|
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 |
$29.23
|
| 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
|
$53.50
|
|
|
Service Code
|
NDC 42023011310
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.77 |
| 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 |
$34.77
|
| Rate for Payer: Priority Health HMO/PPO |
$46.55
|
| 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
|
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 |
$34.77
|
| Rate for Payer: Priority Health HMO/PPO |
$46.55
|
| 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 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 |
$30.29 |
| 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 |
$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 |
$30.29
|
| 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 |
$30.29 |
| 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 |
$30.29
|
| 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: 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
|
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 |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| Rate for Payer: BCN Commercial |
$30.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.77
|
| 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 |
$9.77
|
| 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 |
$9.77
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.77
|
| 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 |
$9.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.77
|
| Rate for Payer: UHC Exchange |
$9.77
|
| Rate for Payer: UHC Medicare Advantage |
$9.77
|
| Rate for Payer: VA VA |
$9.77
|
| 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 |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| Rate for Payer: BCN Commercial |
$30.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.77
|
| 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 |
$9.77
|
| 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 |
$9.77
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.77
|
| 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 |
$9.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.77
|
| Rate for Payer: UHC Exchange |
$9.77
|
| Rate for Payer: UHC Medicare Advantage |
$9.77
|
| Rate for Payer: VA VA |
$9.77
|
| 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
|
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
|
|
|
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
|
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 |
$55.37
|
| 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 |
$55.37
|
|
|
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 |
$18.45
|
| Rate for Payer: BCBS Trust/PPO |
$60.69
|
| Rate for Payer: BCN Commercial |
$57.40
|
| Rate for Payer: BCN Medicare Advantage |
$18.45
|
| 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 |
$18.45
|
| Rate for Payer: Healthscope Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.37
|
| 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 |
$18.45
|
| Rate for Payer: PHP Commercial |
$62.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.45
|
| 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 |
$18.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.96
|
| Rate for Payer: UHC Core |
$61.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.45
|
| Rate for Payer: UHC Exchange |
$18.45
|
| Rate for Payer: UHC Medicare Advantage |
$18.45
|
| Rate for Payer: VA VA |
$18.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.37
|
|
|
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
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.32
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$21.89 |
| Rate for Payer: Aetna Commercial |
$20.67
|
| Rate for Payer: Aetna Commercial |
$12.04
|
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$16.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$12.53
|
| Rate for Payer: BCBS Trust/PPO |
$11.56
|
| Rate for Payer: BCBS Trust/PPO |
$9.80
|
| Rate for Payer: BCN Commercial |
$16.00
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: BCN Commercial |
$9.27
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: BCN Commercial |
$18.79
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.46
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$13.81
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$21.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Nomi Health Commercial |
$11.61
|
| Rate for Payer: Nomi Health Commercial |
$12.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: PHP Commercial |
$13.05
|
| Rate for Payer: PHP Commercial |
$12.04
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO |
$10.44
|
| Rate for Payer: Priority Health HMO/PPO |
$21.16
|
| Rate for Payer: Priority Health HMO/PPO |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health HMO/PPO |
$12.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$20.31
|
| Rate for Payer: UHC Core |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Commercial |
$20.67
|
| Rate for Payer: Aetna Commercial |
$12.04
|
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Medicare |
$3.99
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Aetna Medicare |
$6.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.60
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS MAPPO |
$5.17
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$6.08
|
| Rate for Payer: BCBS Trust/PPO |
$19.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.62
|
| Rate for Payer: BCBS Trust/PPO |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Commercial |
$11.93
|
| Rate for Payer: BCN Commercial |
$11.01
|
| Rate for Payer: BCN Commercial |
$16.09
|
| Rate for Payer: BCN Commercial |
$18.91
|
| Rate for Payer: BCN Commercial |
$9.33
|
| Rate for Payer: BCN Medicare Advantage |
$6.08
|
| Rate for Payer: BCN Medicare Advantage |
$3.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.84
|
| Rate for Payer: BCN Medicare Advantage |
$5.17
