commercial |
$37.41
|
| Rate for Payer: BCN Medicare Advantage |
$11.38
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cofinity Commercial |
$39.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.38
|
| Rate for Payer: Healthscope Commercial |
$40.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.12
|
| Rate for Payer: Mclaren Medicaid |
$8.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.94
|
| Rate for Payer: Meridian Medicaid |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.67
|
| Rate for Payer: Nomi Health Commercial |
$37.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.12
|
| Rate for Payer: PACE Senior Care Partners |
$10.81
|
| Rate for Payer: PACE SWMI |
$11.38
|
| Rate for Payer: PHP Commercial |
$38.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.59
|
| Rate for Payer: Priority Health Medicare |
$11.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.04
|
| Rate for Payer: UHC Core |
$37.99
|
| Rate for Payer: UHC Exchange |
$11.38
|
| Rate for Payer: UHC Medicaid |
$8.02
|
| Rate for Payer: UHC Medicare Advantage |
$11.38
|
| Rate for Payer: UHCCP Medicaid |
$8.02
|
| Rate for Payer: VA VA |
$11.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.12
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$67.70
|
|
|
Service Code
|
NDC 55150043810
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$57.55
|
| Rate for Payer: BCBS Trust/PPO |
$55.91
|
| Rate for Payer: BCN Commercial |
$55.91
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Cofinity Commercial |
$58.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.16
|
| Rate for Payer: Healthscope Commercial |
$60.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.55
|
| Rate for Payer: Nomi Health Commercial |
$55.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.77
|
| Rate for Payer: PHP Commercial |
$57.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.58
|
| Rate for Payer: UHC Core |
$56.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.77
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$67.70
|
|
|
Service Code
|
NDC 55150043810
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$57.55
|
| Rate for Payer: Aetna Medicare |
$17.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.16
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$16.93
|
| Rate for Payer: BCBS Trust/PPO |
$55.66
|
| Rate for Payer: BCN Commercial |
$55.66
|
| Rate for Payer: BCN Medicare Advantage |
$16.93
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Cofinity Commercial |
$58.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.93
|
| Rate for Payer: Healthscope Commercial |
$60.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.77
|
| Rate for Payer: Mclaren Medicaid |
$11.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.77
|
| Rate for Payer: Meridian Medicaid |
$12.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.55
|
| Rate for Payer: Nomi Health Commercial |
$55.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.77
|
| Rate for Payer: PACE Senior Care Partners |
$16.08
|
| Rate for Payer: PACE SWMI |
$16.93
|
| Rate for Payer: PHP Commercial |
$57.55
|
| Rate for Payer: PHP Medicare Advantage |
$16.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.90
|
| Rate for Payer: Priority Health Medicare |
$17.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.12
|
| Rate for Payer: Railroad Medicare Medicare |
$16.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.58
|
| Rate for Payer: UHC Core |
$56.53
|
| Rate for Payer: UHC Exchange |
$16.93
|
| Rate for Payer: UHC Medicaid |
$11.94
|
| Rate for Payer: UHC Medicare Advantage |
$16.93
|
| Rate for Payer: UHCCP Medicaid |
$11.94
|
| Rate for Payer: VA VA |
$16.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.77
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
NDC 69374098255
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.94
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$28.77
|
| Rate for Payer: BCN Medicare Advantage |
$8.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Mclaren Medicaid |
$6.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.19
|
| Rate for Payer: Meridian Medicaid |
$6.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PACE Senior Care Partners |
$8.31
|
| Rate for Payer: PACE SWMI |
$8.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: PHP Medicare Advantage |
$8.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Medicare |
$8.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.23
|
| Rate for Payer: UHC Exchange |
$8.75
|
| Rate for Payer: UHC Medicaid |
$6.17
|
| Rate for Payer: UHC Medicare Advantage |
$8.75
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: VA VA |
$8.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$67.70
|
|
|
Service Code
|
NDC 55150043801
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$57.55
|
| Rate for Payer: Aetna Medicare |
$17.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.16
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$16.93
|
| Rate for Payer: BCBS Trust/PPO |
$55.66
|
| Rate for Payer: BCN Commercial |
$55.66
|
| Rate for Payer: BCN Medicare Advantage |
$16.93
