|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$603.29 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.08
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.44
|
| Rate for Payer: Priority Health SBD |
$603.29
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$891.36
|
|
|
Service Code
|
NDC 65628020810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.54 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna Medicare |
$445.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: BCBS Complete |
$356.54
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$957.60
|
|
|
Service Code
|
NDC 65628020110
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$383.04 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Aetna Commercial |
$813.96
|
| Rate for Payer: Aetna Medicare |
$478.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.44
|
| Rate for Payer: BCBS Complete |
$383.04
|
| Rate for Payer: Cash Price |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$670.32
|
| Rate for Payer: Cofinity Commercial |
$823.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.08
|
| Rate for Payer: Healthscope Commercial |
$861.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.96
|
| Rate for Payer: PHP Commercial |
$813.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.44
|
| Rate for Payer: Priority Health SBD |
$603.29
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,055.52
|
|
|
Service Code
|
NDC 52536010810
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$422.21 |
| Max. Negotiated Rate |
$949.97 |
| Rate for Payer: Aetna Commercial |
$897.19
|
| Rate for Payer: Aetna Medicare |
$527.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.09
|
| Rate for Payer: BCBS Complete |
$422.21
|
| Rate for Payer: Cash Price |
$844.42
|
| Rate for Payer: Cofinity Commercial |
$738.86
|
| Rate for Payer: Cofinity Commercial |
$907.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$738.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.42
|
| Rate for Payer: Healthscope Commercial |
$949.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.19
|
| Rate for Payer: PHP Commercial |
$897.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.09
|
| Rate for Payer: Priority Health SBD |
$664.98
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$891.36
|
|
|
Service Code
|
NDC 65628001610
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.54 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna Medicare |
$445.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: BCBS Complete |
$356.54
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
|
VANCOMYCIN 50 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$891.36
|
|
|
Service Code
|
NDC 65628001610
|
| Hospital Charge Code |
11630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$561.56 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: Aetna Commercial |
$757.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.38
|
| Rate for Payer: Cash Price |
$713.09
|
| Rate for Payer: Cofinity Commercial |
$623.95
|
| Rate for Payer: Cofinity Commercial |
$766.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$623.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.09
|
| Rate for Payer: Healthscope Commercial |
$802.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$757.66
|
| Rate for Payer: PHP Commercial |
$757.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$579.38
|
| Rate for Payer: Priority Health SBD |
$561.56
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.10
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna Commercial |
$48.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.54
|
| Rate for Payer: PHP Commercial |
$48.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health SBD |
$35.97
|
|
|
VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.10
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
8444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$51.39 |
| Rate for Payer: Aetna Commercial |
$48.54
|
| Rate for Payer: Aetna Medicare |
$28.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: BCBS Complete |
$22.84
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$39.97
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.68
|
| Rate for Payer: Healthscope Commercial |
$51.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.54
|
| Rate for Payer: PHP Commercial |
$48.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.12
|
| Rate for Payer: Priority Health SBD |
$35.97
|
|
|
VANCOMYCIN 5 MG/ML IV SPECIAL DILUTION
|
Facility
|
OP
|
$10.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna Medicare |
$5.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: BCBS Complete |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$6.10
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health SBD |
$6.54
|
|
|
VANCOMYCIN 5 MG/ML IV SPECIAL DILUTION
|
Facility
|
IP
|
$10.38
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
154952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health SBD |
$6.54
|
|
|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
OP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: BCBS Complete |
$16.56
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health SBD |
$26.08
|
|
|
VANCOMYCIN 750 MG/150 ML IN DILUENT COMBINATION IV PIGGYBACK
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J3372
|
| Hospital Charge Code |
194728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.08 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.90
|
| Rate for Payer: Priority Health SBD |
$26.08
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
NDC 60687064811
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.12
|
| Rate for Payer: BCBS Complete |
$17.92
