|
JEVITY PLUS 1.2 CAL ORAL LIQUID CUSTOM
|
Facility
|
IP
|
$5.57
|
|
|
Service Code
|
NDC 7007453119
|
| Hospital Charge Code |
150865
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Aetna Commercial |
$5.01
|
| Rate for Payer: ASR ASR |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.32
|
| Rate for Payer: BCN Commercial |
$4.32
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$5.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.57
|
| Rate for Payer: Healthscope Whirlpool |
$5.40
|
| Rate for Payer: Mclaren Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.90
|
|
|
KETAMINE 100 MG/ML INJECTION IM (CODE)
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
NDC 67457-108-10
|
| Hospital Charge Code |
163728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Aetna Commercial |
$50.49
|
| Rate for Payer: ASR ASR |
$54.42
|
| Rate for Payer: BCBS Trust/PPO |
$43.49
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$56.10
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Mclaren Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.37
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
NDC 67457-108-10
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Aetna Commercial |
$50.49
|
| Rate for Payer: ASR ASR |
$54.42
|
| Rate for Payer: BCBS Trust/PPO |
$43.49
|
| Rate for Payer: BCN Commercial |
$43.49
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$52.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$56.10
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Mclaren Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.37
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$59.02
|
|
|
Service Code
|
NDC 0143-9509-10
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.31 |
| Max. Negotiated Rate |
$59.02 |
| Rate for Payer: Aetna Commercial |
$53.12
|
| Rate for Payer: ASR ASR |
$57.25
|
| Rate for Payer: BCBS Trust/PPO |
$45.76
|
| Rate for Payer: BCN Commercial |
$45.76
|
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Cofinity Commercial |
$55.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.22
|
| Rate for Payer: Healthscope Commercial |
$59.02
|
| Rate for Payer: Healthscope Whirlpool |
$57.25
|
| Rate for Payer: Mclaren Commercial |
$53.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.94
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$59.02
|
|
|
Service Code
|
NDC 0143-9509-01
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.31 |
| Max. Negotiated Rate |
$59.02 |
| Rate for Payer: Aetna Commercial |
$53.12
|
| Rate for Payer: ASR ASR |
$57.25
|
| Rate for Payer: BCBS Trust/PPO |
$45.76
|
| Rate for Payer: BCN Commercial |
$45.76
|
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Cofinity Commercial |
$55.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.22
|
| Rate for Payer: Healthscope Commercial |
$59.02
|
| Rate for Payer: Healthscope Whirlpool |
$57.25
|
| Rate for Payer: Mclaren Commercial |
$53.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.94
|
|
|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
NDC 42023-113-10
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: ASR ASR |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$71.33
|
| Rate for Payer: BCN Commercial |
$71.33
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$86.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.60
|
| Rate for Payer: Healthscope Commercial |
$92.00
|
| Rate for Payer: Healthscope Whirlpool |
$89.24
|
| Rate for Payer: Mclaren Commercial |
$82.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.96
|
|
|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
IP
|
$70.20
|
|
|
Service Code
|
NDC 67457-181-00
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$63.18
|
| Rate for Payer: ASR ASR |
$68.09
|
| Rate for Payer: BCBS Trust/PPO |
$54.43
|
| Rate for Payer: BCN Commercial |
$54.43
|
| Rate for Payer: Cash Price |
$56.16
|
| Rate for Payer: Cofinity Commercial |
$65.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.16
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Healthscope Whirlpool |
$68.09
|
| Rate for Payer: Mclaren Commercial |
$63.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.78
|
|
|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
IP
|
$70.20
|
|
|
Service Code
|
NDC 67457-181-20
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$63.18
|
| Rate for Payer: ASR ASR |
$68.09
|
| Rate for Payer: BCBS Trust/PPO |
$54.43
|
| Rate for Payer: BCN Commercial |
$54.43
|
| Rate for Payer: Cash Price |
$56.16
|
| Rate for Payer: Cofinity Commercial |
$65.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.16
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Healthscope Whirlpool |
$68.09
|
| Rate for Payer: Mclaren Commercial |
$63.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.78
|
|
|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
IP
|
$20.46
|
|
|
Service Code
|
NDC 9900-0010-60
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: ASR ASR |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Cofinity Commercial |
