|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.71
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 1,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.79
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.43
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Mclaren Medicare |
$1.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.50
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.29
|
| Rate for Payer: PACE Medicare |
$1.36
|
| Rate for Payer: PACE SWMI |
$1.43
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.98
|
| Rate for Payer: Priority Health Medicare |
$1.43
|
| Rate for Payer: Priority Health Narrow Network |
$3.18
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.43
|
| Rate for Payer: UHC Medicare Advantage |
$1.43
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.43
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 1,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 2,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.79
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.43
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Mclaren Medicare |
$1.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.50
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.29
|
| Rate for Payer: PACE Medicare |
$1.36
|
| Rate for Payer: PACE SWMI |
$1.43
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.98
|
| Rate for Payer: Priority Health Medicare |
$1.43
|
| Rate for Payer: Priority Health Narrow Network |
$3.18
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.43
|
| Rate for Payer: UHC Medicare Advantage |
$1.43
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.43
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 2,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.79
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.43
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Mclaren Medicare |
$1.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.50
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.29
|
| Rate for Payer: PACE Medicare |
$1.36
|
| Rate for Payer: PACE SWMI |
$1.43
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.98
|
| Rate for Payer: Priority Health Medicare |
$1.43
|
| Rate for Payer: Priority Health Narrow Network |
$3.18
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.43
|
| Rate for Payer: UHC Medicare Advantage |
$1.43
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.43
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.79
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.43
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Mclaren Medicare |
$1.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.50
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.29
|
| Rate for Payer: PACE Medicare |
$1.36
|
| Rate for Payer: PACE SWMI |
$1.43
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.98
|
| Rate for Payer: Priority Health Medicare |
$1.43
|
| Rate for Payer: Priority Health Narrow Network |
$3.18
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.43
|
| Rate for Payer: UHC Medicare Advantage |
$1.43
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.43
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
OP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna Medicare |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.79
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$1.43
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.43
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.43
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Mclaren Medicare |
$1.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.50
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: Nomi Health Commercial |
$4.29
|
| Rate for Payer: PACE Medicare |
$1.36
|
| Rate for Payer: PACE SWMI |
$1.43
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.98
|
| Rate for Payer: Priority Health Medicare |
$1.43
|
| Rate for Payer: Priority Health Narrow Network |
$3.18
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.43
|
| Rate for Payer: UHC Medicare Advantage |
$1.43
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.43
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
|
IP
|
$2.88
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.45
|
| Rate for Payer: PHP Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$442.41 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089331
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
IP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$442.41 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
APIXABAN 5 MG TABLET
|
Facility
|
OP
|
$702.24
|
|
|
Service Code
|
NDC 00003089431
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.90 |
| Max. Negotiated Rate |
$632.02 |
| Rate for Payer: Aetna Commercial |
$596.90
|
| Rate for Payer: Aetna Medicare |
$351.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.46
|
| Rate for Payer: BCBS Complete |
$280.90
|
| Rate for Payer: Cash Price |
$561.79
|
| Rate for Payer: Cofinity Commercial |
$491.57
|
| Rate for Payer: Cofinity Commercial |
$603.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$491.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.79
|
| Rate for Payer: Healthscope Commercial |
$632.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.90
|
| Rate for Payer: PHP Commercial |
$596.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.46
|
| Rate for Payer: Priority Health SBD |
$442.41
|
|
|
APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 29105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.09 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$71.10
|
| Rate for Payer: BCN Commercial |
$71.10
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Nomi Health Commercial |
$324.66
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.91
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$388.73
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.09
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$87.04
|
| Rate for Payer: VA VA |
$154.60
|
|
|
APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 29505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.19 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$75.58
|
| Rate for Payer: BCN Commercial |
$75.58
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Nomi Health Commercial |
$324.66
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.91
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$388.73
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.19
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$87.04
|
| Rate for Payer: VA VA |
$154.60
|
|
|
APPLICATION OF LOW COST SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$1,885.01
|
|
|
Service Code
|
CPT C5271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.33 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$255.33
|
| Rate for Payer: BCN Commercial |
$255.33
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,688.24
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$337.66
|
| Rate for Payer: VA VA |
$599.75
|
|
|
APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 29125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$57.42
|
| Rate for Payer: BCN Commercial |
$57.42
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.48
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 29515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$160.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$193.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$193.25
|
| Rate for Payer: BCBS Complete |
$87.01
|
| Rate for Payer: BCBS MAPPO |
$154.60
|
| Rate for Payer: BCBS Trust/PPO |
$63.35
|
| Rate for Payer: BCN Commercial |
$63.35
|
| Rate for Payer: BCN Medicare Advantage |
$154.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.60
|
| Rate for Payer: Mclaren Medicaid |
$82.87
|
| Rate for Payer: Mclaren Medicare |
$154.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.33
|
| Rate for Payer: Meridian Medicaid |
$87.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.79
|
| Rate for Payer: Nomi Health Commercial |
$324.66
|
| Rate for Payer: PACE Medicare |
$146.87
|
| Rate for Payer: PACE SWMI |
$154.60
|
| Rate for Payer: PHP Medicare Advantage |
$154.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.91
|
| Rate for Payer: Priority Health Medicare |
$154.60
|
| Rate for Payer: Priority Health Narrow Network |
$388.73
|
| Rate for Payer: Railroad Medicare Medicare |
$154.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.60
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.60
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$154.60
|
| Rate for Payer: UHCCP Medicaid |
$87.04
|
| Rate for Payer: VA VA |
$154.60
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ CM WOUND SURFACE AREA, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 15276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: BCBS Trust/PPO |
$71.80
|
| Rate for Payer: BCN Commercial |
$71.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.54
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$98.55 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$950.13
|
| Rate for Payer: BCN Commercial |
$950.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.55
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$88.91 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.81
|
| Rate for Payer: BCN Commercial |
$1,186.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.91
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$3,679.24
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$3,504.04 |
| Max. Negotiated Rate |
$3,679.24 |
| Rate for Payer: BCBS Complete |
$3,679.24
|
| Rate for Payer: Mclaren Medicaid |
$3,504.04
|
| Rate for Payer: Meridian Medicaid |
$3,679.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,504.04
|
| Rate for Payer: UHCCP Medicaid |
$3,679.24
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$4,382.63
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$4,173.93 |
| Max. Negotiated Rate |
$4,382.63 |
| Rate for Payer: BCBS Complete |
$4,382.63
|
| Rate for Payer: Mclaren Medicaid |
$4,173.93
|
| Rate for Payer: Meridian Medicaid |
$4,382.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,173.93
|
| Rate for Payer: UHCCP Medicaid |
$4,382.63
|
|
