|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$12.10
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Aetna Medicare |
$8.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.47
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$3.02
|
| Rate for Payer: BCBS MAPPO |
$7.99
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$6.49
|
| Rate for Payer: BCN Commercial |
$24.86
|
| Rate for Payer: BCN Commercial |
$6.13
|
| Rate for Payer: BCN Commercial |
$9.41
|
| Rate for Payer: BCN Medicare Advantage |
$3.02
|
| Rate for Payer: BCN Medicare Advantage |
$7.99
|
| Rate for Payer: BCN Medicare Advantage |
$1.97
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: PACE Senior Care Partners |
$1.87
|
| Rate for Payer: PACE Senior Care Partners |
$2.87
|
| Rate for Payer: PACE Senior Care Partners |
$7.59
|
| Rate for Payer: PACE SWMI |
$7.99
|
| Rate for Payer: PACE SWMI |
$3.02
|
| Rate for Payer: PACE SWMI |
$1.97
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: PHP Medicare Advantage |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$1.97
|
| Rate for Payer: PHP Medicare Advantage |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health HMO/PPO |
$10.53
|
| Rate for Payer: Priority Health HMO/PPO |
$27.81
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Medicare |
$1.99
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.11
|
| Rate for Payer: Railroad Medicare Medicare |
$7.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.97
|
| Rate for Payer: Railroad Medicare Medicare |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$6.59
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.99
|
| Rate for Payer: UHC Exchange |
$7.99
|
| Rate for Payer: UHC Exchange |
$3.02
|
| Rate for Payer: UHC Exchange |
$1.97
|
| Rate for Payer: UHC Medicare Advantage |
$3.02
|
| Rate for Payer: UHC Medicare Advantage |
$7.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.97
|
| Rate for Payer: VA VA |
$7.99
|
| Rate for Payer: VA VA |
$1.97
|
| Rate for Payer: VA VA |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$12.10
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$26.10
|
| Rate for Payer: BCBS Trust/PPO |
$9.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$24.71
|
| Rate for Payer: BCN Commercial |
$9.35
|
| Rate for Payer: BCN Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health HMO/PPO |
$6.86
|
| Rate for Payer: Priority Health HMO/PPO |
$27.81
|
| Rate for Payer: Priority Health HMO/PPO |
$10.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.65
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: UHC Core |
$6.59
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$10.28
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$62.88
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Medicare |
$19.23
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Aetna Medicare |
$8.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.12
|
| Rate for Payer: BCBS Complete |
$12.65
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS Complete |
$29.59
|
| Rate for Payer: BCBS MAPPO |
$18.50
|
| Rate for Payer: BCBS MAPPO |
$2.57
|
| Rate for Payer: BCBS MAPPO |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$8.45
|
| Rate for Payer: BCBS Trust/PPO |
$60.82
|
| Rate for Payer: BCN Commercial |
$24.59
|
| Rate for Payer: BCN Commercial |
$57.52
|
| Rate for Payer: BCN Commercial |
$7.99
|
| Rate for Payer: BCN Medicare Advantage |
$2.57
|
| Rate for Payer: BCN Medicare Advantage |
$7.91
|
| Rate for Payer: BCN Medicare Advantage |
$18.50
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Cofinity Commercial |
$27.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$28.47
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$66.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: Nomi Health Commercial |
$8.43
|
| Rate for Payer: Nomi Health Commercial |
$25.94
|
| Rate for Payer: PACE Senior Care Partners |
$17.57
|
| Rate for Payer: PACE Senior Care Partners |
$2.44
|
| Rate for Payer: PACE Senior Care Partners |
$7.51
|
| Rate for Payer: PACE SWMI |
$7.91
|
| Rate for Payer: PACE SWMI |
$2.57
|
| Rate for Payer: PACE SWMI |
$18.50
|
| Rate for Payer: PHP Commercial |
$62.88
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Medicare Advantage |
$7.91
|
| Rate for Payer: PHP Medicare Advantage |
$18.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.56
|
| Rate for Payer: Priority Health HMO/PPO |
$64.36
|
| Rate for Payer: Priority Health HMO/PPO |
$8.94
|
| Rate for Payer: Priority Health HMO/PPO |
$27.52
|
| Rate for Payer: Priority Health Medicare |
$2.60
|
| Rate for Payer: Priority Health Medicare |
$18.68
|
| Rate for Payer: Priority Health Medicare |
$7.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.89
|
| Rate for Payer: Railroad Medicare Medicare |
$7.91
|
| Rate for Payer: Railroad Medicare Medicare |
$18.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.05
|
| Rate for Payer: UHC Core |
$61.77
|
| Rate for Payer: UHC Core |
$26.41
|
| Rate for Payer: UHC Core |
$8.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.91
|
| Rate for Payer: UHC Exchange |
$7.91
|
| Rate for Payer: UHC Exchange |
$2.57
|
| Rate for Payer: UHC Exchange |
$18.50
|
| Rate for Payer: UHC Medicare Advantage |
$2.57
|
| Rate for Payer: UHC Medicare Advantage |
$7.91
|
| Rate for Payer: UHC Medicare Advantage |
