|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,589.28
|
|
|
Service Code
|
NDC 00472008216
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.59 |
| Max. Negotiated Rate |
$1,430.35 |
| Rate for Payer: Aetna Commercial |
$1,350.89
|
| Rate for Payer: Aetna Medicare |
$794.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.03
|
| Rate for Payer: BCBS Complete |
$635.71
|
| Rate for Payer: Cash Price |
$1,271.42
|
| Rate for Payer: Cofinity Advantage |
$1,112.50
|
| Rate for Payer: Cofinity Commercial |
$1,366.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.42
|
| Rate for Payer: Healthscope Commercial |
$1,430.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,271.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,350.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,191.96
|
| Rate for Payer: PHP Commercial |
$1,350.89
|
| Rate for Payer: Priority Health SBD |
$1,001.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.03
|
| Rate for Payer: UHC Core |
$828.01
|
| Rate for Payer: UHC Exchange |
$624.59
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,589.28
|
|
|
Service Code
|
NDC 00472008216
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,001.25 |
| Max. Negotiated Rate |
$1,430.35 |
| Rate for Payer: Aetna Commercial |
$1,350.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.03
|
| Rate for Payer: Cash Price |
$1,271.42
|
| Rate for Payer: Cofinity Advantage |
$1,112.50
|
| Rate for Payer: Cofinity Commercial |
$1,366.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.42
|
| Rate for Payer: Healthscope Commercial |
$1,430.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,350.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,191.96
|
| Rate for Payer: PHP Commercial |
$1,350.89
|
| Rate for Payer: Priority Health SBD |
$1,001.25
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,367.21
|
|
|
Service Code
|
NDC 50383081016
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.31 |
| Max. Negotiated Rate |
$1,230.49 |
| Rate for Payer: Aetna Commercial |
$1,162.13
|
| Rate for Payer: Aetna Medicare |
$683.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.69
|
| Rate for Payer: BCBS Complete |
$546.88
|
| Rate for Payer: Cash Price |
$1,093.77
|
| Rate for Payer: Cofinity Advantage |
$957.05
|
| Rate for Payer: Cofinity Commercial |
$1,175.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.77
|
| Rate for Payer: Healthscope Commercial |
$1,230.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,093.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,025.41
|
| Rate for Payer: PHP Commercial |
$1,162.13
|
| Rate for Payer: Priority Health SBD |
$861.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$888.69
|
| Rate for Payer: UHC Core |
$712.32
|
| Rate for Payer: UHC Exchange |
$537.31
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,367.21
|
|
|
Service Code
|
NDC 50383081016
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$861.34 |
| Max. Negotiated Rate |
$1,230.49 |
| Rate for Payer: Aetna Commercial |
$1,162.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.69
|
| Rate for Payer: Cash Price |
$1,093.77
|
| Rate for Payer: Cofinity Advantage |
$957.05
|
| Rate for Payer: Cofinity Commercial |
$1,175.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.77
|
| Rate for Payer: Healthscope Commercial |
$1,230.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,162.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,025.41
|
| Rate for Payer: PHP Commercial |
$1,162.13
|
| Rate for Payer: Priority Health SBD |
$861.34
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,911.87
|
|
|
Service Code
|
NDC 70954018810
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,204.48 |
| Max. Negotiated Rate |
$1,720.68 |
| Rate for Payer: Aetna Commercial |
$1,625.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,242.72
|
| Rate for Payer: Cash Price |
$1,529.50
|
| Rate for Payer: Cofinity Advantage |
$1,338.31
|
| Rate for Payer: Cofinity Commercial |
$1,644.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,529.50
|
| Rate for Payer: Healthscope Commercial |
$1,720.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,625.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,433.90
|
| Rate for Payer: PHP Commercial |
$1,625.09
|
| Rate for Payer: Priority Health SBD |
$1,204.48
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 72578000201
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.66 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 72578000201
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.83 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Advantage |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health SBD |
$177.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.30
|
| Rate for Payer: UHC Core |
$146.92
|
| Rate for Payer: UHC Exchange |
$110.83
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 00904579061
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Advantage |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.47
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.15
|
| Rate for Payer: UHC Core |
$105.92
|
| Rate for Payer: UHC Exchange |
$79.90
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 00904750761
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.19 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 00904750761
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.43
|
| Rate for Payer: UHC Core |
$136.61
|
| Rate for Payer: UHC Exchange |
$103.04
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 00904579061
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.08 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Advantage |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.47
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health SBD |
$128.08
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.15
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cofinity Advantage |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$17.14
|
| Rate for Payer: Cofinity Advantage |
$21.80
|
| Rate for Payer: Cofinity Advantage |
