|
HAIR REMOVAL
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 00170
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 51079-734-01
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.19
|
| Rate for Payer: UHC Core |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$361.95
|
|
|
Service Code
|
NDC 51079-734-20
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.75 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna Commercial |
$307.66
|
| Rate for Payer: BCBS Trust/PPO |
$279.71
|
| Rate for Payer: BCN Commercial |
$279.71
|
| Rate for Payer: Cash Price |
$289.56
|
| Rate for Payer: Cofinity Commercial |
$311.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.56
|
| Rate for Payer: Healthscope Commercial |
$325.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.66
|
| Rate for Payer: PHP Commercial |
$307.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.52
|
| Rate for Payer: UHC Core |
$302.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.46
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$346.75
|
|
|
Service Code
|
NDC 68382-079-01
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.48 |
| Max. Negotiated Rate |
$312.08 |
| Rate for Payer: Aetna Commercial |
$294.74
|
| Rate for Payer: BCBS Trust/PPO |
$267.97
|
| Rate for Payer: BCN Commercial |
$267.97
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Cofinity Commercial |
$298.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.40
|
| Rate for Payer: Healthscope Commercial |
$312.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.74
|
| Rate for Payer: PHP Commercial |
$294.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.14
|
| Rate for Payer: UHC Core |
$289.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.06
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$232.65
|
|
|
Service Code
|
NDC 0781-1396-13
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.89 |
| Max. Negotiated Rate |
$209.38 |
| Rate for Payer: Aetna Commercial |
$197.75
|
| Rate for Payer: BCBS Trust/PPO |
$179.79
|
| Rate for Payer: BCN Commercial |
$179.79
|
| Rate for Payer: Cash Price |
$186.12
|
| Rate for Payer: Cofinity Commercial |
$200.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.12
|
| Rate for Payer: Healthscope Commercial |
$209.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.75
|
| Rate for Payer: PHP Commercial |
$197.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.73
|
| Rate for Payer: UHC Core |
$194.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.49
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$408.50
|
|
|
Service Code
|
NDC 0904-6782-61
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.14 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$347.22
|
| Rate for Payer: BCBS Trust/PPO |
$315.69
|
| Rate for Payer: BCN Commercial |
$315.69
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.22
|
| Rate for Payer: PHP Commercial |
$347.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$355.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.48
|
| Rate for Payer: UHC Core |
$341.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
HALOPERIDOL DECANOATE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$548.03
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$334.24 |
| Max. Negotiated Rate |
$493.23 |
| Rate for Payer: Aetna Commercial |
$465.83
|
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: BCBS Trust/PPO |
$111.94
|
| Rate for Payer: BCBS Trust/PPO |
$423.52
|
| Rate for Payer: BCN Commercial |
$423.52
|
| Rate for Payer: BCN Commercial |
$111.94
|
| Rate for Payer: Cash Price |
$115.88
|
| Rate for Payer: Cash Price |
$438.42
|
| Rate for Payer: Cofinity Commercial |
$471.31
|
| Rate for Payer: Cofinity Commercial |
$124.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$438.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$493.23
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$465.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.12
|
| Rate for Payer: PHP Commercial |
$123.12
|
| Rate for Payer: PHP Commercial |
$465.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.47
|
| Rate for Payer: UHC Core |
$120.95
|
| Rate for Payer: UHC Core |
$457.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.02
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$81.40
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.65 |
| Max. Negotiated Rate |
$73.26 |
| Rate for Payer: Aetna Commercial |
$69.19
|
| Rate for Payer: BCBS Trust/PPO |
$62.91
|
| Rate for Payer: BCN Commercial |
$62.91
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.12
|
| Rate for Payer: Healthscope Commercial |
$73.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.19
|
| Rate for Payer: PHP Commercial |
$69.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.63
|
| Rate for Payer: UHC Core |
$67.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.05
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$5.47
|
|
|
Service Code
|
NDC 9900-0018-20
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$4.23
|
| Rate for Payer: BCN Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$4.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.65
|
| Rate for Payer: PHP Commercial |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.81
|
| Rate for Payer: UHC Core |
$4.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.10
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$425.82
|
|
|
Service Code
|
NDC 54838-501-40
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.71 |
| Max. Negotiated Rate |
$383.24 |
| Rate for Payer: Aetna Commercial |
$361.95
|
| Rate for Payer: BCBS Trust/PPO |
$329.07
|
| Rate for Payer: BCN Commercial |
$329.07
|
| Rate for Payer: Cash Price |
$340.66
|
| Rate for Payer: Cofinity Commercial |
$366.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.66
|
| Rate for Payer: Healthscope Commercial |
$383.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.95
|
| Rate for Payer: PHP Commercial |
$361.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.72
|
| Rate for Payer: UHC Core |
$355.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.36
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$243.96
|
|
|
Service Code
|
NDC 0121-0581-04
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.79 |
| Max. Negotiated Rate |
$219.56 |
| Rate for Payer: Aetna Commercial |
