|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$35.21
|
|
|
Service Code
|
NDC 65219018601
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$35.21 |
| Rate for Payer: Aetna Commercial |
$31.69
|
| Rate for Payer: ASR ASR |
$34.15
|
| Rate for Payer: BCBS Trust/PPO |
$28.91
|
| Rate for Payer: BCN Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.17
|
| Rate for Payer: Healthscope Commercial |
$34.15
|
| Rate for Payer: Healthscope Whirlpool |
$35.21
|
| Rate for Payer: Mclaren Commercial |
$31.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.93
|
| Rate for Payer: Nomi Health Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.98
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$42.32
|
|
|
Service Code
|
NDC 143950910
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$42.31 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: ASR ASR |
$41.05
|
| Rate for Payer: BCBS Trust/PPO |
$34.75
|
| Rate for Payer: BCN Commercial |
$34.75
|
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Cofinity Commercial |
$39.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.85
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Healthscope Whirlpool |
$42.31
|
| Rate for Payer: Mclaren Commercial |
$38.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.97
|
| Rate for Payer: Nomi Health Commercial |
$34.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.24
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$42.32
|
|
|
Service Code
|
NDC 143950910
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$42.31 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna Medicare |
$15.66
|
| Rate for Payer: ASR ASR |
$41.05
|
| Rate for Payer: BCBS Complete |
$16.93
|
| Rate for Payer: BCBS Trust/PPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$34.89
|
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Cofinity Commercial |
$39.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.85
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Healthscope Whirlpool |
$42.31
|
| Rate for Payer: Mclaren Commercial |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.97
|
| Rate for Payer: Nomi Health Commercial |
$34.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.08
|
| Rate for Payer: Priority Health Narrow Network |
$29.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.24
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$38.65
|
|
|
Service Code
|
NDC 409004005
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Commercial |
$34.78
|
| Rate for Payer: ASR ASR |
$37.49
|
| Rate for Payer: BCBS Trust/PPO |
$31.74
|
| Rate for Payer: BCN Commercial |
$31.74
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$36.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Healthscope Commercial |
$37.49
|
| Rate for Payer: Healthscope Whirlpool |
$38.65
|
| Rate for Payer: Mclaren Commercial |
$34.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.01
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$35.21
|
|
|
Service Code
|
NDC 65219018601
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$35.21 |
| Rate for Payer: Aetna Commercial |
$31.69
|
| Rate for Payer: Aetna Medicare |
$13.03
|
| Rate for Payer: ASR ASR |
$34.15
|
| Rate for Payer: BCBS Complete |
$14.08
|
| Rate for Payer: BCBS Trust/PPO |
$29.03
|
| Rate for Payer: BCN Commercial |
$29.03
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.17
|
| Rate for Payer: Healthscope Commercial |
$34.15
|
| Rate for Payer: Healthscope Whirlpool |
$35.21
|
| Rate for Payer: Mclaren Commercial |
$31.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.93
|
| Rate for Payer: Nomi Health Commercial |
$28.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.85
|
| Rate for Payer: Priority Health Narrow Network |
$24.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.98
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$42.32
|
|
|
Service Code
|
NDC 143950901
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$42.31 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna Medicare |
$15.66
|
| Rate for Payer: ASR ASR |
$41.05
|
| Rate for Payer: BCBS Complete |
$16.93
|
| Rate for Payer: BCBS Trust/PPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$34.89
|
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Cofinity Commercial |
$39.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.85
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Healthscope Whirlpool |
$42.31
|
| Rate for Payer: Mclaren Commercial |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.97
|
| Rate for Payer: Nomi Health Commercial |
$34.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.08
|
| Rate for Payer: Priority Health Narrow Network |
$29.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.24
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$38.65
|
|
|
Service Code
|
NDC 409004010
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Commercial |
$34.78
|
| Rate for Payer: Aetna Medicare |
$14.30
|
| Rate for Payer: ASR ASR |
$37.49
|
| Rate for Payer: BCBS Complete |
$15.46
|
| Rate for Payer: BCBS Trust/PPO |
$31.87
|
| Rate for Payer: BCN Commercial |
$31.87
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$36.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Healthscope Commercial |
$37.49
|
| Rate for Payer: Healthscope Whirlpool |
$38.65
|
| Rate for Payer: Mclaren Commercial |
$34.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Narrow Network |
$27.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.01
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$42.32
|
|
|
Service Code
|
NDC 143950901
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$42.31 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: ASR ASR |
$41.05
|
| Rate for Payer: BCBS Trust/PPO |
$34.75
|
| Rate for Payer: BCN Commercial |
$34.75
|
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Cofinity Commercial |
$39.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.85
|
| Rate for Payer: Healthscope Commercial |
$41.05
|
| Rate for Payer: Healthscope Whirlpool |
$42.31
|
| Rate for Payer: Mclaren Commercial |
$38.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.97
