|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$31.08
|
|
|
Service Code
|
NDC 168009930
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$31.08 |
| Rate for Payer: Aetna Commercial |
$27.97
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: ASR ASR |
$30.15
|
| Rate for Payer: BCBS Complete |
$12.43
|
| Rate for Payer: BCBS Trust/PPO |
$25.63
|
| Rate for Payer: BCN Commercial |
$25.63
|
| 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: MI Amish Medical Board Commercial |
$24.86
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.23
|
| Rate for Payer: Priority Health Narrow Network |
$21.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.35
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
OP
|
$26.37
|
|
|
Service Code
|
NDC 41616021990
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$26.37 |
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Medicare |
$9.76
|
| Rate for Payer: ASR ASR |
$25.58
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS Trust/PPO |
$21.74
|
| Rate for Payer: BCN Commercial |
$21.74
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$24.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Whirlpool |
$26.37
|
| Rate for Payer: Mclaren Commercial |
$23.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.10
|
| Rate for Payer: Priority Health Narrow Network |
$18.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.20
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$26.37
|
|
|
Service Code
|
NDC 41616021990
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.77 |
| 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 |
$21.65
|
| Rate for Payer: BCN Commercial |
$21.65
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$24.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Whirlpool |
$26.37
|
| Rate for Payer: Mclaren Commercial |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.20
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$104.37
|
|
|
Service Code
|
NDC 60505100301
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.28 |
| 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 |
$85.71
|
| Rate for Payer: BCN Commercial |
$85.71
|
| 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 |
$101.24
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Mclaren Commercial |
$93.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.71
|
| Rate for Payer: Nomi Health Commercial |
$85.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.85
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$104.83
|
|
|
Service Code
|
NDC 17478020910
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$104.83 |
| Rate for Payer: Aetna Commercial |
$94.34
|
| Rate for Payer: ASR ASR |
$101.68
|
| Rate for Payer: BCBS Trust/PPO |
$86.08
|
| Rate for Payer: BCN Commercial |
$86.08
|
| 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 |
$101.68
|
| Rate for Payer: Healthscope Whirlpool |
$104.83
|
| Rate for Payer: Mclaren Commercial |
$94.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.10
|
| Rate for Payer: Nomi Health Commercial |
$85.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.25
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
OP
|
$104.37
|
|
|
Service Code
|
NDC 60505100301
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$104.37 |
| Rate for Payer: Aetna Commercial |
$93.93
|
| Rate for Payer: Aetna Medicare |
$38.62
|
| Rate for Payer: ASR ASR |
$101.24
|
| Rate for Payer: BCBS Complete |
$41.75
|
| Rate for Payer: BCBS Trust/PPO |
$86.05
|
| Rate for Payer: BCN Commercial |
$86.05
|
| 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 |
$101.24
|
| Rate for Payer: Healthscope Whirlpool |
$104.37
|
| Rate for Payer: Mclaren Commercial |
$93.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.71
|
| Rate for Payer: Nomi Health Commercial |
$85.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.45
|
| Rate for Payer: Priority Health Narrow Network |
$73.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.85
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 17478020919
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Trust/PPO |
$39.45
|
| Rate for Payer: BCN Commercial |
$39.45
|
| 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 |
$46.41
|
| Rate for Payer: Healthscope Whirlpool |
$47.85
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.93
|
| Rate for Payer: Priority Health Narrow Network |
$33.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
OP
|
$104.83
|
|
|
Service Code
|
NDC 17478020910
