|
DESVENLAFAXINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$344.33
|
|
|
Service Code
|
NDC 63304-191-30
|
| Hospital Charge Code |
166026
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.01 |
| Max. Negotiated Rate |
$309.90 |
| Rate for Payer: Aetna Commercial |
$292.68
|
| Rate for Payer: BCBS Trust/PPO |
$266.10
|
| Rate for Payer: BCN Commercial |
$266.10
|
| Rate for Payer: Cash Price |
$275.46
|
| Rate for Payer: Cofinity Commercial |
$296.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.46
|
| Rate for Payer: Healthscope Commercial |
$309.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.68
|
| Rate for Payer: PHP Commercial |
$292.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.01
|
| Rate for Payer: UHC Core |
$287.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.25
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 60687-607-11
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: BCBS Trust/PPO |
$7.25
|
| Rate for Payer: BCN Commercial |
$7.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.97
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.04
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,507.05
|
|
|
Service Code
|
NDC 0008-1211-30
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$919.15 |
| Max. Negotiated Rate |
$1,356.34 |
| Rate for Payer: Aetna Commercial |
$1,280.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.65
|
| Rate for Payer: BCN Commercial |
$1,164.65
|
| Rate for Payer: Cash Price |
$1,205.64
|
| Rate for Payer: Cofinity Commercial |
$1,296.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,205.64
|
| Rate for Payer: Healthscope Commercial |
$1,356.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,130.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,280.99
|
| Rate for Payer: PHP Commercial |
$1,280.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$919.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,326.20
|
| Rate for Payer: UHC Core |
$1,258.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,130.29
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$281.24
|
|
|
Service Code
|
NDC 60687-607-21
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.53 |
| Max. Negotiated Rate |
$253.12 |
| Rate for Payer: Aetna Commercial |
$239.05
|
| Rate for Payer: BCBS Trust/PPO |
$217.34
|
| Rate for Payer: BCN Commercial |
$217.34
|
| Rate for Payer: Cash Price |
$224.99
|
| Rate for Payer: Cofinity Commercial |
$241.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.99
|
| Rate for Payer: Healthscope Commercial |
$253.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.05
|
| Rate for Payer: PHP Commercial |
$239.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.49
|
| Rate for Payer: UHC Core |
$234.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.93
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$86.12
|
|
|
Service Code
|
NDC 70436-012-04
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$77.51 |
| Rate for Payer: Aetna Commercial |
$73.20
|
| Rate for Payer: BCBS Trust/PPO |
$66.55
|
| Rate for Payer: BCN Commercial |
$66.55
|
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Cofinity Commercial |
$74.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.90
|
| Rate for Payer: Healthscope Commercial |
$77.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.20
|
| Rate for Payer: PHP Commercial |
$73.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.79
|
| Rate for Payer: UHC Core |
$71.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.59
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 9900-0001-70
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.89
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.29
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
NDC 70069-021-25
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: BCBS Trust/PPO |
$7.03
|
| Rate for Payer: BCN Commercial |
$7.03
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.01
|
| Rate for Payer: UHC Core |
$7.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.82
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$447.84
|
|
|
Service Code
|
NDC 0054-8175-25
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.14 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: BCBS Trust/PPO |
$346.09
|
| Rate for Payer: BCN Commercial |
$346.09
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.66
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.10
|
| Rate for Payer: UHC Core |
$373.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.88
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
NDC 0054-4186-25
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$373.26 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: BCBS Trust/PPO |
$472.95
|
| Rate for Payer: BCN Commercial |
$472.95
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$520.20
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$532.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$373.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.56
|
| Rate for Payer: UHC Core |
$511.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.00
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$705.12
|
|
|
Service Code
|
NDC 0054-8183-25
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$430.05 |
| Max. Negotiated Rate |
$634.61 |
| Rate for Payer: Aetna Commercial |
$599.35
|
| Rate for Payer: BCBS Trust/PPO |
$544.92
|
| Rate for Payer: BCN Commercial |
$544.92
|
| Rate for Payer: Cash Price |
$564.10
|
| Rate for Payer: Cofinity Commercial |
$606.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.10
|
| Rate for Payer: Healthscope Commercial |
$634.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.35
|
| Rate for Payer: PHP Commercial |
$599.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$430.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.51
|
| Rate for Payer: UHC Core |
$588.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$64.08
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.08 |
| Max. Negotiated Rate |
$57.67 |
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$8.48
|
| Rate for Payer: BCBS Trust/PPO |
$49.52
|
| Rate for Payer: BCBS Trust/PPO |
$14.34
|
| Rate for Payer: BCN Commercial |
$49.52
|
| Rate for Payer: BCN Commercial |
$14.34
|
| Rate for Payer: BCN Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.32
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.33
|
| Rate for Payer: UHC Core |
$15.50
|
| Rate for Payer: UHC Core |
$9.16
|
| Rate for Payer: UHC Core |
$53.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
IP
|
$11.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$8.83
|
| Rate for Payer: BCN Commercial |
$8.83
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.06
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.57
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$11.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: BCBS Trust/PPO |
$353.65
|
| Rate for Payer: BCBS Trust/PPO |
$8.83
|
| Rate for Payer: BCBS Trust/PPO |
$9.08
|
| Rate for Payer: BCBS Trust/PPO |
$15.27
|
| Rate for Payer: BCN Commercial |
$353.65
|
| Rate for Payer: BCN Commercial |
$15.27
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: BCN Commercial |
$8.83
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.98
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$398.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.34
|
| Rate for Payer: UHC Core |
$9.54
|
| Rate for Payer: UHC Core |
$9.81
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Core |
$382.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.22
