|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
NDC 79854020060
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$165.18
|
| Rate for Payer: BCN Commercial |
$165.18
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
NDC 79854020060
|
| Hospital Charge Code |
2012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.26 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.50
|
| Rate for Payer: BCBS Complete |
$37.02
|
| Rate for Payer: BCBS MAPPO |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.42
|
| Rate for Payer: BCN Commercial |
$164.42
|
| Rate for Payer: BCN Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Mclaren Medicaid |
$35.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.50
|
| Rate for Payer: Meridian Medicaid |
$37.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PACE Senior Care Partners |
$47.50
|
| Rate for Payer: PACE SWMI |
$50.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$50.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.00
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.20
|
| Rate for Payer: Railroad Medicare Medicare |
$50.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.00
|
| Rate for Payer: UHC Core |
$167.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
| Rate for Payer: UHC Medicaid |
$35.26
|
| Rate for Payer: UHC Medicare Advantage |
$50.00
|
| Rate for Payer: UHCCP Medicaid |
$35.26
|
| Rate for Payer: VA VA |
$50.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$16.97
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Commercial |
$14.02
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Healthscope Commercial |
$15.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.42
|
| Rate for Payer: Nomi Health Commercial |
$13.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.73
|
| Rate for Payer: PHP Commercial |
$14.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.93
|
| Rate for Payer: UHC Core |
$14.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.73
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: Aetna Medicare |
$4.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.89
|
| Rate for Payer: BCBS Complete |
$3.49
|
| Rate for Payer: BCBS MAPPO |
$4.71
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$15.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.71
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.71
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Mclaren Medicaid |
$3.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.95
|
| Rate for Payer: Meridian Medicaid |
$3.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: PACE Senior Care Partners |
$4.48
|
| Rate for Payer: PACE SWMI |
$4.71
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: PHP Medicare Advantage |
$4.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.41
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.13
|
| Rate for Payer: Railroad Medicare Medicare |
$4.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.60
|
| Rate for Payer: UHC Core |
$15.75
|
| Rate for Payer: UHC Exchange |
$4.71
|
| Rate for Payer: UHC Medicaid |
$3.33
|
| Rate for Payer: UHC Medicare Advantage |
$4.71
|
| Rate for Payer: UHCCP Medicaid |
$3.33
|
| Rate for Payer: VA VA |
$4.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.58
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS MAPPO |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$33.09
|
| Rate for Payer: BCN Commercial |
$33.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.06
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.06
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.57
|
| Rate for Payer: Meridian Medicaid |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: PACE Senior Care Partners |
$9.56
|
| Rate for Payer: PACE SWMI |
$10.06
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: PHP Medicare Advantage |
$10.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.02
|
| Rate for Payer: Priority Health Medicare |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.01
|
| Rate for Payer: Railroad Medicare Medicare |
$10.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.42
|
| Rate for Payer: UHC Core |
$33.61
|
| Rate for Payer: UHC Exchange |
$10.06
|
| Rate for Payer: UHC Medicaid |
$7.10
|
| Rate for Payer: UHC Medicare Advantage |
$10.06
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
NDC 17478010002
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Aetna Commercial |
$16.03
|
| Rate for Payer: BCBS Trust/PPO |
$15.58
|
| Rate for Payer: BCN Commercial |
$15.58
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.09
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.03
|
| Rate for Payer: Nomi Health Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.14
|
| Rate for Payer: PHP Commercial |
$16.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.60
|
| Rate for Payer: UHC Core |
$15.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.14
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
OP
|
$16.97
|
|
|
Service Code
|
NDC 61314039601
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$4.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.30
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: BCBS MAPPO |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCN Commercial |
