|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.65
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: BCBS MAPPO |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: BCN Medicare Advantage |
$2.92
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$9.58
|
| Rate for Payer: PACE Senior Care Partners |
$2.77
|
| Rate for Payer: PACE SWMI |
$2.92
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health HMO/PPO |
$10.16
|
| Rate for Payer: Priority Health Medicare |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.92
|
| Rate for Payer: UHC Exchange |
$2.92
|
| Rate for Payer: UHC Medicare Advantage |
$2.92
|
| Rate for Payer: VA VA |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.65
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: BCBS MAPPO |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: BCN Medicare Advantage |
$2.92
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$9.58
|
| Rate for Payer: PACE Senior Care Partners |
$2.77
|
| Rate for Payer: PACE SWMI |
$2.92
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health HMO/PPO |
$10.16
|
| Rate for Payer: Priority Health Medicare |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.92
|
| Rate for Payer: UHC Exchange |
$2.92
|
| Rate for Payer: UHC Medicare Advantage |
$2.92
|
| Rate for Payer: VA VA |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.53
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$9.58
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health HMO/PPO |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.98
|
| Rate for Payer: BCN Commercial |
$139.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.60
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: Aetna Medicare |
$71.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.12
|
| Rate for Payer: BCBS Complete |
$110.24
|
| Rate for Payer: BCBS MAPPO |
$68.90
|
| Rate for Payer: BCBS Trust/PPO |
$226.57
|
| Rate for Payer: BCN Commercial |
$214.28
|
| Rate for Payer: BCN Medicare Advantage |
$68.90
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.90
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: Nomi Health Commercial |
$225.99
|
| Rate for Payer: PACE Senior Care Partners |
$65.46
|
| Rate for Payer: PACE SWMI |
$68.90
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: PHP Medicare Advantage |
$68.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health HMO/PPO |
$239.77
|
| Rate for Payer: Priority Health Medicare |
$69.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.65
|
| Rate for Payer: Railroad Medicare Medicare |
$68.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.53
|
| Rate for Payer: UHC Core |
$230.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.90
|
| Rate for Payer: UHC Exchange |
$68.90
|
| Rate for Payer: UHC Medicare Advantage |
$68.90
|
| Rate for Payer: VA VA |
$68.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: BCBS Trust/PPO |
$224.97
|
| Rate for Payer: BCN Commercial |
$212.98
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: Nomi Health Commercial |
$225.99
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health HMO/PPO |
$239.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.53
|
| Rate for Payer: UHC Core |
$230.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: BCBS Trust/PPO |
$152.81
|
| Rate for Payer: BCN Commercial |
$144.67
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: Nomi Health Commercial |
$153.50
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.68
|
| Rate for Payer: Priority Health HMO/PPO |
$162.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$156.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$146.93
|
| Rate for Payer: BCN Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Medicare |
$48.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.50
|
| Rate for Payer: BCBS Complete |
$74.88
|
| Rate for Payer: BCBS MAPPO |
$46.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.90
|
| Rate for Payer: BCN Commercial |
$145.55
|
| Rate for Payer: BCN Medicare Advantage |
$46.80
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.80
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: Nomi Health Commercial |
$153.50
|
| Rate for Payer: PACE Senior Care Partners |
$44.46
|
| Rate for Payer: PACE SWMI |
$46.80
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: PHP Medicare Advantage |
$46.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.68
|
| Rate for Payer: Priority Health HMO/PPO |
$162.86
|
| Rate for Payer: Priority Health Medicare |
$47.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.42
|
| Rate for Payer: Railroad Medicare Medicare |
$46.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$156.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.80
|
| Rate for Payer: UHC Exchange |
$46.80
|
| Rate for Payer: UHC Medicare Advantage |
$46.80
|
| Rate for Payer: VA VA |
$46.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCN Commercial |
$16.16
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$17.05
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: Priority Health HMO/PPO |
$18.09
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.93
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.30
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna Medicare |
$7.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.36
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS MAPPO |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$24.63
|
| Rate for Payer: BCN Commercial |
$23.29
|
| Rate for Payer: BCN Medicare Advantage |
$7.49
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Nomi Health Commercial |