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$31.36
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health SBD |
$28.22
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
OP
|
$1,343.88
|
|
|
Service Code
|
NDC 60687064821
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.55 |
| Max. Negotiated Rate |
$1,209.49 |
| Rate for Payer: Aetna Commercial |
$1,142.30
|
| Rate for Payer: Aetna Medicare |
$671.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.52
|
| Rate for Payer: BCBS Complete |
$537.55
|
| Rate for Payer: Cash Price |
$1,075.10
|
| Rate for Payer: Cofinity Commercial |
$1,155.74
|
| Rate for Payer: Cofinity Commercial |
$940.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$940.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.10
|
| Rate for Payer: Healthscope Commercial |
$1,209.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,142.30
|
| Rate for Payer: PHP Commercial |
$1,142.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.52
|
| Rate for Payer: Priority Health SBD |
$846.64
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
NDC 60687064811
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.12
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$31.36
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health SBD |
$28.22
|
|
|
VARENICLINE TARTRATE 1 MG TABLET
|
Facility
|
IP
|
$1,343.88
|
|
|
Service Code
|
NDC 60687064821
|
| Hospital Charge Code |
76445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$846.64 |
| Max. Negotiated Rate |
$1,209.49 |
| Rate for Payer: Aetna Commercial |
$1,142.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.52
|
| Rate for Payer: Cash Price |
$1,075.10
|
| Rate for Payer: Cofinity Commercial |
$1,155.74
|
| Rate for Payer: Cofinity Commercial |
$940.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$940.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.10
|
| Rate for Payer: Healthscope Commercial |
$1,209.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,142.30
|
| Rate for Payer: PHP Commercial |
$1,142.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.52
|
| Rate for Payer: Priority Health SBD |
$846.64
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$786.18 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$786.18
|
| Rate for Payer: BCN Commercial |
$786.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,649.76
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,129.99
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
|
IP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.77 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health SBD |
$58.77
|
|
|
VASOPRESSIN 20 UNIT/ML INJECTION (CODE)
|
Facility
|
OP
|
$93.29
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
163709
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$83.96 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Medicare |
$46.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health SBD |
$58.77
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.73
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$48.36 |
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Aetna Commercial |
$83.02
|
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Medicare |
$46.64
|
| Rate for Payer: Aetna Medicare |
$26.86
|
| Rate for Payer: Aetna Medicare |
$60.08
|
| Rate for Payer: Aetna Medicare |
$77.43
|
| Rate for Payer: Aetna Medicare |
$48.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: BCBS Complete |
$48.07
|
| Rate for Payer: BCBS Complete |
$39.07
|
| Rate for Payer: BCBS Complete |
$21.49
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS Complete |
$61.94
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$84.12
|
| Rate for Payer: Cofinity Commercial |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$46.21
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Healthscope Commercial |
$87.90
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Healthscope Commercial |
$108.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$83.02
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: PHP Commercial |
$45.67
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health SBD |
$97.56
|
| Rate for Payer: Priority Health SBD |
$33.85
|
| Rate for Payer: Priority Health SBD |
$75.71
|
| Rate for Payer: Priority Health SBD |
$61.53
|
| Rate for Payer: Priority Health SBD |
$58.77
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$120.17
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
173104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$108.15 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$83.02
|
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.66
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cash Price |
$42.98
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$84.12
|
| Rate for Payer: Cofinity Commercial |
$108.40
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$46.21
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.23
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.14
|
| Rate for Payer: Healthscope Commercial |
$83.96
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$108.15
|
| Rate for Payer: Healthscope Commercial |
$87.90
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$45.67
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: PHP Commercial |
$83.02
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.49
|
| Rate for Payer: Priority Health SBD |
$33.85
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: Priority Health SBD |
$97.56
|
| Rate for Payer: Priority Health SBD |
$75.71
|
| Rate for Payer: Priority Health SBD |
$61.53
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$384.20
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$345.78 |
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Commercial |
