|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.21
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: BCBS Trust/PPO |
$18.17
|
| Rate for Payer: BCBS Trust/PPO |
$14.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.58
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: BCN Commercial |
$13.30
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Commercial |
$20.63
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.39
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Commercial |
$20.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: Priority Health HMO/PPO |
$20.87
|
| Rate for Payer: Priority Health HMO/PPO |
$19.37
|
| Rate for Payer: Priority Health HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: UHC Core |
$20.03
|
| Rate for Payer: UHC Core |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.21
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Aetna Commercial |
$20.39
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna Medicare |
$4.47
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.50
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$4.30
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$19.72
|
| Rate for Payer: BCN Commercial |
$17.31
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cash Price |
$19.19
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$20.63
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.30
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.63
|
| Rate for Payer: Nomi Health Commercial |
$19.67
|
| Rate for Payer: Nomi Health Commercial |
$14.11
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE Senior Care Partners |
$4.09
|
| Rate for Payer: PACE Senior Care Partners |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PACE SWMI |
$4.30
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PHP Commercial |
$20.39
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: PHP Medicare Advantage |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.47
|
| Rate for Payer: Priority Health HMO/PPO |
$20.87
|
| Rate for Payer: Priority Health HMO/PPO |
$14.97
|
| Rate for Payer: Priority Health HMO/PPO |
$19.37
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.53
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| Rate for Payer: Railroad Medicare Medicare |
$4.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$20.03
|
| Rate for Payer: UHC Core |
$18.59
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Exchange |
$5.57
|
| Rate for Payer: UHC Exchange |
$4.30
|
| Rate for Payer: UHC Exchange |
$6.00
|
| Rate for Payer: UHC Medicare Advantage |
$4.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
| Rate for Payer: VA VA |
$5.57
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: VA VA |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
OP
|
$58.24
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.20
|
| Rate for Payer: BCBS Complete |
$23.30
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$47.88
|
| Rate for Payer: BCN Commercial |
$45.28
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.76
|
| Rate for Payer: PACE Senior Care Partners |
$13.83
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.86
|
| Rate for Payer: Priority Health HMO/PPO |
$50.67
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.02
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.25
|
| Rate for Payer: UHC Core |
$48.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.56
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.68
|
|
|
OFLOXACIN 0.3 % EAR DROPS
|
Facility
|
IP
|
$58.24
|
|
|
Service Code
|
NDC 60505036301
|
| Hospital Charge Code |
22257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.86 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$47.54
|
| Rate for Payer: BCN Commercial |
$45.01
|
| Rate for Payer: Cash Price |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.59
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$47.76
|
| Rate for Payer: PHP Commercial |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.86
|
| Rate for Payer: Priority Health HMO/PPO |
$50.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.25
|
| Rate for Payer: UHC Core |
$48.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.68
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$26.04
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCN Commercial |
$20.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.35
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health HMO/PPO |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$6.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.45
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.51
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UHC Medicare Advantage |
$6.51
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.53
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna Medicare |
$6.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.92
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS MAPPO |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.83
|
| Rate for Payer: BCN Commercial |
$19.70
|
| Rate for Payer: BCN Medicare Advantage |
$6.33
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cofinity Commercial |
$21.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.33
|
| Rate for Payer: Healthscope Commercial |
$22.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.54
|
| Rate for Payer: Nomi Health Commercial |
$20.78
|
| Rate for Payer: PACE Senior Care Partners |
$6.02
|
| Rate for Payer: PACE SWMI |