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$27.47
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$24.72 |
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$15.32
|
| Rate for Payer: BCN Commercial |
$21.23
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$23.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.45
|
| Rate for Payer: UHC Core |
$16.56
|
| Rate for Payer: UHC Core |
$22.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.60
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.55
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: BCBS Trust/PPO |
$18.20
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$15.32
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: BCN Commercial |
$15.32
|
| Rate for Payer: BCN Commercial |
$21.23
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$23.62
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.45
|
| Rate for Payer: UHC Core |
$19.66
|
| Rate for Payer: UHC Core |
$16.56
|
| Rate for Payer: UHC Core |
$22.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.97
|
|
|
Service Code
|
NDC 66794-233-02
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$72.87 |
| Rate for Payer: Aetna Commercial |
$68.82
|
| Rate for Payer: BCBS Trust/PPO |
$62.57
|
| Rate for Payer: BCN Commercial |
$62.57
|
| Rate for Payer: Cash Price |
$64.78
|
| Rate for Payer: Cofinity Commercial |
$69.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.78
|
| Rate for Payer: Healthscope Commercial |
$72.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.82
|
| Rate for Payer: PHP Commercial |
$68.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.25
|
| Rate for Payer: UHC Core |
$67.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.73
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.97
|
|
|
Service Code
|
NDC 66794-230-42
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$72.87 |
| Rate for Payer: Aetna Commercial |
$68.82
|
| Rate for Payer: BCBS Trust/PPO |
$62.57
|
| Rate for Payer: BCN Commercial |
$62.57
|
| Rate for Payer: Cash Price |
$64.78
|
| Rate for Payer: Cofinity Commercial |
$69.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.78
|
| Rate for Payer: Healthscope Commercial |
$72.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.82
|
| Rate for Payer: PHP Commercial |
$68.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.25
|
| Rate for Payer: UHC Core |
$67.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.73
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.97
|
|
|
Service Code
|
NDC 66794-230-02
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$72.87 |
| Rate for Payer: Aetna Commercial |
$68.82
|
| Rate for Payer: BCBS Trust/PPO |
$62.57
|
| Rate for Payer: BCN Commercial |
$62.57
|
| Rate for Payer: Cash Price |
$64.78
|
| Rate for Payer: Cofinity Commercial |
$69.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.78
|
| Rate for Payer: Healthscope Commercial |
$72.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.82
|
| Rate for Payer: PHP Commercial |
$68.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.25
|
| Rate for Payer: UHC Core |
$67.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.73
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.57
|
|
|
Service Code
|
NDC 71288-505-02
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.01 |
| Max. Negotiated Rate |
$42.81 |
| Rate for Payer: Aetna Commercial |
$40.43
|
| Rate for Payer: BCBS Trust/PPO |
$36.76
|
| Rate for Payer: BCN Commercial |
$36.76
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cofinity Commercial |
$40.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.06
|
| Rate for Payer: Healthscope Commercial |
$42.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.43
|
| Rate for Payer: PHP Commercial |
$40.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.86
|
| Rate for Payer: UHC Core |
$39.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.68
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.97
|
|
|
Service Code
|
NDC 66794-233-42
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$72.87 |
| Rate for Payer: Aetna Commercial |
$68.82
|
| Rate for Payer: BCBS Trust/PPO |
$62.57
|
| Rate for Payer: BCN Commercial |
$62.57
|
| Rate for Payer: Cash Price |
$64.78
|
| Rate for Payer: Cofinity Commercial |
$69.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.78
|
| Rate for Payer: Healthscope Commercial |
$72.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.82
|
| Rate for Payer: PHP Commercial |
$68.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.25
|
| Rate for Payer: UHC Core |
$67.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.73
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.57
|
|
|
Service Code
|
NDC 71288-505-03
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.01 |
| Max. Negotiated Rate |
$42.81 |
| Rate for Payer: Aetna Commercial |
$40.43
|
| Rate for Payer: BCBS Trust/PPO |
$36.76
|
| Rate for Payer: BCN Commercial |
$36.76
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cofinity Commercial |
$40.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.06
|
| Rate for Payer: Healthscope Commercial |
$42.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.43
|
| Rate for Payer: PHP Commercial |
$40.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.86
|
| Rate for Payer: UHC Core |
$39.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.68
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$141.71
|
|
|
Service Code
|
NDC 70121-1389-7
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.43 |
| Max. Negotiated Rate |
$127.54 |
| Rate for Payer: Aetna Commercial |
$120.45
|
| Rate for Payer: BCBS Trust/PPO |
$109.51
|
| Rate for Payer: BCN Commercial |
$109.51
|
| Rate for Payer: Cash Price |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$121.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.37
|
| Rate for Payer: Healthscope Commercial |
$127.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.45
|
| Rate for Payer: PHP Commercial |
$120.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.70
|
| Rate for Payer: UHC Core |
$118.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.28
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$141.71
|
|
|
Service Code
|
NDC 70121-1389-1
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.43 |
| Max. Negotiated Rate |
$127.54 |
| Rate for Payer: Aetna Commercial |
$120.45
|
| Rate for Payer: BCBS Trust/PPO |
$109.51
|
| Rate for Payer: BCN Commercial |
$109.51
|
| Rate for Payer: Cash Price |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$121.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.37
|
| Rate for Payer: Healthscope Commercial |
$127.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.45
|
| Rate for Payer: PHP Commercial |
$120.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.70
|
| Rate for Payer: UHC Core |
$118.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.28
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 0409-1660-22
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.74 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$70.63
|
| Rate for Payer: BCN Commercial |
$70.63
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.68
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 0409-3301-10
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.74 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$70.63
|
| Rate for Payer: BCN Commercial |
$70.63
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.68
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
