|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
NDC 67457-181-20
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.92 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna American Axle |
$44.20
|
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$47.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: UMR Bronson Commercial |
$29.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$67.70
|
|
|
Service Code
|
NDC 55150-438-01
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.79 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna American Axle |
$44.00
|
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.00
|
| Rate for Payer: Cash Price |
$54.16
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$47.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.54
|
| Rate for Payer: PHP Commercial |
$57.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.39
|
| Rate for Payer: Priority Health SBD |
$42.65
|
| Rate for Payer: UMR Bronson Commercial |
$29.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.78
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
NDC 9900-0019-25
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna American Axle |
$62.40
|
| Rate for Payer: Aetna Commercial |
$81.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$67.20
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$67.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: PHP Commercial |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health SBD |
$60.48
|
| Rate for Payer: UMR Bronson Commercial |
$42.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.00
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
NDC 69374-982-55
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna American Axle |
$22.75
|
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$24.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health SBD |
$22.05
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE
|
Facility
|
IP
|
$32.20
|
|
|
Service Code
|
NDC 70092-1119-44
|
| Hospital Charge Code |
118700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$28.98 |
| Rate for Payer: Aetna American Axle |
$20.93
|
| Rate for Payer: Aetna Commercial |
$27.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.93
|
| Rate for Payer: Cash Price |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$22.54
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$22.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.37
|
| Rate for Payer: PHP Commercial |
$27.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: Priority Health SBD |
$20.29
|
| Rate for Payer: UMR Bronson Commercial |
$14.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.15
|
|
|
KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE
|
Facility
|
IP
|
$42.98
|
|
|
Service Code
|
NDC 70092-9119-44
|
| Hospital Charge Code |
118700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$38.68 |
| Rate for Payer: Aetna American Axle |
$27.94
|
| Rate for Payer: Aetna Commercial |
$36.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.94
|
| Rate for Payer: Cash Price |
$34.38
|
| Rate for Payer: Cofinity Commercial |
$30.09
|
| Rate for Payer: Cofinity Commercial |
$36.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.38
|
| Rate for Payer: Healthscope Commercial |
$38.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.53
|
| Rate for Payer: PHP Commercial |
$36.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.09
|
| Rate for Payer: Priority Health SBD |
$27.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.24
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$32.85
|
|
|
Service Code
|
NDC 67457-001-00
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$29.56 |
| Rate for Payer: Aetna American Axle |
$21.35
|
| Rate for Payer: Aetna Commercial |
$27.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.35
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$28.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.28
|
| Rate for Payer: Healthscope Commercial |
$29.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.92
|
| Rate for Payer: PHP Commercial |
$27.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UMR Bronson Commercial |
$14.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$32.65
|
|
|
Service Code
|
NDC 42023-114-10
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna American Axle |
$21.22
|
| Rate for Payer: Aetna Commercial |
$27.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: Cofinity Commercial |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$28.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.12
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.75
|
| Rate for Payer: PHP Commercial |
$27.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$20.57
|
| Rate for Payer: UMR Bronson Commercial |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.49
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$39.41
|
|
|
Service Code
|
NDC 0143-9508-01
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna American Axle |
$25.62
|
| Rate for Payer: Aetna Commercial |
$33.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.62
|
| Rate for Payer: Cash Price |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$33.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.53
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.50
|
| Rate for Payer: PHP Commercial |
$33.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health SBD |
$24.83
|
| Rate for Payer: UMR Bronson Commercial |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.56
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$32.85
|
|
|
Service Code
|
NDC 67457-001-10
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$29.56 |
| Rate for Payer: Aetna American Axle |
$21.35
|
| Rate for Payer: Aetna Commercial |
$27.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.35
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cofinity Commercial |
$23.00
|
| Rate for Payer: Cofinity Commercial |
$28.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.28
|
| Rate for Payer: Healthscope Commercial |
$29.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.92
|
| Rate for Payer: PHP Commercial |
$27.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health SBD |
$20.70
|
| Rate for Payer: UMR Bronson Commercial |
$14.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.64
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$39.41
|
|
|
Service Code
|
NDC 0143-9508-10
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna American Axle |
$25.62
|
| Rate for Payer: Aetna Commercial |
$33.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.62
|