$6.33
|
| Rate for Payer: PHP Commercial |
$21.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.47
|
| Rate for Payer: Priority Health HMO/PPO |
$22.05
|
| Rate for Payer: Priority Health Medicare |
$6.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.98
|
| Rate for Payer: Railroad Medicare Medicare |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.30
|
| Rate for Payer: UHC Core |
$21.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.33
|
| Rate for Payer: UHC Exchange |
$6.33
|
| Rate for Payer: UHC Medicare Advantage |
$6.33
|
| Rate for Payer: VA VA |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.00
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$26.04
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.26
|
| Rate for Payer: BCN Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.35
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health HMO/PPO |
$22.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.92
|
| Rate for Payer: UHC Core |
$21.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.53
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$126.42
|
|
|
Service Code
|
NDC 24208043410
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$113.78 |
| Rate for Payer: Aetna Commercial |
$107.46
|
| Rate for Payer: Aetna Medicare |
$32.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.51
|
| Rate for Payer: BCBS Complete |
$50.57
|
| Rate for Payer: BCBS MAPPO |
$31.61
|
| Rate for Payer: BCBS Trust/PPO |
$103.93
|
| Rate for Payer: BCN Commercial |
$98.29
|
| Rate for Payer: BCN Medicare Advantage |
$31.61
|
| Rate for Payer: Cash Price |
$101.14
|
| Rate for Payer: Cofinity Commercial |
$108.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.61
|
| Rate for Payer: Healthscope Commercial |
$113.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.46
|
| Rate for Payer: Nomi Health Commercial |
$103.66
|
| Rate for Payer: PACE Senior Care Partners |
$30.02
|
| Rate for Payer: PACE SWMI |
$31.61
|
| Rate for Payer: PHP Commercial |
$107.46
|
| Rate for Payer: PHP Medicare Advantage |
$31.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.17
|
| Rate for Payer: Priority Health HMO/PPO |
$109.99
|
| Rate for Payer: Priority Health Medicare |
$31.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.70
|
| Rate for Payer: Railroad Medicare Medicare |
$31.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.25
|
| Rate for Payer: UHC Core |
$105.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.61
|
| Rate for Payer: UHC Exchange |
$31.61
|
| Rate for Payer: UHC Medicare Advantage |
$31.61
|
| Rate for Payer: VA VA |
$31.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.81
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$126.42
|
|
|
Service Code
|
NDC 24208043410
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$113.78 |
| Rate for Payer: Aetna Commercial |
$107.46
|
| Rate for Payer: BCBS Trust/PPO |
$103.20
|
| Rate for Payer: BCN Commercial |
$97.70
|
| Rate for Payer: Cash Price |
$101.14
|
| Rate for Payer: Cofinity Commercial |
$108.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.14
|
| Rate for Payer: Healthscope Commercial |
$113.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.46
|
| Rate for Payer: Nomi Health Commercial |
$103.66
|
| Rate for Payer: PHP Commercial |
$107.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.17
|
| Rate for Payer: Priority Health HMO/PPO |
$109.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.25
|
| Rate for Payer: UHC Core |
$105.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.81
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
NDC 17478071310
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.92
|
| Rate for Payer: BCBS Complete |
$12.70
|
| Rate for Payer: BCBS MAPPO |
$7.94
|
| Rate for Payer: BCBS Trust/PPO |
$26.10
|
| Rate for Payer: BCN Commercial |
$24.69
|
| Rate for Payer: BCN Medicare Advantage |
$7.94
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.94
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.99
|
| Rate for Payer: Nomi Health Commercial |
$26.04
|
| Rate for Payer: PACE Senior Care Partners |
$7.54
|
| Rate for Payer: PACE SWMI |
$7.94
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: PHP Medicare Advantage |
$7.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.64
|
| Rate for Payer: Priority Health HMO/PPO |
$27.62
|
| Rate for Payer: Priority Health Medicare |
$8.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.27
|
| Rate for Payer: Railroad Medicare Medicare |
$7.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.94
|
| Rate for Payer: UHC Core |
$26.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.94
|
| Rate for Payer: UHC Exchange |
$7.94
|
| Rate for Payer: UHC Medicare Advantage |
$7.94
|
| Rate for Payer: VA VA |
$7.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.81
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.79
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$54.70
|
| Rate for Payer: BCN Commercial |
$51.73
|
| Rate for Payer: BCN Medicare Advantage |
$16.64
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.64
|
| Rate for Payer: Healthscope Commercial |
$59.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$54.56
|
| Rate for Payer: PACE Senior Care Partners |
$15.80
|
| Rate for Payer: PACE SWMI |
$16.64
|
| Rate for Payer: PHP Commercial |
$56.56
|
| Rate for Payer: PHP Medicare Advantage |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.25
|
