|
KATE FARMS PEDIATRIC PEPTIDE CONTINUOUS FEED VANILLA 1.5 0.05 GRAM-1.5L
|
Facility
|
OP
|
$45.33
|
|
|
Service Code
|
NDC 11112003069
|
| Hospital Charge Code |
301446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna American Axle |
$29.46
|
| Rate for Payer: Aetna Commercial |
$38.53
|
| Rate for Payer: Aetna Medicare |
$22.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.46
|
| Rate for Payer: BCBS Complete |
$18.13
|
| Rate for Payer: Cash Price |
$36.26
|
| Rate for Payer: Cofinity Advantage |
$31.73
|
| Rate for Payer: Cofinity Commercial |
$38.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.26
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.00
|
| Rate for Payer: PHP Commercial |
$38.53
|
| Rate for Payer: Priority Health SBD |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.46
|
| Rate for Payer: UHC Core |
$23.62
|
| Rate for Payer: UHC Exchange |
$17.81
|
| Rate for Payer: UMR Bronson Commercial |
$16.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.00
|
|
|
KATE FARMS PEDIATRIC PEPTIDE CONTINUOUS FEED VANILLA 1.5 0.05 GRAM-1.5L
|
Facility
|
IP
|
$45.33
|
|
|
Service Code
|
NDC 11112003069
|
| Hospital Charge Code |
301446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Aetna American Axle |
$29.46
|
| Rate for Payer: Aetna Commercial |
$38.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.46
|
| Rate for Payer: Cash Price |
$36.26
|
| Rate for Payer: Cofinity Advantage |
$31.73
|
| Rate for Payer: Cofinity Commercial |
$38.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.26
|
| Rate for Payer: Healthscope Commercial |
$40.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.00
|
| Rate for Payer: PHP Commercial |
$38.53
|
| Rate for Payer: Priority Health SBD |
$28.56
|
| Rate for Payer: UMR Bronson Commercial |
$19.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.00
|
|
|
KATE FARMS PEDIATRIC STANDARD BOLUS FEED VANILLA 1.2 0.05 GRAM-1.2 KCAL
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 51823000690
|
| Hospital Charge Code |
301449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.62
|
| Rate for Payer: UHC Core |
$7.71
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
KATE FARMS PEDIATRIC STANDARD BOLUS FEED VANILLA 1.2 0.05 GRAM-1.2 KCAL
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 51823000690
|
| Hospital Charge Code |
301449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
KATE FARMS PEDIATRIC STANDARD CONTINUOUS FEED VANILLA 1.2 0.05 GRAM-LIQUID
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 51823000690
|
| Hospital Charge Code |
301448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.62
|
| Rate for Payer: UHC Core |
$7.71
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
KATE FARMS PEDIATRIC STANDARD CONTINUOUS FEED VANILLA 1.2 0.05 GRAM-LIQUID
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 51823000690
|
| Hospital Charge Code |
301448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna American Axle |
$9.62
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$13.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.10
|
| Rate for Payer: PHP Commercial |
$12.58
|
| Rate for Payer: Priority Health SBD |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.10
|
|
|
KETAMINE 100 MG/ML INJECTION IM (CODE)
|
Facility
|
IP
|
$62.03
|
|
|
Service Code
|
NDC 42023011510
|
| Hospital Charge Code |
163728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna American Axle |
$40.32
|
| Rate for Payer: Aetna Commercial |
$52.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.32
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Cofinity Advantage |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.62
|
| Rate for Payer: Healthscope Commercial |
$55.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.52
|
| Rate for Payer: PHP Commercial |
$52.73
|
| Rate for Payer: Priority Health SBD |
$39.08
|
| Rate for Payer: UMR Bronson Commercial |
$27.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.52
|
|
|
KETAMINE 100 MG/ML INJECTION IM (CODE)
|
Facility
|
OP
|
$62.03
|
|
|
Service Code
|
NDC 42023011510
|
| Hospital Charge Code |
163728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna American Axle |
$40.32
|
| Rate for Payer: Aetna Commercial |
$52.73
|
| Rate for Payer: Aetna Medicare |
$31.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.32
|
| Rate for Payer: BCBS Complete |
$24.81
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Cofinity Advantage |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.62
|
| Rate for Payer: Healthscope Commercial |
$55.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.52
|
| Rate for Payer: PHP Commercial |
$52.73
|
| Rate for Payer: Priority Health SBD |
$39.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.32
|
| Rate for Payer: UHC Core |
$32.32
|
| Rate for Payer: UHC Exchange |
$24.38
|
| Rate for Payer: UMR Bronson Commercial |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.52
|
|
|
KETAMINE 100 MG/ML INJECTION IM (CODE)
|
Facility
|
OP
|
$38.63
|
|
|
Service Code
|
NDC 00409205105
|
| Hospital Charge Code |
163728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna American Axle |
$25.11
|
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.11
|