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$20.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| 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 |
$19.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.84
|
| Rate for Payer: Healthscope Commercial |
$21.89
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$13.81
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.43
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.05
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$12.59
|
| Rate for Payer: Nomi Health Commercial |
$11.61
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: PACE Senior Care Partners |
$3.65
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE Senior Care Partners |
$5.78
|
| Rate for Payer: PACE Senior Care Partners |
$2.85
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE SWMI |
$3.00
|
| Rate for Payer: PACE SWMI |
$6.08
|
| Rate for Payer: PACE SWMI |
$5.17
|
| Rate for Payer: PACE SWMI |
$3.84
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$20.67
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: PHP Commercial |
$13.05
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$12.04
|
| Rate for Payer: PHP Medicare Advantage |
$3.00
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.08
|
| Rate for Payer: PHP Medicare Advantage |
$3.84
|
| Rate for Payer: PHP Medicare Advantage |
$5.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health HMO/PPO |
$10.44
|
| Rate for Payer: Priority Health HMO/PPO |
$12.32
|
| Rate for Payer: Priority Health HMO/PPO |
$13.35
|
| Rate for Payer: Priority Health HMO/PPO |
$21.16
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$6.14
|
| Rate for Payer: Priority Health Medicare |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$3.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Railroad Medicare Medicare |
$3.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.17
|
| Rate for Payer: Railroad Medicare Medicare |
$3.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.46
|
| Rate for Payer: UHC Core |
$12.82
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Core |
$10.02
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$20.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.00
|
| Rate for Payer: UHC Exchange |
$6.08
|
| Rate for Payer: UHC Exchange |
$3.00
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Exchange |
$5.17
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$5.17
|
| Rate for Payer: UHC Medicare Advantage |
$3.84
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.00
|
| Rate for Payer: UHC Medicare Advantage |
$6.08
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: VA VA |
$6.08
|
| Rate for Payer: VA VA |
$3.00
|
| Rate for Payer: VA VA |
$3.84
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: VA VA |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.62
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$27.02
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$24.32 |
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.00
|
| Rate for Payer: BCN Commercial |
$13.49
|
| Rate for Payer: BCN Commercial |
$12.21
|
| Rate for Payer: BCN Commercial |
$8.52
|
| Rate for Payer: BCN Commercial |
$9.75
|
| Rate for Payer: BCN Commercial |
$20.88
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| 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 |
$21.62
|
| Rate for Payer: Healthscope Commercial |
$11.36
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| 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 |
$10.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$10.35
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$22.16
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$10.73
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$22.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| 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 HMO/PPO |
$9.60
|
| Rate for Payer: Priority Health HMO/PPO |
$23.51
|
| Rate for Payer: Priority Health HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health HMO/PPO |
$15.18
|
| Rate for Payer: Priority Health HMO/PPO |
$10.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.36
|
| Rate for Payer: UHC Core |
$9.21
|
| Rate for Payer: UHC Core |
$10.54
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: UHC Core |
$22.56
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.09
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna Medicare |
$2.87
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Aetna Medicare |
$7.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.44
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.23
|
| Rate for Payer: BCBS MAPPO |
$4.36
|
| Rate for Payer: BCBS MAPPO |
$3.15
|
| Rate for Payer: BCBS MAPPO |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$22.21
|
| Rate for Payer: BCBS Trust/PPO |
$14.35
|
| Rate for Payer: BCBS Trust/PPO |
$12.99
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$9.07
|
| Rate for Payer: BCN Commercial |
$12.28
|
| Rate for Payer: BCN Commercial |
$9.81
|
| Rate for Payer: BCN Commercial |
$13.57
|
| Rate for Payer: BCN Commercial |
$21.01
|
| Rate for Payer: BCN Commercial |
$8.58
|
| Rate for Payer: BCN Medicare Advantage |
$6.75
|
| Rate for Payer: BCN Medicare Advantage |
$2.76
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.36
|
| Rate for Payer: BCN Medicare Advantage |
$3.15
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| 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 |
$10.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.58
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: Meridian Medicaid |
$0.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.97
|
| 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 |
$10.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$22.16
|
| Rate for Payer: Nomi Health Commercial |
$12.96
|
| Rate for Payer: Nomi Health Commercial |
$10.35
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: PACE Senior Care Partners |
