|
LEVOTHYROXINE 88 MCG TABLET
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 42292003801
|
| Hospital Charge Code |
10403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.17
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: BCN Medicare Advantage |
$1.17
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.17
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Mclaren Medicaid |
$0.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.22
|
| Rate for Payer: Meridian Medicaid |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PACE Senior Care Partners |
$1.11
|
| Rate for Payer: PACE SWMI |
$1.17
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Medicare |
$1.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.10
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: UHC Exchange |
$1.17
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$1.17
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: VA VA |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
LEVOTHYROXINE 88 MCG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 42292003820
|
| Hospital Charge Code |
10403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.07 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$121.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.47
|
| Rate for Payer: BCBS Complete |
$86.16
|
| Rate for Payer: BCBS MAPPO |
$116.38
|
| Rate for Payer: BCBS Trust/PPO |
$382.69
|
| Rate for Payer: BCN Commercial |
$382.69
|
| Rate for Payer: BCN Medicare Advantage |
$116.38
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.38
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Mclaren Medicaid |
$82.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.19
|
| Rate for Payer: Meridian Medicaid |
$86.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Nomi Health Commercial |
$381.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PACE Senior Care Partners |
$110.56
|
| Rate for Payer: PACE SWMI |
$116.38
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: PHP Medicare Advantage |
$116.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$404.99
|
| Rate for Payer: Priority Health Medicare |
$117.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.99
|
| Rate for Payer: Railroad Medicare Medicare |
$116.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.64
|
| Rate for Payer: UHC Core |
$388.69
|
| Rate for Payer: UHC Exchange |
$116.38
|
| Rate for Payer: UHC Medicaid |
$82.07
|
| Rate for Payer: UHC Medicare Advantage |
$116.38
|
| Rate for Payer: UHCCP Medicaid |
$82.07
|
| Rate for Payer: VA VA |
$116.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
LEVOTHYROXINE 88 MCG TABLET
|
Facility
|
OP
|
$447.45
|
|
|
Service Code
|
NDC 60687048601
|
| Hospital Charge Code |
10403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$402.70 |
| Rate for Payer: Aetna Commercial |
$380.33
|
| Rate for Payer: Aetna Medicare |
$116.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.83
|
| Rate for Payer: BCBS Complete |
$82.82
|
| Rate for Payer: BCBS MAPPO |
$111.86
|
| Rate for Payer: BCBS Trust/PPO |
$367.85
|
| Rate for Payer: BCN Commercial |
$367.85
|
| Rate for Payer: BCN Medicare Advantage |
$111.86
|
| Rate for Payer: Cash Price |
$357.96
|
| Rate for Payer: Cofinity Commercial |
$384.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.86
|
| Rate for Payer: Healthscope Commercial |
$402.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.59
|
| Rate for Payer: Mclaren Medicaid |
$78.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.46
|
| Rate for Payer: Meridian Medicaid |
$82.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.33
|
| Rate for Payer: Nomi Health Commercial |
$366.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.59
|
| Rate for Payer: PACE Senior Care Partners |
$106.27
|
| Rate for Payer: PACE SWMI |
$111.86
|
| Rate for Payer: PHP Commercial |
$380.33
|
| Rate for Payer: PHP Medicare Advantage |
$111.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.28
|
| Rate for Payer: Priority Health Medicare |
$112.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.43
|
| Rate for Payer: Railroad Medicare Medicare |
$111.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.76
|
| Rate for Payer: UHC Core |
$373.62
|
| Rate for Payer: UHC Exchange |
$111.86
|
| Rate for Payer: UHC Medicaid |
$78.89
|
| Rate for Payer: UHC Medicare Advantage |
$111.86
|
| Rate for Payer: UHCCP Medicaid |
$78.89
|
| Rate for Payer: VA VA |
$111.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.59
|
|
|
LEVOTHYROXINE 88 MCG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 42292003820
|
| Hospital Charge Code |
10403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.99 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: BCBS Trust/PPO |
$384.46
|
| Rate for Payer: BCN Commercial |
$384.46
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Nomi Health Commercial |
$381.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$404.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.64
|
| Rate for Payer: UHC Core |
$388.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
LEVOTHYROXINE 88 MCG TABLET
|
Facility
|
OP
|
$406.60
|
|
|
Service Code
|
NDC 00904695261
|
| Hospital Charge Code |
10403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$365.94 |
| Rate for Payer: Aetna Commercial |
$345.61
|
| Rate for Payer: Aetna Medicare |
$105.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.06
|
| Rate for Payer: BCBS Complete |
$75.26
|
| Rate for Payer: BCBS MAPPO |
$101.65
|