$24.57
|
| Rate for Payer: PACE Senior Care Partners |
$7.12
|
| Rate for Payer: PACE SWMI |
$7.49
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: PHP Medicare Advantage |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health HMO/PPO |
$26.07
|
| Rate for Payer: Priority Health Medicare |
$7.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.07
|
| Rate for Payer: Railroad Medicare Medicare |
$7.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.36
|
| Rate for Payer: UHC Core |
$25.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.49
|
| Rate for Payer: UHC Exchange |
$7.49
|
| Rate for Payer: UHC Medicare Advantage |
$7.49
|
| Rate for Payer: VA VA |
$7.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: BCBS Trust/PPO |
$24.46
|
| Rate for Payer: BCN Commercial |
$23.15
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Nomi Health Commercial |
$24.57
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health HMO/PPO |
$26.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.36
|
| Rate for Payer: UHC Core |
$25.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$16.97
|
| Rate for Payer: BCN Commercial |
$16.07
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: Priority Health HMO/PPO |
$18.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.30
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$319.15
|
|
|
Service Code
|
NDC 54643565002
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$287.24 |
| Rate for Payer: Aetna Commercial |
$271.28
|
| Rate for Payer: Aetna Medicare |
$82.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.73
|
| Rate for Payer: BCBS Complete |
$127.66
|
| Rate for Payer: BCBS MAPPO |
$79.79
|
| Rate for Payer: BCBS Trust/PPO |
$262.37
|
| Rate for Payer: BCN Commercial |
$248.14
|
| Rate for Payer: BCN Medicare Advantage |
$79.79
|
| Rate for Payer: Cash Price |
$255.32
|
| Rate for Payer: Cofinity Commercial |
$274.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.79
|
| Rate for Payer: Healthscope Commercial |
$287.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.28
|
| Rate for Payer: Nomi Health Commercial |
$261.70
|
| Rate for Payer: PACE Senior Care Partners |
$75.80
|
| Rate for Payer: PACE SWMI |
$79.79
|
| Rate for Payer: PHP Commercial |
$271.28
|
| Rate for Payer: PHP Medicare Advantage |
$79.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.45
|
| Rate for Payer: Priority Health HMO/PPO |
$277.66
|
| Rate for Payer: Priority Health Medicare |
$80.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.83
|
| Rate for Payer: Railroad Medicare Medicare |
$79.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.85
|
| Rate for Payer: UHC Core |
$266.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.79
|
| Rate for Payer: UHC Exchange |
$79.79
|
| Rate for Payer: UHC Medicare Advantage |
$79.79
|
| Rate for Payer: VA VA |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.36
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$319.15
|
|
|
Service Code
|
NDC 54643565002
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$207.45 |
| Max. Negotiated Rate |
$287.24 |
| Rate for Payer: Aetna Commercial |
$271.28
|
| Rate for Payer: BCBS Trust/PPO |
$260.52
|
| Rate for Payer: BCN Commercial |
$246.64
|
| Rate for Payer: Cash Price |
$255.32
|
| Rate for Payer: Cofinity Commercial |
$274.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.32
|
| Rate for Payer: Healthscope Commercial |
$287.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.28
|
| Rate for Payer: Nomi Health Commercial |
$261.70
|
| Rate for Payer: PHP Commercial |
$271.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.45
|
| Rate for Payer: Priority Health HMO/PPO |
$277.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.85
|
| Rate for Payer: UHC Core |
$266.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.36
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.17
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCN Commercial |
$36.45
|
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$40.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.74
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.09
|
| Rate for Payer: Nomi Health Commercial |
$38.68
|
| Rate for Payer: PHP Commercial |
$40.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.66
|
| Rate for Payer: Priority Health HMO/PPO |
$41.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.51
|
| Rate for Payer: UHC Core |
$39.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.38
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.68
|
|
|
Service Code
|
NDC 54643900701
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$57.31 |
| Rate for Payer: Aetna Commercial |
$54.13
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.90
|
| Rate for Payer: BCBS Complete |
$25.47
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$52.35
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$57.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.13
|
| Rate for Payer: Nomi Health Commercial |
$52.22
|
| Rate for Payer: PACE Senior Care Partners |
$15.12
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$54.13
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.39
|
| Rate for Payer: Priority Health HMO/PPO |
$55.40
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.67
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.04
|
| Rate for Payer: UHC Core |
$53.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.92
|
| Rate for Payer: UHC Exchange |
$15.92
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: VA VA |
