|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
NDC 67457018100
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.51
|
| Rate for Payer: BCN Commercial |
$52.55
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.80
|
| Rate for Payer: Nomi Health Commercial |
$55.76
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health HMO/PPO |
$59.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
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 |
$16.08 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| 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 |
$27.08
|
| Rate for Payer: BCBS MAPPO |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$55.66
|
| Rate for Payer: BCN Commercial |
$52.64
|
| Rate for Payer: BCN Medicare Advantage |
$16.92
|
| 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 |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$60.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.54
|
| Rate for Payer: Nomi Health Commercial |
$55.51
|
| Rate for Payer: PACE Senior Care Partners |
$16.08
|
| Rate for Payer: PACE SWMI |
$16.92
|
| Rate for Payer: PHP Commercial |
$57.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.00
|
| Rate for Payer: Priority Health HMO/PPO |
$58.90
|
| Rate for Payer: Priority Health Medicare |
$17.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.36
|
| Rate for Payer: Railroad Medicare Medicare |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.58
|
| Rate for Payer: UHC Core |
$56.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.92
|
| Rate for Payer: UHC Exchange |
$16.92
|
| Rate for Payer: UHC Medicare Advantage |
$16.92
|
| Rate for Payer: VA VA |
$16.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.78
|
|
|
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 |
$8.31 |
| 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 |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$27.21
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| 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 Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Medicare |
$8.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.45
|
| Rate for Payer: Railroad Medicare Medicare |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.75
|
| Rate for Payer: UHC Exchange |
$8.75
|
| Rate for Payer: UHC Medicare Advantage |
$8.75
|
| 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
|
$96.00
|
|
|
Service Code
|
NDC 09900000869
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.80 |
| 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 |
$38.40
|
| Rate for Payer: BCBS MAPPO |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.92
|
| Rate for Payer: BCN Commercial |
$74.64
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.60
|
| Rate for Payer: Nomi Health Commercial |
$78.72
|
| 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 Cigna Priority Health |
$62.40
|
| Rate for Payer: Priority Health HMO/PPO |
$83.52
|
| Rate for Payer: Priority Health Medicare |
$24.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.32
|
| 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 Dual Complete DSNP |
$24.00
|
| Rate for Payer: UHC Exchange |
$24.00
|
| Rate for Payer: UHC Medicare Advantage |
$24.00
|
| 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
|
$96.00
|
|
|
Service Code
|
NDC 09900000869
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$78.36
|
| Rate for Payer: BCN Commercial |
$74.19
|
| 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: PHP Commercial |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: Priority Health HMO/PPO |
$83.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.32
|
| 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
|
$53.50
|
|
|
Service Code
|
NDC 42023011310
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.71 |
| 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 |
$21.40
|
| Rate for Payer: BCBS MAPPO |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$43.98
|
| Rate for Payer: BCN Commercial |
$41.60
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Nomi Health Commercial |
$43.87
|
| 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 Cigna Priority Health |
$34.78
|
| Rate for Payer: Priority Health HMO/PPO |
$46.54
|
| Rate for Payer: Priority Health Medicare |
$13.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.84
|
| 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 Dual Complete DSNP |
$13.38
|
| Rate for Payer: UHC Exchange |
$13.38
|
| Rate for Payer: UHC Medicare Advantage |
$13.38
|
| 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
|
$55.80
|
|
|
Service Code
|
NDC 25021068220
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$50.22 |
| Rate for Payer: Aetna Commercial |
$47.43
|
| Rate for Payer: BCBS Trust/PPO |
$45.55
|
| Rate for Payer: BCN Commercial |
$43.12
|
| Rate for Payer: Cash Price |
$44.64
|
| Rate for Payer: Cofinity Commercial |
$47.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.64
|
| Rate for Payer: Healthscope Commercial |
$50.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.43
|
| Rate for Payer: Nomi Health Commercial |
$45.76
|
| Rate for Payer: PHP Commercial |
$47.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.27
|
| Rate for Payer: Priority Health HMO/PPO |
$48.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.10
|
| Rate for Payer: UHC Core |
$46.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.85
|
|
|
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 |
$34.78 |
| Max. Negotiated Rate |
$48.15 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: BCBS Trust/PPO |
$43.67
|
| Rate for Payer: BCN Commercial |
$41.34
|
| 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: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.78
|
| Rate for Payer: Priority Health HMO/PPO |
$46.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.84
|
| 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
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 69374098255
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.57
|
| Rate for Payer: BCN Commercial |
$27.05
|
| 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: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
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 |
$16.08 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| 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 |
$27.08
|
| Rate for Payer: BCBS MAPPO |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$55.66
|
| Rate for Payer: BCN Commercial |
$52.64
|
| Rate for Payer: BCN Medicare Advantage |
$16.92
|