|
| Rate for Payer: Nomi Health Commercial |
$34.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.24
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$38.65
|
|
|
Service Code
|
NDC 409004010
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Commercial |
$34.78
|
| Rate for Payer: ASR ASR |
$37.49
|
| Rate for Payer: BCBS Trust/PPO |
$31.74
|
| Rate for Payer: BCN Commercial |
$31.74
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$36.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Healthscope Commercial |
$37.49
|
| Rate for Payer: Healthscope Whirlpool |
$38.65
|
| Rate for Payer: Mclaren Commercial |
$34.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.01
|
|
|
KETAMINE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$38.65
|
|
|
Service Code
|
NDC 409004005
|
| Hospital Charge Code |
4237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$38.65 |
| Rate for Payer: Aetna Commercial |
$34.78
|
| Rate for Payer: Aetna Medicare |
$14.30
|
| Rate for Payer: ASR ASR |
$37.49
|
| Rate for Payer: BCBS Complete |
$15.46
|
| Rate for Payer: BCBS Trust/PPO |
$31.87
|
| Rate for Payer: BCN Commercial |
$31.87
|
| Rate for Payer: Cash Price |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$36.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.92
|
| Rate for Payer: Healthscope Commercial |
$37.49
|
| Rate for Payer: Healthscope Whirlpool |
$38.65
|
| Rate for Payer: Mclaren Commercial |
$34.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.85
|
| Rate for Payer: Nomi Health Commercial |
$31.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Narrow Network |
$27.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.01
|
|
|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
IP
|
$20.46
|
|
|
Service Code
|
NDC 9900001060
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.35 |
| 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 |
$16.80
|
| Rate for Payer: BCN Commercial |
$16.80
|
| 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 |
$19.85
|
| Rate for Payer: Healthscope Whirlpool |
$20.46
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.39
|
| Rate for Payer: Nomi Health Commercial |
$16.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.01
|
|
|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
IP
|
$53.50
|
|
|
Service Code
|
NDC 42023011310
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna Commercial |
$48.15
|
| Rate for Payer: ASR ASR |
$51.90
|
| Rate for Payer: BCBS Trust/PPO |
$43.93
|
| Rate for Payer: BCN Commercial |
$43.93
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cofinity Commercial |
$50.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.80
|
| Rate for Payer: Healthscope Commercial |
$51.90
|
| Rate for Payer: Healthscope Whirlpool |
$53.50
|
| Rate for Payer: Mclaren Commercial |
$48.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Nomi Health Commercial |
$43.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.08
|
|
|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
OP
|
$20.46
|
|
|
Service Code
|
NDC 9900001060
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: ASR ASR |
$19.85
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.87
|
| Rate for Payer: BCN Commercial |
$16.87
|
| 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 |
$19.85
|
| Rate for Payer: Healthscope Whirlpool |
$20.46
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.39
|
| Rate for Payer: Nomi Health Commercial |
$16.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.01
|
|
|
KETAMINE 10 MG/ML INJECTION IV (CODE)
|
Facility
|
OP
|
$53.50
|
|
|
Service Code
|
NDC 42023011310
|
| Hospital Charge Code |
163727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Aetna Commercial |
$48.15
|
| Rate for Payer: Aetna Medicare |
$19.80
|
| Rate for Payer: ASR ASR |
$51.90
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS Trust/PPO |
$44.11
|
| Rate for Payer: BCN Commercial |
$44.11
|
| Rate for Payer: Cash Price |
$42.80
|
| Rate for Payer: Cofinity Commercial |
$50.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.80
|
| Rate for Payer: Healthscope Commercial |
$51.90
|
| Rate for Payer: Healthscope Whirlpool |
$53.50
|
| Rate for Payer: Mclaren Commercial |
$48.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Nomi Health Commercial |
$43.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.88
|
| Rate for Payer: Priority Health Narrow Network |
$37.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.08
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.46
|
|
|
Service Code
|
NDC 9900001060
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: ASR ASR |
$19.85
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.87
|
| Rate for Payer: BCN Commercial |
$16.87
|
| 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 |
$19.85
|
| Rate for Payer: Healthscope Whirlpool |
$20.46
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.39
|
| Rate for Payer: Nomi Health Commercial |
$16.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.01
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.20
|
|
|
Service Code
|
NDC 9900000869
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna Commercial |
$17.28
|
| Rate for Payer: Aetna Medicare |
$7.10
|
| Rate for Payer: ASR ASR |
$18.62
|
| Rate for Payer: BCBS Complete |
$7.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.83
|
| Rate for Payer: BCN Commercial |
$15.83
|
| 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 |
$18.62
|
| Rate for Payer: Healthscope Whirlpool |
$19.20
|
| Rate for Payer: Mclaren Commercial |
$17.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.32
|
| Rate for Payer: Nomi Health Commercial |
$15.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.82
|
| Rate for Payer: Priority Health Narrow Network |
$13.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.90
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$69.80
|
|
|
Service Code
|
NDC 55150043810
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.35 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: ASR ASR |
$67.71
|
| Rate for Payer: BCBS Trust/PPO |
$57.32
|
| Rate for Payer: BCN Commercial |