$15.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.76
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.17
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Medicare |
$12.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.74
|
| Rate for Payer: BCBS Complete |
$18.87
|
| Rate for Payer: BCBS MAPPO |
$11.79
|
| Rate for Payer: BCBS Trust/PPO |
$38.78
|
| Rate for Payer: BCN Commercial |
$36.67
|
| Rate for Payer: BCN Medicare Advantage |
$11.79
|
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$40.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.79
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.09
|
| Rate for Payer: Nomi Health Commercial |
$38.68
|
| Rate for Payer: PACE Senior Care Partners |
$11.20
|
| Rate for Payer: PACE SWMI |
$11.79
|
| Rate for Payer: PHP Commercial |
$40.09
|
| Rate for Payer: PHP Medicare Advantage |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.66
|
| Rate for Payer: Priority Health HMO/PPO |
$41.04
|
| Rate for Payer: Priority Health Medicare |
$11.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.60
|
| Rate for Payer: Railroad Medicare Medicare |
$11.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.51
|
| Rate for Payer: UHC Core |
$39.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.79
|
| Rate for Payer: UHC Exchange |
$11.79
|
| Rate for Payer: UHC Medicare Advantage |
$11.79
|
| Rate for Payer: VA VA |
$11.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.38
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.68
|
|
|
Service Code
|
NDC 54643900701
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.39 |
| Max. Negotiated Rate |
$57.31 |
| Rate for Payer: Aetna Commercial |
$54.13
|
| Rate for Payer: BCBS Trust/PPO |
$51.98
|
| Rate for Payer: BCN Commercial |
$49.21
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.13
|
| Rate for Payer: Nomi Health Commercial |
$52.22
|
| Rate for Payer: PHP Commercial |
$54.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.39
|
| Rate for Payer: Priority Health HMO/PPO |
$55.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.04
|
| Rate for Payer: UHC Core |
$53.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.76
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$240.82 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.92
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: BCBS Trust/PPO |
$302.44
|
| Rate for Payer: BCBS Trust/PPO |
$329.95
|
| Rate for Payer: BCN Commercial |
$286.32
|
| Rate for Payer: BCN Commercial |
$312.37
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$303.81
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: PHP Commercial |
$314.92
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health HMO/PPO |
$322.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$314.92
|
| Rate for Payer: Aetna Medicare |
$105.09
|
| Rate for Payer: Aetna Medicare |
$96.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.78
|
| Rate for Payer: BCBS Complete |
$148.20
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS MAPPO |
$92.62
|
| Rate for Payer: BCBS MAPPO |
$101.05
|
| Rate for Payer: BCBS Trust/PPO |
$332.29
|
| Rate for Payer: BCBS Trust/PPO |
$304.59
|
| Rate for Payer: BCN Commercial |
$314.27
|
| Rate for Payer: BCN Commercial |
$288.06
|
| Rate for Payer: BCN Medicare Advantage |
$101.05
|
| Rate for Payer: BCN Medicare Advantage |
$92.62
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.05
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.92
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Nomi Health Commercial |
$303.81
|
| Rate for Payer: PACE Senior Care Partners |
$96.00
|
| Rate for Payer: PACE Senior Care Partners |
$87.99
|
| Rate for Payer: PACE SWMI |
$101.05
|
| Rate for Payer: PACE SWMI |
$92.62
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$314.92
|
| Rate for Payer: PHP Medicare Advantage |
$92.62
|
| Rate for Payer: PHP Medicare Advantage |
$101.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.82
|
| Rate for Payer: Priority Health HMO/PPO |
$322.34
|
| Rate for Payer: Priority Health HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Medicare |
$102.06
|
| Rate for Payer: Priority Health Medicare |
$93.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.24
|
| Rate for Payer: Railroad Medicare Medicare |
$92.62
|
| Rate for Payer: Railroad Medicare Medicare |
$101.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.62
|
| Rate for Payer: UHC Exchange |
$92.62
|
| Rate for Payer: UHC Exchange |
$101.05
|
| Rate for Payer: UHC Medicare Advantage |
$92.62
|
| Rate for Payer: UHC Medicare Advantage |
$101.05
|
| Rate for Payer: VA VA |
$92.62
|
| Rate for Payer: VA VA |
$101.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$20.99
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$23.56
|
| Rate for Payer: Aetna Commercial |
$17.40
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Aetna Medicare |
$24.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.66
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS Complete |
$8.19
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS MAPPO |
$6.02
|
| Rate for Payer: BCBS MAPPO |
$5.12
|
| Rate for Payer: BCBS MAPPO |
$5.25
|
| Rate for Payer: BCBS MAPPO |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$16.83
|
| Rate for Payer: BCBS Trust/PPO |
$17.26
|
| Rate for Payer: BCBS Trust/PPO |
$19.80
|
| Rate for Payer: BCBS Trust/PPO |
$76.55
|
| Rate for Payer: BCBS Trust/PPO |
$22.79
|
| Rate for Payer: BCN Commercial |
$72.40
|
| Rate for Payer: BCN Commercial |
$15.92
|
| Rate for Payer: BCN Commercial |
$16.32
|
