|
LOSARTAN 25 MG TABLET
|
Facility
|
OP
|
$308.75
|
|
|
Service Code
|
NDC 00904704761
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$277.88 |
| Rate for Payer: Aetna Commercial |
$262.44
|
| Rate for Payer: Aetna Medicare |
$80.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.48
|
| Rate for Payer: BCBS Complete |
$57.15
|
| Rate for Payer: BCBS MAPPO |
$77.19
|
| Rate for Payer: BCBS Trust/PPO |
$253.82
|
| Rate for Payer: BCN Commercial |
$253.82
|
| Rate for Payer: BCN Medicare Advantage |
$77.19
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cofinity Commercial |
$265.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.19
|
| Rate for Payer: Healthscope Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.56
|
| Rate for Payer: Mclaren Medicaid |
$54.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.05
|
| Rate for Payer: Meridian Medicaid |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.44
|
| Rate for Payer: Nomi Health Commercial |
$253.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.56
|
| Rate for Payer: PACE Senior Care Partners |
$73.33
|
| Rate for Payer: PACE SWMI |
$77.19
|
| Rate for Payer: PHP Commercial |
$262.44
|
| Rate for Payer: PHP Medicare Advantage |
$77.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$268.61
|
| Rate for Payer: Priority Health Medicare |
$77.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.89
|
| Rate for Payer: Railroad Medicare Medicare |
$77.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.70
|
| Rate for Payer: UHC Core |
$257.81
|
| Rate for Payer: UHC Exchange |
$77.19
|
| Rate for Payer: UHC Medicaid |
$54.43
|
| Rate for Payer: UHC Medicare Advantage |
$77.19
|
| Rate for Payer: UHCCP Medicaid |
$54.43
|
| Rate for Payer: VA VA |
$77.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.56
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
NDC 68084034611
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| Rate for Payer: BCN Commercial |
$2.82
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.90
|
| Rate for Payer: Nomi Health Commercial |
$2.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
LOSARTAN 25 MG TABLET
|
Facility
|
IP
|
$340.10
|
|
|
Service Code
|
NDC 68084034601
|
| Hospital Charge Code |
14823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.71 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: BCBS Trust/PPO |
$280.89
|
| Rate for Payer: BCN Commercial |
$280.89
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: Nomi Health Commercial |
$278.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.29
|
| Rate for Payer: UHC Core |
$283.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.07
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$235.60
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Aetna Medicare |
$61.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.62
|
| Rate for Payer: BCBS Complete |
$43.61
|
| Rate for Payer: BCBS MAPPO |
$58.90
|
| Rate for Payer: BCBS Trust/PPO |
$193.69
|
| Rate for Payer: BCN Commercial |
$193.69
|
| Rate for Payer: BCN Medicare Advantage |
$58.90
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.90
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.70
|
| Rate for Payer: Mclaren Medicaid |
$41.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.84
|
| Rate for Payer: Meridian Medicaid |
$43.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Nomi Health Commercial |
$193.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PACE Senior Care Partners |
$55.95
|
| Rate for Payer: PACE SWMI |
$58.90
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: PHP Medicare Advantage |
$58.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.97
|
| Rate for Payer: Priority Health Medicare |
$59.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.98
|
| Rate for Payer: Railroad Medicare Medicare |
$58.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.33
|
| Rate for Payer: UHC Core |
$196.73
|
| Rate for Payer: UHC Exchange |
$58.90
|
| Rate for Payer: UHC Medicaid |
$41.54
|
| Rate for Payer: UHC Medicare Advantage |
$58.90
|
| Rate for Payer: UHCCP Medicaid |
$41.54
|
| Rate for Payer: VA VA |
$58.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.70
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$235.60
|
|
|
Service Code
|
NDC 00904704861
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.98 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: BCBS Trust/PPO |
$194.58
|
| Rate for Payer: BCN Commercial |
$194.58
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Nomi Health Commercial |
$193.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.33
|
| Rate for Payer: UHC Core |
$196.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.70
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.51 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: BCBS Trust/PPO |
$214.20
|
| Rate for Payer: BCN Commercial |
$214.20
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Nomi Health Commercial |
$212.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.23