| Rate for Payer: BCBS Complete |
$15.45
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Advantage |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health SBD |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.11
|
| Rate for Payer: UHC Core |
$20.13
|
| Rate for Payer: UHC Exchange |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$14.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
KETAMINE 100 MG/ML INJECTION IM (CODE)
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 00409205105
|
| Hospital Charge Code |
163728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna American Axle |
$25.11
|
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.11
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Advantage |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health SBD |
$24.34
|
| Rate for Payer: UMR Bronson Commercial |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$53.05
|
|
|
Service Code
|
NDC 55150044001
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna American Axle |
$34.48
|
| Rate for Payer: Aetna Commercial |
$45.09
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: Cash Price |
$42.44
|
| Rate for Payer: Cofinity Advantage |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$45.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.44
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.79
|
| Rate for Payer: PHP Commercial |
$45.09
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.48
|
| Rate for Payer: UHC Core |
$27.64
|
| Rate for Payer: UHC Exchange |
$20.85
|
| Rate for Payer: UMR Bronson Commercial |
$19.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.79
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$45.75
|
|
|
Service Code
|
NDC 81483000700
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.13 |
| Max. Negotiated Rate |
$41.17 |
| Rate for Payer: Aetna American Axle |
$29.74
|
| Rate for Payer: Aetna Commercial |
$38.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.74
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cofinity Advantage |
$32.02
|
| Rate for Payer: Cofinity Commercial |
$39.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.60
|
| Rate for Payer: Healthscope Commercial |
$41.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.31
|
| Rate for Payer: PHP Commercial |
$38.89
|
| Rate for Payer: Priority Health SBD |
$28.82
|
| Rate for Payer: UMR Bronson Commercial |
$20.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.31
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$62.03
|
|
|
Service Code
|
NDC 42023011510
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna American Axle |
$40.32
|
| Rate for Payer: Aetna Commercial |
$52.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.32
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Cofinity Advantage |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.62
|
| Rate for Payer: Healthscope Commercial |
$55.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.52
|
| Rate for Payer: PHP Commercial |
$52.73
|
| Rate for Payer: Priority Health SBD |
$39.08
|
| Rate for Payer: UMR Bronson Commercial |
$27.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.52
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$53.05
|
|
|
Service Code
|
NDC 55150044010
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna American Axle |
$34.48
|
| Rate for Payer: Aetna Commercial |
$45.09
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: Cash Price |
$42.44
|
| Rate for Payer: Cofinity Advantage |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$45.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.44
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.79
|
| Rate for Payer: PHP Commercial |
$45.09
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.48
|
| Rate for Payer: UHC Core |
$27.64
|
| Rate for Payer: UHC Exchange |
$20.85
|
| Rate for Payer: UMR Bronson Commercial |
$19.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.79
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$45.75
|
|
|
Service Code
|
NDC 81483000700
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$41.17 |
| Rate for Payer: Aetna American Axle |
$29.74
|
| Rate for Payer: Aetna Commercial |
$38.89
|
| Rate for Payer: Aetna Medicare |
$22.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.74
|
| Rate for Payer: BCBS Complete |
$18.30
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cofinity Advantage |
$32.02
|
| Rate for Payer: Cofinity Commercial |
$39.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.60
|
| Rate for Payer: Healthscope Commercial |
$41.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.31
|
| Rate for Payer: PHP Commercial |
$38.89
|
| Rate for Payer: Priority Health SBD |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.74
|
| Rate for Payer: UHC Core |
$23.84
|
| Rate for Payer: UHC Exchange |
$17.98
|
| Rate for Payer: UMR Bronson Commercial |
$16.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.31
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
NDC 00143950910
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna Medicare |
$20.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Advantage |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.11