$14.04
|
| Rate for Payer: Cofinity Advantage |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.36
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$21.14
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health SBD |
$15.67
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: Priority Health SBD |
$19.62
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.15
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Medicare |
$10.03
|
| Rate for Payer: Aetna Medicare |
$11.32
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna Medicare |
$15.57
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.04
|
| Rate for Payer: BCBS Complete |
$12.46
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Advantage |
$21.80
|
| Rate for Payer: Cofinity Advantage |
$17.41
|
| Rate for Payer: Cofinity Advantage |
$15.86
|
| Rate for Payer: Cofinity Advantage |
$14.04
|
| Rate for Payer: Cofinity Advantage |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$18.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.65
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: PHP Commercial |
$21.14
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: Priority Health SBD |
$15.67
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
|
|
ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS SYRINGE KIT
|
Facility
|
OP
|
$17,548.83
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
34652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.25 |
| Max. Negotiated Rate |
$15,793.95 |
| Rate for Payer: Aetna Commercial |
$14,916.51
|
| Rate for Payer: Aetna Medicare |
$8,774.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,406.74
|
| Rate for Payer: BCBS Complete |
$7,019.53
|
| Rate for Payer: Cash Price |
$14,039.06
|
| Rate for Payer: Cash Price |
$14,039.06
|
| Rate for Payer: Cofinity Advantage |
$12,284.18
|
| Rate for Payer: Cofinity Commercial |
$15,091.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,039.06
|
| Rate for Payer: Healthscope Commercial |
$15,793.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,039.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,916.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,161.62
|
| Rate for Payer: PHP Commercial |
$14,916.51
|
| Rate for Payer: Priority Health SBD |
$11,055.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.25
|
| Rate for Payer: UHC Core |
$269.25
|
| Rate for Payer: UHC Exchange |
$269.25
|
|
|
ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS SYRINGE KIT
|
Facility
|
IP
|
$17,548.83
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
34652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,055.76 |
| Max. Negotiated Rate |
$15,793.95 |
| Rate for Payer: Aetna Commercial |
$14,916.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,406.74
|
| Rate for Payer: Cash Price |
$14,039.06
|
| Rate for Payer: Cofinity Advantage |
$12,284.18
|
| Rate for Payer: Cofinity Commercial |
$15,091.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,039.06
|
| Rate for Payer: Healthscope Commercial |
$15,793.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,916.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,161.62
|
| Rate for Payer: PHP Commercial |
$14,916.51
|
| Rate for Payer: Priority Health SBD |
$11,055.76
|
|
|
ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,043.99
|
| Rate for Payer: BCN Commercial |
$2,043.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,672.05 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.05
|
| Rate for Payer: BCN Commercial |
$1,672.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
ADENOIDECTOMY, SECONDARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42835
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,256.18 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.18
|
| Rate for Payer: BCN Commercial |
$1,256.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Medicare |
$12.63
|
| Rate for Payer: Aetna Medicare |
$12.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS Complete |
$9.90
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Advantage |
$17.32
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$21.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.95
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.03
|
| Rate for Payer: Priority Health SBD |
$15.59
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.74
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$22.27 |
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Advantage |
$17.32
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.95
|
| Rate for Payer: PHP Commercial |
$21.03
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health SBD |
$15.59
|
| Rate for Payer: Priority Health SBD |
$15.91
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$39.13
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
39477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Advantage |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$35.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.35
|
| Rate for Payer: PHP Commercial |
$33.26
|
| Rate for Payer: Priority Health SBD |
$24.65
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.13
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
39477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$19.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: BCBS Complete |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Advantage |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$35.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.35
|
| Rate for Payer: PHP Commercial |
$33.26
|
| Rate for Payer: Priority Health SBD |
$24.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.95
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.95
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health SBD |
$15.91
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 14001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,050.16 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.16
|
| Rate for Payer: BCN Commercial |
$1,050.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