| Rate for Payer: BCBS Trust/PPO |
$334.27
|
| Rate for Payer: BCN Commercial |
$334.27
|
| Rate for Payer: BCN Medicare Advantage |
$101.65
|
| Rate for Payer: Cash Price |
$325.28
|
| Rate for Payer: Cofinity Commercial |
$349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.65
|
| Rate for Payer: Healthscope Commercial |
$365.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.95
|
| Rate for Payer: Mclaren Medicaid |
$71.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.73
|
| Rate for Payer: Meridian Medicaid |
$75.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.61
|
| Rate for Payer: Nomi Health Commercial |
$333.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.95
|
| Rate for Payer: PACE Senior Care Partners |
$96.57
|
| Rate for Payer: PACE SWMI |
$101.65
|
| Rate for Payer: PHP Commercial |
$345.61
|
| Rate for Payer: PHP Medicare Advantage |
$101.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.74
|
| Rate for Payer: Priority Health Medicare |
$102.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.99
|
| Rate for Payer: Railroad Medicare Medicare |
$101.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.81
|
| Rate for Payer: UHC Core |
$339.51
|
| Rate for Payer: UHC Exchange |
$101.65
|
| Rate for Payer: UHC Medicaid |
$71.68
|
| Rate for Payer: UHC Medicare Advantage |
$101.65
|
| Rate for Payer: UHCCP Medicaid |
$71.68
|
| Rate for Payer: VA VA |
$101.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.95
|
|
|
LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
IP
|
$17.40
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$15.04
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: BCBS Trust/PPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$14.61
|
| Rate for Payer: BCN Commercial |
$14.37
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$17.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Nomi Health Commercial |
$14.27
|
| Rate for Payer: Nomi Health Commercial |
$14.51
|
| Rate for Payer: Nomi Health Commercial |
$15.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.42
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.31
|
| Rate for Payer: UHC Core |
$14.53
|
| Rate for Payer: UHC Core |
$16.06
|
| Rate for Payer: UHC Core |
$14.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.27
|
|
|
LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
OP
|
$17.40
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$15.04
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.01
|
| Rate for Payer: BCBS Complete |
$3.27
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS MAPPO |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$4.42
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCBS Trust/PPO |
$14.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.81
|
| Rate for Payer: BCN Commercial |
$14.54
|
| Rate for Payer: BCN Commercial |
$15.81
|
| Rate for Payer: BCN Commercial |
$14.30
|
| Rate for Payer: BCN Medicare Advantage |
$4.81
|
| Rate for Payer: BCN Medicare Advantage |
$4.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.35
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.35
|
| Rate for Payer: Healthscope Commercial |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$17.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.27
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicaid |
$3.39
|
| Rate for Payer: Mclaren Medicaid |
$3.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.05
|
| Rate for Payer: Meridian Medicaid |
$3.56
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Nomi Health Commercial |
$15.77
|
| Rate for Payer: Nomi Health Commercial |
$14.51
|
| Rate for Payer: Nomi Health Commercial |
$14.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.05
|
| Rate for Payer: PACE Senior Care Partners |
$4.20
|
| Rate for Payer: PACE Senior Care Partners |
$4.13
|
| Rate for Payer: PACE Senior Care Partners |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PACE SWMI |
$4.42
|
| Rate for Payer: PACE SWMI |
$4.35
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$15.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.35
|
| Rate for Payer: PHP Medicare Advantage |
$4.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.73
|
| Rate for Payer: Priority Health Medicare |
$4.86
|
| Rate for Payer: Priority Health Medicare |
$4.47
|
| Rate for Payer: Priority Health Medicare |
$4.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.31
|
| Rate for Payer: UHC Core |
$14.53
|
| Rate for Payer: UHC Core |
$16.06
|
| Rate for Payer: UHC Core |
$14.77
|
| Rate for Payer: UHC Exchange |
$4.81
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.35
|
| Rate for Payer: UHC Medicaid |
$3.07
|
| Rate for Payer: UHC Medicaid |
$3.39
|
| Rate for Payer: UHC Medicaid |
$3.12
|
| Rate for Payer: UHC Medicare Advantage |
$4.42
|
| Rate for Payer: UHC Medicare Advantage |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.81
|
| Rate for Payer: UHCCP Medicaid |
$3.12
|
| Rate for Payer: UHCCP Medicaid |
$3.07
|
| Rate for Payer: UHCCP Medicaid |
$3.39
|
| Rate for Payer: VA VA |
$4.35
|
| Rate for Payer: VA VA |
$4.81
|
| Rate for Payer: VA VA |
$4.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.42
|
|
|
LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
IP
|
$19.50
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Commercial |
$16.57
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: BCBS Trust/PPO |
$16.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$16.11
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.60
|