$13.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.24
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$15.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.73
|
| Rate for Payer: Mclaren Medicaid |
$2.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.45
|
| Rate for Payer: Meridian Medicaid |
$3.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.42
|
| Rate for Payer: Nomi Health Commercial |
$13.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.73
|
| Rate for Payer: PACE Senior Care Partners |
$4.03
|
| Rate for Payer: PACE SWMI |
$4.24
|
| Rate for Payer: PHP Commercial |
$14.42
|
| Rate for Payer: PHP Medicare Advantage |
$4.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.76
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.93
|
| Rate for Payer: UHC Core |
$14.17
|
| Rate for Payer: UHC Exchange |
$4.24
|
| Rate for Payer: UHC Medicaid |
$2.99
|
| Rate for Payer: UHC Medicare Advantage |
$4.24
|
| Rate for Payer: UHCCP Medicaid |
$2.99
|
| Rate for Payer: VA VA |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.73
|
|
|
CYCLOPENTOLATE 1 % EYE DROPS
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
NDC 24208073501
|
| Hospital Charge Code |
2025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna Commercial |
$34.21
|
| Rate for Payer: BCBS Trust/PPO |
$33.24
|
| Rate for Payer: BCN Commercial |
$33.24
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$34.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$36.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$33.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.19
|
| Rate for Payer: PHP Commercial |
$34.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.42
|
| Rate for Payer: UHC Core |
$33.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.19
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
IP
|
$114.98
|
|
|
Service Code
|
NDC 00065035902
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$103.48 |
| Rate for Payer: Aetna Commercial |
$97.73
|
| Rate for Payer: BCBS Trust/PPO |
$94.96
|
| Rate for Payer: BCN Commercial |
$94.96
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cofinity Commercial |
$98.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.98
|
| Rate for Payer: Healthscope Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.73
|
| Rate for Payer: Nomi Health Commercial |
$94.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.23
|
| Rate for Payer: PHP Commercial |
$97.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.18
|
| Rate for Payer: UHC Core |
$96.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.23
|
|
|
CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS
|
Facility
|
OP
|
$114.98
|
|
|
Service Code
|
NDC 00065035902
|
| Hospital Charge Code |
9701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$103.48 |
| Rate for Payer: Aetna Commercial |
$97.73
|
| Rate for Payer: Aetna Medicare |
$29.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.93
|
| Rate for Payer: BCBS Complete |
$21.28
|
| Rate for Payer: BCBS MAPPO |
$28.75
|
| Rate for Payer: BCBS Trust/PPO |
$94.53
|
| Rate for Payer: BCN Commercial |
$94.53
|
| Rate for Payer: BCN Medicare Advantage |
$28.75
|
| Rate for Payer: Cash Price |
$91.98
|
| Rate for Payer: Cofinity Commercial |
$98.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.75
|
| Rate for Payer: Healthscope Commercial |
$103.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.23
|
| Rate for Payer: Mclaren Medicaid |
$20.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.18
|
| Rate for Payer: Meridian Medicaid |
$21.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.73
|
| Rate for Payer: Nomi Health Commercial |
$94.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.23
|
| Rate for Payer: PACE Senior Care Partners |
$27.31
|
| Rate for Payer: PACE SWMI |
$28.75
|
| Rate for Payer: PHP Commercial |
$97.73
|
| Rate for Payer: PHP Medicare Advantage |
$28.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$100.03
|
| Rate for Payer: Priority Health Medicare |
$29.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.03
|
| Rate for Payer: Railroad Medicare Medicare |
$28.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.18
|
| Rate for Payer: UHC Core |
$96.01
|
| Rate for Payer: UHC Exchange |
$28.75
|
| Rate for Payer: UHC Medicaid |
$20.27
|
| Rate for Payer: UHC Medicare Advantage |
$28.75
|
| Rate for Payer: UHCCP Medicaid |
$20.27
|
| Rate for Payer: VA VA |
$28.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.23
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
IP
|
$122.84
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Aetna Commercial |
$104.41
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$101.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$101.45
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$98.27
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$105.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.27
|
| Rate for Payer: Healthscope Commercial |
$110.56
|
| Rate for Payer: Healthscope Commercial |
$3.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Nomi Health Commercial |
$100.73
|
| Rate for Payer: Nomi Health Commercial |