|
| Rate for Payer: UHC Core |
$216.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
LOSARTAN 50 MG TABLET
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 68084034711
|
| Hospital Charge Code |
14824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna Medicare |
$67.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.05
|
| Rate for Payer: BCBS Complete |
$48.01
|
| Rate for Payer: BCBS MAPPO |
$64.84
|
| Rate for Payer: BCBS Trust/PPO |
$213.21
|
| Rate for Payer: BCN Commercial |
$213.21
|
| Rate for Payer: BCN Medicare Advantage |
$64.84
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.84
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Mclaren Medicaid |
$45.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.08
|
| Rate for Payer: Meridian Medicaid |
$48.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: Nomi Health Commercial |
$212.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.51
|
| Rate for Payer: PACE Senior Care Partners |
$61.60
|
| Rate for Payer: PACE SWMI |
$64.84
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: PHP Medicare Advantage |
$64.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.63
|
| Rate for Payer: Priority Health Medicare |
$65.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.51
|
| Rate for Payer: Railroad Medicare Medicare |
$64.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.23
|
| Rate for Payer: UHC Core |
$216.56
|
| Rate for Payer: UHC Exchange |
$64.84
|
| Rate for Payer: UHC Medicaid |
$45.72
|
| Rate for Payer: UHC Medicare Advantage |
$64.84
|
| Rate for Payer: UHCCP Medicaid |
$45.72
|
| Rate for Payer: VA VA |
$64.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
LOVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$74.73
|
|
|
Service Code
|
NDC 68180046707
|
| Hospital Charge Code |
10469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$67.26 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Aetna Medicare |
$19.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.35
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: BCBS MAPPO |
$18.68
|
| Rate for Payer: BCBS Trust/PPO |
$61.44
|
| Rate for Payer: BCN Commercial |
$61.44
|
| Rate for Payer: BCN Medicare Advantage |
$18.68
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$64.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$67.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.05
|
| Rate for Payer: Mclaren Medicaid |
$13.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.62
|
| Rate for Payer: Meridian Medicaid |
$13.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.05
|
| Rate for Payer: PACE Senior Care Partners |
$17.75
|
| Rate for Payer: PACE SWMI |
$18.68
|
| Rate for Payer: PHP Commercial |
$63.52
|
| Rate for Payer: PHP Medicare Advantage |
$18.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.02
|
| Rate for Payer: Priority Health Medicare |
$18.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.01
|
| Rate for Payer: Railroad Medicare Medicare |
$18.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.76
|
| Rate for Payer: UHC Core |
$62.40
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicaid |
$13.17
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: UHCCP Medicaid |
$13.17
|
| Rate for Payer: VA VA |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.05
|
|
|
LOVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$74.73
|
|
|
Service Code
|
NDC 68180046707
|
| Hospital Charge Code |
10469
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.01 |
| Max. Negotiated Rate |
$67.26 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: BCBS Trust/PPO |
$61.72
|
| Rate for Payer: BCN Commercial |
$61.72
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cofinity Commercial |
$64.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.78
|
| Rate for Payer: Healthscope Commercial |
$67.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.52
|
| Rate for Payer: Nomi Health Commercial |
$61.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.05
|
| Rate for Payer: PHP Commercial |
$63.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.76
|
| Rate for Payer: UHC Core |
$62.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.05
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$13,304.80
|
|
|
Service Code
|
APR-DRG 1812
|
| Min. Negotiated Rate |
$12,671.24 |
| Max. Negotiated Rate |
$13,304.80 |
| Rate for Payer: BCBS Complete |
$13,304.80
|
| Rate for Payer: Mclaren Medicaid |
$12,671.24
|
| Rate for Payer: Meridian Medicaid |
$13,304.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,671.24
|
| Rate for Payer: UHC Medicaid |
$12,671.24
|
| Rate for Payer: UHCCP Medicaid |
$12,671.24
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$18,160.94
|
|
|
Service Code
|
APR-DRG 1813
|
| Min. Negotiated Rate |
$17,296.13 |
| Max. Negotiated Rate |
$18,160.94 |
| Rate for Payer: BCBS Complete |
$18,160.94
|
| Rate for Payer: Mclaren Medicaid |
$17,296.13
|
| Rate for Payer: Meridian Medicaid |
$18,160.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,296.13