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$104.83 |
| Rate for Payer: Aetna Commercial |
$94.34
|
| Rate for Payer: Aetna Medicare |
$38.79
|
| Rate for Payer: ASR ASR |
$101.68
|
| Rate for Payer: BCBS Complete |
$41.93
|
| Rate for Payer: BCBS Trust/PPO |
$86.43
|
| Rate for Payer: BCN Commercial |
$86.43
|
| 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 |
$101.68
|
| Rate for Payer: Healthscope Whirlpool |
$104.83
|
| Rate for Payer: Mclaren Commercial |
$94.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.10
|
| Rate for Payer: Nomi Health Commercial |
$85.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.85
|
| Rate for Payer: Priority Health Narrow Network |
$73.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.25
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 17478020919
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.89 |
| 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 |
$39.29
|
| Rate for Payer: BCN Commercial |
$39.29
|
| 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 |
$46.41
|
| Rate for Payer: Healthscope Whirlpool |
$47.85
|
| Rate for Payer: Mclaren Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.89
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$16.89 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna Commercial |
$14.02
|
| Rate for Payer: Aetna Commercial |
$5.85
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: ASR ASR |
$23.59
|
| Rate for Payer: ASR ASR |
$16.39
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR ASR |
$15.11
|
| Rate for Payer: ASR ASR |
$6.30
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS Trust/PPO |
$5.36
|
| Rate for Payer: BCBS Trust/PPO |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$13.93
|
| Rate for Payer: BCBS Trust/PPO |
$12.84
|
| Rate for Payer: BCBS Trust/PPO |
$11.67
|
| Rate for Payer: BCN Commercial |
$12.84
|
| Rate for Payer: BCN Commercial |
$5.36
|
| Rate for Payer: BCN Commercial |
$13.93
|
| Rate for Payer: BCN Commercial |
$20.05
|
| Rate for Payer: BCN Commercial |
$11.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Cofinity Commercial |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Healthscope Commercial |
$23.59
|
| Rate for Payer: Healthscope Commercial |
$15.11
|
| Rate for Payer: Healthscope Commercial |
$6.30
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$13.73
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Healthscope Whirlpool |
$6.50
|
| Rate for Payer: Healthscope Whirlpool |
$16.89
|
| Rate for Payer: Healthscope Whirlpool |
$14.15
|
| Rate for Payer: Healthscope Whirlpool |
$24.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Mclaren Commercial |
$21.89
|
| Rate for Payer: Mclaren Commercial |
$12.74
|
| Rate for Payer: Mclaren Commercial |
$15.20
|
| Rate for Payer: Mclaren Commercial |
$5.85
|
| Rate for Payer: Mclaren Commercial |
$14.02
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$5.33
|
| Rate for Payer: Nomi Health Commercial |
$12.77
|
| Rate for Payer: Nomi Health Commercial |
$13.85
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.68
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: VA VA |
$0.33
|
| Rate for Payer: VA VA |
$0.33
|
| Rate for Payer: VA VA |
$0.33
|
| Rate for Payer: VA VA |
$0.33
|
| Rate for Payer: VA VA |
$0.33
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$6.50
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$5.85
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna Commercial |
$14.02
|
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: ASR ASR |
$16.39
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR ASR |
$6.30
|
| Rate for Payer: ASR ASR |
$15.11
|
| Rate for Payer: ASR ASR |
$23.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCBS Trust/PPO |
$11.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.97
|
| Rate for Payer: BCBS Trust/PPO |
$13.87
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Commercial |
$19.97
|
| Rate for Payer: BCN Commercial |
$5.34
|
| Rate for Payer: BCN Commercial |
$11.62
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$15.11
|
| Rate for Payer: Healthscope Commercial |
$23.59
|
| Rate for Payer: Healthscope Commercial |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$6.30
|
| Rate for Payer: Healthscope Whirlpool |
$24.32
|
| Rate for Payer: Healthscope Whirlpool |
$6.50
|
| Rate for Payer: Healthscope Whirlpool |
$14.15
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Healthscope Whirlpool |
$16.89
|
| Rate for Payer: Mclaren Commercial |
