|
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 |
$27.92 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$62.82
|
| Rate for Payer: Aetna Medicare |
$34.90
|
| Rate for Payer: ASR ASR |
$67.71
|
| Rate for Payer: ASR Commercial |
$67.71
|
| Rate for Payer: BCBS Complete |
$27.92
|
| Rate for Payer: BCBS Trust/PPO |
$57.16
|
| Rate for Payer: BCN Commercial |
$54.12
|
| 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 |
$69.80
|
| Rate for Payer: Healthscope Whirlpool |
$67.71
|
| 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: Priority Health Cigna Priority Health |
$45.37
|
| Rate for Payer: 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 |
$20.93 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$28.98
|
| Rate for Payer: ASR ASR |
$31.23
|
| Rate for Payer: ASR Commercial |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| 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 Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.93
|
| 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 |
$12.88 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$28.98
|
| Rate for Payer: Aetna Medicare |
$16.10
|
| Rate for Payer: ASR ASR |
$31.23
|
| Rate for Payer: ASR Commercial |
$31.23
|
| Rate for Payer: BCBS Complete |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.37
|
| 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 Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.93
|
| Rate for Payer: 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
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 00143950801
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: ASR ASR |
$37.89
|
| Rate for Payer: ASR Commercial |
$37.89
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.99
|
| Rate for Payer: BCN Commercial |
$30.28
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$36.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$39.06
|
| Rate for Payer: Healthscope Whirlpool |
$37.89
|
| Rate for Payer: Mclaren Commercial |
$35.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.22
|
| Rate for Payer: Priority Health Narrow Network |
$27.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.37
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 00143950810
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: ASR ASR |
$37.89
|
| Rate for Payer: ASR Commercial |
$37.89
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.99
|
| Rate for Payer: BCN Commercial |
$30.28
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$36.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$39.06
|
| Rate for Payer: Healthscope Whirlpool |
$37.89
|
| Rate for Payer: Mclaren Commercial |
$35.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.22
|
| Rate for Payer: Priority Health Narrow Network |
$27.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.37
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 00143950810
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: ASR ASR |
$37.89
|
| Rate for Payer: ASR Commercial |
$37.89
|
| Rate for Payer: BCBS Trust/PPO |
$31.83
|
| Rate for Payer: BCN Commercial |
$30.28
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$36.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$39.06
|
| Rate for Payer: Healthscope Whirlpool |
$37.89
|
| Rate for Payer: Mclaren Commercial |
$35.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.37
|
|
|
KETAMINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 00143950801
|
| Hospital Charge Code |
4238
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$39.06 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: ASR ASR |
$37.89
|
| Rate for Payer: ASR Commercial |
$37.89
|
| Rate for Payer: BCBS Trust/PPO |
$31.83
|
| Rate for Payer: BCN Commercial |
$30.28
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$36.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$39.06
|
| Rate for Payer: Healthscope Whirlpool |
$37.89
|
| Rate for Payer: Mclaren Commercial |
$35.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.37
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$45.99
|
|
|
Service Code
|
NDC 00168009930
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$45.99 |
| Rate for Payer: Aetna Commercial |
$41.39
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: ASR ASR |
$44.61
|
| Rate for Payer: ASR Commercial |
$44.61
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$37.66
|
| Rate for Payer: BCN Commercial |
$35.66
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cofinity Commercial |
$43.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.79
|
| Rate for Payer: Healthscope Commercial |
$45.99
|
| Rate for Payer: Healthscope Whirlpool |
$44.61
|
| Rate for Payer: Mclaren Commercial |
$41.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.09
|
| Rate for Payer: Nomi Health Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.30
|
| Rate for Payer: Priority Health Narrow Network |
$32.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.47
|
|
|
KETOCONAZOLE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$45.99
|
|
|
Service Code
|
NDC 00168009930
|
| Hospital Charge Code |
10368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$45.99 |
| Rate for Payer: Aetna Commercial |
$41.39
|
| Rate for Payer: ASR ASR |
$44.61
|
| Rate for Payer: ASR Commercial |
$44.61
|
| Rate for Payer: BCBS Trust/PPO |
$37.48
|
| Rate for Payer: BCN Commercial |
$35.66
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cofinity Commercial |
$43.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.79
|
| Rate for Payer: Healthscope Commercial |
$45.99
|
| Rate for Payer: Healthscope Whirlpool |
$44.61
|
| Rate for Payer: Mclaren Commercial |
$41.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.09
|
| Rate for Payer: Nomi Health Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.47
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
OP
|
$26.37
|
|
|
Service Code
|
NDC 41616021990
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$26.37 |
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: Aetna Medicare |
$13.19
|
| Rate for Payer: ASR ASR |
$25.58
|
| Rate for Payer: ASR Commercial |
$25.58
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| 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 Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.11
|
| Rate for Payer: Priority Health Narrow Network |