$207.37
|
| Rate for Payer: BCBS Trust/PPO |
$188.53
|
| Rate for Payer: BCN Commercial |
$188.53
|
| Rate for Payer: Cash Price |
$195.17
|
| Rate for Payer: Cofinity Commercial |
$209.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.17
|
| Rate for Payer: Healthscope Commercial |
$219.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.37
|
| Rate for Payer: PHP Commercial |
$207.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.68
|
| Rate for Payer: UHC Core |
$203.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.97
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$93.10
|
|
|
Service Code
|
NDC 54838-501-15
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.78 |
| Max. Negotiated Rate |
$83.79 |
| Rate for Payer: Aetna Commercial |
$79.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.95
|
| Rate for Payer: BCN Commercial |
$71.95
|
| Rate for Payer: Cash Price |
$74.48
|
| Rate for Payer: Cofinity Commercial |
$80.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.48
|
| Rate for Payer: Healthscope Commercial |
$83.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.14
|
| Rate for Payer: PHP Commercial |
$79.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.93
|
| Rate for Payer: UHC Core |
$77.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.82
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.15
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$8.14
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.95
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC Core |
$8.79
|
| Rate for Payer: UHC Core |
$10.75
|
| Rate for Payer: UHC Core |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.90
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
IP
|
$64.26
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: BCBS Trust/PPO |
$49.66
|
| Rate for Payer: BCN Commercial |
$49.66
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.62
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.55
|
| Rate for Payer: UHC Core |
$53.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.20
|
|
|
HC 11 DEOXYCORTISOL
|
Facility
|
OP
|
$64.26
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
30100189
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.08
|
| Rate for Payer: BCBS Complete |
$22.69
|
| Rate for Payer: BCBS MAPPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$49.96
|
| Rate for Payer: BCN Medicare Advantage |
$16.06
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.20
|
| Rate for Payer: Mclaren Medicaid |
$21.61
|
| Rate for Payer: Meridian Medicaid |
$22.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.62
|
| Rate for Payer: PACE Senior Care Partners |
$15.26
|
| Rate for Payer: PACE SWMI |
$16.06
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: PHP Medicare Advantage |
$16.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.91
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.19
|
| Rate for Payer: Railroad Medicare Medicare |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.55
|
| Rate for Payer: UHC Core |
$53.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.06
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: VA VA |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.20
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
IP
|
$6.75
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna Commercial |
$5.74
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$5.22
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.74
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.94
|
| Rate for Payer: UHC Core |
$5.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.06
|
|
|
HC 1/2 X 1/2 STERILE W/LL
|
Facility
|
OP
|
$6.75
|
|
| Hospital Charge Code |
27000680
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$6.08 |
| Rate for Payer: Aetna Commercial |
$5.74
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.11
|
| Rate for Payer: BCBS Complete |
$2.70
|
| Rate for Payer: BCBS MAPPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Commercial |
$5.25
|
| Rate for Payer: BCN Medicare Advantage |
$1.69
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.69
|
| Rate for Payer: Healthscope Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.74
|
| Rate for Payer: PACE Senior Care Partners |
$1.60
|
| Rate for Payer: PACE SWMI |
$1.69
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicare Advantage |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.87
|
| Rate for Payer: Priority Health Medicare |
$1.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.94
|
| Rate for Payer: UHC Core |
$5.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.69
|
| Rate for Payer: UHC Medicare Advantage |
$1.74
|
| Rate for Payer: VA VA |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.06
|
|
|
HC 20CM TL CATHETER
|
Facility
|
OP
|
$272.95
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$245.66 |
| Rate for Payer: Aetna Commercial |
$232.01
|
| Rate for Payer: Aetna Medicare |
$70.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.30
|
| Rate for Payer: BCBS Complete |
$109.18
|
| Rate for Payer: BCBS MAPPO |
$68.24
|
| Rate for Payer: BCBS Trust/PPO |
$212.22
|
| Rate for Payer: BCN Commercial |
$212.22
|
| Rate for Payer: BCN Medicare Advantage |
$68.24
|
| Rate for Payer: Cash Price |
$218.36
|
| Rate for Payer: Cofinity Commercial |
$234.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.24
|
| Rate for Payer: Healthscope Commercial |
$245.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.01
|
| Rate for Payer: PACE Senior Care Partners |
$64.83
|
| Rate for Payer: PACE SWMI |
$68.24
|
| Rate for Payer: PHP Commercial |
$232.01
|
| Rate for Payer: PHP Medicare Advantage |
$68.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.47
|
| Rate for Payer: Priority Health Medicare |
$68.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.47
|
| Rate for Payer: Railroad Medicare Medicare |
$68.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.20
|
| Rate for Payer: UHC Core |
$227.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.24
|
| Rate for Payer: UHC Medicare Advantage |
$70.28
|
| Rate for Payer: VA VA |
$68.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.71
|
|
|
HC 20CM TL CATHETER
|
Facility
|
IP
|
$272.95
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.47 |
| Max. Negotiated Rate |