| Rate for Payer: Cash Price |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$33.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.53
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.50
|
| Rate for Payer: PHP Commercial |
$33.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health SBD |
$24.83
|
| Rate for Payer: UMR Bronson Commercial |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.56
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.10
|
|
|
Service Code
|
NDC 0409-2053-10
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Aetna American Axle |
$15.02
|
| Rate for Payer: Aetna Commercial |
$19.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.02
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$19.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.48
|
| Rate for Payer: Healthscope Commercial |
$20.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.64
|
| Rate for Payer: PHP Commercial |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.17
|
| Rate for Payer: Priority Health SBD |
$14.55
|
| Rate for Payer: UMR Bronson Commercial |
$10.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.32
|
|
|
KETAMINE (BULK) 100 % POWDER
|
Facility
|
IP
|
$198.90
|
|
|
Service Code
|
NDC 38779-1754-4
|
| Hospital Charge Code |
23101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$179.01 |
| Rate for Payer: Aetna American Axle |
$129.28
|
| Rate for Payer: Aetna Commercial |
$169.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.28
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cofinity Commercial |
$139.23
|
| Rate for Payer: Cofinity Commercial |
$171.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.12
|
| Rate for Payer: Healthscope Commercial |
$179.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.06
|
| Rate for Payer: PHP Commercial |
$169.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: Priority Health SBD |
$125.31
|
| Rate for Payer: UMR Bronson Commercial |
$87.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.18
|
|
|
KETOCONAZOLE 200 MG TABLET
|
Facility
|
IP
|
$375.36
|
|
|
Service Code
|
NDC 35573-433-02
|
| Hospital Charge Code |
10369
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$337.82 |
| Rate for Payer: Aetna American Axle |
$243.98
|
| Rate for Payer: Aetna Commercial |
$319.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.98
|
| Rate for Payer: Cash Price |
$300.29
|
| Rate for Payer: Cofinity Commercial |
$262.75
|
| Rate for Payer: Cofinity Commercial |
$322.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$337.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.06
|
| Rate for Payer: PHP Commercial |
$319.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.75
|
| Rate for Payer: Priority Health SBD |
$236.48
|
| Rate for Payer: UMR Bronson Commercial |
$165.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.52
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$73.82
|
|
|
Service Code
|
NDC 51672-1298-1
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.48 |
| Max. Negotiated Rate |
$66.44 |
| Rate for Payer: Aetna American Axle |
$47.98
|
| Rate for Payer: Aetna Commercial |
$62.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.98
|
| Rate for Payer: Cash Price |
$59.06
|
| Rate for Payer: Cofinity Commercial |
$51.67
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$51.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.75
|
| Rate for Payer: PHP Commercial |
$62.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.67
|
| Rate for Payer: Priority Health SBD |
$46.51
|
| Rate for Payer: UMR Bronson Commercial |
$32.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.36
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
NDC 21922-025-04
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.49 |
| Max. Negotiated Rate |
$43.95 |
| Rate for Payer: Aetna American Axle |
$31.74
|
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.74
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.51
|
| Rate for Payer: PHP Commercial |
$41.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.18
|
| Rate for Payer: Priority Health SBD |
$30.76
|
| Rate for Payer: UMR Bronson Commercial |
$21.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.16
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna American Axle |
$9.20
|
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna American Axle |
$15.78
|
| Rate for Payer: Aetna American Axle |
$9.98
|
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Commercial |
$20.64
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$12.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.98
|
| Rate for Payer: Cash Price |
$19.42
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$13.20
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$20.88
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.42
|
| Rate for Payer: Healthscope Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.05
|
| Rate for Payer: PHP Commercial |
$20.64
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$12.04
|
| Rate for Payer: PHP Commercial |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.74
|
| Rate for Payer: Priority Health SBD |
$8.92
|
| Rate for Payer: Priority Health SBD |
$9.67
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$15.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.68
|
| Rate for Payer: UMR Bronson Commercial |
$6.23
|
| Rate for Payer: UMR Bronson Commercial |
$9.11
|
| Rate for Payer: UMR Bronson Commercial |
$6.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.21
|
|
|
KETOROLAC 15MG ROPIVACAINE 0.5 % 50ML IN SODIUM CHLORIDE 0.9% ML INFILTRATION (TOTAL KNEE)
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
301036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna American Axle |
$71.50
|
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: UMR Bronson Commercial |
$48.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
KETOROLAC 15 MG ROPIVACAINE 0.5% 60 ML IN SODIUM CHLORIDE 0.9% ML INFILTRATION (TOTAL HIP)
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
301035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna American Axle |
$71.50
|
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$77.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health SBD |
$69.30
|
| Rate for Payer: UMR Bronson Commercial |
$48.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$11.31
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: Aetna American Axle |
$7.35
|
| Rate for Payer: Aetna American Axle |
$7.57
|
| Rate for Payer: Aetna American Axle |
$17.56
|
| Rate for Payer: Aetna American Axle |
$13.63
|
| Rate for Payer: Aetna American Axle |
$10.27
|