| Rate for Payer: BCN Commercial |
$18.73
|
| Rate for Payer: BCN Commercial |
$21.55
|
| Rate for Payer: BCN Medicare Advantage |
$23.28
|
| Rate for Payer: BCN Medicare Advantage |
$6.93
|
| Rate for Payer: BCN Medicare Advantage |
$5.12
|
| Rate for Payer: BCN Medicare Advantage |
$5.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.02
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$23.84
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.02
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Healthscope Commercial |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Nomi Health Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$22.73
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Nomi Health Commercial |
$76.36
|
| Rate for Payer: Nomi Health Commercial |
$16.79
|
| Rate for Payer: PACE Senior Care Partners |
$4.86
|
| Rate for Payer: PACE Senior Care Partners |
$6.58
|
| Rate for Payer: PACE Senior Care Partners |
$4.99
|
| Rate for Payer: PACE Senior Care Partners |
$5.72
|
| Rate for Payer: PACE Senior Care Partners |
$22.12
|
| Rate for Payer: PACE SWMI |
$5.12
|
| Rate for Payer: PACE SWMI |
$6.93
|
| Rate for Payer: PACE SWMI |
$6.02
|
| Rate for Payer: PACE SWMI |
$5.25
|
| Rate for Payer: PACE SWMI |
$23.28
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$17.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.93
|
| Rate for Payer: PHP Medicare Advantage |
$23.28
|
| Rate for Payer: PHP Medicare Advantage |
$5.12
|
| Rate for Payer: PHP Medicare Advantage |
$5.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.31
|
| Rate for Payer: Priority Health HMO/PPO |
$17.81
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO |
$81.01
|
| Rate for Payer: Priority Health HMO/PPO |
$24.12
|
| Rate for Payer: Priority Health HMO/PPO |
$18.26
|
| Rate for Payer: Priority Health Medicare |
$23.51
|
| Rate for Payer: Priority Health Medicare |
$6.08
|
| Rate for Payer: Priority Health Medicare |
$5.30
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$5.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6.02
|
| Rate for Payer: Railroad Medicare Medicare |
$5.12
|
| Rate for Payer: Railroad Medicare Medicare |
$5.25
|
| Rate for Payer: Railroad Medicare Medicare |
$23.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$17.53
|
| Rate for Payer: UHC Core |
$77.76
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: UHC Core |
$17.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.02
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Exchange |
$23.28
|
| Rate for Payer: UHC Exchange |
$5.12
|
| Rate for Payer: UHC Exchange |
$6.93
|
| Rate for Payer: UHC Exchange |
$5.25
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: UHC Medicare Advantage |
$23.28
|
| Rate for Payer: UHC Medicare Advantage |
$6.02
|
| Rate for Payer: UHC Medicare Advantage |
$5.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.93
|
| Rate for Payer: VA VA |
$5.12
|
| Rate for Payer: VA VA |
$6.93
|
| Rate for Payer: VA VA |
$5.25
|
| Rate for Payer: VA VA |
$23.28
|
| Rate for Payer: VA VA |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$23.56
|
| Rate for Payer: Aetna Commercial |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$22.63
|
| Rate for Payer: BCBS Trust/PPO |
$76.01
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCBS Trust/PPO |
$17.13
|
| Rate for Payer: BCBS Trust/PPO |
$16.71
|
| Rate for Payer: BCN Commercial |
$21.42
|
| Rate for Payer: BCN Commercial |
$18.62
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Commercial |
$16.22
|
| Rate for Payer: BCN Commercial |
$71.96
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$23.84
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$18.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$18.42
|
| Rate for Payer: Healthscope Commercial |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.56
|
| Rate for Payer: Nomi Health Commercial |
$16.79
|
| Rate for Payer: Nomi Health Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Nomi Health Commercial |
$22.73
|
| Rate for Payer: Nomi Health Commercial |
$76.36
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$17.84
|
| Rate for Payer: PHP Commercial |
$17.40
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.31
|
| Rate for Payer: Priority Health HMO/PPO |
$17.81
|
| Rate for Payer: Priority Health HMO/PPO |
$81.01
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO |
$24.12
|
| Rate for Payer: Priority Health HMO/PPO |
$18.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.39
|
| Rate for Payer: UHC Core |
$17.09
|
| Rate for Payer: UHC Core |
$17.53
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: UHC Core |
$77.76
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.79
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCN Commercial |
$18.62
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.53
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS MAPPO |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.80
|
| Rate for Payer: BCN Commercial |
$18.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.02
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.02
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: PACE Senior Care Partners |
$5.72
|
| Rate for Payer: PACE SWMI |
$6.02
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Medicare Advantage |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Medicare |
$6.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.02
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Medicare Advantage |
$6.02
|
| Rate for Payer: VA VA |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