| 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 |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$60.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.54
|
| Rate for Payer: Nomi Health Commercial |
$55.51
|
| Rate for Payer: PACE Senior Care Partners |
$16.08
|
| Rate for Payer: PACE SWMI |
$16.92
|
| Rate for Payer: PHP Commercial |
$57.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.00
|
| Rate for Payer: Priority Health HMO/PPO |
$58.90
|
| Rate for Payer: Priority Health Medicare |
$17.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.36
|
| Rate for Payer: Railroad Medicare Medicare |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.58
|
| Rate for Payer: UHC Core |
$56.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.92
|
| Rate for Payer: UHC Exchange |
$16.92
|
| Rate for Payer: UHC Medicare Advantage |
$16.92
|
| Rate for Payer: VA VA |
$16.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.78
|
|
|
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 |
$44.00 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: BCBS Trust/PPO |
$55.26
|
| Rate for Payer: BCN Commercial |
$52.32
|
| 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 |
$50.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.54
|
| Rate for Payer: Nomi Health Commercial |
$55.51
|
| Rate for Payer: PHP Commercial |
$57.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.00
|
| Rate for Payer: Priority Health HMO/PPO |
$58.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.36
|
| 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 |
$50.78
|
|
|
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 |
$44.00 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: BCBS Trust/PPO |
$55.26
|
| Rate for Payer: BCN Commercial |
$52.32
|
| 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 |
$50.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.54
|
| Rate for Payer: Nomi Health Commercial |
$55.51
|
| Rate for Payer: PHP Commercial |
$57.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.00
|
| Rate for Payer: Priority Health HMO/PPO |
$58.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.36
|
| 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 |
$50.78
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$55.80
|
|
|
Service Code
|
NDC 25021068220
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$50.22 |
| Rate for Payer: Aetna Commercial |
$47.43
|
| Rate for Payer: Aetna Medicare |
$14.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.44
|
| Rate for Payer: BCBS Complete |
$22.32
|
| Rate for Payer: BCBS MAPPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$45.87
|
| Rate for Payer: BCN Commercial |
$43.38
|
| Rate for Payer: BCN Medicare Advantage |
$13.95
|
| Rate for Payer: Cash Price |
$44.64
|
| Rate for Payer: Cofinity Commercial |
$47.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.95
|
| Rate for Payer: Healthscope Commercial |
$50.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.43
|
| Rate for Payer: Nomi Health Commercial |
$45.76
|
| Rate for Payer: PACE Senior Care Partners |
$13.25
|
| Rate for Payer: PACE SWMI |
$13.95
|
| Rate for Payer: PHP Commercial |
$47.43
|
| Rate for Payer: PHP Medicare Advantage |
$13.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.27
|
| Rate for Payer: Priority Health HMO/PPO |
$48.55
|
| Rate for Payer: Priority Health Medicare |
$14.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.39
|
| Rate for Payer: Railroad Medicare Medicare |
$13.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.10
|
| Rate for Payer: UHC Core |
$46.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.95
|
| Rate for Payer: UHC Exchange |
$13.95
|
| Rate for Payer: UHC Medicare Advantage |
$13.95
|
| Rate for Payer: VA VA |
$13.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.85
|
|
|
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 |
$7.99 |
| Max. Negotiated Rate |
$30.28 |
| 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 |
$13.46
|
| Rate for Payer: BCBS MAPPO |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$27.66
|
| Rate for Payer: BCN Commercial |
$26.16
|
| 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 |
$30.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Nomi Health Commercial |
$27.59
|
| 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 Cigna Priority Health |
$21.87
|
| Rate for Payer: Priority Health HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Medicare |
$8.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.55
|
| 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 Dual Complete DSNP |
$8.41
|
| Rate for Payer: UHC Exchange |
$8.41
|
| Rate for Payer: UHC Medicare Advantage |
$8.41
|
| 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 |
$21.87 |
| Max. Negotiated Rate |
$30.28 |
| Rate for Payer: Aetna Commercial |
$28.60
|
| Rate for Payer: BCBS Trust/PPO |
$27.47
|
| Rate for Payer: BCN Commercial |
$26.00
|
| 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 |
$30.28
|
| 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: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.87
|
| Rate for Payer: Priority Health HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.55
|
| 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 |
$7.65 |
| 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 |
$12.88
|
| Rate for Payer: BCBS MAPPO |
$8.05
|
| Rate for Payer: BCBS Trust/PPO |
$26.47
|
| Rate for Payer: BCN Commercial |
$25.04
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$26.40
|
| 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 Cigna Priority Health |
$20.93
|
| Rate for Payer: Priority Health HMO/PPO |
$28.01
|
| Rate for Payer: Priority Health Medicare |
$8.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.57
|
| 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 Dual Complete DSNP |
$8.05
|
| Rate for Payer: UHC Exchange |
$8.05
|
| Rate for Payer: UHC Medicare Advantage |
$8.05
|
| Rate for Payer: VA VA |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.15
|
|
|
KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE
|
Facility
|
IP
|
$32.20
|
|
|
Service Code
|
NDC 70092111944
|
| Hospital Charge Code |
118700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna Commercial |
$27.37
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCN Commercial |
$24.88
|
| 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: Healthscope Commercial |
$28.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$26.40
|
| Rate for Payer: PHP Commercial |
$27.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.93
|