| Rate for Payer: Aetna American Axle |
$9.84
|
| Rate for Payer: Aetna American Axle |
$8.20
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.56
|
| Rate for Payer: Cash Price |
$9.05
|
| Rate for Payer: Cash Price |
$9.32
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$18.91
|
| Rate for Payer: Cofinity Commercial |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$13.02
|
| Rate for Payer: Cofinity Commercial |
$9.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Healthscope Commercial |
$10.48
|
| Rate for Payer: Healthscope Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$11.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.73
|
| Rate for Payer: PHP Commercial |
$12.87
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$10.73
|
| Rate for Payer: PHP Commercial |
$17.82
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$9.90
|
| Rate for Payer: PHP Commercial |
$22.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health SBD |
$7.13
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$7.95
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: Priority Health SBD |
$13.21
|
| Rate for Payer: Priority Health SBD |
$17.02
|
| Rate for Payer: Priority Health SBD |
$7.34
|
| Rate for Payer: UMR Bronson Commercial |
$5.55
|
| Rate for Payer: UMR Bronson Commercial |
$4.98
|
| Rate for Payer: UMR Bronson Commercial |
$5.13
|
| Rate for Payer: UMR Bronson Commercial |
$6.66
|
| Rate for Payer: UMR Bronson Commercial |
$6.95
|
| Rate for Payer: UMR Bronson Commercial |
$11.89
|
| Rate for Payer: UMR Bronson Commercial |
$9.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$12.62
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$11.36 |
| Rate for Payer: Aetna American Axle |
$8.20
|
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.20
|
| Rate for Payer: BCBS Complete |
$5.05
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cash Price |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$10.85
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.10
|
| Rate for Payer: Healthscope Commercial |
$11.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.73
|
| Rate for Payer: PHP Commercial |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.83
|
| Rate for Payer: Priority Health SBD |
$7.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.46
|
|
|
KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$11.46
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
91349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: BCBS Complete |
$4.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$14.19
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
91349
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Aetna American Axle |
$9.22
|
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna American Axle |
$12.50
|
| Rate for Payer: Aetna American Axle |
$14.62
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: Aetna Commercial |
$12.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.50
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cash Price |
$11.35
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Commercial |
$12.20
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$19.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$12.77
|
| Rate for Payer: Healthscope Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.12
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$19.12
|
| Rate for Payer: PHP Commercial |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.93
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: Priority Health SBD |
$8.94
|
| Rate for Payer: Priority Health SBD |
$14.18
|
| Rate for Payer: Priority Health SBD |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.90
|
| Rate for Payer: UMR Bronson Commercial |
$8.46
|
| Rate for Payer: UMR Bronson Commercial |
$5.04
|
| Rate for Payer: UMR Bronson Commercial |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
|
Facility
|
IP
|
$40,254.15
|
|
|
Service Code
|
MS-DRG 657
|
| Min. Negotiated Rate |
$13,987.62 |
| Max. Negotiated Rate |
$40,254.15 |
| Rate for Payer: Aetna Medicare |
$15,312.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,404.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,404.76
|
| Rate for Payer: BCBS MAPPO |
$14,723.81
|
| Rate for Payer: BCBS Trust/PPO |
$40,254.15
|
| Rate for Payer: BCN Medicare Advantage |
$14,723.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,723.81
|
| Rate for Payer: Mclaren Medicare |
$14,723.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,460.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,932.38
|
| Rate for Payer: PACE Medicare |
$13,987.62
|
| Rate for Payer: PACE SWMI |
$14,723.81
|
| Rate for Payer: PHP Medicare Advantage |
$14,723.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,464.12
|
| Rate for Payer: Priority Health Medicare |
$14,723.81
|
| Rate for Payer: Priority Health Narrow Network |
$21,171.30
|
| Rate for Payer: Railroad Medicare Medicare |
$14,723.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,131.43
|
| Rate for Payer: UHC Core |
$23,067.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,723.81
|
| Rate for Payer: UHC Exchange |
$18,338.72
|
| Rate for Payer: UHC Medicare Advantage |
$15,165.52
|
| Rate for Payer: VA VA |
$14,723.81
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC
|
Facility
|
IP
|
$72,140.33
|
|
|
Service Code
|
MS-DRG 656
|
| Min. Negotiated Rate |
$23,456.26 |
| Max. Negotiated Rate |
$72,140.33 |
| Rate for Payer: Aetna Medicare |
$25,678.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,863.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,863.50
|
| Rate for Payer: BCBS MAPPO |
$24,690.80
|
| Rate for Payer: BCBS Trust/PPO |
$72,140.33
|
| Rate for Payer: BCN Medicare Advantage |
$24,690.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,690.80
|
| Rate for Payer: Mclaren Medicare |
$24,690.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,925.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,394.42
|
| Rate for Payer: PACE Medicare |
$23,456.26
|
| Rate for Payer: PACE SWMI |
$24,690.80
|
| Rate for Payer: PHP Medicare Advantage |
$24,690.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45,024.31
|
| Rate for Payer: Priority Health Medicare |
$24,690.80
|
| Rate for Payer: Priority Health Narrow Network |
$36,019.45
|
| Rate for Payer: Railroad Medicare Medicare |
$24,690.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,860.95
|
| Rate for Payer: UHC Core |
$39,245.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,690.80
|
| Rate for Payer: UHC Exchange |
$31,200.29
|
| Rate for Payer: UHC Medicare Advantage |
$25,431.52
|
| Rate for Payer: VA VA |
$24,690.80
|
|