$245.66 |
| Rate for Payer: Aetna Commercial |
$232.01
|
| Rate for Payer: BCBS Trust/PPO |
$210.94
|
| Rate for Payer: BCN Commercial |
$210.94
|
| Rate for Payer: Cash Price |
$218.36
|
| Rate for Payer: Cofinity Commercial |
$234.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.36
|
| Rate for Payer: Healthscope Commercial |
$245.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.01
|
| Rate for Payer: PHP Commercial |
$232.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.20
|
| Rate for Payer: UHC Core |
$227.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.71
|
|
|
HC 23BPG, U
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$32.37
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$57.10
|
| Rate for Payer: BCN Commercial |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$30.83
|
| Rate for Payer: Meridian Medicaid |
$32.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.89
|
| Rate for Payer: Priority Health Medicare |
$18.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.79
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.91
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC 23BPG, U
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$56.75
|
| Rate for Payer: BCN Commercial |
$56.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC 23BPR URINE
|
Facility
|
IP
|
$85.21
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$76.69 |
| Rate for Payer: Aetna Commercial |
$72.43
|
| Rate for Payer: BCBS Trust/PPO |
$65.85
|
| Rate for Payer: BCN Commercial |
$65.85
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Cofinity Commercial |
$73.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.17
|
| Rate for Payer: Healthscope Commercial |
$76.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.43
|
| Rate for Payer: PHP Commercial |
$72.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.98
|
| Rate for Payer: UHC Core |
$71.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.91
|
|
|
HC 23BPR URINE
|
Facility
|
OP
|
$85.21
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
30100735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$76.69 |
| Rate for Payer: Aetna Commercial |
$72.43
|
| Rate for Payer: Aetna Medicare |
$22.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.63
|
| Rate for Payer: BCBS Complete |
$32.37
|
| Rate for Payer: BCBS MAPPO |
$21.30
|
| Rate for Payer: BCBS Trust/PPO |
$66.25
|
| Rate for Payer: BCN Commercial |
$66.25
|
| Rate for Payer: BCN Medicare Advantage |
$21.30
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Cofinity Commercial |
$73.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.30
|
| Rate for Payer: Healthscope Commercial |
$76.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.91
|
| Rate for Payer: Mclaren Medicaid |
$30.83
|
| Rate for Payer: Meridian Medicaid |
$32.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.43
|
| Rate for Payer: PACE Senior Care Partners |
$20.24
|
| Rate for Payer: PACE SWMI |
$21.30
|
| Rate for Payer: PHP Commercial |
$72.43
|
| Rate for Payer: PHP Medicare Advantage |
$21.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.13
|
| Rate for Payer: Priority Health Medicare |
$21.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.97
|
| Rate for Payer: Railroad Medicare Medicare |
$21.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.98
|
| Rate for Payer: UHC Core |
$71.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.30
|
| Rate for Payer: UHC Medicare Advantage |
$21.94
|
| Rate for Payer: VA VA |
$21.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.91
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
OP
|
$1,521.71
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$1,369.54 |
| Rate for Payer: Aetna Commercial |
$1,293.45
|
| Rate for Payer: Aetna Medicare |
$395.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$475.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$475.53
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$380.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.13
|
| Rate for Payer: BCN Commercial |
$1,183.13
|
| Rate for Payer: BCN Medicare Advantage |
$380.43
|
| Rate for Payer: Cash Price |
$1,217.37
|
| Rate for Payer: Cash Price |
$1,217.37
|
| Rate for Payer: Cofinity Commercial |
$1,308.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.43
|
| Rate for Payer: Healthscope Commercial |
$1,369.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,141.28
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$399.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$437.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,293.45
|
| Rate for Payer: PACE Senior Care Partners |
$361.41
|
| Rate for Payer: PACE SWMI |
$380.43
|
| Rate for Payer: PHP Commercial |
$1,293.45
|
| Rate for Payer: PHP Medicare Advantage |
$380.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,323.89
|
| Rate for Payer: Priority Health Medicare |
$380.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$928.09
|
| Rate for Payer: Railroad Medicare Medicare |
$380.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,339.10
|
| Rate for Payer: UHC Core |
$1,270.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.43
|
| Rate for Payer: UHC Medicare Advantage |
$391.84
|
| Rate for Payer: VA VA |
$380.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,141.28
|
|
|
HC 24 HOUR PH MONITOR
|
Facility
|
IP
|
$1,521.71
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
75000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$928.09 |
| Max. Negotiated Rate |
$1,369.54 |
| Rate for Payer: Aetna Commercial |
$1,293.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.98
|
| Rate for Payer: BCN Commercial |
$1,175.98
|
| Rate for Payer: Cash Price |
$1,217.37
|
| Rate for Payer: Cofinity Commercial |
$1,308.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,217.37
|
| Rate for Payer: Healthscope Commercial |
$1,369.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,293.45
|
| Rate for Payer: PHP Commercial |
$1,293.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,065.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,323.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$928.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,339.10
|
| Rate for Payer: UHC Core |
$1,270.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,141.28
|
|