$19.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.37
|
| Rate for Payer: Healthscope Commercial |
$20.46
|
| Rate for Payer: Healthscope Whirlpool |
$19.85
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.00
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.20
|
|
|
Service Code
|
NDC 9900-0008-69
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna Commercial |
$17.28
|
| Rate for Payer: ASR ASR |
$18.62
|
| Rate for Payer: BCBS Trust/PPO |
$14.89
|
| Rate for Payer: BCN Commercial |
$14.89
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.36
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Healthscope Whirlpool |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$17.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.90
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.46
|
|
|
Service Code
|
NDC 9900-0010-60
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: ASR ASR |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Cofinity Commercial |
$19.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.37
|
| Rate for Payer: Healthscope Commercial |
$20.46
|
| Rate for Payer: Healthscope Whirlpool |
$19.85
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.00
|
|
|
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 |
$22.54 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$28.98
|
| Rate for Payer: ASR ASR |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$24.96
|
| Rate for Payer: BCN Commercial |
$24.96
|
| Rate for Payer: Cash Price |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$30.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.76
|
| Rate for Payer: Healthscope Commercial |
$32.20
|
| Rate for Payer: Healthscope Whirlpool |
$31.23
|
| Rate for Payer: Mclaren Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.34
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$26.37
|
|
|
Service Code
|
NDC 41616-219-90
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$26.37 |
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: ASR ASR |
$25.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.44
|
| Rate for Payer: BCN Commercial |
$20.44
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$24.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.10
|
| Rate for Payer: Healthscope Commercial |
$26.37
|
| Rate for Payer: Healthscope Whirlpool |
$25.58
|
| Rate for Payer: Mclaren Commercial |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.21
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$104.37
|
|
|
Service Code
|
NDC 60505-1003-1
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$104.37 |
| Rate for Payer: Aetna Commercial |
$93.93
|
| Rate for Payer: ASR ASR |
$101.24
|
| Rate for Payer: BCBS Trust/PPO |
$80.92
|
| Rate for Payer: BCN Commercial |
$80.92
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cofinity Commercial |
$98.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.50
|
| Rate for Payer: Healthscope Commercial |
$104.37
|
| Rate for Payer: Healthscope Whirlpool |
$101.24
|
| Rate for Payer: Mclaren Commercial |
$93.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.85
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 17478-209-19
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.10
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$47.85
|
| Rate for Payer: Healthscope Whirlpool |
$46.41
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$104.83
|
|
|
Service Code
|
NDC 17478-209-10
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$104.83 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: ASR ASR |
$101.69
|
| Rate for Payer: BCBS Trust/PPO |
$81.27
|
| Rate for Payer: BCN Commercial |
$81.27
|
| Rate for Payer: Cash Price |
$83.86
|
| Rate for Payer: Cofinity Commercial |
$98.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.86
|
| Rate for Payer: Healthscope Commercial |
$104.83
|
| Rate for Payer: Healthscope Whirlpool |
$101.69
|
| Rate for Payer: Mclaren Commercial |
$94.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.25
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.27
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$21.84
|
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: Aetna Commercial |
$13.82
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: ASR ASR |
$14.89
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR ASR |
$23.54
|
| Rate for Payer: BCBS Trust/PPO |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.82
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Commercial |
$10.00
|
| Rate for Payer: BCN Commercial |
$18.82
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$19.42
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$22.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Whirlpool |
$12.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.54
|
| Rate for Payer: Healthscope Whirlpool |
$14.89
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$21.84
|