$18.50
|
| Rate for Payer: VA VA |
$7.91
|
| Rate for Payer: VA VA |
$18.50
|
| Rate for Payer: VA VA |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$10.28
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Commercial |
$62.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.82
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCBS Trust/PPO |
$60.39
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: BCN Commercial |
$7.94
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.18
|
| Rate for Payer: Healthscope Commercial |
$28.47
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$66.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.88
|
| Rate for Payer: Nomi Health Commercial |
$8.43
|
| Rate for Payer: Nomi Health Commercial |
$25.94
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Commercial |
$62.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.56
|
| Rate for Payer: Priority Health HMO/PPO |
$64.36
|
| Rate for Payer: Priority Health HMO/PPO |
$27.52
|
| Rate for Payer: Priority Health HMO/PPO |
$8.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.05
|
| Rate for Payer: UHC Core |
$8.58
|
| Rate for Payer: UHC Core |
$61.77
|
| Rate for Payer: UHC Core |
$26.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.01
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.61
|
| Rate for Payer: BCN Commercial |
$144.34
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Medicare |
$46.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: BCBS Trust/PPO |
$151.54
|
| Rate for Payer: BCN Commercial |
$143.46
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.01
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.61
|
| Rate for Payer: BCN Commercial |
$144.34
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Medicare |
$46.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: BCBS Trust/PPO |
$151.54
|
| Rate for Payer: BCN Commercial |
$143.46
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$25.52
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.59 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: BCBS Trust/PPO |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.48
|
| Rate for Payer: BCN Commercial |
$19.72
|
| Rate for Payer: BCN Commercial |
$22.23
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.45
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Nomi Health Commercial |
$23.59
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health HMO/PPO |
$25.03
|
| Rate for Payer: Priority Health HMO/PPO |
$22.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC Core |
$21.31
|
| Rate for Payer: UHC Core |
$24.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$25.52
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Aetna Medicare |
$7.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.99
|
| Rate for Payer: BCBS Complete |
$0.44
|
| Rate for Payer: BCBS Complete |
$0.44
|
| Rate for Payer: BCBS MAPPO |
$7.19
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$23.65
|
| Rate for Payer: BCN Commercial |
$19.84
|
| Rate for Payer: BCN Commercial |
$22.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: BCN Medicare Advantage |
$7.19
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.19
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Mclaren Medicaid |
$0.42
|
| Rate for Payer: Mclaren Medicaid |
$0.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.70
|
| Rate for Payer: Meridian Medicaid |
$0.44
|
| Rate for Payer: Meridian Medicaid |
$0.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.45
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Nomi Health Commercial |
$23.59
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE Senior Care Partners |
$6.83
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PACE SWMI |
$7.19
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: PHP Medicare Advantage |
$7.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health HMO/PPO |
$25.03
|
| Rate for Payer: Priority Health HMO/PPO |
$22.20
|
| Rate for Payer: Priority Health Medicare |
$6.44
|
| Rate for Payer: Priority Health Medicare |
$7.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$7.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC Core |
$24.02
|
| Rate for Payer: UHC Core |
$21.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.19
|
| Rate for Payer: UHC Exchange |
$7.19
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$7.19
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$0.42
|
| Rate for Payer: UHCCP Medicaid |
$0.42
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: VA VA |
$7.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 50268013011
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 50268013011
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS MAPPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: BCN Medicare Advantage |
$1.08
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.08
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.76
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.08
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.08
|
| Rate for Payer: VA VA |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$215.76
|
|
|
Service Code
|
NDC 50268013015
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$194.18 |
| Rate for Payer: Aetna Commercial |
$183.40
|
| Rate for Payer: Aetna Medicare |