$14.02
|
| Rate for Payer: Mclaren Commercial |
$21.89
|
| Rate for Payer: Mclaren Commercial |
$12.74
|
| Rate for Payer: Mclaren Commercial |
$5.85
|
| Rate for Payer: Mclaren Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.53
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$13.85
|
| Rate for Payer: Nomi Health Commercial |
$12.77
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: Nomi Health Commercial |
$5.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$16.05
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna Commercial |
$7.33
|
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.41
|
| Rate for Payer: ASR ASR |
$7.91
|
| Rate for Payer: ASR ASR |
$10.82
|
| Rate for Payer: ASR ASR |
$7.44
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.18
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.33
|
| Rate for Payer: BCBS Trust/PPO |
$9.19
|
| Rate for Payer: BCBS Trust/PPO |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.23
|
| Rate for Payer: BCBS Trust/PPO |
$6.72
|
| Rate for Payer: BCN Commercial |
$9.19
|
| Rate for Payer: BCN Commercial |
$13.23
|
| Rate for Payer: BCN Commercial |
$6.72
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.33
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$7.21
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.33
|
| Rate for Payer: Healthscope Commercial |
$10.82
|
| Rate for Payer: Healthscope Commercial |
$7.91
|
| Rate for Payer: Healthscope Commercial |
$15.57
|
| Rate for Payer: Healthscope Commercial |
$7.44
|
| Rate for Payer: Healthscope Whirlpool |
$8.15
|
| Rate for Payer: Healthscope Whirlpool |
$11.15
|
| Rate for Payer: Healthscope Whirlpool |
$7.67
|
| Rate for Payer: Healthscope Whirlpool |
$16.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.33
|
| Rate for Payer: Mclaren Commercial |
$7.33
|
| Rate for Payer: Mclaren Commercial |
$14.45
|
| Rate for Payer: Mclaren Commercial |
$10.04
|
| Rate for Payer: Mclaren Commercial |
$6.91
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Mclaren Medicare |
$0.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: Meridian Medicaid |
$0.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.93
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$6.29
|
| Rate for Payer: Nomi Health Commercial |
$9.14
|
| Rate for Payer: Nomi Health Commercial |
$6.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.36
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE Medicare |
$0.31
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Commercial |
$0.36
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicaid |
$0.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.35
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Medicare |
$0.33
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Priority Health Narrow Network |
$0.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.33
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHC Medicaid |
$0.17
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP DNSP |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: UHCCP Medicaid |
$0.17
|
| Rate for Payer: VA VA |
$0.33
|
| Rate for Payer: VA VA |
$0.33
|
| Rate for Payer: VA VA |
$0.33
|
| Rate for Payer: VA VA |
$0.33
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$7.68
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$7.67 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$7.33
|
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: ASR ASR |
$7.91
|
| Rate for Payer: ASR ASR |
$7.44
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: ASR ASR |
$10.82
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$13.18
|
| Rate for Payer: BCBS Trust/PPO |
$6.69
|
| Rate for Payer: BCN Commercial |
$9.16
|
| Rate for Payer: BCN Commercial |
$6.69
|
| Rate for Payer: BCN Commercial |
$13.18
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$6.14
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cofinity Commercial |
$7.21
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$7.44
|
| Rate for Payer: Healthscope Commercial |
$10.82
|
| Rate for Payer: Healthscope Commercial |
$15.57
|
| Rate for Payer: Healthscope Commercial |
$7.91
|
| Rate for Payer: Healthscope Whirlpool |
$7.67
|
| Rate for Payer: Healthscope Whirlpool |
$8.15
|
| Rate for Payer: Healthscope Whirlpool |
$11.15
|
| Rate for Payer: Healthscope Whirlpool |
$16.05
|
| Rate for Payer: Mclaren Commercial |
$10.04
|
| Rate for Payer: Mclaren Commercial |
$7.33
|
| Rate for Payer: Mclaren Commercial |