$3.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$104.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.61
|
| Rate for Payer: UHC Core |
$102.57
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.08
|
|
|
CYCLOSPORINE MODIFIED 25 MG CAPSULE
|
Facility
|
OP
|
$122.84
|
|
|
Service Code
|
HCPCS J7515
|
| Hospital Charge Code |
28842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.66 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Aetna Commercial |
$104.41
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Aetna Medicare |
$31.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.28
|
| Rate for Payer: BCBS Complete |
$22.74
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$30.71
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$100.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$100.99
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: BCN Medicare Advantage |
$30.71
|
| Rate for Payer: Cash Price |
$98.27
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$105.64
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.71
|
| Rate for Payer: Healthscope Commercial |
$110.56
|
| Rate for Payer: Healthscope Commercial |
$3.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.08
|
| Rate for Payer: Mclaren Medicaid |
$0.72
|
| Rate for Payer: Mclaren Medicaid |
$21.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.25
|
| Rate for Payer: Meridian Medicaid |
$22.74
|
| Rate for Payer: Meridian Medicaid |
$0.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.41
|
| Rate for Payer: Nomi Health Commercial |
$3.36
|
| Rate for Payer: Nomi Health Commercial |
$100.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.08
|
| Rate for Payer: PACE Senior Care Partners |
$0.97
|
| Rate for Payer: PACE Senior Care Partners |
$29.17
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PACE SWMI |
$30.71
|
| Rate for Payer: PHP Commercial |
$104.41
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: PHP Medicare Advantage |
$30.71
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.87
|
| Rate for Payer: Priority Health Medicare |
$1.04
|
| Rate for Payer: Priority Health Medicare |
$31.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: Railroad Medicare Medicare |
$30.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.61
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Core |
$102.57
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Exchange |
$30.71
|
| Rate for Payer: UHC Medicaid |
$0.72
|
| Rate for Payer: UHC Medicaid |
$21.66
|
| Rate for Payer: UHC Medicare Advantage |
$30.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.02
|
| Rate for Payer: UHCCP Medicaid |
$21.66
|
| Rate for Payer: UHCCP Medicaid |
$0.72
|
| Rate for Payer: VA VA |
$30.71
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.13
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$14,959.62
|
|
|
Service Code
|
APR-DRG 1314
|
| Min. Negotiated Rate |
$14,247.26 |
| Max. Negotiated Rate |
$14,959.62 |
| Rate for Payer: BCBS Complete |
$14,959.62
|
| Rate for Payer: Mclaren Medicaid |
$14,247.26
|
| Rate for Payer: Meridian Medicaid |
$14,959.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,247.26
|
| Rate for Payer: UHC Medicaid |
$14,247.26
|
| Rate for Payer: UHCCP Medicaid |
$14,247.26
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$14,141.42
|
|
|
Service Code
|
APR-DRG 1313
|
| Min. Negotiated Rate |
$13,468.01 |
| Max. Negotiated Rate |
$14,141.42 |
| Rate for Payer: BCBS Complete |
$14,141.42
|
| Rate for Payer: Mclaren Medicaid |
$13,468.01
|
| Rate for Payer: Meridian Medicaid |
$14,141.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,468.01
|
| Rate for Payer: UHC Medicaid |
$13,468.01
|
| Rate for Payer: UHCCP Medicaid |
$13,468.01
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$7,154.05
|
|
|
Service Code
|
APR-DRG 1311
|
| Min. Negotiated Rate |
$6,813.38 |
| Max. Negotiated Rate |
$7,154.05 |
| Rate for Payer: BCBS Complete |
$7,154.05
|
| Rate for Payer: Mclaren Medicaid |
$6,813.38
|
| Rate for Payer: Meridian Medicaid |
$7,154.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,813.38
|
| Rate for Payer: UHC Medicaid |
$6,813.38
|
| Rate for Payer: UHCCP Medicaid |
$6,813.38
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$11,685.22
|
|
|
Service Code
|
APR-DRG 1312
|
| Min. Negotiated Rate |
$11,128.78 |
| Max. Negotiated Rate |
$11,685.22 |
| Rate for Payer: BCBS Complete |
$11,685.22
|
| Rate for Payer: Mclaren Medicaid |
$11,128.78
|
| Rate for Payer: Meridian Medicaid |
$11,685.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,128.78
|
| Rate for Payer: UHC Medicaid |
$11,128.78
|
| Rate for Payer: UHCCP Medicaid |
$11,128.78
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
IP
|
$679.99
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$473.27 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: BCBS Trust/PPO |
$561.60
|
| Rate for Payer: BCN Commercial |
$561.60
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Nomi Health Commercial |
$557.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.99
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$591.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$473.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.39