|
| Rate for Payer: UHC Medicaid |
$17,296.13
|
| Rate for Payer: UHCCP Medicaid |
$17,296.13
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$9,103.87
|
|
|
Service Code
|
APR-DRG 1811
|
| Min. Negotiated Rate |
$8,670.35 |
| Max. Negotiated Rate |
$9,103.87 |
| Rate for Payer: BCBS Complete |
$9,103.87
|
| Rate for Payer: Mclaren Medicaid |
$8,670.35
|
| Rate for Payer: Meridian Medicaid |
$9,103.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,670.35
|
| Rate for Payer: UHC Medicaid |
$8,670.35
|
| Rate for Payer: UHCCP Medicaid |
$8,670.35
|
|
|
LOWER VASCULAR PROCEDURES
|
Facility
|
IP
|
$26,705.84
|
|
|
Service Code
|
APR-DRG 1814
|
| Min. Negotiated Rate |
$25,434.13 |
| Max. Negotiated Rate |
$26,705.84 |
| Rate for Payer: BCBS Complete |
$26,705.84
|
| Rate for Payer: Mclaren Medicaid |
$25,434.13
|
| Rate for Payer: Meridian Medicaid |
$26,705.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,434.13
|
| Rate for Payer: UHC Medicaid |
$25,434.13
|
| Rate for Payer: UHCCP Medicaid |
$25,434.13
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$488.16
|
|
|
Service Code
|
NDC 00591037101
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.76 |
| Max. Negotiated Rate |
$439.34 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: BCBS Trust/PPO |
$403.17
|
| Rate for Payer: BCN Commercial |
$403.17
|
| Rate for Payer: Cash Price |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$419.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.53
|
| Rate for Payer: Healthscope Commercial |
$439.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.94
|
| Rate for Payer: Nomi Health Commercial |
$400.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.12
|
| Rate for Payer: PHP Commercial |
$414.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$424.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.58
|
| Rate for Payer: UHC Core |
$407.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.12
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
IP
|
$486.24
|
|
|
Service Code
|
NDC 00378702501
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$338.42 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: BCBS Trust/PPO |
$401.59
|
| Rate for Payer: BCN Commercial |
$401.59
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.30
|
| Rate for Payer: Nomi Health Commercial |
$398.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.68
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$423.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.89
|
| Rate for Payer: UHC Core |
$406.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$486.24
|
|
|
Service Code
|
NDC 00378702501
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$437.62 |
| Rate for Payer: Aetna Commercial |
$413.30
|
| Rate for Payer: Aetna Medicare |
$126.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.95
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS MAPPO |
$121.56
|
| Rate for Payer: BCBS Trust/PPO |
$399.74
|
| Rate for Payer: BCN Commercial |
$399.74
|
| Rate for Payer: BCN Medicare Advantage |
$121.56
|
| Rate for Payer: Cash Price |
$388.99
|
| Rate for Payer: Cofinity Commercial |
$418.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.56
|
| Rate for Payer: Healthscope Commercial |
$437.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.68
|
| Rate for Payer: Mclaren Medicaid |
$85.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.64
|
| Rate for Payer: Meridian Medicaid |
$90.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.30
|
| Rate for Payer: Nomi Health Commercial |
$398.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$364.68
|
| Rate for Payer: PACE Senior Care Partners |
$115.48
|
| Rate for Payer: PACE SWMI |
$121.56
|
| Rate for Payer: PHP Commercial |
$413.30
|
| Rate for Payer: PHP Medicare Advantage |
$121.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$423.03
|
| Rate for Payer: Priority Health Medicare |
$122.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.42
|
| Rate for Payer: Railroad Medicare Medicare |
$121.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.89
|
| Rate for Payer: UHC Core |
$406.01
|
| Rate for Payer: UHC Exchange |
$121.56
|
| Rate for Payer: UHC Medicaid |
$85.72
|
| Rate for Payer: UHC Medicare Advantage |
$121.56
|
| Rate for Payer: UHCCP Medicaid |
$85.72
|
| Rate for Payer: VA VA |
$121.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.68
|
|
|
LOXAPINE SUCCINATE 25 MG CAPSULE
|
Facility
|
OP
|
$488.16
|
|
|
Service Code
|
NDC 00591037101
|
| Hospital Charge Code |
4600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$439.34 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$126.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.55
|
| Rate for Payer: BCBS Complete |
$90.36
|
| Rate for Payer: BCBS MAPPO |
$122.04
|
| Rate for Payer: BCBS Trust/PPO |
$401.32
|
| Rate for Payer: BCN Commercial |
$401.32
|
| Rate for Payer: BCN Medicare Advantage |
$122.04
|
| Rate for Payer: Cash Price |
$390.53
|
| Rate for Payer: Cofinity Commercial |
