|
KETOROLAC TROMETHAMINE 0.5 % OP SOLN
|
Facility
|
IP
|
$21.10
|
|
|
Service Code
|
NDC 6131412605
|
| Hospital Charge Code |
6131412605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$10.55 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.55
|
|
|
KETOROLAC TROMETHAMINE 0.5 % OP SOLN
|
Facility
|
IP
|
$21.37
|
|
|
Service Code
|
NDC 6050510031
|
| Hospital Charge Code |
6050510031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.69
|
|
|
KETOROLAC TROMETHAMINE 0.5 % OP SOLN
|
Facility
|
OP
|
$21.10
|
|
|
Service Code
|
NDC 6131412605
|
| Hospital Charge Code |
6131412605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.55
|
| Rate for Payer: Aetna Government |
$10.55
|
| Rate for Payer: Brighton Health Commercial |
$15.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.35
|
| Rate for Payer: EmblemHealth Commercial |
$10.55
|
| Rate for Payer: Group Health Inc Commercial |
$10.55
|
| Rate for Payer: Group Health Inc Medicare |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.71
|
|
|
KETOROLAC TROMETHAMINE 0.5 % OP SOLN
|
Facility
|
OP
|
$21.20
|
|
|
Service Code
|
NDC 4257113725
|
| Hospital Charge Code |
4257113725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.60
|
| Rate for Payer: Aetna Government |
$10.60
|
| Rate for Payer: Brighton Health Commercial |
$15.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.42
|
| Rate for Payer: EmblemHealth Commercial |
$10.60
|
| Rate for Payer: Group Health Inc Commercial |
$10.60
|
| Rate for Payer: Group Health Inc Medicare |
$7.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.78
|
|
|
KETOROLAC TROMETHAMINE 0.5 % OP SOLN
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
NDC 4257113725
|
| Hospital Charge Code |
4257113725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.60
|
|
|
KETOROLAC TROMETHAMINE 0.5 % OP SOLN
|
Facility
|
OP
|
$21.37
|
|
|
Service Code
|
NDC 6050510031
|
| Hospital Charge Code |
6050510031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.69
|
| Rate for Payer: Aetna Government |
$10.69
|
| Rate for Payer: Brighton Health Commercial |
$16.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.53
|
| Rate for Payer: EmblemHealth Commercial |
$10.69
|
| Rate for Payer: Group Health Inc Commercial |
$10.69
|
| Rate for Payer: Group Health Inc Medicare |
$7.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.89
|
|
|
KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$3.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0409379319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$2.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.25
|
|
|
KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0409379319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.80
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0338007225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0338007225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7226611801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$7.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0409379519
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$5.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$7.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0409379519
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.92
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$7.84
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
0409379501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$5.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7604510410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.04
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$1.82
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6514514501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$1.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7226611801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7226611825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
7604510410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$3.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
IP
|
$1.82
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6514514501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.91
|
|
|
KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
6332316201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.31
|
| Rate for Payer: Healthfirst QHP |
$0.37
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.35
|
| Rate for Payer: Wellcare Medicare |
$0.35
|
|