|
| Rate for Payer: UHC Core |
$567.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DABIGATRAN ETEXILATE 75 MG CAPSULE
|
Facility
|
OP
|
$679.99
|
|
|
Service Code
|
NDC 00597035556
|
| Hospital Charge Code |
106490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.88 |
| Max. Negotiated Rate |
$611.99 |
| Rate for Payer: Aetna Commercial |
$577.99
|
| Rate for Payer: Aetna Medicare |
$176.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.50
|
| Rate for Payer: BCBS Complete |
$125.87
|
| Rate for Payer: BCBS MAPPO |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$559.02
|
| Rate for Payer: BCN Commercial |
$559.02
|
| Rate for Payer: BCN Medicare Advantage |
$170.00
|
| Rate for Payer: Cash Price |
$543.99
|
| Rate for Payer: Cofinity Commercial |
$584.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.00
|
| Rate for Payer: Healthscope Commercial |
$611.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.99
|
| Rate for Payer: Mclaren Medicaid |
$119.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.50
|
| Rate for Payer: Meridian Medicaid |
$125.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.99
|
| Rate for Payer: Nomi Health Commercial |
$557.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.99
|
| Rate for Payer: PACE Senior Care Partners |
$161.50
|
| Rate for Payer: PACE SWMI |
$170.00
|
| Rate for Payer: PHP Commercial |
$577.99
|
| Rate for Payer: PHP Medicare Advantage |
$170.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$591.59
|
| Rate for Payer: Priority Health Medicare |
$171.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$473.27
|
| Rate for Payer: Railroad Medicare Medicare |
$170.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.39
|
| Rate for Payer: UHC Core |
$567.79
|
| Rate for Payer: UHC Exchange |
$170.00
|
| Rate for Payer: UHC Medicaid |
$119.88
|
| Rate for Payer: UHC Medicare Advantage |
$170.00
|
| Rate for Payer: UHCCP Medicaid |
$119.88
|
| Rate for Payer: VA VA |
$170.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.99
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.37 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: BCBS Trust/PPO |
$180.81
|
| Rate for Payer: BCN Commercial |
$180.81
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: Nomi Health Commercial |
$179.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.19
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.65
|
| Rate for Payer: UHC Core |
$182.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.19
|
|
|
DANTROLENE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$218.92
|
|
|
Service Code
|
NDC 27505000367
|
| Hospital Charge Code |
9716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Aetna Commercial |
$186.08
|
| Rate for Payer: Aetna Medicare |
$56.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.41
|
| Rate for Payer: BCBS Complete |
$40.52
|
| Rate for Payer: BCBS MAPPO |
$54.73
|
| Rate for Payer: BCBS Trust/PPO |
$179.97
|
| Rate for Payer: BCN Commercial |
$179.97
|
| Rate for Payer: BCN Medicare Advantage |
$54.73
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Cofinity Commercial |
$188.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.73
|
| Rate for Payer: Healthscope Commercial |
$197.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.19
|
| Rate for Payer: Mclaren Medicaid |
$38.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.47
|
| Rate for Payer: Meridian Medicaid |
$40.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.08
|
| Rate for Payer: Nomi Health Commercial |
$179.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.19
|
| Rate for Payer: PACE Senior Care Partners |
$51.99
|
| Rate for Payer: PACE SWMI |
$54.73
|
| Rate for Payer: PHP Commercial |
$186.08
|
| Rate for Payer: PHP Medicare Advantage |
$54.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.46
|
| Rate for Payer: Priority Health Medicare |
$55.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.37
|
| Rate for Payer: Railroad Medicare Medicare |
$54.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.65
|
| Rate for Payer: UHC Core |
$182.80
|
| Rate for Payer: UHC Exchange |
$54.73
|
| Rate for Payer: UHC Medicaid |
$38.60
|
| Rate for Payer: UHC Medicare Advantage |
$54.73
|
| Rate for Payer: UHCCP Medicaid |
$38.60
|
| Rate for Payer: VA VA |
$54.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.19
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
IP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621039
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$974.51 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,156.39
|
| Rate for Payer: BCN Commercial |
$1,156.39
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: Nomi Health Commercial |
$1,148.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,050.12
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,218.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$974.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,232.14
|
| Rate for Payer: UHC Core |
$1,169.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
|
DAPAGLIFLOZIN PROPANEDIOL 10 MG TABLET
|
Facility
|
OP
|
$1,400.16
|
|
|
Service Code
|
NDC 00310621039
|
| Hospital Charge Code |