| Rate for Payer: Priority Health HMO/PPO |
$57.89
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.58
|
| Rate for Payer: Railroad Medicare Medicare |
$16.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.56
|
| Rate for Payer: UHC Core |
$55.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.64
|
| Rate for Payer: UHC Exchange |
$16.64
|
| Rate for Payer: UHC Medicare Advantage |
$16.64
|
| Rate for Payer: VA VA |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.91
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: BCBS Trust/PPO |
$54.32
|
| Rate for Payer: BCN Commercial |
$51.42
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.23
|
| Rate for Payer: Healthscope Commercial |
$59.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$54.56
|
| Rate for Payer: PHP Commercial |
$56.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.25
|
| Rate for Payer: Priority Health HMO/PPO |
$57.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.56
|
| Rate for Payer: UHC Core |
$55.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.91
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.58
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cofinity Commercial |
$21.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.27
|
| Rate for Payer: Healthscope Commercial |
$22.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.54
|
| Rate for Payer: Nomi Health Commercial |
$20.78
|
| Rate for Payer: PHP Commercial |
$21.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.47
|
| Rate for Payer: Priority Health HMO/PPO |
$22.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.30
|
| Rate for Payer: UHC Core |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.00
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$31.75
|
|
|
Service Code
|
NDC 17478071310
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: BCBS Trust/PPO |
$25.92
|
| Rate for Payer: BCN Commercial |
$24.54
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.99
|
| Rate for Payer: Nomi Health Commercial |
$26.04
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.64
|
| Rate for Payer: Priority Health HMO/PPO |
$27.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.94
|
| Rate for Payer: UHC Core |
$26.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.81
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$118.56
|
|
|
Service Code
|
NDC 33342008407
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Medicare |
$30.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.05
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS MAPPO |
$29.64
|
| Rate for Payer: BCBS Trust/PPO |
$97.47
|
| Rate for Payer: BCN Commercial |
$92.18
|
| Rate for Payer: BCN Medicare Advantage |
$29.64
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cofinity Commercial |
$101.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$106.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.78
|
| Rate for Payer: Nomi Health Commercial |
$97.22
|
| Rate for Payer: PACE Senior Care Partners |
$28.16
|
| Rate for Payer: PACE SWMI |
$29.64
|
| Rate for Payer: PHP Commercial |
$100.78
|
| Rate for Payer: PHP Medicare Advantage |
$29.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.06
|
| Rate for Payer: Priority Health HMO/PPO |
$103.15
|
| Rate for Payer: Priority Health Medicare |
$29.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.44
|
| Rate for Payer: Railroad Medicare Medicare |
$29.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.33
|
| Rate for Payer: UHC Core |
$99.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.64
|
| Rate for Payer: UHC Exchange |
$29.64
|
| Rate for Payer: UHC Medicare Advantage |
$29.64
|
| Rate for Payer: VA VA |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.92
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$118.56
|
|
|
Service Code
|
NDC 33342008407
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: BCBS Trust/PPO |
$96.78
|
| Rate for Payer: BCN Commercial |
$91.62
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cofinity Commercial |
$101.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.85
|
| Rate for Payer: Healthscope Commercial |
$106.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.78
|
| Rate for Payer: Nomi Health Commercial |
$97.22
|
| Rate for Payer: PHP Commercial |
$100.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.06
|
| Rate for Payer: Priority Health HMO/PPO |
$103.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.33
|
| Rate for Payer: UHC Core |
$99.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.92
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$113.84
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Commercial |
$132.51
|
| Rate for Payer: Aetna Medicare |
$40.53
|
| Rate for Payer: Aetna Medicare |
$29.60
|
| Rate for Payer: Aetna Medicare |
$14.01
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.58
|
| Rate for Payer: BCBS Complete |
$45.54
|
| Rate for Payer: BCBS Complete |
$62.36
|
| Rate for Payer: BCBS Complete |
$31.15
|
| Rate for Payer: BCBS Complete |
$21.56
|
| Rate for Payer: BCBS MAPPO |
$28.46
|
| Rate for Payer: BCBS MAPPO |
$38.97
|
| Rate for Payer: BCBS MAPPO |
$19.47
|
| Rate for Payer: BCBS MAPPO |
$13.47
|
| Rate for Payer: BCBS Trust/PPO |
$93.59
|
| Rate for Payer: BCBS Trust/PPO |
$64.03
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCBS Trust/PPO |
$44.30
|
| Rate for Payer: BCN Commercial |
$88.51
|
| Rate for Payer: BCN Commercial |
$41.90
|
| Rate for Payer: BCN Commercial |
