|
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
|
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 |
$13.18
|
| 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
|
$104.37
|
|
|
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 |
$52.18
|
| 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 15 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.57
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
22472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$15.57 |
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: Aetna Commercial |
$15.70
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: ASR ASR |
$23.59
|
| Rate for Payer: ASR ASR |
$13.73
|
| Rate for Payer: ASR ASR |
$15.10
|
| Rate for Payer: ASR ASR |
$16.93
|
| Rate for Payer: ASR Commercial |
$15.10
|
| Rate for Payer: ASR Commercial |
$16.93
|
| Rate for Payer: ASR Commercial |
$13.73
|
| Rate for Payer: ASR Commercial |
$23.59
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$14.29
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$10.97
|
| Rate for Payer: BCN Commercial |
$12.07
|
| Rate for Payer: BCN Commercial |
$18.86
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$12.46
|
| Rate for Payer: Cash Price |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$14.64
|
| Rate for Payer: Cofinity Commercial |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| 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 |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$24.32
|
| Rate for Payer: Healthscope Commercial |
$15.57
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$14.15
|
| Rate for Payer: Healthscope Whirlpool |
$13.73
|
| Rate for Payer: Healthscope Whirlpool |
$15.10
|
| Rate for Payer: Healthscope Whirlpool |
$23.59
|
| Rate for Payer: Healthscope Whirlpool |
$16.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Mclaren Commercial |
$12.74
|
| Rate for Payer: Mclaren Commercial |
$21.89
|
| Rate for Payer: Mclaren Commercial |
$15.70
|
| Rate for Payer: Mclaren Commercial |
$14.01
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| 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: Multiplan/Beech St/PHCS Commercial |
$13.23
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: Nomi Health Commercial |
$12.77
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$19.94
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| 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: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
|
|
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 |
$15.70
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna Commercial |
$12.74
|
| 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 |
$15.70
|
| Rate for Payer: Mclaren Commercial |
$21.89
|
| Rate for Payer: Mclaren Commercial |
$14.01
|
| Rate for Payer: Mclaren Commercial |
$12.74
|
| 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 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 |
$0.39 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna Commercial |
$14.44
|
| Rate for Payer: Aetna Commercial |
$24.32
|
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna Commercial |
$15.70
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: ASR ASR |
$26.21
|
| Rate for Payer: ASR ASR |
$10.82
|
| Rate for Payer: ASR ASR |
$15.57
|
| Rate for Payer: ASR ASR |
$16.93
|
| Rate for Payer: ASR Commercial |
$15.57
|
| Rate for Payer: ASR Commercial |
$16.93
|
| Rate for Payer: ASR Commercial |
$10.82
|
| Rate for Payer: ASR Commercial |
$26.21
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$9.13
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.29
|
| Rate for Payer: BCBS Trust/PPO |
$22.13
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$8.64
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$8.92
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| 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 |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$11.15
|
| Rate for Payer: Healthscope Whirlpool |
$10.82
|
| Rate for Payer: Healthscope Whirlpool |
$15.57
|
| Rate for Payer: Healthscope Whirlpool |
$26.21
|
| Rate for Payer: Healthscope Whirlpool |
$16.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.73
|
| Rate for Payer: Mclaren Commercial |
$10.04
|
| Rate for Payer: Mclaren Commercial |
$24.32
|
| Rate for Payer: Mclaren Commercial |
$15.70
|
| Rate for Payer: Mclaren Commercial |
$14.44
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Mclaren Medicare |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| 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: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Nomi Health Commercial |
$9.14
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$14.31
|
| Rate for Payer: Nomi Health Commercial |
$22.16
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE Medicare |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicaid |
$0.39
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| 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: Priority Health Cigna Priority Health |
$7.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.52
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Priority Health Narrow Network |
$0.42
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
| 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 |
$23.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP DNSP |
$0.73
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: VA VA |
$0.73
|
|
|
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 |
$15.70
|
| Rate for Payer: Aetna Commercial |
$14.44
|
| 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 |
$15.70
|
| Rate for Payer: Mclaren Commercial |
$24.32
|
| Rate for Payer: Mclaren Commercial |
$14.44
|
| 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
|
$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
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 51079092801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: ASR ASR |
$2.76
|
| Rate for Payer: ASR Commercial |
$2.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.85
|
| Rate for Payer: Healthscope Whirlpool |
$2.76
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.51
|
|
|
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
|
OP
|
$323.95
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.58 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna Commercial |
$291.56
|
| Rate for Payer: Aetna Medicare |
$161.98
|
| Rate for Payer: ASR ASR |
$314.23
|
| Rate for Payer: ASR Commercial |
$314.23
|
| Rate for Payer: BCBS Complete |
$129.58
|
| Rate for Payer: BCBS Trust/PPO |
$265.28
|
| 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: Priority Health HMO/PPO/Tiered Network |
$283.84
|
| Rate for Payer: Priority Health Narrow Network |
$227.09
|
| 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
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 51079092820
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: ASR Commercial |
$276.45
|
| Rate for Payer: BCBS Trust/PPO |
$232.25
|
| 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: UHC All Payor (Choice/PPO) + Core |
$250.80
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 51079092801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare |
$1.42
|
| Rate for Payer: ASR ASR |
$2.76
|
| Rate for Payer: ASR Commercial |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.85
|
| Rate for Payer: Healthscope Whirlpool |
$2.76
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.50