169524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.85 |
| Max. Negotiated Rate |
$1,260.14 |
| Rate for Payer: Aetna Commercial |
$1,190.14
|
| Rate for Payer: Aetna Medicare |
$364.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.55
|
| Rate for Payer: BCBS Complete |
$259.17
|
| Rate for Payer: BCBS MAPPO |
$350.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.07
|
| Rate for Payer: BCN Commercial |
$1,151.07
|
| Rate for Payer: BCN Medicare Advantage |
$350.04
|
| Rate for Payer: Cash Price |
$1,120.13
|
| Rate for Payer: Cofinity Commercial |
$1,204.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.04
|
| Rate for Payer: Healthscope Commercial |
$1,260.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.12
|
| Rate for Payer: Mclaren Medicaid |
$246.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.54
|
| Rate for Payer: Meridian Medicaid |
$259.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$385.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.14
|
| Rate for Payer: Nomi Health Commercial |
$1,148.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,050.12
|
| Rate for Payer: PACE Senior Care Partners |
$332.54
|
| Rate for Payer: PACE SWMI |
$350.04
|
| Rate for Payer: PHP Commercial |
$1,190.14
|
| Rate for Payer: PHP Medicare Advantage |
$350.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,218.14
|
| Rate for Payer: Priority Health Medicare |
$353.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$974.51
|
| Rate for Payer: Railroad Medicare Medicare |
$350.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,232.14
|
| Rate for Payer: UHC Core |
$1,169.13
|
| Rate for Payer: UHC Exchange |
$350.04
|
| Rate for Payer: UHC Medicaid |
$246.85
|
| Rate for Payer: UHC Medicare Advantage |
$350.04
|
| Rate for Payer: UHCCP Medicaid |
$246.85
|
| Rate for Payer: VA VA |
$350.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.12
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$36.85
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$33.16 |
| Rate for Payer: Aetna Commercial |
$31.32
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$48.49
|
| Rate for Payer: Aetna Medicare |
$14.83
|
| Rate for Payer: Aetna Medicare |
$9.58
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.52
|
| Rate for Payer: BCBS Complete |
$16.99
|
| Rate for Payer: BCBS Complete |
$10.56
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Complete |
$15.86
|
| Rate for Payer: BCBS MAPPO |
$9.21
|
| Rate for Payer: BCBS MAPPO |
$14.26
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$70.43
|
| Rate for Payer: BCBS Trust/PPO |
$30.29
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCBS Trust/PPO |
$46.90
|
| Rate for Payer: BCN Commercial |
$70.43
|
| Rate for Payer: BCN Commercial |
$75.47
|
| Rate for Payer: BCN Commercial |
$46.90
|
| Rate for Payer: BCN Commercial |
$30.29
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: BCN Medicare Advantage |
$14.26
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: BCN Medicare Advantage |
$9.21
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$29.48
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Cofinity Commercial |
$49.06
|
| Rate for Payer: Cofinity Commercial |
$31.69
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$33.16
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.64
|
| Rate for Payer: Mclaren Medicaid |
$15.10
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicaid |
$6.50
|
| Rate for Payer: Mclaren Medicaid |
$16.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.67
|
| Rate for Payer: Meridian Medicaid |
$6.82
|
| Rate for Payer: Meridian Medicaid |
$15.86
|
| Rate for Payer: Meridian Medicaid |
$16.99
|
| Rate for Payer: Meridian Medicaid |
$10.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$70.25
|
| Rate for Payer: Nomi Health Commercial |
$30.22
|
| Rate for Payer: Nomi Health Commercial |
$46.78
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.64
|
| Rate for Payer: PACE Senior Care Partners |
$20.35
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE Senior Care Partners |
$8.75
|
| Rate for Payer: PACE Senior Care Partners |
$13.55
|
| Rate for Payer: PACE SWMI |
$9.21
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PACE SWMI |
$14.26
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$31.32
|
| Rate for Payer: PHP Commercial |
$48.49
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$9.21
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: PHP Medicare Advantage |
$14.26
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.06
|
| Rate for Payer: Priority Health Medicare |
$14.41
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Medicare |
$21.63
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.65
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: Railroad Medicare Medicare |
$9.21
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: Railroad Medicare Medicare |
$14.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$30.77
|
| Rate for Payer: UHC Core |
$71.53
|
| Rate for Payer: UHC Core |
$47.64
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Exchange |
$14.26
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Exchange |
$9.21
|
| Rate for Payer: UHC Medicaid |
$6.50
|