$18.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.21
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
OP
|
$104.83
|
|
|
Service Code
|
NDC 17478020910
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$104.83 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna Medicare |
$52.41
|
| Rate for Payer: ASR ASR |
$101.69
|
| Rate for Payer: ASR Commercial |
$101.69
|
| Rate for Payer: BCBS Complete |
$41.93
|
| Rate for Payer: BCBS Trust/PPO |
$85.85
|
| 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 Commercial |
$89.11
|
| Rate for Payer: Nomi Health Commercial |
$85.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.85
|
| Rate for Payer: Priority Health Narrow Network |
$73.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.25
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
IP
|
$26.37
|
|
|
Service Code
|
NDC 41616021990
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$26.37 |
| Rate for Payer: Aetna Commercial |
$23.73
|
| Rate for Payer: ASR ASR |
$25.58
|
| Rate for Payer: ASR Commercial |
$25.58
|
| Rate for Payer: BCBS Trust/PPO |
$21.49
|
| 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 Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$21.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.21
|
|
|
KETOROLAC 0.5 % EYE DROPS
|
Facility
|
OP
|
$104.37
|
|
|
Service Code
|
NDC 60505100301
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$104.37 |
| Rate for Payer: Aetna Commercial |
$93.93
|
| Rate for Payer: Aetna Medicare |
$52.19
|
| Rate for Payer: ASR ASR |
$101.24
|
| Rate for Payer: ASR Commercial |
$101.24
|
| Rate for Payer: BCBS Complete |
$41.75
|
| Rate for Payer: BCBS Trust/PPO |
$85.47
|
| 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 Commercial |
$88.71
|
| Rate for Payer: Nomi Health Commercial |
$85.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.84
|
| Rate for Payer: 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 |
$19.14 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: ASR Commercial |
$46.41
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: BCBS Trust/PPO |
$39.18
|
| 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 Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: 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
|
IP
|
$104.37
|
|
|
Service Code
|
NDC 60505100301
|
| Hospital Charge Code |
19733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.84 |
| Max. Negotiated Rate |
$104.37 |
| Rate for Payer: Aetna Commercial |
$93.93
|
| Rate for Payer: ASR ASR |
$101.24
|
| Rate for Payer: ASR Commercial |
$101.24
|
| Rate for Payer: BCBS Trust/PPO |
$85.05
|
| 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 Commercial |
$88.71
|
| Rate for Payer: Nomi Health Commercial |
$85.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.84
|
| 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 |
$68.14 |
| Max. Negotiated Rate |
$104.83 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: ASR ASR |
$101.69
|
| Rate for Payer: ASR Commercial |
$101.69
|
| Rate for Payer: BCBS Trust/PPO |
$85.43
|
| 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 Commercial |
$89.11
|
| Rate for Payer: Nomi Health Commercial |
$85.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.14
|
| 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 |
$31.10 |
| Max. Negotiated Rate |
$47.85 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: ASR ASR |
$46.41
|
| Rate for Payer: ASR Commercial |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$38.99
|
| 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 Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.11
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.45
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR ASR |
$16.93
|
| Rate for Payer: ASR ASR |
$15.10
|
| Rate for Payer: ASR ASR |
$23.59
|
| Rate for Payer: ASR Commercial |
$16.93
|
| Rate for Payer: ASR Commercial |
$23.59
|
| Rate for Payer: ASR Commercial |
$15.10
|
| Rate for Payer: ASR Commercial |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$19.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.69
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$18.86
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$12.07
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.46
|
| 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 |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$15.57
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Healthscope Whirlpool |
$23.59
|
| Rate for Payer: Healthscope Whirlpool |
$15.10
|
| Rate for Payer: Healthscope Whirlpool |
$16.93
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Mclaren Commercial |
$21.89
|
| Rate for Payer: Mclaren Commercial |
$14.01
|
| Rate for Payer: Mclaren Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$12.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
|
|
KETOROLAC 15 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$12.73
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: ASR ASR |
$16.93
|
| Rate for Payer: ASR ASR |
$15.10
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR ASR |
$23.59
|
| Rate for Payer: ASR Commercial |
$16.93
|
| Rate for Payer: ASR Commercial |
$13.73
|
| Rate for Payer: ASR Commercial |
$15.10
|
| Rate for Payer: ASR Commercial |
$23.59
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCBS Trust/PPO |
$14.29
|
| Rate for Payer: BCN Commercial |
$12.07
|
| Rate for Payer: BCN Commercial |
$18.86
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$22.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Commercial |
$15.57
|
| Rate for Payer: Healthscope Whirlpool |
$23.59
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Healthscope Whirlpool |
$16.93
|
| Rate for Payer: Healthscope Whirlpool |
$15.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Mclaren Commercial |
$12.73
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Mclaren Commercial |
$21.89
|
| Rate for Payer: Mclaren Commercial |
$14.01
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| 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 |
$13.23
|
| Rate for Payer: Nomi Health Commercial |
$12.77
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.29
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Narrow Network |
$12.23
|
| Rate for Payer: Priority Health Narrow Network |
$9.92
|