| Rate for Payer: Healthscope Commercial |
$17.55
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Nomi Health Commercial |
$15.99
|
| Rate for Payer: Nomi Health Commercial |
$18.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.96
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: PHP Commercial |
$16.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.91
|
| Rate for Payer: UHC Core |
$16.28
|
| Rate for Payer: UHC Core |
$18.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
|
|
LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
OP
|
$19.50
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Commercial |
$16.57
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Aetna Medicare |
$5.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.07
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS Complete |
$4.19
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS MAPPO |
$5.66
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCBS Trust/PPO |
$18.60
|
| Rate for Payer: BCN Commercial |
$18.60
|
| Rate for Payer: BCN Commercial |
$16.03
|
| Rate for Payer: BCN Medicare Advantage |
$5.66
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$17.55
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Mclaren Medicaid |
$3.99
|
| Rate for Payer: Mclaren Medicaid |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$3.61
|
| Rate for Payer: Meridian Medicaid |
$4.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.57
|
| Rate for Payer: Nomi Health Commercial |
$18.55
|
| Rate for Payer: Nomi Health Commercial |
$15.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.96
|
| Rate for Payer: PACE Senior Care Partners |
$5.37
|
| Rate for Payer: PACE Senior Care Partners |
$4.63
|
| Rate for Payer: PACE SWMI |
$5.66
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$16.57
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: PHP Medicare Advantage |
$5.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.96
|
| Rate for Payer: Priority Health Medicare |
$5.71
|
| Rate for Payer: Priority Health Medicare |
$4.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.91
|
| Rate for Payer: UHC Core |
$18.89
|
| Rate for Payer: UHC Core |
$16.28
|
| Rate for Payer: UHC Exchange |
$5.66
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicaid |
$3.99
|
| Rate for Payer: UHC Medicaid |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.66
|
| Rate for Payer: UHCCP Medicaid |
$3.44
|
| Rate for Payer: UHCCP Medicaid |
$3.99
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: VA VA |
$5.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.62
|
|
|
LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
118255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$5.83
|
| Rate for Payer: BCN Commercial |
$5.83
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cofinity Commercial |
$6.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$6.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.21
|
| Rate for Payer: UHC Core |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
118255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.21
|
| Rate for Payer: BCBS Complete |
$1.31
|
| Rate for Payer: BCBS MAPPO |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.80
|
| Rate for Payer: BCN Medicare Advantage |
$1.76
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cofinity Commercial |
$6.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$6.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Mclaren Medicaid |
$1.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.85
|
| Rate for Payer: Meridian Medicaid |
$1.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Nomi Health Commercial |
$5.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PACE Senior Care Partners |
$1.68
|
| Rate for Payer: PACE SWMI |
$1.76
|
| Rate for Payer: PHP Commercial |
$6.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.14
|
| Rate for Payer: Priority Health Medicare |
$1.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.21
|
| Rate for Payer: UHC Core |
$5.90
|
| Rate for Payer: UHC Exchange |
$1.76
|
| Rate for Payer: UHC Medicaid |
$1.24
|
| Rate for Payer: UHC Medicare Advantage |
$1.76
|
| Rate for Payer: UHCCP Medicaid |
$1.24
|
| Rate for Payer: VA VA |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
OP
|
$15.21
|
|
|
Service Code
|
NDC 25021067376
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Mclaren Medicaid |
$2.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: Meridian Medicaid |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.41
|
| Rate for Payer: PACE Senior Care Partners |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.23
|
| Rate for Payer: Priority Health Medicare |
$3.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.70
|
| Rate for Payer: UHC Exchange |
$3.80
|
| Rate for Payer: UHC Medicaid |
$2.68
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$2.68
|
| Rate for Payer: VA VA |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
OP
|
$39.55
|
|
|
Service Code
|
NDC 76329301505
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.62
|
| Rate for Payer: Aetna Medicare |
$10.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.36
|
| Rate for Payer: BCBS Complete |
$7.32
|
| Rate for Payer: BCBS MAPPO |
$9.89
|
| Rate for Payer: BCBS Trust/PPO |
$32.51
|
| Rate for Payer: BCN Commercial |
$32.51
|
| Rate for Payer: BCN Medicare Advantage |
$9.89
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: Cofinity Commercial |
$34.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.89