$14.45
|
| Rate for Payer: Mclaren Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.48
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.29
|
| Rate for Payer: Nomi Health Commercial |
$9.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.17
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
|
Facility
|
IP
|
$25,142.00
|
|
|
Service Code
|
MSDRG 657
|
| Min. Negotiated Rate |
$14,186.10 |
| Max. Negotiated Rate |
$25,142.00 |
| Rate for Payer: Aetna Medicare |
$14,932.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,665.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,665.92
|
| Rate for Payer: BCBS MAPPO |
$14,932.74
|
| Rate for Payer: BCN Medicare Advantage |
$14,932.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,932.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,932.74
|
| Rate for Payer: Mclaren Medicare |
$14,932.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,679.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,172.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,426.01
|
| Rate for Payer: PACE Medicare |
$14,186.10
|
| Rate for Payer: PACE SWMI |
$14,932.74
|
| Rate for Payer: PHP Commercial |
$16,426.01
|
| Rate for Payer: PHP Medicare Advantage |
$14,932.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,142.00
|
| Rate for Payer: Priority Health Medicare |
$14,932.74
|
| Rate for Payer: Priority Health Narrow Network |
$20,113.60
|
| Rate for Payer: Railroad Medicare Medicare |
$14,932.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,932.74
|
| Rate for Payer: UHC Exchange |
$23,145.75
|
| Rate for Payer: UHCCP DNSP |
$14,932.74
|
| Rate for Payer: VA VA |
$14,932.74
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC
|
Facility
|
IP
|
$43,741.59
|
|
|
Service Code
|
MSDRG 656
|
| Min. Negotiated Rate |
$23,447.69 |
| Max. Negotiated Rate |
$43,741.59 |
| Rate for Payer: Aetna Medicare |
$24,681.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,852.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,852.22
|
| Rate for Payer: BCBS MAPPO |
$24,681.78
|
| Rate for Payer: BCN Medicare Advantage |
$24,681.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,681.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,681.78
|
| Rate for Payer: Mclaren Medicare |
$24,681.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,915.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,384.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,149.96
|
| Rate for Payer: PACE Medicare |
$23,447.69
|
| Rate for Payer: PACE SWMI |
$24,681.78
|
| Rate for Payer: PHP Commercial |
$27,149.96
|
| Rate for Payer: PHP Medicare Advantage |
$24,681.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43,741.59
|
| Rate for Payer: Priority Health Medicare |
$24,681.78
|
| Rate for Payer: Priority Health Narrow Network |
$34,993.27
|
| Rate for Payer: Railroad Medicare Medicare |
$24,681.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,681.78
|
| Rate for Payer: UHC Exchange |
$38,256.76
|
| Rate for Payer: UHCCP DNSP |
$24,681.78
|
| Rate for Payer: VA VA |
$24,681.78
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$21,319.87
|
|
|
Service Code
|
MSDRG 658
|
| Min. Negotiated Rate |
$12,282.88 |
| Max. Negotiated Rate |
$21,319.87 |
| Rate for Payer: Aetna Medicare |
$12,929.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,161.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,161.69
|
| Rate for Payer: BCBS MAPPO |
$12,929.35
|
| Rate for Payer: BCN Medicare Advantage |
$12,929.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,929.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,929.35
|
| Rate for Payer: Mclaren Medicare |
$12,929.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,575.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,868.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,222.28
|
| Rate for Payer: PACE Medicare |
$12,282.88
|
| Rate for Payer: PACE SWMI |
$12,929.35
|
| Rate for Payer: PHP Commercial |
$14,222.28
|
| Rate for Payer: PHP Medicare Advantage |
$12,929.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21,319.87
|
| Rate for Payer: Priority Health Medicare |
$12,929.35
|
| Rate for Payer: Priority Health Narrow Network |
$17,055.90
|
| Rate for Payer: Railroad Medicare Medicare |
$12,929.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,929.35
|
| Rate for Payer: UHC Exchange |
$20,040.49
|
| Rate for Payer: UHCCP DNSP |
$12,929.35
|
| Rate for Payer: VA VA |
$12,929.35
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC
|
Facility
|
IP
|
$18,158.57
|
|
|
Service Code
|
MSDRG 660
|
| Min. Negotiated Rate |
$10,708.73 |
| Max. Negotiated Rate |
$18,158.57 |
| Rate for Payer: Aetna Medicare |
$11,272.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,090.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,090.44
|
| Rate for Payer: BCBS MAPPO |
$11,272.35
|
| Rate for Payer: BCN Medicare Advantage |
$11,272.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,272.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,272.35
|
| Rate for Payer: Mclaren Medicare |
$11,272.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,835.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,963.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,399.58
|
| Rate for Payer: PACE Medicare |
$10,708.73
|
| Rate for Payer: PACE SWMI |
$11,272.35
|
| Rate for Payer: PHP Commercial |
$12,399.58
|
| Rate for Payer: PHP Medicare Advantage |
$11,272.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,158.57
|
| Rate for Payer: Priority Health Medicare |
$11,272.35
|
| Rate for Payer: Priority Health Narrow Network |
$14,526.86
|
| Rate for Payer: Railroad Medicare Medicare |
$11,272.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,272.35
|
| Rate for Payer: UHC Exchange |
$17,472.14
|
| Rate for Payer: UHCCP DNSP |
$11,272.35
|
| Rate for Payer: VA VA |
$11,272.35
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC
|
Facility
|
IP
|
$34,908.92
|
|
|
Service Code
|
MSDRG 659
|
| Min. Negotiated Rate |
$19,049.49 |
| Max. Negotiated Rate |
$34,908.92 |
| Rate for Payer: Aetna Medicare |
$20,052.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,065.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,065.12
|
| Rate for Payer: BCBS MAPPO |
$20,052.10
|
| Rate for Payer: BCN Medicare Advantage |
$20,052.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,052.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,052.10
|
| Rate for Payer: Mclaren Medicare |
$20,052.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,054.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,059.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,057.31
|
| Rate for Payer: PACE Medicare |
$19,049.49
|
| Rate for Payer: PACE SWMI |
$20,052.10
|
| Rate for Payer: PHP Commercial |
$22,057.31
|
| Rate for Payer: PHP Medicare Advantage |
$20,052.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34,908.92
|
| Rate for Payer: Priority Health Medicare |
$20,052.10
|
| Rate for Payer: Priority Health Narrow Network |
$27,927.13
|
| Rate for Payer: Railroad Medicare Medicare |
$20,052.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,052.10
|
| Rate for Payer: UHC Exchange |
$31,080.76
|
| Rate for Payer: UHCCP DNSP |
$20,052.10
|
| Rate for Payer: VA VA |
$20,052.10
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$14,276.48
|
|
|
Service Code
|
MSDRG 661
|
| Min. Negotiated Rate |
$8,750.10 |
| Max. Negotiated Rate |
$14,276.48 |
| Rate for Payer: Aetna Medicare |
$9,210.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,513.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,513.29
|
| Rate for Payer: BCBS MAPPO |
$9,210.63
|
| Rate for Payer: BCN Medicare Advantage |
$9,210.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,210.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,210.63
|
| Rate for Payer: Mclaren Medicare |
$9,210.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,671.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,592.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,131.69
|
| Rate for Payer: PACE Medicare |
$8,750.10
|
| Rate for Payer: PACE SWMI |
$9,210.63
|
| Rate for Payer: PHP Commercial |
$10,131.69
|
| Rate for Payer: PHP Medicare Advantage |
$9,210.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,225.15
|
| Rate for Payer: Priority Health Medicare |
$9,210.63
|
| Rate for Payer: Priority Health Narrow Network |
$11,380.12
|
| Rate for Payer: Railroad Medicare Medicare |
$9,210.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,210.63
|
| Rate for Payer: UHC Exchange |
$14,276.48
|
| Rate for Payer: UHCCP DNSP |
$9,210.63
|
| Rate for Payer: VA VA |
$9,210.63
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
IP
|
$5,223.89
|
|
|
Service Code
|
APR-DRG 4633
|
| Min. Negotiated Rate |
$4,723.02 |
| Max. Negotiated Rate |
$5,223.89 |
| Rate for Payer: BCBS Complete |
$5,223.89
|
| Rate for Payer: Mclaren Medicaid |
$4,975.13
|
| Rate for Payer: Meridian Medicaid |
$5,223.89
|
| Rate for Payer: PHP Medicaid |