| Rate for Payer: Priority Health HMO/PPO |
$28.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.34
|
| Rate for Payer: UHC Core |
$26.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.15
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 00143950810
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.88
|
| Rate for Payer: BCN Commercial |
$30.19
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 00143950801
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.88
|
| Rate for Payer: BCN Commercial |
$30.19
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 00143950810
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.21
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: BCBS MAPPO |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| Rate for Payer: BCN Commercial |
$30.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.76
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.76
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: PACE Senior Care Partners |
$9.28
|
| Rate for Payer: PACE SWMI |
$9.76
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Medicare |
$9.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.17
|
| Rate for Payer: Railroad Medicare Medicare |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.76
|
| Rate for Payer: UHC Exchange |
$9.76
|
| Rate for Payer: UHC Medicare Advantage |
$9.76
|
| Rate for Payer: VA VA |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 00143950801
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.21
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: BCBS MAPPO |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| Rate for Payer: BCN Commercial |
$30.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.76
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.76
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: PACE Senior Care Partners |
$9.28
|
| Rate for Payer: PACE SWMI |
$9.76
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Medicare |
$9.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.17
|
| Rate for Payer: Railroad Medicare Medicare |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.76
|
| Rate for Payer: UHC Exchange |
$9.76
|
| Rate for Payer: UHC Medicare Advantage |
$9.76
|
| Rate for Payer: VA VA |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$73.82
|
|
|
Service Code
|
NDC 51672129801
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$66.44 |
| Rate for Payer: Aetna Commercial |
$62.75
|
| Rate for Payer: BCBS Trust/PPO |
$60.26
|
| Rate for Payer: BCN Commercial |
$57.05
|
| Rate for Payer: Cash Price |
$59.06
|
| Rate for Payer: Cofinity Commercial |
$63.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.06
|
| Rate for Payer: Healthscope Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.75
|
| Rate for Payer: Nomi Health Commercial |
$60.53
|
| Rate for Payer: PHP Commercial |
$62.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.98
|
| Rate for Payer: Priority Health HMO/PPO |
$64.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.96
|
| Rate for Payer: UHC Core |
$61.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.36
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$24.31
|
|
|
Service Code
|
NDC 00168009915
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: Aetna Medicare |
$6.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.60
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$6.08
|
| Rate for Payer: BCBS Trust/PPO |
$19.99
|
| Rate for Payer: BCN Commercial |
$18.90
|
| Rate for Payer: BCN Medicare Advantage |
$6.08
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$20.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.66
|
| Rate for Payer: Nomi Health Commercial |
$19.93
|
| Rate for Payer: PACE Senior Care Partners |
$5.77
|
| Rate for Payer: PACE SWMI |
$6.08
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: PHP Medicare Advantage |
$6.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.80
|
| Rate for Payer: Priority Health HMO/PPO |
$21.15
|
| Rate for Payer: Priority Health Medicare |
$6.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.39
|
| Rate for Payer: UHC Core |
$20.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.08
|
| Rate for Payer: UHC Exchange |
$6.08
|
| Rate for Payer: UHC Medicare Advantage |
$6.08
|
| Rate for Payer: VA VA |
$6.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.23
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$24.31
|
|
|
Service Code
|
NDC 00168009915
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: BCBS Trust/PPO |
$19.84
|
| Rate for Payer: BCN Commercial |
$18.79
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$20.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$21.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.66
|
| Rate for Payer: Nomi Health Commercial |
$19.93
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.80
|
| Rate for Payer: Priority Health HMO/PPO |
$21.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.39
|
| Rate for Payer: UHC Core |
$20.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.23
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$73.82
|
|
|
Service Code
|
NDC 51672129801
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.53 |
| Max. Negotiated Rate |
$66.44 |
| Rate for Payer: Aetna Commercial |
$62.75
|
| Rate for Payer: Aetna Medicare |
$19.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.07
|
| Rate for Payer: BCBS Complete |
$29.53
|
| Rate for Payer: BCBS MAPPO |
$18.46
|
| Rate for Payer: BCBS Trust/PPO |
$60.69
|
| Rate for Payer: BCN Commercial |
$57.40
|
| Rate for Payer: BCN Medicare Advantage |
$18.46
|
| Rate for Payer: Cash Price |
$59.06
|
| Rate for Payer: Cofinity Commercial |
$63.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.46
|
| Rate for Payer: Healthscope Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.75
|
| Rate for Payer: Nomi Health Commercial |
$60.53
|
| Rate for Payer: PACE Senior Care Partners |
$17.53
|
| Rate for Payer: PACE SWMI |
$18.46
|
| Rate for Payer: PHP Commercial |
$62.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.98
|
| Rate for Payer: Priority Health HMO/PPO |
$64.22
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.46
|
| Rate for Payer: Railroad Medicare Medicare |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.96
|
| Rate for Payer: UHC Core |
$61.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.46
|
| Rate for Payer: UHC Exchange |
$18.46
|
| Rate for Payer: UHC Medicare Advantage |
$18.46
|
| Rate for Payer: VA VA |
$18.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.36
|
|