| Rate for Payer: UHC Medicaid |
$10.06
|
| Rate for Payer: UHC Medicaid |
$15.10
|
| Rate for Payer: UHC Medicaid |
$16.18
|
| Rate for Payer: UHC Medicare Advantage |
$14.26
|
| Rate for Payer: UHC Medicare Advantage |
$9.21
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$15.10
|
| Rate for Payer: UHCCP Medicaid |
$16.18
|
| Rate for Payer: UHCCP Medicaid |
$10.06
|
| Rate for Payer: UHCCP Medicaid |
$6.50
|
| Rate for Payer: VA VA |
$9.21
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: VA VA |
$14.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$85.67
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.63 |
| Max. Negotiated Rate |
$77.10 |
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Commercial |
$48.49
|
| Rate for Payer: Aetna Commercial |
$31.32
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$70.75
|
| Rate for Payer: BCBS Trust/PPO |
$75.82
|
| Rate for Payer: BCBS Trust/PPO |
$47.12
|
| Rate for Payer: BCBS Trust/PPO |
$30.43
|
| Rate for Payer: BCN Commercial |
$70.75
|
| Rate for Payer: BCN Commercial |
$30.43
|
| Rate for Payer: BCN Commercial |
$75.82
|
| Rate for Payer: BCN Commercial |
$47.12
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$29.48
|
| Rate for Payer: Cofinity Commercial |
$31.69
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$49.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$33.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$30.22
|
| Rate for Payer: Nomi Health Commercial |
$46.78
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Nomi Health Commercial |
$70.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$31.32
|
| Rate for Payer: PHP Commercial |
$48.49
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.39
|
| Rate for Payer: UHC Core |
$71.53
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Core |
$47.64
|
| Rate for Payer: UHC Core |
$30.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.19
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$116.27 |
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: Aetna Commercial |
$55.42
|
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Medicare |
$16.95
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$16.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.38
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS Complete |
$23.91
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS MAPPO |
$16.30
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS MAPPO |
$16.30
|
| Rate for Payer: BCBS Trust/PPO |
$106.21
|
| Rate for Payer: BCBS Trust/PPO |
$53.59
|
| Rate for Payer: BCBS Trust/PPO |
$53.60
|
| Rate for Payer: BCN Commercial |
$53.59
|
| Rate for Payer: BCN Commercial |
$53.60
|
| Rate for Payer: BCN Commercial |
$106.21
|
| Rate for Payer: BCN Medicare Advantage |
$16.30
|
| Rate for Payer: BCN Medicare Advantage |
$16.30
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$58.67
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$58.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.89
|
| Rate for Payer: Mclaren Medicaid |
$22.78
|
| Rate for Payer: Mclaren Medicaid |
$11.49
|
| Rate for Payer: Mclaren Medicaid |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.11
|
| Rate for Payer: Meridian Medicaid |
$12.07
|
| Rate for Payer: Meridian Medicaid |
$23.91
|
| Rate for Payer: Meridian Medicaid |
$12.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Nomi Health Commercial |
$53.46
|
| Rate for Payer: Nomi Health Commercial |
$53.46
|
| Rate for Payer: Nomi Health Commercial |
$105.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.89
|
| Rate for Payer: PACE Senior Care Partners |
$15.48
|
| Rate for Payer: PACE Senior Care Partners |
$30.68
|
| Rate for Payer: PACE Senior Care Partners |
$15.48
|
| Rate for Payer: PACE SWMI |
$16.30
|
| Rate for Payer: PACE SWMI |
$16.30
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Commercial |
$55.42
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Medicare Advantage |
$16.30
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: PHP Medicare Advantage |
$16.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$112.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.72
|
| Rate for Payer: Priority Health Medicare |
$16.46
|
| Rate for Payer: Priority Health Medicare |
$16.46
|
| Rate for Payer: Priority Health Medicare |
$32.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16.30
|
| Rate for Payer: Railroad Medicare Medicare |
$16.30
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.69
|
| Rate for Payer: UHC Core |
$107.87
|
| Rate for Payer: UHC Core |
$54.44
|
| Rate for Payer: UHC Core |
$54.43
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UHC Exchange |
$32.30
|
| Rate for Payer: UHC Medicaid |
$22.78
|
| Rate for Payer: UHC Medicaid |
$11.49
|
| Rate for Payer: UHC Medicaid |
$11.49
|
| Rate for Payer: UHC Medicare Advantage |
$16.30
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHC Medicare Advantage |
$16.30
|
| Rate for Payer: UHCCP Medicaid |
$11.49
|
| Rate for Payer: UHCCP Medicaid |
$22.78
|
| Rate for Payer: UHCCP Medicaid |
$11.49
|
| Rate for Payer: VA VA |
$32.30
|
| Rate for Payer: VA VA |
$16.30
|
| Rate for Payer: VA VA |
$16.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.90
|
|