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Cofinity Commercial |
$58.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.93
|
| Rate for Payer: Healthscope Commercial |
$60.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.77
|
| Rate for Payer: Mclaren Medicaid |
$11.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.77
|
| Rate for Payer: Meridian Medicaid |
$12.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.55
|
| Rate for Payer: Nomi Health Commercial |
$55.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.77
|
| Rate for Payer: PACE Senior Care Partners |
$16.08
|
| Rate for Payer: PACE SWMI |
$16.93
|
| Rate for Payer: PHP Commercial |
$57.55
|
| Rate for Payer: PHP Medicare Advantage |
$16.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.90
|
| Rate for Payer: Priority Health Medicare |
$17.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.12
|
| Rate for Payer: Railroad Medicare Medicare |
$16.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.58
|
| Rate for Payer: UHC Core |
$56.53
|
| Rate for Payer: UHC Exchange |
$16.93
|
| Rate for Payer: UHC Medicaid |
$11.94
|
| Rate for Payer: UHC Medicare Advantage |
$16.93
|
| Rate for Payer: UHCCP Medicaid |
$11.94
|
| Rate for Payer: VA VA |
$16.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.77
|
|
|
KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLOR,ISO-OSMOTIC IV SYRINGE
|
Facility
|
OP
|
$33.65
|
|
|
Service Code
|
NDC 73177015602
|
| Hospital Charge Code |
201243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.60
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.52
|
| Rate for Payer: BCBS Complete |
$6.23
|
| Rate for Payer: BCBS MAPPO |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$27.66
|
| Rate for Payer: BCN Commercial |
$27.66
|
| Rate for Payer: BCN Medicare Advantage |
$8.41
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Mclaren Medicaid |
$5.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.83
|
| Rate for Payer: Meridian Medicaid |
$6.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Nomi Health Commercial |
$27.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.24
|
| Rate for Payer: PACE Senior Care Partners |
$7.99
|
| Rate for Payer: PACE SWMI |
$8.41
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: PHP Medicare Advantage |
$8.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Medicare |
$8.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.42
|
| Rate for Payer: Railroad Medicare Medicare |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.61
|
| Rate for Payer: UHC Core |
$28.10
|
| Rate for Payer: UHC Exchange |
$8.41
|
| Rate for Payer: UHC Medicaid |
$5.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.41
|
| Rate for Payer: UHCCP Medicaid |
$5.93
|
| Rate for Payer: VA VA |
$8.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
KETAMINE 50 MG/5 ML (10 MG/ML) IN SODIUM CHLOR,ISO-OSMOTIC IV SYRINGE
|
Facility
|
IP
|
$33.65
|
|
|
Service Code
|
NDC 73177015602
|
| Hospital Charge Code |
201243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.60
|
| Rate for Payer: BCBS Trust/PPO |
$27.79
|
| Rate for Payer: BCN Commercial |
$27.79
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.92
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Nomi Health Commercial |
$27.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.24
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.61
|
| Rate for Payer: UHC Core |
$28.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
NDC 70092111944
|
| Hospital Charge Code |
118700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna Commercial |
$27.37
|
| Rate for Payer: Aetna Medicare |
$8.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.06
|
| Rate for Payer: BCBS Complete |
$5.96
|
| Rate for Payer: BCBS MAPPO |
$8.05
|
| Rate for Payer: BCBS Trust/PPO |
$26.47
|
| Rate for Payer: BCN Commercial |
$26.47
|
| Rate for Payer: BCN Medicare Advantage |
$8.05
|
| Rate for Payer: Cash Price |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$27.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.05
|
| Rate for Payer: Healthscope Commercial |
$28.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.15
|
| Rate for Payer: Mclaren Medicaid |
$5.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.45
|
| Rate for Payer: Meridian Medicaid |
$5.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$26.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.15
|
| Rate for Payer: PACE Senior Care Partners |
$7.65
|
| Rate for Payer: PACE SWMI |
$8.05
|
| Rate for Payer: PHP Commercial |
$27.37
|
| Rate for Payer: PHP Medicare Advantage |
$8.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.01
|
| Rate for Payer: Priority Health Medicare |
$8.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.41
|
| Rate for Payer: Railroad Medicare Medicare |
$8.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.34
|
| Rate for Payer: UHC Core |
$26.89
|
| Rate for Payer: UHC Exchange |
$8.05
|
| Rate for Payer: UHC Medicaid |
$5.68
|
| Rate for Payer: UHC Medicare Advantage |
$8.05
|
| Rate for Payer: UHCCP Medicaid |
$5.68
|
| Rate for Payer: VA VA |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.15
|
|