| Rate for Payer: Priority Health Narrow Network |
$17.05
|
| Rate for Payer: Priority Health Narrow Network |
$10.91
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
OP
|
$17.45
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna Commercial |
$24.32
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.38
|
| Rate for Payer: ASR ASR |
$16.93
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: ASR ASR |
$10.82
|
| Rate for Payer: ASR ASR |
$26.21
|
| Rate for Payer: ASR Commercial |
$16.93
|
| Rate for Payer: ASR Commercial |
$10.82
|
| Rate for Payer: ASR Commercial |
$15.57
|
| Rate for Payer: ASR Commercial |
$26.21
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.17
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCBS Trust/PPO |
$9.13
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCBS Trust/PPO |
$22.13
|
| Rate for Payer: BCBS Trust/PPO |
$14.29
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$8.64
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$25.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$11.15
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Whirlpool |
$26.21
|
| Rate for Payer: Healthscope Whirlpool |
$10.82
|
| Rate for Payer: Healthscope Whirlpool |
$16.93
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.30
|
| Rate for Payer: Mclaren Commercial |
$10.04
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Mclaren Commercial |
$24.32
|
| Rate for Payer: Mclaren Commercial |
$14.45
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicaid |
$0.16
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Mclaren Medicare |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: Meridian Medicaid |
$0.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$9.14
|
| Rate for Payer: Nomi Health Commercial |
$22.16
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE Medicare |
$0.29
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Commercial |
$0.33
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicaid |
$0.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.29
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: Priority Health Narrow Network |
$12.23
|
| Rate for Payer: Priority Health Narrow Network |
$7.82
|
| Rate for Payer: Priority Health Narrow Network |
$18.94
|
| Rate for Payer: Priority Health Narrow Network |
$11.25
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP DNSP |
$0.30
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: UHCCP Medicaid |
$0.16
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
| Rate for Payer: VA VA |
$0.30
|
|
|
KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION
|
Facility
|
IP
|
$17.45
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$17.45 |
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Commercial |
$24.32
|
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: ASR ASR |
$10.82
|
| Rate for Payer: ASR ASR |
$16.93
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: ASR ASR |
$26.21
|
| Rate for Payer: ASR Commercial |
$16.93
|
| Rate for Payer: ASR Commercial |
$26.21
|
| Rate for Payer: ASR Commercial |
$15.57
|
| Rate for Payer: ASR Commercial |
$10.82
|
| Rate for Payer: BCBS Trust/PPO |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$9.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.08
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: BCN Commercial |
$8.64
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$11.15
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$27.02
|
| Rate for Payer: Healthscope Whirlpool |
$26.21
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Healthscope Whirlpool |
$16.93
|
| Rate for Payer: Healthscope Whirlpool |
$10.82
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Mclaren Commercial |
$24.32
|
| Rate for Payer: Mclaren Commercial |
$14.45
|
| Rate for Payer: Mclaren Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.48
|
| Rate for Payer: Nomi Health Commercial |
$9.14
|
| Rate for Payer: Nomi Health Commercial |
$22.16
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.81
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
NDC 51079092820
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Medicare |
$142.50
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: ASR Commercial |
$276.45
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: BCBS Trust/PPO |
$233.39
|
| Rate for Payer: BCN Commercial |
$220.96
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$267.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$285.00
|
| Rate for Payer: Healthscope Whirlpool |
$276.45
|
| Rate for Payer: Mclaren Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Nomi Health Commercial |
$233.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.72
|
| Rate for Payer: Priority Health Narrow Network |
$199.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.80
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$323.95
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.57 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna Commercial |
$291.56
|
| Rate for Payer: ASR ASR |
$314.23
|
| Rate for Payer: ASR Commercial |
$314.23
|
| Rate for Payer: BCBS Trust/PPO |
$263.99
|
| Rate for Payer: BCN Commercial |
$251.16
|
| Rate for Payer: Cash Price |
$259.16
|
| Rate for Payer: Cofinity Commercial |
$304.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.16
|
| Rate for Payer: Healthscope Commercial |
$323.95
|
| Rate for Payer: Healthscope Whirlpool |
$314.23
|
| Rate for Payer: Mclaren Commercial |
$291.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.36
|
| Rate for Payer: Nomi Health Commercial |
$265.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.08
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: ASR ASR |
$3.14
|
| Rate for Payer: ASR Commercial |
$3.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.14
|
| Rate for Payer: Mclaren Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.85
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
NDC 60687043911
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: ASR ASR |
$3.14
|
| Rate for Payer: ASR Commercial |
$3.14
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.14
|
| Rate for Payer: Mclaren Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.84
|
| Rate for Payer: Priority Health Narrow Network |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.85
|
|