$4,723.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,975.13
|
| Rate for Payer: UHC Medicaid |
$4,975.13
|
| Rate for Payer: UHCCP Medicaid |
$4,975.13
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
IP
|
$3,640.27
|
|
|
Service Code
|
APR-DRG 4632
|
| Min. Negotiated Rate |
$3,291.24 |
| Max. Negotiated Rate |
$3,640.27 |
| Rate for Payer: BCBS Complete |
$3,640.27
|
| Rate for Payer: Mclaren Medicaid |
$3,466.92
|
| Rate for Payer: Meridian Medicaid |
$3,640.27
|
| Rate for Payer: PHP Medicaid |
$3,291.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,466.92
|
| Rate for Payer: UHC Medicaid |
$3,466.92
|
| Rate for Payer: UHCCP Medicaid |
$3,466.92
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
IP
|
$2,914.94
|
|
|
Service Code
|
APR-DRG 4631
|
| Min. Negotiated Rate |
$2,635.45 |
| Max. Negotiated Rate |
$2,914.94 |
| Rate for Payer: BCBS Complete |
$2,914.94
|
| Rate for Payer: Mclaren Medicaid |
$2,776.13
|
| Rate for Payer: Meridian Medicaid |
$2,914.94
|
| Rate for Payer: PHP Medicaid |
$2,635.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,776.13
|
| Rate for Payer: UHC Medicaid |
$2,776.13
|
| Rate for Payer: UHCCP Medicaid |
$2,776.13
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
IP
|
$7,856.54
|
|
|
Service Code
|
APR-DRG 4634
|
| Min. Negotiated Rate |
$7,103.26 |
| Max. Negotiated Rate |
$7,856.54 |
| Rate for Payer: BCBS Complete |
$7,856.54
|
| Rate for Payer: Mclaren Medicaid |
$7,482.42
|
| Rate for Payer: Meridian Medicaid |
$7,856.54
|
| Rate for Payer: PHP Medicaid |
$7,103.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,482.42
|
| Rate for Payer: UHC Medicaid |
$7,482.42
|
| Rate for Payer: UHCCP Medicaid |
$7,482.42
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC
|
Facility
|
IP
|
$15,941.13
|
|
|
Service Code
|
MSDRG 689
|
| Min. Negotiated Rate |
$9,604.55 |
| Max. Negotiated Rate |
$15,941.13 |
| Rate for Payer: Aetna Medicare |
$10,110.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,637.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,637.56
|
| Rate for Payer: BCBS MAPPO |
$10,110.05
|
| Rate for Payer: BCN Medicare Advantage |
$10,110.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,110.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,110.05
|
| Rate for Payer: Mclaren Medicare |
$10,110.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,615.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,626.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,121.06
|
| Rate for Payer: PACE Medicare |
$9,604.55
|
| Rate for Payer: PACE SWMI |
$10,110.05
|
| Rate for Payer: PHP Commercial |
$11,121.06
|
| Rate for Payer: PHP Medicare Advantage |
$10,110.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,941.13
|
| Rate for Payer: Priority Health Medicare |
$10,110.05
|
| Rate for Payer: Priority Health Narrow Network |
$12,752.90
|
| Rate for Payer: Railroad Medicare Medicare |
$10,110.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,110.05
|
| Rate for Payer: UHC Exchange |
$15,670.58
|
| Rate for Payer: UHCCP DNSP |
$10,110.05
|
| Rate for Payer: VA VA |
$10,110.05
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$11,755.00
|
|
|
Service Code
|
MSDRG 690
|
| Min. Negotiated Rate |
$7,204.68 |
| Max. Negotiated Rate |
$11,755.00 |
| Rate for Payer: Aetna Medicare |
$7,583.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,479.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,479.84
|
| Rate for Payer: BCBS MAPPO |
$7,583.87
|
| Rate for Payer: BCN Medicare Advantage |
$7,583.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,583.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,583.87
|
| Rate for Payer: Mclaren Medicare |
$7,583.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,963.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,721.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,342.26
|
| Rate for Payer: PACE Medicare |
$7,204.68
|
| Rate for Payer: PACE SWMI |
$7,583.87
|
| Rate for Payer: PHP Commercial |
$8,342.26
|
| Rate for Payer: PHP Medicare Advantage |
$7,583.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,121.56
|
| Rate for Payer: Priority Health Medicare |
$7,583.87
|
| Rate for Payer: Priority Health Narrow Network |
$8,897.25
|
| Rate for Payer: Railroad Medicare Medicare |
$7,583.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,583.87
|
| Rate for Payer: UHC Exchange |
$11,755.00
|
| Rate for Payer: UHCCP DNSP |
$7,583.87
|
| Rate for Payer: VA VA |
$7,583.87
|
|