$419.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.04
|
| Rate for Payer: Healthscope Commercial |
$439.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.12
|
| Rate for Payer: Mclaren Medicaid |
$86.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.14
|
| Rate for Payer: Meridian Medicaid |
$90.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.94
|
| Rate for Payer: Nomi Health Commercial |
$400.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.12
|
| Rate for Payer: PACE Senior Care Partners |
$115.94
|
| Rate for Payer: PACE SWMI |
$122.04
|
| Rate for Payer: PHP Commercial |
$414.94
|
| Rate for Payer: PHP Medicare Advantage |
$122.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$424.70
|
| Rate for Payer: Priority Health Medicare |
$123.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.76
|
| Rate for Payer: Railroad Medicare Medicare |
$122.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.58
|
| Rate for Payer: UHC Core |
$407.61
|
| Rate for Payer: UHC Exchange |
$122.04
|
| Rate for Payer: UHC Medicaid |
$86.06
|
| Rate for Payer: UHC Medicare Advantage |
$122.04
|
| Rate for Payer: UHCCP Medicaid |
$86.06
|
| Rate for Payer: VA VA |
$122.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.12
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
OP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.13 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: Aetna Medicare |
$332.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.05
|
| Rate for Payer: BCBS Complete |
$236.36
|
| Rate for Payer: BCBS MAPPO |
$319.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.78
|
| Rate for Payer: BCN Commercial |
$1,049.78
|
| Rate for Payer: BCN Medicare Advantage |
$319.24
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.24
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.71
|
| Rate for Payer: Mclaren Medicaid |
$225.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.20
|
| Rate for Payer: Meridian Medicaid |
$236.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$351.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.41
|
| Rate for Payer: Nomi Health Commercial |
$1,047.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.71
|
| Rate for Payer: PACE Senior Care Partners |
$303.28
|
| Rate for Payer: PACE SWMI |
$319.24
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: PHP Medicare Advantage |
$319.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,110.95
|
| Rate for Payer: Priority Health Medicare |
$322.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.76
|
| Rate for Payer: Railroad Medicare Medicare |
$319.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.72
|
| Rate for Payer: UHC Core |
$1,066.25
|
| Rate for Payer: UHC Exchange |
$319.24
|
| Rate for Payer: UHC Medicaid |
$225.13
|
| Rate for Payer: UHC Medicare Advantage |
$319.24
|
| Rate for Payer: UHCCP Medicaid |
$225.13
|
| Rate for Payer: VA VA |
$319.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.71
|
|
|
LUBIPROSTONE 8 MCG CAPSULE
|
Facility
|
IP
|
$1,276.95
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
91534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$888.76 |
| Max. Negotiated Rate |
$1,149.26 |
| Rate for Payer: Aetna Commercial |
$1,085.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,054.63
|
| Rate for Payer: BCN Commercial |
$1,054.63
|
| Rate for Payer: Cash Price |
$1,021.56
|
| Rate for Payer: Cofinity Commercial |
$1,098.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.56
|
| Rate for Payer: Healthscope Commercial |
$1,149.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.41
|
| Rate for Payer: Nomi Health Commercial |
$1,047.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$957.71
|
| Rate for Payer: PHP Commercial |
$1,085.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,110.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.72
|
| Rate for Payer: UHC Core |
$1,066.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.71
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$119.15
|
|
|
Service Code
|
NDC 31722008030
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.01 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: Aetna Medicare |
$30.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.23
|
| Rate for Payer: BCBS Complete |
$22.05
|
| Rate for Payer: BCBS MAPPO |
$29.79
|
| Rate for Payer: BCBS Trust/PPO |
$97.95
|
| Rate for Payer: BCN Commercial |
$97.95
|
| Rate for Payer: BCN Medicare Advantage |
$29.79
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.79
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: Mclaren Medicaid |
$21.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.28
|
| Rate for Payer: Meridian Medicaid |
$22.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Nomi Health Commercial |
$97.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PACE Senior Care Partners |
$28.30
|
| Rate for Payer: PACE SWMI |
$29.79
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: PHP Medicare Advantage |