$56.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.42
|
| Rate for Payer: BCBS Complete |
$86.30
|
| Rate for Payer: BCBS MAPPO |
$53.94
|
| Rate for Payer: BCBS Trust/PPO |
$177.38
|
| Rate for Payer: BCN Commercial |
$167.75
|
| Rate for Payer: BCN Medicare Advantage |
$53.94
|
| Rate for Payer: Cash Price |
$172.61
|
| Rate for Payer: Cofinity Commercial |
$185.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.94
|
| Rate for Payer: Healthscope Commercial |
$194.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.40
|
| Rate for Payer: Nomi Health Commercial |
$176.92
|
| Rate for Payer: PACE Senior Care Partners |
$51.24
|
| Rate for Payer: PACE SWMI |
$53.94
|
| Rate for Payer: PHP Commercial |
$183.40
|
| Rate for Payer: PHP Medicare Advantage |
$53.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.24
|
| Rate for Payer: Priority Health HMO/PPO |
$187.71
|
| Rate for Payer: Priority Health Medicare |
$54.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.56
|
| Rate for Payer: Railroad Medicare Medicare |
$53.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.87
|
| Rate for Payer: UHC Core |
$180.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.94
|
| Rate for Payer: UHC Exchange |
$53.94
|
| Rate for Payer: UHC Medicare Advantage |
$53.94
|
| Rate for Payer: VA VA |
$53.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.82
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$215.76
|
|
|
Service Code
|
NDC 50268013015
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.24 |
| Max. Negotiated Rate |
$194.18 |
| Rate for Payer: Aetna Commercial |
$183.40
|
| Rate for Payer: BCBS Trust/PPO |
$176.12
|
| Rate for Payer: BCN Commercial |
$166.74
|
| Rate for Payer: Cash Price |
$172.61
|
| Rate for Payer: Cofinity Commercial |
$185.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.61
|
| Rate for Payer: Healthscope Commercial |
$194.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.40
|
| Rate for Payer: Nomi Health Commercial |
$176.92
|
| Rate for Payer: PHP Commercial |
$183.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.24
|
| Rate for Payer: Priority Health HMO/PPO |
$187.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.87
|
| Rate for Payer: UHC Core |
$180.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.82
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.73 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: BCBS Trust/PPO |
$324.93
|
| Rate for Payer: BCN Commercial |
$307.61
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.28
|
| Rate for Payer: UHC Core |
$332.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 69238148901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna Medicare |
$78.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.81
|
| Rate for Payer: BCBS Complete |
$120.08
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCBS Trust/PPO |
$246.79
|
| Rate for Payer: BCN Commercial |
$233.41
|
| Rate for Payer: BCN Medicare Advantage |
$75.05
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.05
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| Rate for Payer: PACE Senior Care Partners |
$71.30
|
| Rate for Payer: PACE SWMI |
$75.05
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: PHP Medicare Advantage |
$75.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Medicare |
$75.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.13
|
| Rate for Payer: Railroad Medicare Medicare |
$75.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.18
|
| Rate for Payer: UHC Core |
$250.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.05
|
| Rate for Payer: UHC Exchange |
$75.05
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
| Rate for Payer: VA VA |
$75.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.54 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$103.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.39
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: BCBS MAPPO |
$99.51
|
| Rate for Payer: BCBS Trust/PPO |
$327.24
|
| Rate for Payer: BCN Commercial |
$309.48
|
| Rate for Payer: BCN Medicare Advantage |
$99.51
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.51
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| Rate for Payer: PACE Senior Care Partners |
$94.54
|
| Rate for Payer: PACE SWMI |
$99.51
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: PHP Medicare Advantage |
$99.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Medicare |
$100.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.69
|
| Rate for Payer: Railroad Medicare Medicare |
$99.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.28
|
| Rate for Payer: UHC Core |
$332.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.51
|
| Rate for Payer: UHC Exchange |
$99.51
|
| Rate for Payer: UHC Medicare Advantage |
$99.51
|
| Rate for Payer: VA VA |
$99.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 42799011901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: BCBS Trust/PPO |
$245.05
|
| Rate for Payer: BCN Commercial |
$231.99
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.18
|
| Rate for Payer: UHC Core |
$250.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 42799011901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna Medicare |
$78.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.81
|