$379.92
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.54
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: BCBS MAPPO |
$3.63
|
| Rate for Payer: BCBS MAPPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.63
|
| Rate for Payer: BCN Medicare Advantage |
$3.63
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Cofinity Commercial |
$384.39
|
| Rate for Payer: Cofinity Commercial |
$312.88
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$402.27
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Mclaren Medicaid |
$1.95
|
| Rate for Payer: Mclaren Medicaid |
$1.95
|
| Rate for Payer: Mclaren Medicare |
$3.63
|
| Rate for Payer: Mclaren Medicare |
$3.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.81
|
| Rate for Payer: Meridian Medicaid |
$2.04
|
| Rate for Payer: Meridian Medicaid |
$2.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: Nomi Health Commercial |
$10.89
|
| Rate for Payer: Nomi Health Commercial |
$10.89
|
| Rate for Payer: PACE Medicare |
$3.45
|
| Rate for Payer: PACE Medicare |
$3.45
|
| Rate for Payer: PACE SWMI |
$3.63
|
| Rate for Payer: PACE SWMI |
$3.63
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: PHP Commercial |
$379.92
|
| Rate for Payer: PHP Medicare Advantage |
$3.63
|
| Rate for Payer: PHP Medicare Advantage |
$3.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.86
|
| Rate for Payer: Priority Health Medicare |
$3.63
|
| Rate for Payer: Priority Health Medicare |
$3.63
|
| Rate for Payer: Priority Health Narrow Network |
$8.69
|
| Rate for Payer: Priority Health Narrow Network |
$8.69
|
| Rate for Payer: Priority Health SBD |
$281.59
|
| Rate for Payer: Priority Health SBD |
$242.05
|
| Rate for Payer: Railroad Medicare Medicare |
$3.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.63
|
| Rate for Payer: UHC Medicare Advantage |
$3.63
|
| Rate for Payer: UHC Medicare Advantage |
$3.63
|
| Rate for Payer: UHCCP Medicaid |
$2.04
|
| Rate for Payer: UHCCP Medicaid |
$2.04
|
| Rate for Payer: VA VA |
$3.63
|
| Rate for Payer: VA VA |
$3.63
|
|
|
VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$384.20
|
|
|
Service Code
|
HCPCS J2601
|
| Hospital Charge Code |
184045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.05 |
| Max. Negotiated Rate |
$345.78 |
| Rate for Payer: Aetna Commercial |
$326.57
|
| Rate for Payer: Aetna Commercial |
$379.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.53
|
| Rate for Payer: Cash Price |
$307.36
|
| Rate for Payer: Cash Price |
$357.58
|
| Rate for Payer: Cofinity Commercial |
$268.94
|
| Rate for Payer: Cofinity Commercial |
$312.88
|
| Rate for Payer: Cofinity Commercial |
$384.39
|
| Rate for Payer: Cofinity Commercial |
$330.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.58
|
| Rate for Payer: Healthscope Commercial |
$345.78
|
| Rate for Payer: Healthscope Commercial |
$402.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$326.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.92
|
| Rate for Payer: PHP Commercial |
$326.57
|
| Rate for Payer: PHP Commercial |
$379.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.73
|
| Rate for Payer: Priority Health SBD |
$281.59
|
| Rate for Payer: Priority Health SBD |
$242.05
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,335.77
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$21,902.19 |
| Rate for Payer: Aetna Commercial |
$20,685.40
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,818.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS MAPPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$62.88
|
| Rate for Payer: BCN Commercial |
$62.88
|
| Rate for Payer: BCN Medicare Advantage |
$21.67
|
| Rate for Payer: Cash Price |
$19,468.62
|
| Rate for Payer: Cash Price |
$19,468.62
|
| Rate for Payer: Cofinity Commercial |
$20,928.76
|
| Rate for Payer: Cofinity Commercial |
$17,035.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,035.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,468.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$21,902.19
|
| Rate for Payer: Mclaren Medicaid |
$11.62
|
| Rate for Payer: Mclaren Medicare |
$21.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.75
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,685.40
|
| Rate for Payer: Nomi Health Commercial |
$65.01
|
| Rate for Payer: PACE Medicare |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.67
|
| Rate for Payer: PHP Commercial |
$20,685.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,818.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.05
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health Narrow Network |
$51.24
|
| Rate for Payer: Priority Health SBD |
$15,331.54
|
| Rate for Payer: Railroad Medicare Medicare |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.67
|
| Rate for Payer: UHC Medicare Advantage |
$21.67
|
| Rate for Payer: UHCCP Medicaid |
$12.20
|
| Rate for Payer: VA VA |
$21.67
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,335.77
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,331.54 |
| Max. Negotiated Rate |
$21,902.19 |
| Rate for Payer: Aetna Commercial |
$20,685.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,818.25
|
| Rate for Payer: Cash Price |
$19,468.62
|
| Rate for Payer: Cofinity Commercial |
$17,035.04
|
| Rate for Payer: Cofinity Commercial |
$20,928.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,035.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,468.62
|
| Rate for Payer: Healthscope Commercial |
$21,902.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,685.40
|
| Rate for Payer: PHP Commercial |
$20,685.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,818.25
|
| Rate for Payer: Priority Health SBD |
$15,331.54
|
|