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Mclaren Medicaid |
$6.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.38
|
| Rate for Payer: Meridian Medicaid |
$7.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.62
|
| Rate for Payer: Nomi Health Commercial |
$32.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.66
|
| Rate for Payer: PACE Senior Care Partners |
$9.39
|
| Rate for Payer: PACE SWMI |
$9.89
|
| Rate for Payer: PHP Commercial |
$33.62
|
| Rate for Payer: PHP Medicare Advantage |
$9.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.41
|
| Rate for Payer: Priority Health Medicare |
$9.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.53
|
| Rate for Payer: Railroad Medicare Medicare |
$9.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.80
|
| Rate for Payer: UHC Core |
$33.02
|
| Rate for Payer: UHC Exchange |
$9.89
|
| Rate for Payer: UHC Medicaid |
$6.97
|
| Rate for Payer: UHC Medicare Advantage |
$9.89
|
| Rate for Payer: UHCCP Medicaid |
$6.97
|
| Rate for Payer: VA VA |
$9.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
IP
|
$26.85
|
|
|
Service Code
|
NDC 76329301205
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: BCBS Trust/PPO |
$22.18
|
| Rate for Payer: BCN Commercial |
$22.18
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.48
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.82
|
| Rate for Payer: Nomi Health Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.14
|
| Rate for Payer: PHP Commercial |
$22.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.63
|
| Rate for Payer: UHC Core |
$22.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.14
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
IP
|
$15.21
|
|
|
Service Code
|
NDC 25021067376
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: BCBS Trust/PPO |
$12.56
|
| Rate for Payer: BCN Commercial |
$12.56
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.41
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
IP
|
$39.55
|
|
|
Service Code
|
NDC 76329301505
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.62
|
| Rate for Payer: BCBS Trust/PPO |
$32.66
|
| Rate for Payer: BCN Commercial |
$32.66
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: Cofinity Commercial |
$34.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.64
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.62
|
| Rate for Payer: Nomi Health Commercial |
$32.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.66
|
| Rate for Payer: PHP Commercial |
$33.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.80
|
| Rate for Payer: UHC Core |
$33.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
OP
|
$26.85
|
|
|
Service Code
|
NDC 76329301205
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.39
|
| Rate for Payer: BCBS Complete |
$4.97
|
| Rate for Payer: BCBS MAPPO |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$22.07
|
| Rate for Payer: BCN Commercial |
$22.07
|
| Rate for Payer: BCN Medicare Advantage |
$6.71
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.71
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.14
|
| Rate for Payer: Mclaren Medicaid |
$4.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.05
|
| Rate for Payer: Meridian Medicaid |
$4.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.82
|
| Rate for Payer: Nomi Health Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.14
|
| Rate for Payer: PACE Senior Care Partners |
$6.38
|
| Rate for Payer: PACE SWMI |
$6.71
|
| Rate for Payer: PHP Commercial |
$22.82
|
| Rate for Payer: PHP Medicare Advantage |
$6.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.36
|
| Rate for Payer: Priority Health Medicare |
$6.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.69
|
| Rate for Payer: Railroad Medicare Medicare |
$6.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.63
|
| Rate for Payer: UHC Core |
$22.42
|
| Rate for Payer: UHC Exchange |
$6.71
|
| Rate for Payer: UHC Medicaid |
$4.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.71
|
| Rate for Payer: UHCCP Medicaid |
$4.73
|
| Rate for Payer: VA VA |
$6.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.14
|
|
|
LIDOCAINE 4 %-EPINEPHRINE 0.18 %-TETRACAINE 0.5 % TOPICAL GEL
|
Facility
|
OP
|
$29.93
|
|
|
Service Code
|
NDC 71266629001
|
| Hospital Charge Code |
196007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$26.94 |
| Rate for Payer: Aetna Commercial |
$25.44
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.35
|
| Rate for Payer: BCBS Complete |
$5.54
|
| Rate for Payer: BCBS MAPPO |
$7.48
|
| Rate for Payer: BCBS Trust/PPO |
$24.61
|
| Rate for Payer: BCN Commercial |
$24.61
|
| Rate for Payer: BCN Medicare Advantage |
$7.48
|
| Rate for Payer: Cash Price |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$25.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$26.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.45
|
| Rate for Payer: Mclaren Medicaid |
$5.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.86
|
| Rate for Payer: Meridian Medicaid |
$5.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.44
|
| Rate for Payer: Nomi Health Commercial |
$24.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.45
|
| Rate for Payer: PACE Senior Care Partners |
$7.11
|
| Rate for Payer: PACE SWMI |
$7.48
|
| Rate for Payer: PHP Commercial |
$25.44
|
| Rate for Payer: PHP Medicare Advantage |
$7.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.04
|
| Rate for Payer: Priority Health Medicare |
$7.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.83