$29.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.66
|
| Rate for Payer: Priority Health Medicare |
$30.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.93
|
| Rate for Payer: Railroad Medicare Medicare |
$29.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.85
|
| Rate for Payer: UHC Core |
$99.49
|
| Rate for Payer: UHC Exchange |
$29.79
|
| Rate for Payer: UHC Medicaid |
$21.01
|
| Rate for Payer: UHC Medicare Advantage |
$29.79
|
| Rate for Payer: UHCCP Medicaid |
$21.01
|
| Rate for Payer: VA VA |
$29.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$119.15
|
|
|
Service Code
|
NDC 31722008030
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.93 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Aetna Commercial |
$101.28
|
| Rate for Payer: BCBS Trust/PPO |
$98.41
|
| Rate for Payer: BCN Commercial |
$98.41
|
| Rate for Payer: Cash Price |
$95.32
|
| Rate for Payer: Cofinity Commercial |
$102.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.32
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.28
|
| Rate for Payer: Nomi Health Commercial |
$97.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.36
|
| Rate for Payer: PHP Commercial |
$101.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$103.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.85
|
| Rate for Payer: UHC Core |
$99.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.36
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
IP
|
$103.17
|
|
|
Service Code
|
NDC 67877063830
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$92.85 |
| Rate for Payer: Aetna Commercial |
$87.69
|
| Rate for Payer: BCBS Trust/PPO |
$85.21
|
| Rate for Payer: BCN Commercial |
$85.21
|
| Rate for Payer: Cash Price |
$82.54
|
| Rate for Payer: Cofinity Commercial |
$88.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.54
|
| Rate for Payer: Healthscope Commercial |
$92.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.69
|
| Rate for Payer: Nomi Health Commercial |
$84.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.38
|
| Rate for Payer: PHP Commercial |
$87.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.79
|
| Rate for Payer: UHC Core |
$86.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.38
|
|
|
LURASIDONE 20 MG TABLET
|
Facility
|
OP
|
$103.17
|
|
|
Service Code
|
NDC 67877063830
|
| Hospital Charge Code |
158952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$92.85 |
| Rate for Payer: Aetna Commercial |
$87.69
|
| Rate for Payer: Aetna Medicare |
$26.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.24
|
| Rate for Payer: BCBS Complete |
$19.10
|
| Rate for Payer: BCBS MAPPO |
$25.79
|
| Rate for Payer: BCBS Trust/PPO |
$84.82
|
| Rate for Payer: BCN Commercial |
$84.82
|
| Rate for Payer: BCN Medicare Advantage |
$25.79
|
| Rate for Payer: Cash Price |
$82.54
|
| Rate for Payer: Cofinity Commercial |
$88.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.79
|
| Rate for Payer: Healthscope Commercial |
$92.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.38
|
| Rate for Payer: Mclaren Medicaid |
$18.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.08
|
| Rate for Payer: Meridian Medicaid |
$19.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.69
|
| Rate for Payer: Nomi Health Commercial |
$84.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.38
|
| Rate for Payer: PACE Senior Care Partners |
$24.50
|
| Rate for Payer: PACE SWMI |
$25.79
|
| Rate for Payer: PHP Commercial |
$87.69
|
| Rate for Payer: PHP Medicare Advantage |
$25.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.76
|
| Rate for Payer: Priority Health Medicare |
$26.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.81
|
| Rate for Payer: Railroad Medicare Medicare |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.79
|
| Rate for Payer: UHC Core |
$86.15
|
| Rate for Payer: UHC Exchange |
$25.79
|
| Rate for Payer: UHC Medicaid |
$18.19
|
| Rate for Payer: UHC Medicare Advantage |
$25.79
|
| Rate for Payer: UHCCP Medicaid |
$18.19
|
| Rate for Payer: VA VA |
$25.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.38
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$10,780.77
|
|
|
Service Code
|
APR-DRG 6944
|
| Min. Negotiated Rate |
$10,267.40 |
| Max. Negotiated Rate |
$10,780.77 |
| Rate for Payer: BCBS Complete |
$10,780.77
|
| Rate for Payer: Mclaren Medicaid |
$10,267.40
|
| Rate for Payer: Meridian Medicaid |
$10,780.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,267.40
|
| Rate for Payer: UHC Medicaid |
$10,267.40
|
| Rate for Payer: UHCCP Medicaid |
$10,267.40
|
|
|
LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR
|
Facility
|
IP
|
$4,007.43
|
|
|
Service Code
|
APR-DRG 6941
|
| Min. Negotiated Rate |
$3,816.60 |
| Max. Negotiated Rate |
$4,007.43 |
| Rate for Payer: BCBS Complete |
$4,007.43
|
| Rate for Payer: Mclaren Medicaid |
$3,816.60
|
| Rate for Payer: Meridian Medicaid |
$4,007.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,816.60
|
| Rate for Payer: UHC Medicaid |
$3,816.60
|
| Rate for Payer: UHCCP Medicaid |
$3,816.60
|
|