$57.32
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Commercial |
$65.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$67.71
|
| Rate for Payer: Healthscope Whirlpool |
$69.80
|
| Rate for Payer: Mclaren Commercial |
$62.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Nomi Health Commercial |
$57.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.42
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.20
|
|
|
Service Code
|
NDC 9900000869
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.40 |
| 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 |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| 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 |
$18.62
|
| Rate for Payer: Healthscope Whirlpool |
$19.20
|
| Rate for Payer: Mclaren Commercial |
$17.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.32
|
| Rate for Payer: Nomi Health Commercial |
$15.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.90
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$69.80
|
|
|
Service Code
|
NDC 55150043801
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.83 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: Aetna Medicare |
$25.83
|
| Rate for Payer: ASR ASR |
$67.71
|
| Rate for Payer: BCBS Complete |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$57.55
|
| Rate for Payer: BCN Commercial |
$57.55
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Commercial |
$65.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$67.71
|
| Rate for Payer: Healthscope Whirlpool |
$69.80
|
| Rate for Payer: Mclaren Commercial |
$62.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Nomi Health Commercial |
$57.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.16
|
| Rate for Payer: Priority Health Narrow Network |
$48.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.42
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$69.80
|
|
|
Service Code
|
NDC 55150043801
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.35 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: ASR ASR |
$67.71
|
| Rate for Payer: BCBS Trust/PPO |
$57.32
|
| Rate for Payer: BCN Commercial |
$57.32
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Commercial |
$65.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$67.71
|
| Rate for Payer: Healthscope Whirlpool |
$69.80
|
| Rate for Payer: Mclaren Commercial |
$62.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Nomi Health Commercial |
$57.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.42
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.46
|
|
|
Service Code
|
NDC 9900001060
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.35 |
| 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 |
$16.80
|
| Rate for Payer: BCN Commercial |
$16.80
|
| 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 |
$19.85
|
| Rate for Payer: Healthscope Whirlpool |
$20.46
|
| Rate for Payer: Mclaren Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.39
|
| Rate for Payer: Nomi Health Commercial |
$16.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.01
|
|
|
KETAMINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$69.80
|
|
|
Service Code
|
NDC 55150043810
|
| Hospital Charge Code |
4236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.83 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: Aetna Medicare |
$25.83
|
| Rate for Payer: ASR ASR |
$67.71
|
| Rate for Payer: BCBS Complete |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$57.55
|
| Rate for Payer: BCN Commercial |
$57.55
|
| Rate for Payer: Cash Price |
$55.84
|
| Rate for Payer: Cofinity Commercial |
$65.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$67.71
|
| Rate for Payer: Healthscope Whirlpool |
$69.80
|
| Rate for Payer: Mclaren Commercial |
$62.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.33
|
| Rate for Payer: Nomi Health Commercial |
$57.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.16
|
| Rate for Payer: Priority Health Narrow Network |
$48.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.42
|
|
|
KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE
|
Facility
|
IP
|
$32.20
|
|
|
Service Code
|
NDC 70092111944
|
| Hospital Charge Code |
118700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.15 |
| 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 |
$26.44
|
| Rate for Payer: BCN Commercial |
$26.44
|
| 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 |
$31.23
|
| Rate for Payer: Healthscope Whirlpool |
$32.20
|
| Rate for Payer: Mclaren Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$26.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.34
|
|
|
KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
NDC 70092111944
|
| Hospital Charge Code |
118700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$28.98
|
| Rate for Payer: Aetna Medicare |
$11.91
|
| Rate for Payer: ASR ASR |
$31.23
|
| Rate for Payer: BCBS Complete |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.55
|
| Rate for Payer: BCN Commercial |
$26.55
|
| 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 |
$31.23
|
| Rate for Payer: Healthscope Whirlpool |
$32.20
|
| Rate for Payer: Mclaren Commercial |
$28.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$26.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.21
|
| Rate for Payer: Priority Health Narrow Network |
$22.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.34
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$31.08
|
|
|
Service Code
|
NDC 168009930
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$31.08 |
| Rate for Payer: Aetna Commercial |
$27.97
|
| Rate for Payer: ASR ASR |
$30.15
|
| Rate for Payer: BCBS Trust/PPO |
$25.52
|
| Rate for Payer: BCN Commercial |
$25.52
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cofinity Commercial |
$29.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$30.15
|
| Rate for Payer: Healthscope Whirlpool |
$31.08
|
| Rate for Payer: Mclaren Commercial |
$27.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.42
|
| Rate for Payer: Nomi Health Commercial |
$25.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.35
|
|