| Rate for Payer: BCBS Complete |
$120.08
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCBS Trust/PPO |
$246.79
|
| Rate for Payer: BCN Commercial |
$233.41
|
| Rate for Payer: BCN Medicare Advantage |
$75.05
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.05
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| Rate for Payer: PACE Senior Care Partners |
$71.30
|
| Rate for Payer: PACE SWMI |
$75.05
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: PHP Medicare Advantage |
$75.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Medicare |
$75.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.13
|
| Rate for Payer: Railroad Medicare Medicare |
$75.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.18
|
| Rate for Payer: UHC Core |
$250.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.05
|
| Rate for Payer: UHC Exchange |
$75.05
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
| Rate for Payer: VA VA |
$75.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 69238148901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: BCBS Trust/PPO |
$245.05
|
| Rate for Payer: BCN Commercial |
$231.99
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.18
|
| Rate for Payer: UHC Core |
$250.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$394.56
|
|
|
Service Code
|
NDC 00904701661
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.46 |
| Max. Negotiated Rate |
$355.10 |
| Rate for Payer: Aetna Commercial |
$335.38
|
| Rate for Payer: BCBS Trust/PPO |
$322.08
|
| Rate for Payer: BCN Commercial |
$304.92
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Cofinity Commercial |
$339.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.65
|
| Rate for Payer: Healthscope Commercial |
$355.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.38
|
| Rate for Payer: Nomi Health Commercial |
$323.54
|
| Rate for Payer: PHP Commercial |
$335.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.46
|
| Rate for Payer: Priority Health HMO/PPO |
$343.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.21
|
| Rate for Payer: UHC Core |
$329.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.92
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna Medicare |
$104.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.28
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: BCBS MAPPO |
$100.22
|
| Rate for Payer: BCBS Trust/PPO |
$329.58
|
| Rate for Payer: BCN Commercial |
$311.70
|
| Rate for Payer: BCN Medicare Advantage |
$100.22
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.22
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: PACE Senior Care Partners |
$95.21
|
| Rate for Payer: PACE SWMI |
$100.22
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: PHP Medicare Advantage |
$100.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health HMO/PPO |
$348.78
|
| Rate for Payer: Priority Health Medicare |
$101.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.60
|
| Rate for Payer: Railroad Medicare Medicare |
$100.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.79
|
| Rate for Payer: UHC Core |
$334.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.22
|
| Rate for Payer: UHC Exchange |
$100.22
|
| Rate for Payer: UHC Medicare Advantage |
$100.22
|
| Rate for Payer: VA VA |
$100.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.58 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: BCBS Trust/PPO |
$327.25
|
| Rate for Payer: BCN Commercial |
$309.82
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health HMO/PPO |
$348.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.79
|
| Rate for Payer: UHC Core |
$334.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$394.56
|
|
|
Service Code
|
NDC 00904701661
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.71 |
| Max. Negotiated Rate |
$355.10 |
| Rate for Payer: Aetna Commercial |
$335.38
|
| Rate for Payer: Aetna Medicare |
$102.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.30
|
| Rate for Payer: BCBS Complete |
$157.82
|
| Rate for Payer: BCBS MAPPO |
$98.64
|
| Rate for Payer: BCBS Trust/PPO |
$324.37
|
| Rate for Payer: BCN Commercial |
$306.77
|
| Rate for Payer: BCN Medicare Advantage |
$98.64
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Cofinity Commercial |
$339.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.64
|
| Rate for Payer: Healthscope Commercial |
$355.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.38
|
| Rate for Payer: Nomi Health Commercial |
$323.54
|
| Rate for Payer: PACE Senior Care Partners |
$93.71
|
| Rate for Payer: PACE SWMI |
$98.64
|
| Rate for Payer: PHP Commercial |
$335.38
|
| Rate for Payer: PHP Medicare Advantage |
$98.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.46
|
| Rate for Payer: Priority Health HMO/PPO |
$343.27
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.36
|
| Rate for Payer: Railroad Medicare Medicare |
$98.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.21
|
| Rate for Payer: UHC Core |
$329.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.64
|
| Rate for Payer: UHC Exchange |
$98.64
|
| Rate for Payer: UHC Medicare Advantage |
$98.64
|
| Rate for Payer: VA VA |
$98.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.92
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 00362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