$121.20
|
| Rate for Payer: BCN Commercial |
$60.55
|
| Rate for Payer: BCN Medicare Advantage |
$38.97
|
| Rate for Payer: BCN Medicare Advantage |
$19.47
|
| Rate for Payer: BCN Medicare Advantage |
$28.46
|
| Rate for Payer: BCN Medicare Advantage |
$13.47
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$124.71
|
| Rate for Payer: Cofinity Commercial |
$66.98
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Healthscope Commercial |
$70.09
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$140.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Nomi Health Commercial |
$44.19
|
| Rate for Payer: Nomi Health Commercial |
$63.86
|
| Rate for Payer: Nomi Health Commercial |
$93.35
|
| Rate for Payer: Nomi Health Commercial |
$127.83
|
| Rate for Payer: PACE Senior Care Partners |
$27.04
|
| Rate for Payer: PACE Senior Care Partners |
$12.80
|
| Rate for Payer: PACE Senior Care Partners |
$18.50
|
| Rate for Payer: PACE Senior Care Partners |
$37.02
|
| Rate for Payer: PACE SWMI |
$38.97
|
| Rate for Payer: PACE SWMI |
$28.46
|
| Rate for Payer: PACE SWMI |
$13.47
|
| Rate for Payer: PACE SWMI |
$19.47
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$66.20
|
| Rate for Payer: PHP Commercial |
$132.51
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: PHP Medicare Advantage |
$38.97
|
| Rate for Payer: PHP Medicare Advantage |
$28.46
|
| Rate for Payer: PHP Medicare Advantage |
$19.47
|
| Rate for Payer: PHP Medicare Advantage |
$13.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.00
|
| Rate for Payer: Priority Health HMO/PPO |
$135.62
|
| Rate for Payer: Priority Health HMO/PPO |
$67.76
|
| Rate for Payer: Priority Health HMO/PPO |
$46.88
|
| Rate for Payer: Priority Health HMO/PPO |
$99.04
|
| Rate for Payer: Priority Health Medicare |
$13.61
|
| Rate for Payer: Priority Health Medicare |
$28.74
|
| Rate for Payer: Priority Health Medicare |
$39.36
|
| Rate for Payer: Priority Health Medicare |
$19.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.27
|
| Rate for Payer: Railroad Medicare Medicare |
$38.97
|
| Rate for Payer: Railroad Medicare Medicare |
$13.47
|
| Rate for Payer: Railroad Medicare Medicare |
$28.46
|
| Rate for Payer: Railroad Medicare Medicare |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.18
|
| Rate for Payer: UHC Core |
$95.06
|
| Rate for Payer: UHC Core |
$65.03
|
| Rate for Payer: UHC Core |
$130.17
|
| Rate for Payer: UHC Core |
$45.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.97
|
| Rate for Payer: UHC Exchange |
$19.47
|
| Rate for Payer: UHC Exchange |
$38.97
|
| Rate for Payer: UHC Exchange |
$28.46
|
| Rate for Payer: UHC Exchange |
$13.47
|
| Rate for Payer: UHC Medicare Advantage |
$19.47
|
| Rate for Payer: UHC Medicare Advantage |
$28.46
|
| Rate for Payer: UHC Medicare Advantage |
$13.47
|
| Rate for Payer: UHC Medicare Advantage |
$38.97
|
| Rate for Payer: VA VA |
$38.97
|
| Rate for Payer: VA VA |
$19.47
|
| Rate for Payer: VA VA |
$13.47
|
| Rate for Payer: VA VA |
$28.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$53.89
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Commercial |
$132.51
|
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: BCBS Trust/PPO |
$43.99
|
| Rate for Payer: BCBS Trust/PPO |
$63.57
|
| Rate for Payer: BCBS Trust/PPO |
$127.25
|
| Rate for Payer: BCBS Trust/PPO |
$92.93
|
| Rate for Payer: BCN Commercial |
$41.65
|
| Rate for Payer: BCN Commercial |
$87.98
|
| Rate for Payer: BCN Commercial |
$60.19
|
| Rate for Payer: BCN Commercial |
$120.47
|
| Rate for Payer: Cash Price |
$124.71
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Commercial |
$66.98
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Healthscope Commercial |
$70.09
|
| Rate for Payer: Healthscope Commercial |
$140.30
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.20
|
| Rate for Payer: Nomi Health Commercial |
$93.35
|
| Rate for Payer: Nomi Health Commercial |
$127.83
|
| Rate for Payer: Nomi Health Commercial |
$63.86
|
| Rate for Payer: Nomi Health Commercial |
$44.19
|
| Rate for Payer: PHP Commercial |
$132.51
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$66.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.03
|
| Rate for Payer: Priority Health HMO/PPO |
$46.88
|
| Rate for Payer: Priority Health HMO/PPO |
$67.76
|
| Rate for Payer: Priority Health HMO/PPO |
$99.04
|
| Rate for Payer: Priority Health HMO/PPO |
$135.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.42
|
| Rate for Payer: UHC Core |
$45.00
|
| Rate for Payer: UHC Core |
$65.03
|
| Rate for Payer: UHC Core |
$130.17
|
| Rate for Payer: UHC Core |
$95.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
IP
|
$70.97
|
|
|
Service Code
|
NDC 43598016630
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.13 |
| Max. Negotiated Rate |
$63.87 |
| Rate for Payer: Aetna Commercial |
$60.32
|
| Rate for Payer: BCBS Trust/PPO |
$57.93
|
| Rate for Payer: BCN Commercial |
$54.85
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Cofinity Commercial |
$61.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.78
|
| Rate for Payer: Healthscope Commercial |
$63.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.32
|
| Rate for Payer: Nomi Health Commercial |
$58.20
|
| Rate for Payer: PHP Commercial |
$60.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.13
|
| Rate for Payer: Priority Health HMO/PPO |
$61.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.45
|
| Rate for Payer: UHC Core |