$3.75
|
| Rate for Payer: PACE Senior Care Partners |
$3.00
|
| Rate for Payer: PACE Senior Care Partners |
$6.42
|
| Rate for Payer: PACE Senior Care Partners |
$2.62
|
| Rate for Payer: PACE Senior Care Partners |
$4.14
|
| Rate for Payer: PACE SWMI |
$2.76
|
| Rate for Payer: PACE SWMI |
$6.75
|
| Rate for Payer: PACE SWMI |
$4.36
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PACE SWMI |
$3.15
|
| Rate for Payer: PHP Commercial |
$22.97
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$10.73
|
| Rate for Payer: PHP Medicare Advantage |
$2.76
|
| Rate for Payer: PHP Medicare Advantage |
$3.15
|
| Rate for Payer: PHP Medicare Advantage |
$6.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: PHP Medicare Advantage |
$4.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.20
|
| Rate for Payer: Priority Health HMO/PPO |
$15.18
|
| Rate for Payer: Priority Health HMO/PPO |
$9.60
|
| Rate for Payer: Priority Health HMO/PPO |
$10.98
|
| Rate for Payer: Priority Health HMO/PPO |
$13.75
|
| Rate for Payer: Priority Health HMO/PPO |
$23.51
|
| Rate for Payer: Priority Health Medicare |
$4.41
|
| Rate for Payer: Priority Health Medicare |
$3.19
|
| Rate for Payer: Priority Health Medicare |
$6.82
|
| Rate for Payer: Priority Health Medicare |
$2.79
|
| Rate for Payer: Priority Health Medicare |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: Railroad Medicare Medicare |
$6.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.11
|
| Rate for Payer: UHC Core |
$13.19
|
| Rate for Payer: UHC Core |
$10.54
|
| Rate for Payer: UHC Core |
$9.21
|
| Rate for Payer: UHC Core |
$14.57
|
| Rate for Payer: UHC Core |
$22.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.76
|
| Rate for Payer: UHC Exchange |
$6.75
|
| Rate for Payer: UHC Exchange |
$2.76
|
| Rate for Payer: UHC Exchange |
$3.95
|
| Rate for Payer: UHC Exchange |
$4.36
|
| Rate for Payer: UHC Exchange |
$3.15
|
| Rate for Payer: UHC Medicare Advantage |
$4.36
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: UHC Medicare Advantage |
$3.15
|
| Rate for Payer: UHC Medicare Advantage |
$2.76
|
| Rate for Payer: UHC Medicare Advantage |
$6.75
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: UHCCP Medicaid |
$0.22
|
| Rate for Payer: VA VA |
$6.75
|
| Rate for Payer: VA VA |
$2.76
|
| Rate for Payer: VA VA |
$3.95
|
| Rate for Payer: VA VA |
$3.15
|
| Rate for Payer: VA VA |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.46
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 00904710961
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.88 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: BCBS Trust/PPO |
$180.69
|
| Rate for Payer: BCN Commercial |
$171.06
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Nomi Health Commercial |
$181.51
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health HMO/PPO |
$192.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.79
|
| Rate for Payer: UHC Core |
$184.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.01
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS MAPPO |
$0.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.52
|
| Rate for Payer: BCN Medicare Advantage |
$0.81
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: PACE Senior Care Partners |
$0.77
|
| Rate for Payer: PACE SWMI |
$0.81
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO |
$2.82
|
| Rate for Payer: Priority Health Medicare |
$0.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.17
|
| Rate for Payer: Railroad Medicare Medicare |
$0.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.85
|
| Rate for Payer: UHC Core |
$2.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.81
|
| Rate for Payer: UHC Exchange |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$0.81
|
| Rate for Payer: VA VA |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$323.95
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.57 |
| Max. Negotiated Rate |
$291.56 |
| Rate for Payer: Aetna Commercial |
$275.36
|
| Rate for Payer: BCBS Trust/PPO |
$264.44
|
| Rate for Payer: BCN Commercial |
$250.35
|
| Rate for Payer: Cash Price |
$259.16
|
| Rate for Payer: Cofinity Commercial |
$278.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.16
|
| Rate for Payer: Healthscope Commercial |
$291.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.36
|
| Rate for Payer: Nomi Health Commercial |
$265.64
|
| Rate for Payer: PHP Commercial |
$275.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.57
|
| Rate for Payer: Priority Health HMO/PPO |
$281.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.08
|
| Rate for Payer: UHC Core |
$270.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.96
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
NDC 68382079801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna Medicare |
$114.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.33
|
| Rate for Payer: BCBS Complete |
$175.78
|
| Rate for Payer: BCBS MAPPO |
$109.86
|
| Rate for Payer: BCBS Trust/PPO |
$361.27
|
| Rate for Payer: BCN Commercial |
$341.67
|
| Rate for Payer: BCN Medicare Advantage |
$109.86
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: Nomi Health Commercial |
$360.35
|
| Rate for Payer: PACE Senior Care Partners |
$104.37
|
| Rate for Payer: PACE SWMI |
$109.86
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: PHP Medicare Advantage |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.64
|
| Rate for Payer: Priority Health HMO/PPO |
$382.32
|
| Rate for Payer: Priority Health Medicare |
$110.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.43
|
| Rate for Payer: Railroad Medicare Medicare |
$109.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.72
|
| Rate for Payer: UHC Core |
$366.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.86
|
| Rate for Payer: UHC Exchange |
$109.86
|
| Rate for Payer: UHC Medicare Advantage |
$109.86
|
| Rate for Payer: VA VA |
$109.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
