|
KATE FARMS PEDIATRIC PEPTIDE CONTINUOUS FEED VANILLA 1.5 0.05 GRAM-1.5L
|
Facility
|
OP
|
$41.63
|
|
|
Service Code
|
NDC 51823000687
|
| Hospital Charge Code |
301446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: Aetna American Axle |
$27.06
|
| Rate for Payer: Aetna Commercial |
$35.39
|
| Rate for Payer: Aetna Medicare |
$20.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.06
|
| Rate for Payer: BCBS Complete |
$16.65
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.39
|
| Rate for Payer: PHP Commercial |
$35.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.06
|
| Rate for Payer: Priority Health SBD |
$26.23
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
KATE FARMS PEDIATRIC PEPTIDE CONTINUOUS FEED VANILLA 1.5 0.05 GRAM-1.5L
|
Facility
|
OP
|
$43.48
|
|
|
Service Code
|
NDC 11112003069
|
| Hospital Charge Code |
301446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$39.13 |
| Rate for Payer: Aetna American Axle |
$28.26
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna Medicare |
$21.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: BCBS Complete |
$17.39
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.26
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: UMR Bronson Commercial |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.61
|
|
|
KATE FARMS PEDIATRIC PEPTIDE CONTINUOUS FEED VANILLA 1.5 0.05 GRAM-1.5L
|
Facility
|
IP
|
$41.63
|
|
|
Service Code
|
NDC 51823000687
|
| Hospital Charge Code |
301446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$37.47 |
| Rate for Payer: Aetna American Axle |
$27.06
|
| Rate for Payer: Aetna Commercial |
$35.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.06
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.14
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.39
|
| Rate for Payer: PHP Commercial |
$35.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.06
|
| Rate for Payer: Priority Health SBD |
$26.23
|
| Rate for Payer: UMR Bronson Commercial |
$18.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
KATE FARMS PEDIATRIC PEPTIDE CONTINUOUS FEED VANILLA 1.5 0.05 GRAM-1.5L
|
Facility
|
IP
|
$43.48
|
|
|
Service Code
|
NDC 11112003069
|
| Hospital Charge Code |
301446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$39.13 |
| Rate for Payer: Aetna American Axle |
$28.26
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.26
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.61
|
|
|
KATE FARMS PEDIATRIC STANDARD BOLUS FEED VANILLA 1.2 0.05 GRAM-1.2 KCAL
|
Facility
|
OP
|
$13.88
|
|
|
Service Code
|
NDC 51823000690
|
| Hospital Charge Code |
301449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna American Axle |
$9.02
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Medicare |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: BCBS Complete |
$5.55
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.41
|
|
|
KATE FARMS PEDIATRIC STANDARD BOLUS FEED VANILLA 1.2 0.05 GRAM-1.2 KCAL
|
Facility
|
IP
|
$13.88
|
|
|
Service Code
|
NDC 51823000690
|
| Hospital Charge Code |
301449
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna American Axle |
$9.02
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.41
|
|
|
KATE FARMS PEDIATRIC STANDARD CONTINUOUS FEED VANILLA 1.2 0.05 GRAM-LIQUID
|
Facility
|
IP
|
$13.88
|
|
|
Service Code
|
NDC 51823000690
|
| Hospital Charge Code |
301448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna American Axle |
$9.02
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.41
|
|
|
KATE FARMS PEDIATRIC STANDARD CONTINUOUS FEED VANILLA 1.2 0.05 GRAM-LIQUID
|
Facility
|
OP
|
$13.88
|
|
|
Service Code
|
NDC 51823000690
|
| Hospital Charge Code |
301448
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: Aetna American Axle |
$9.02
|
| Rate for Payer: Aetna Commercial |
$11.80
|
| Rate for Payer: Aetna Medicare |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.02
|
| Rate for Payer: BCBS Complete |
$5.55
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.10
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.80
|
| Rate for Payer: PHP Commercial |
$11.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.41
|
|
|
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 Commercial |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.04
|
| 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: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.11
|
| Rate for Payer: Priority Health SBD |
$24.34
|
| 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
|
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 Commercial |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.42
|
| 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: PHP Commercial |
$52.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.32
|
| Rate for Payer: Priority Health SBD |
$39.08
|
| 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
|
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 Commercial |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.04
|
| 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: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.11
|
| 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 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 Commercial |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.42
|
| 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: PHP Commercial |
$52.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.32
|
| 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
|
$54.45
|
|
|
Service Code
|
NDC 67457010800
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna American Axle |
$35.39
|
| Rate for Payer: Aetna Commercial |
$46.28
|
| Rate for Payer: Aetna Medicare |
$27.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.39
|
| Rate for Payer: BCBS Complete |
$21.78
|
| Rate for Payer: Cash Price |
$43.56
|
| Rate for Payer: Cofinity Commercial |
$38.12
|
| Rate for Payer: Cofinity Commercial |
$46.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.56
|
| Rate for Payer: Healthscope Commercial |
$49.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.28
|
| Rate for Payer: PHP Commercial |
$46.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.39
|
| Rate for Payer: Priority Health SBD |
$34.30
|
| Rate for Payer: UMR Bronson Commercial |
$20.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.84
|
|
|
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 Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.14
|
| 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 |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.09
|
| Rate for Payer: PHP Commercial |
$45.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| 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
|
$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 Commercial |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.42
|
| 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: PHP Commercial |
$52.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.32
|
| Rate for Payer: Priority Health SBD |
$39.08
|
| 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
|
$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 Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.14
|
| 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 |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.09
|
| Rate for Payer: PHP Commercial |
$45.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| 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 00143950901
|
| 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 Commercial |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.04
|
| 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: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| 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
|
$45.75
|
|
|
Service Code
|
NDC 81483000700
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.13 |
| Max. Negotiated Rate |
$41.18 |
| 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 Commercial |
$32.02
|
| Rate for Payer: Cofinity Commercial |
$39.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.60
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| 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: PHP Commercial |
$38.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.74
|
| 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
|
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 Commercial |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.04
|
| 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: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| 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
|
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 Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.14
|
| 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 |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.09
|
| Rate for Payer: PHP Commercial |
$45.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| 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
|
$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 Commercial |
$43.42
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.42
|
| 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: PHP Commercial |
$52.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.32
|
| 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
|
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 Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.14
|
| 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 |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.09
|
| Rate for Payer: PHP Commercial |
$45.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| 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
|
$45.75
|
|
|
Service Code
|
NDC 81483000700
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$41.18 |
| 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 Commercial |
$32.02
|
| Rate for Payer: Cofinity Commercial |
$39.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.60
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| 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: PHP Commercial |
$38.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.74
|
| Rate for Payer: Priority Health SBD |
$28.82
|
| 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
|
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 Commercial |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.04
|
| 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: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.11
|
| 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
|
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 Commercial |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.04
|
| 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: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| 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
|
|