|
| Rate for Payer: Railroad Medicare Medicare |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.34
|
| Rate for Payer: UHC Core |
$24.99
|
| Rate for Payer: UHC Exchange |
$7.48
|
| Rate for Payer: UHC Medicaid |
$5.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.48
|
| Rate for Payer: UHCCP Medicaid |
$5.28
|
| Rate for Payer: VA VA |
$7.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.45
|
|
|
LIDOCAINE 4 %-EPINEPHRINE 0.18 %-TETRACAINE 0.5 % TOPICAL GEL
|
Facility
|
IP
|
$29.93
|
|
|
Service Code
|
NDC 71266629001
|
| Hospital Charge Code |
196007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$26.94 |
| Rate for Payer: Aetna Commercial |
$25.44
|
| Rate for Payer: BCBS Trust/PPO |
$24.72
|
| Rate for Payer: BCN Commercial |
$24.72
|
| Rate for Payer: Cash Price |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$25.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$26.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.44
|
| Rate for Payer: Nomi Health Commercial |
$24.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.45
|
| Rate for Payer: PHP Commercial |
$25.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.34
|
| Rate for Payer: UHC Core |
$24.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.45
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$30.44
|
|
|
Service Code
|
NDC 00536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna Commercial |
$25.87
|
| Rate for Payer: BCBS Trust/PPO |
$25.14
|
| Rate for Payer: BCN Commercial |
$25.14
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Nomi Health Commercial |
$24.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.83
|
| Rate for Payer: PHP Commercial |
$25.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.79
|
| Rate for Payer: UHC Core |
$25.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.83
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
NDC 96295013458
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.04
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$405.12
|
|
|
Service Code
|
NDC 00536120229
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.96 |
| Max. Negotiated Rate |
$364.61 |
| Rate for Payer: Aetna Commercial |
$344.35
|
| Rate for Payer: BCBS Trust/PPO |
$334.59
|
| Rate for Payer: BCN Commercial |
$334.59
|
| Rate for Payer: Cash Price |
$324.10
|
| Rate for Payer: Cofinity Commercial |
$348.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.10
|
| Rate for Payer: Healthscope Commercial |
$364.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.35
|
| Rate for Payer: Nomi Health Commercial |
$332.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.84
|
| Rate for Payer: PHP Commercial |
$344.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.51
|
| Rate for Payer: UHC Core |
$338.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.84
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$3.64
|
|
|
Service Code
|
NDC 00121097001
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.01
|
| Rate for Payer: BCN Commercial |
$3.01
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.73
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.73
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$3.64
|
|
|
Service Code
|
NDC 00121097001
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.14
|
| Rate for Payer: BCBS Complete |
$0.67
|
| Rate for Payer: BCBS MAPPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: BCN Medicare Advantage |
$0.91
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.73
|
| Rate for Payer: Mclaren Medicaid |
$0.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: Meridian Medicaid |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.73
|
| Rate for Payer: PACE Senior Care Partners |
$0.86
|
| Rate for Payer: PACE SWMI |
$0.91
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.17
|
| Rate for Payer: Priority Health Medicare |
$0.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: Railroad Medicare Medicare |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: UHC Exchange |
$0.91
|
| Rate for Payer: UHC Medicaid |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.91
|
| Rate for Payer: UHCCP Medicaid |
$0.64
|
| Rate for Payer: VA VA |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.73
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$30.44
|
|
|
Service Code
|
NDC 00536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna Commercial |
$25.87
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.51
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCBS Trust/PPO |
$25.02
|
| Rate for Payer: BCN Commercial |
$25.02
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.83
|
| Rate for Payer: Mclaren Medicaid |
$5.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Meridian Medicaid |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Nomi Health Commercial |
$24.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.83
|
| Rate for Payer: PACE Senior Care Partners |
$7.23
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Commercial |
$25.87
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.48
|
| Rate for Payer: Priority Health Medicare |
$7.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.79
|
| Rate for Payer: UHC Core |
$25.42
|
| Rate for Payer: UHC Exchange |
$7.61
|
| Rate for Payer: UHC Medicaid |
$5.37
|
| Rate for Payer: UHC Medicare Advantage |
$7.61
|
| Rate for Payer: UHCCP Medicaid |
$5.37
|
| Rate for Payer: VA VA |
$7.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.83
|
|