|
| Rate for Payer: Priority Health Narrow Network |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.51
|
|
|
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 10 MG/2 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$21.68
|
|
|
Service Code
|
HCPCS J1921
|
| Hospital Charge Code |
190443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$19.51
|
| Rate for Payer: Aetna Medicare |
$10.84
|
| Rate for Payer: ASR ASR |
$21.03
|
| Rate for Payer: ASR Commercial |
$21.03
|
| Rate for Payer: BCBS Complete |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$17.75
|
| Rate for Payer: BCN Commercial |
$16.81
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Whirlpool |
$21.03
|
| Rate for Payer: Mclaren Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.43
|
| Rate for Payer: Nomi Health Commercial |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.43
|
| Rate for Payer: Priority Health Narrow Network |
$1.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.08
|
|
|
LABETALOL 10 MG/2 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$21.68
|
|
|
Service Code
|
HCPCS J1921
|
| Hospital Charge Code |
190443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$19.51
|
| Rate for Payer: ASR ASR |
$21.03
|
| Rate for Payer: ASR Commercial |
$21.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.67
|
| Rate for Payer: BCN Commercial |
$16.81
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Whirlpool |
$21.03
|
| Rate for Payer: Mclaren Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.43
|
| Rate for Payer: Nomi Health Commercial |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.08
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
NDC 51079092901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: ASR ASR |
$3.73
|
| Rate for Payer: ASR Commercial |
$3.73
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.85
|
| Rate for Payer: Healthscope Whirlpool |
$3.73
|
| Rate for Payer: Mclaren Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.27
|
| Rate for Payer: Nomi Health Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.37
|
| Rate for Payer: Priority Health Narrow Network |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.39
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$251.75
|
|
|
Service Code
|
NDC 68382079901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$226.58
|
| Rate for Payer: Aetna Medicare |
$125.88
|
| Rate for Payer: ASR ASR |
$244.20
|
| Rate for Payer: ASR Commercial |
$244.20
|
| Rate for Payer: BCBS Complete |
$100.70
|
| Rate for Payer: BCBS Trust/PPO |
$206.16
|
| Rate for Payer: BCN Commercial |
$195.18
|
| Rate for Payer: Cash Price |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$236.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.40
|
| Rate for Payer: Healthscope Commercial |
$251.75
|
| Rate for Payer: Healthscope Whirlpool |
$244.20
|
| Rate for Payer: Mclaren Commercial |
$226.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.99
|
| Rate for Payer: Nomi Health Commercial |
$206.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.58
|
| Rate for Payer: Priority Health Narrow Network |
$176.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.54
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$346.28
|
| Rate for Payer: Aetna Medicare |
$192.38
|
| Rate for Payer: ASR ASR |
$373.21
|
| Rate for Payer: ASR Commercial |
$373.21
|
| Rate for Payer: BCBS Complete |
$153.90
|
| Rate for Payer: BCBS Trust/PPO |
$315.07
|
| Rate for Payer: BCN Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$384.75
|
| Rate for Payer: Healthscope Whirlpool |
$373.21
|
| Rate for Payer: Mclaren Commercial |
$346.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Nomi Health Commercial |
$315.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$337.12
|
| Rate for Payer: Priority Health Narrow Network |
$269.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.58
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 60687045001
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.74 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$221.18
|
| Rate for Payer: ASR ASR |
$238.39
|
| Rate for Payer: ASR Commercial |
$238.39
|
| Rate for Payer: BCBS Trust/PPO |
$200.27
|
| Rate for Payer: BCN Commercial |
$190.54
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Commercial |
$231.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$245.76
|
| Rate for Payer: Healthscope Whirlpool |
$238.39
|
| Rate for Payer: Mclaren Commercial |
$221.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: Nomi Health Commercial |
$201.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.27
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$384.93
|
| Rate for Payer: ASR ASR |
$414.87
|
| Rate for Payer: ASR Commercial |
$414.87
|
| Rate for Payer: BCBS Trust/PPO |
$348.53
|
| Rate for Payer: BCN Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$402.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$427.70
|
| Rate for Payer: Healthscope Whirlpool |
$414.87
|
| Rate for Payer: Mclaren Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.54
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.38
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
OP
|
$427.70
|
|
|
Service Code
|
NDC 70377006112
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$384.93
|
| Rate for Payer: Aetna Medicare |
$213.85
|
| Rate for Payer: ASR ASR |
$414.87
|
| Rate for Payer: ASR Commercial |
$414.87
|
| Rate for Payer: BCBS Complete |
$171.08
|
| Rate for Payer: BCBS Trust/PPO |
$350.24
|
| Rate for Payer: BCN Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$402.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$427.70
|
| Rate for Payer: Healthscope Whirlpool |
$414.87
|
| Rate for Payer: Mclaren Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.54
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.75
|
| Rate for Payer: Priority Health Narrow Network |
$299.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.38
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 51079092920
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.09 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$346.28
|
| Rate for Payer: ASR ASR |
$373.21
|
| Rate for Payer: ASR Commercial |
$373.21
|
| Rate for Payer: BCBS Trust/PPO |
$313.53
|
| Rate for Payer: BCN Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$384.75
|
| Rate for Payer: Healthscope Whirlpool |
$373.21
|
| Rate for Payer: Mclaren Commercial |
$346.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.04
|
| Rate for Payer: Nomi Health Commercial |
$315.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.58
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$251.75
|
|
|
Service Code
|
NDC 68382079901
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.64 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$226.58
|
| Rate for Payer: ASR ASR |
$244.20
|
| Rate for Payer: ASR Commercial |
$244.20
|
| Rate for Payer: BCBS Trust/PPO |
$205.15
|
| Rate for Payer: BCN Commercial |
$195.18
|
| Rate for Payer: Cash Price |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$236.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.40
|
| Rate for Payer: Healthscope Commercial |
$251.75
|
| Rate for Payer: Healthscope Whirlpool |
$244.20
|
| Rate for Payer: Mclaren Commercial |
$226.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.99
|
| Rate for Payer: Nomi Health Commercial |
$206.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.54
|
|