| Rate for Payer: Mclaren Commercial |
$13.82
|
| Rate for Payer: Mclaren Commercial |
$12.74
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna Commercial |
$14.22
|
| Rate for Payer: Aetna Commercial |
$13.63
|
| Rate for Payer: Aetna Commercial |
$24.32
|
| Rate for Payer: ASR ASR |
$15.33
|
| Rate for Payer: ASR ASR |
$14.69
|
| Rate for Payer: ASR ASR |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$20.95
|
| Rate for Payer: BCBS Trust/PPO |
$12.25
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: BCN Commercial |
$12.25
|
| Rate for Payer: BCN Commercial |
$11.74
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$25.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Whirlpool |
$15.33
|
| Rate for Payer: Healthscope Whirlpool |
$14.69
|
| Rate for Payer: Healthscope Whirlpool |
$26.21
|
| Rate for Payer: Mclaren Commercial |
$14.22
|
| Rate for Payer: Mclaren Commercial |
$13.63
|
| Rate for Payer: Mclaren Commercial |
$24.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.97
|
| 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 Cigna Priority Health |
$18.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.78
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
|
Facility
|
IP
|
$23,679.53
|
|
|
Service Code
|
MS-DRG 657
|
| Min. Negotiated Rate |
$16,429.93 |
| Max. Negotiated Rate |
$23,679.53 |
| Rate for Payer: Aetna Medicare |
$17,294.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,618.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,618.32
|
| Rate for Payer: BCBS MAPPO |
$17,294.66
|
| Rate for Payer: BCN Medicare Advantage |
$17,294.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,294.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,294.66
|
| Rate for Payer: Mclaren Medicare |
$17,294.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,159.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,888.86
|
| Rate for Payer: PACE Medicare |
$16,429.93
|
| Rate for Payer: PACE SWMI |
$17,294.66
|
| Rate for Payer: PHP Commercial |
$19,024.13
|
| Rate for Payer: PHP Medicare Advantage |
$17,294.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,679.53
|
| Rate for Payer: Priority Health Medicare |
$17,294.66
|
| Rate for Payer: Priority Health Narrow Network |
$18,943.62
|
| Rate for Payer: Railroad Medicare Medicare |
$17,294.66
|
| Rate for Payer: UHC Medicare Advantage |
$17,813.50
|
| Rate for Payer: VA VA |
$17,294.66
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC
|
Facility
|
IP
|
$40,286.78
|
|
|
Service Code
|
MS-DRG 656
|
| Min. Negotiated Rate |
$26,832.84 |
| Max. Negotiated Rate |
$40,286.78 |
| Rate for Payer: Aetna Medicare |
$28,245.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,306.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,306.38
|
| Rate for Payer: BCBS MAPPO |
$28,245.10
|
| Rate for Payer: BCN Medicare Advantage |
$28,245.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,245.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$28,245.10
|
| Rate for Payer: Mclaren Medicare |
$28,245.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,657.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,481.86
|
| Rate for Payer: PACE Medicare |
$26,832.84
|
| Rate for Payer: PACE SWMI |
$28,245.10
|
| Rate for Payer: PHP Commercial |
$31,069.61
|
| Rate for Payer: PHP Medicare Advantage |
$28,245.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,286.78
|
| Rate for Payer: Priority Health Medicare |
$28,245.10
|
| Rate for Payer: Priority Health Narrow Network |
$32,229.42
|
| Rate for Payer: Railroad Medicare Medicare |
$28,245.10
|
| Rate for Payer: UHC Medicare Advantage |
$29,092.45
|
| Rate for Payer: VA VA |
$28,245.10
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$19,008.34
|
|
|
Service Code
|
MS-DRG 658
|
| Min. Negotiated Rate |
$13,503.86 |
| Max. Negotiated Rate |
$19,008.34 |
| Rate for Payer: Aetna Medicare |
$14,214.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,768.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,768.24
|
| Rate for Payer: BCBS MAPPO |
$14,214.59
|
| Rate for Payer: BCN Medicare Advantage |
$14,214.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,214.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,214.59
|
| Rate for Payer: Mclaren Medicare |
$14,214.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,925.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,346.78
|
| Rate for Payer: PACE Medicare |
$13,503.86
|
| Rate for Payer: PACE SWMI |
$14,214.59
|
| Rate for Payer: PHP Commercial |
$15,636.05
|
| Rate for Payer: PHP Medicare Advantage |
$14,214.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,008.34
|
| Rate for Payer: Priority Health Medicare |
$14,214.59
|
| Rate for Payer: Priority Health Narrow Network |
$15,206.67
|
| Rate for Payer: Railroad Medicare Medicare |
$14,214.59
|
| Rate for Payer: UHC Medicare Advantage |
$14,641.03
|
| Rate for Payer: VA VA |
$14,214.59
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC
|
Facility
|
IP
|
$17,281.36
|
|
|
Service Code
|
MS-DRG 660
|
| Min. Negotiated Rate |
$12,422.07 |
| Max. Negotiated Rate |
$17,281.36 |
| Rate for Payer: Aetna Medicare |
$13,075.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,344.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,344.82
|
| Rate for Payer: BCBS MAPPO |
$13,075.86
|
| Rate for Payer: BCN Medicare Advantage |
$13,075.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,075.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,075.86
|
| Rate for Payer: Mclaren Medicare |
$13,075.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,729.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,037.24
|
| Rate for Payer: PACE Medicare |
$12,422.07
|
| Rate for Payer: PACE SWMI |
$13,075.86
|
| Rate for Payer: PHP Commercial |
$14,383.45
|
| Rate for Payer: PHP Medicare Advantage |
$13,075.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,281.36
|
| Rate for Payer: Priority Health Medicare |
$13,075.86
|
| Rate for Payer: Priority Health Narrow Network |
$13,825.09
|
| Rate for Payer: Railroad Medicare Medicare |
$13,075.86
|
| Rate for Payer: UHC Medicare Advantage |
$13,468.14
|
| Rate for Payer: VA VA |
$13,075.86
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC
|
Facility
|
IP
|
$33,241.48
|
|
|
Service Code
|
MS-DRG 659
|
| Min. Negotiated Rate |
$22,419.61 |
| Max. Negotiated Rate |
$33,241.48 |
| Rate for Payer: Aetna Medicare |
$23,599.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,499.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,499.49
|
| Rate for Payer: BCBS MAPPO |
$23,599.59
|
| Rate for Payer: BCN Medicare Advantage |
$23,599.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,599.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,599.59
|
| Rate for Payer: Mclaren Medicare |
$23,599.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,779.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,139.53
|
| Rate for Payer: PACE Medicare |
$22,419.61
|
| Rate for Payer: PACE SWMI |
$23,599.59
|
| Rate for Payer: PHP Commercial |
$25,959.55
|
| Rate for Payer: PHP Medicare Advantage |
$23,599.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,241.48
|
| Rate for Payer: Priority Health Medicare |
$23,599.59
|
| Rate for Payer: Priority Health Narrow Network |
$26,593.18
|
| Rate for Payer: Railroad Medicare Medicare |
$23,599.59
|
| Rate for Payer: UHC Medicare Advantage |
$24,307.58
|
| Rate for Payer: VA VA |
$23,599.59
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$13,461.46
|
|
|
Service Code
|
MS-DRG 661
|
| Min. Negotiated Rate |
$10,029.24 |
| Max. Negotiated Rate |
$13,461.46 |
| Rate for Payer: Aetna Medicare |
$10,557.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,196.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,196.38
|
| Rate for Payer: BCBS MAPPO |
$10,557.10
|
| Rate for Payer: BCN Medicare Advantage |
$10,557.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,557.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,557.10
|
| Rate for Payer: Mclaren Medicare |
$10,557.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,084.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,140.66
|
| Rate for Payer: PACE Medicare |
$10,029.24
|
| Rate for Payer: PACE SWMI |
$10,557.10
|
| Rate for Payer: PHP Commercial |
$11,612.81
|
| Rate for Payer: PHP Medicare Advantage |
$10,557.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,461.46
|
| Rate for Payer: Priority Health Medicare |
$10,557.10
|
| Rate for Payer: Priority Health Narrow Network |
$10,769.17
|
| Rate for Payer: Railroad Medicare Medicare |
$10,557.10
|
| Rate for Payer: UHC Medicare Advantage |
$10,873.81
|
| Rate for Payer: VA VA |
$10,557.10
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC
|
Facility
|
IP
|
$15,079.30
|
|
|
Service Code
|
MS-DRG 689
|
| Min. Negotiated Rate |
$11,042.67 |
| Max. Negotiated Rate |
$15,079.30 |
| Rate for Payer: Aetna Medicare |
$11,623.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,529.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,529.82
|
| Rate for Payer: BCBS MAPPO |
$11,623.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,623.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,623.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,623.86
|
| Rate for Payer: Mclaren Medicare |
$11,623.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,205.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,367.44
|
| Rate for Payer: PACE Medicare |
$11,042.67
|
| Rate for Payer: PACE SWMI |
$11,623.86
|
| Rate for Payer: PHP Commercial |
$12,786.25
|
| Rate for Payer: PHP Medicare Advantage |
$11,623.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,079.30
|
| Rate for Payer: Priority Health Medicare |
$11,623.86
|
| Rate for Payer: Priority Health Narrow Network |
$12,063.44
|
| Rate for Payer: Railroad Medicare Medicare |
$11,623.86
|
| Rate for Payer: UHC Medicare Advantage |
$11,972.58
|
| Rate for Payer: VA VA |
$11,623.86
|
|
