|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.46
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$16.61 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health SBD |
$77.60
|
| Rate for Payer: Priority Health SBD |
$11.63
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.46
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$16.61 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$104.70
|
| Rate for Payer: Aetna Medicare |
$61.59
|
| Rate for Payer: Aetna Medicare |
$9.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.07
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Complete |
$49.27
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$98.54
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$105.93
|
| Rate for Payer: Cofinity Commercial |
$86.23
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$110.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.70
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$104.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health SBD |
$77.60
|
| Rate for Payer: Priority Health SBD |
$11.63
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health SBD |
$11.65
|
|
|
ATROPINE 0.4 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Medicare |
$9.23
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health SBD |
$11.63
|
| Rate for Payer: Priority Health SBD |
$11.65
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$291.33
|
|
|
Service Code
|
NDC 17478021515
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.53 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$247.63
|
| Rate for Payer: Aetna Medicare |
$145.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.36
|
| Rate for Payer: BCBS Complete |
$116.53
|
| Rate for Payer: Cash Price |
$233.06
|
| Rate for Payer: Cofinity Commercial |
$203.93
|
| Rate for Payer: Cofinity Commercial |
$250.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.06
|
| Rate for Payer: Healthscope Commercial |
$262.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.63
|
| Rate for Payer: PHP Commercial |
$247.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.36
|
| Rate for Payer: Priority Health SBD |
$183.54
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$187.36
|
|
|
Service Code
|
NDC 00065081701
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$168.62 |
| Rate for Payer: Aetna Commercial |
$159.26
|
| Rate for Payer: Aetna Medicare |
$93.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.78
|
| Rate for Payer: BCBS Complete |
$74.94
|
| Rate for Payer: Cash Price |
$149.89
|
| Rate for Payer: Cofinity Commercial |
$131.15
|
| Rate for Payer: Cofinity Commercial |
$161.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.89
|
| Rate for Payer: Healthscope Commercial |
$168.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.26
|
| Rate for Payer: PHP Commercial |
$159.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.78
|
| Rate for Payer: Priority Health SBD |
$118.04
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health SBD |
$76.91
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$161.25
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Aetna Medicare |
$80.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.81
|
| Rate for Payer: BCBS Complete |
$64.50
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.06
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.81
|
| Rate for Payer: Priority Health SBD |
$101.59
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$161.25
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$145.12 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.81
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cofinity Commercial |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.00
|
| Rate for Payer: Healthscope Commercial |
$145.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.06
|
| Rate for Payer: PHP Commercial |
$137.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.81
|
| Rate for Payer: Priority Health SBD |
$101.59
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna Medicare |
$61.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: BCBS Complete |
$48.83
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health SBD |
$76.91
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$187.36
|
|
|
Service Code
|
NDC 00065081701
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.04 |
| Max. Negotiated Rate |
$168.62 |
| Rate for Payer: Aetna Commercial |
$159.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.78
|
| Rate for Payer: Cash Price |
$149.89
|
| Rate for Payer: Cofinity Commercial |
$131.15
|
| Rate for Payer: Cofinity Commercial |
$161.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.89
|
| Rate for Payer: Healthscope Commercial |
$168.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.26
|
| Rate for Payer: PHP Commercial |
$159.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.78
|
| Rate for Payer: Priority Health SBD |
$118.04
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$153.23
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$137.91 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.60
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.26
|
| Rate for Payer: Cofinity Commercial |
$131.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.25
|
| Rate for Payer: PHP Commercial |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.60
|
| Rate for Payer: Priority Health SBD |
$96.53
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
OP
|
$153.23
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.29 |
| Max. Negotiated Rate |
$137.91 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna Medicare |
$76.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.60
|
| Rate for Payer: BCBS Complete |
$61.29
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.26
|
| Rate for Payer: Cofinity Commercial |
$131.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.25
|
| Rate for Payer: PHP Commercial |
$130.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.60
|
| Rate for Payer: Priority Health SBD |
$96.53
|
|
|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$291.33
|
|
|
Service Code
|
NDC 17478021515
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$247.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.36
|
| Rate for Payer: Cash Price |
$233.06
|
| Rate for Payer: Cofinity Commercial |
$203.93
|
| Rate for Payer: Cofinity Commercial |
$250.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.06
|
| Rate for Payer: Healthscope Commercial |
$262.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.63
|
| Rate for Payer: PHP Commercial |
$247.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.36
|
| Rate for Payer: Priority Health SBD |
$183.54
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$30.35
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: Aetna Commercial |
$25.80
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.73
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: BCBS Complete |
$12.14
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$21.25
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.10
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$27.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: Priority Health SBD |
$19.12
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health SBD |
$19.08
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$49.25
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.03 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Aetna Commercial |
$41.86
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.01
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Cofinity Commercial |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.40
|
| Rate for Payer: Healthscope Commercial |
$44.33
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.86
|
| Rate for Payer: PHP Commercial |
$41.86
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.01
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: Priority Health SBD |
$31.03
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$49.25
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Aetna Commercial |
$41.86
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Aetna Medicare |
$24.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: BCBS Complete |
$19.70
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Commercial |
$34.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.40
|
| Rate for Payer: Healthscope Commercial |
$44.33
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$41.86
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.01
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: Priority Health SBD |
$31.03
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
AXILLARY LYMPHADENECTOMY; COMPLETE
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 38745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,203.54
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
OP
|
$327.39
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.96 |
| Max. Negotiated Rate |
$294.65 |
| Rate for Payer: Aetna Commercial |
$278.28
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$243.69
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$595.27
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Medicare |
$163.69
|
| Rate for Payer: Aetna Medicare |
$1,313.87
|
| Rate for Payer: Aetna Medicare |
$143.35
|
| Rate for Payer: Aetna Medicare |
$350.16
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.21
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$280.13
|
| Rate for Payer: BCBS Complete |
$130.96
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$560.26
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$602.28
|
| Rate for Payer: Cofinity Commercial |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Cofinity Commercial |
$281.56
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.26
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$630.29
|
| Rate for Payer: Healthscope Commercial |
$294.65
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$595.27
|
| Rate for Payer: PHP Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$243.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.21
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$206.26
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$441.20
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$267.38
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.45 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$700.32
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$280.13 |
| Max. Negotiated Rate |
$630.29 |
| Rate for Payer: Aetna Commercial |
$595.27
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$243.69
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$278.28
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Medicare |
$163.69
|
| Rate for Payer: Aetna Medicare |
$350.16
|
| Rate for Payer: Aetna Medicare |
$1,313.87
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$143.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.21
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$130.96
|
| Rate for Payer: BCBS Complete |
$280.13
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$560.26
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$602.28
|
| Rate for Payer: Cofinity Commercial |
$490.22
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$281.56
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Healthscope Commercial |
$294.65
|
| Rate for Payer: Healthscope Commercial |
$630.29
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$243.69
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$595.27
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$206.26
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$441.20
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$250.77 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Commercial |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$228.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$239.33
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.03
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health SBD |
$167.53
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$258.55
|
|