$59.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.23
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
OP
|
$70.97
|
|
|
Service Code
|
NDC 43598016630
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$63.87 |
| Rate for Payer: Aetna Commercial |
$60.32
|
| Rate for Payer: Aetna Medicare |
$18.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.18
|
| Rate for Payer: BCBS Complete |
$28.39
|
| Rate for Payer: BCBS MAPPO |
$17.74
|
| Rate for Payer: BCBS Trust/PPO |
$58.34
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: BCN Medicare Advantage |
$17.74
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Cofinity Commercial |
$61.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$63.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.32
|
| Rate for Payer: Nomi Health Commercial |
$58.20
|
| Rate for Payer: PACE Senior Care Partners |
$16.86
|
| Rate for Payer: PACE SWMI |
$17.74
|
| Rate for Payer: PHP Commercial |
$60.32
|
| Rate for Payer: PHP Medicare Advantage |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.13
|
| Rate for Payer: Priority Health HMO/PPO |
$61.74
|
| Rate for Payer: Priority Health Medicare |
$17.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.45
|
| Rate for Payer: UHC Core |
$59.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.74
|
| Rate for Payer: UHC Exchange |
$17.74
|
| Rate for Payer: UHC Medicare Advantage |
$17.74
|
| Rate for Payer: VA VA |
$17.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.23
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00904628361
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$70.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| Rate for Payer: BCBS MAPPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$224.10
|
| Rate for Payer: BCN Commercial |
$211.95
|
| Rate for Payer: BCN Medicare Advantage |
$68.15
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.15
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: PACE Senior Care Partners |
$64.74
|
| Rate for Payer: PACE SWMI |
$68.15
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Medicare |
$68.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.64
|
| Rate for Payer: Railroad Medicare Medicare |
$68.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.15
|
| Rate for Payer: UHC Exchange |
$68.15
|
| Rate for Payer: UHC Medicare Advantage |
$68.15
|
| Rate for Payer: VA VA |
$68.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00904628361
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.19 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: BCBS Trust/PPO |
$222.52
|
| Rate for Payer: BCN Commercial |
$210.67
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$300.80
|
|
|
Service Code
|
NDC 60505311000
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna Medicare |
$78.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.00
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS MAPPO |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$247.29
|
| Rate for Payer: BCN Commercial |
$233.87
|
| Rate for Payer: BCN Medicare Advantage |
$75.20
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.20
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: Nomi Health Commercial |
$246.66
|
| Rate for Payer: PACE Senior Care Partners |
$71.44
|
| Rate for Payer: PACE SWMI |
$75.20
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: PHP Medicare Advantage |
$75.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health HMO/PPO |
$261.70
|
| Rate for Payer: Priority Health Medicare |
$75.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.54
|
| Rate for Payer: Railroad Medicare Medicare |
$75.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.70
|
| Rate for Payer: UHC Core |
$251.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.20
|
| Rate for Payer: UHC Exchange |
$75.20
|
| Rate for Payer: UHC Medicare Advantage |
$75.20
|
| Rate for Payer: VA VA |
$75.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$300.80
|
|
|
Service Code
|
NDC 60505311000
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.52 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: BCBS Trust/PPO |
$245.54
|
| Rate for Payer: BCN Commercial |
$232.46
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: Nomi Health Commercial |
$246.66
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health HMO/PPO |
$261.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.70
|
| Rate for Payer: UHC Core |
$251.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: Aetna Medicare |
$2.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.41
|
| Rate for Payer: BCBS Complete |
$3.09
|
| Rate for Payer: BCBS MAPPO |
$1.93
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.00
|
| Rate for Payer: BCN Medicare Advantage |
$1.93
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.56
|
| Rate for Payer: Nomi Health Commercial |
$6.33
|
| Rate for Payer: PACE Senior Care Partners |
$1.83
|
| Rate for Payer: PACE SWMI |
$1.93
|
| Rate for Payer: PHP Commercial |
$6.56
|
| Rate for Payer: PHP Medicare Advantage |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health HMO/PPO |
$6.72
|
| Rate for Payer: Priority Health Medicare |
$1.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.79
|
| Rate for Payer: UHC Core |
$6.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.93
|
| Rate for Payer: UHC Exchange |
$1.93
|
| Rate for Payer: UHC Medicare Advantage |
$1.93
|
| Rate for Payer: VA VA |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.79
|
|