|
| Rate for Payer: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.96
|
| Rate for Payer: UHC Core |
$21.61
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UMR Bronson Commercial |
$15.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.11
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$53.05
|
|
|
Service Code
|
NDC 55150044001
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna American Axle |
$34.48
|
| Rate for Payer: Aetna Commercial |
$45.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: Cash Price |
$42.44
|
| Rate for Payer: Cofinity Advantage |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$45.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.44
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.79
|
| Rate for Payer: PHP Commercial |
$45.09
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.79
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
NDC 00143950910
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Advantage |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.11
|
| Rate for Payer: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.11
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 00409205115
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna American Axle |
$25.11
|
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.11
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Advantage |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health SBD |
$24.34
|
| Rate for Payer: UMR Bronson Commercial |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$38.63
|
|
|
Service Code
|
NDC 00409205105
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna American Axle |
$25.11
|
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.11
|
| Rate for Payer: BCBS Complete |
$15.45
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Advantage |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health SBD |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.11
|
| Rate for Payer: UHC Core |
$20.13
|
| Rate for Payer: UHC Exchange |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$14.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$62.03
|
|
|
Service Code
|
NDC 42023011510
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna American Axle |
$40.32
|
| Rate for Payer: Aetna Commercial |
$52.73
|
| Rate for Payer: Aetna Medicare |
$31.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.32
|
| Rate for Payer: BCBS Complete |
$24.81
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Cofinity Advantage |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.62
|
| Rate for Payer: Healthscope Commercial |
$55.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.52
|
| Rate for Payer: PHP Commercial |
$52.73
|
| Rate for Payer: Priority Health SBD |
$39.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.32
|
| Rate for Payer: UHC Core |
$32.32
|
| Rate for Payer: UHC Exchange |
$24.38
|
| Rate for Payer: UMR Bronson Commercial |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.52
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 00409205105
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna American Axle |
$25.11
|
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.11
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Advantage |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health SBD |
$24.34
|
| Rate for Payer: UMR Bronson Commercial |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
NDC 00143950901
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna Medicare |
$20.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Advantage |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.11
|
| Rate for Payer: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.96
|
| Rate for Payer: UHC Core |
$21.61
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UMR Bronson Commercial |
$15.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.11
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$53.05
|
|
|
Service Code
|
NDC 55150044010
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna American Axle |
$34.48
|
| Rate for Payer: Aetna Commercial |
$45.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: Cash Price |
$42.44
|
| Rate for Payer: Cofinity Advantage |
$37.13
|
| Rate for Payer: Cofinity Commercial |
$45.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.44
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.79
|
| Rate for Payer: PHP Commercial |
$45.09
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.79
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$38.63
|
|
|
Service Code
|
NDC 00409205115
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna American Axle |
$25.11
|
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.11
|
| Rate for Payer: BCBS Complete |
$15.45
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Advantage |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.97
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health SBD |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.11
|
| Rate for Payer: UHC Core |
$20.13
|
| Rate for Payer: UHC Exchange |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$14.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
