|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$351.45
|
|
|
Service Code
|
HCPCS J0209
|
| Hospital Charge Code |
7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.64 |
| Max. Negotiated Rate |
$316.30 |
| Rate for Payer: Aetna American Axle |
$228.44
|
| Rate for Payer: Aetna Commercial |
$298.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.44
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cofinity Commercial |
$246.02
|
| Rate for Payer: Cofinity Commercial |
$302.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.16
|
| Rate for Payer: Healthscope Commercial |
$316.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.73
|
| Rate for Payer: PHP Commercial |
$298.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.44
|
| Rate for Payer: Priority Health SBD |
$221.41
|
| Rate for Payer: UMR Bronson Commercial |
$154.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.59
|
|
|
SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$351.45
|
|
|
Service Code
|
HCPCS J0209
|
| Hospital Charge Code |
7364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$316.30 |
| Rate for Payer: Aetna American Axle |
$228.44
|
| Rate for Payer: Aetna Commercial |
$298.73
|
| Rate for Payer: Aetna Medicare |
$175.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.44
|
| Rate for Payer: BCBS Complete |
$140.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.64
|
| Rate for Payer: BCN Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cash Price |
$281.16
|
| Rate for Payer: Cofinity Commercial |
$246.02
|
| Rate for Payer: Cofinity Commercial |
$302.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.16
|
| Rate for Payer: Healthscope Commercial |
$316.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.73
|
| Rate for Payer: PHP Commercial |
$298.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.44
|
| Rate for Payer: Priority Health SBD |
$221.41
|
| Rate for Payer: UMR Bronson Commercial |
$130.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.59
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$32.61
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$29.35 |
| Rate for Payer: Aetna American Axle |
$21.20
|
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.20
|
| Rate for Payer: Cash Price |
$26.09
|
| Rate for Payer: Cofinity Commercial |
$22.83
|
| Rate for Payer: Cofinity Commercial |
$28.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.09
|
| Rate for Payer: Healthscope Commercial |
$29.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.72
|
| Rate for Payer: PHP Commercial |
$27.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health SBD |
$20.54
|
| Rate for Payer: UMR Bronson Commercial |
$14.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.46
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$978.25
|
|
|
Service Code
|
NDC 00310111030
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.95 |
| Max. Negotiated Rate |
$880.42 |
| Rate for Payer: Aetna American Axle |
$635.86
|
| Rate for Payer: Aetna Commercial |
$831.51
|
| Rate for Payer: Aetna Medicare |
$489.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.86
|
| Rate for Payer: BCBS Complete |
$391.30
|
| Rate for Payer: Cash Price |
$782.60
|
| Rate for Payer: Cofinity Commercial |
$684.78
|
| Rate for Payer: Cofinity Commercial |
$841.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$684.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$782.60
|
| Rate for Payer: Healthscope Commercial |
$880.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$684.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$733.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$831.51
|
| Rate for Payer: PHP Commercial |
$831.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.86
|
| Rate for Payer: Priority Health SBD |
$616.30
|
| Rate for Payer: UMR Bronson Commercial |
$361.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$733.69
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$978.25
|
|
|
Service Code
|
NDC 00310111030
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$430.43 |
| Max. Negotiated Rate |
$880.42 |
| Rate for Payer: Aetna American Axle |
$635.86
|
| Rate for Payer: Aetna Commercial |
$831.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.86
|
| Rate for Payer: Cash Price |
$782.60
|
| Rate for Payer: Cofinity Commercial |
$684.78
|
| Rate for Payer: Cofinity Commercial |
$841.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$684.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$782.60
|
| Rate for Payer: Healthscope Commercial |
$880.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$684.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$733.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$831.51
|
| Rate for Payer: PHP Commercial |
$831.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.86
|
| Rate for Payer: Priority Health SBD |
$616.30
|
| Rate for Payer: UMR Bronson Commercial |
$430.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$733.69
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$32.61
|
|
|
Service Code
|
NDC 00310111001
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$29.35 |
| Rate for Payer: Aetna American Axle |
$21.20
|
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Medicare |
$16.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.20
|
| Rate for Payer: BCBS Complete |
$13.04
|
| Rate for Payer: Cash Price |
$26.09
|
| Rate for Payer: Cofinity Commercial |
$22.83
|
| Rate for Payer: Cofinity Commercial |
$28.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.09
|
| Rate for Payer: Healthscope Commercial |
$29.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.72
|
| Rate for Payer: PHP Commercial |
$27.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health SBD |
$20.54
|
| Rate for Payer: UMR Bronson Commercial |
$12.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.46
|
|
|
SOMATROPIN 0.2 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$785.01
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$706.51 |
| Rate for Payer: UHC Medicare Advantage |
$48.92
|
| Rate for Payer: UHC Medicare Advantage |
$48.92
|
| Rate for Payer: UHCCP Medicaid |
$26.22
|
| Rate for Payer: UHCCP Medicaid |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$41.50
|
| Rate for Payer: UMR Bronson Commercial |
$290.45
|
| Rate for Payer: VA VA |
$48.92
|
| Rate for Payer: VA VA |
$48.92
|
| Rate for Payer: Aetna American Axle |
$510.26
|
| Rate for Payer: Aetna American Axle |
$72.90
|
| Rate for Payer: Aetna Commercial |
$95.33
|
| Rate for Payer: Aetna Commercial |
$667.26
|
| Rate for Payer: Aetna Medicare |
$50.88
|
| Rate for Payer: Aetna Medicare |
$50.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.15
|
| Rate for Payer: BCBS Complete |
$27.53
|
| Rate for Payer: BCBS Complete |
$27.53
|
| Rate for Payer: BCBS MAPPO |
$48.92
|
| Rate for Payer: BCBS MAPPO |
$48.92
|
| Rate for Payer: BCN Medicare Advantage |
$48.92
|
| Rate for Payer: BCN Medicare Advantage |
$48.92
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Cash Price |
$628.01
|
| Rate for Payer: Cash Price |
$628.01
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Cofinity Commercial |
$549.51
|
| Rate for Payer: Cofinity Commercial |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$675.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$549.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.92
|
| Rate for Payer: Healthscope Commercial |
$100.94
|
| Rate for Payer: Healthscope Commercial |
$706.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$549.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$588.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.11
|
| Rate for Payer: Mclaren Medicaid |
$26.22
|
| Rate for Payer: Mclaren Medicaid |
$26.22
|
| Rate for Payer: Mclaren Medicare |
$48.92
|
| Rate for Payer: Mclaren Medicare |
$48.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.37
|
| Rate for Payer: Meridian Medicaid |
$27.53
|
| Rate for Payer: Meridian Medicaid |
$27.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.33
|
| Rate for Payer: Nomi Health Commercial |
$146.76
|
| Rate for Payer: Nomi Health Commercial |
$146.76
|
| Rate for Payer: PACE Medicare |
$46.47
|
| Rate for Payer: PACE Medicare |
$46.47
|
| Rate for Payer: PACE SWMI |
$48.92
|
| Rate for Payer: PACE SWMI |
$48.92
|
| Rate for Payer: PHP Commercial |
$667.26
|
| Rate for Payer: PHP Commercial |
$95.33
|
| Rate for Payer: PHP Medicare Advantage |
$48.92
|
| Rate for Payer: PHP Medicare Advantage |
$48.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.79
|
| Rate for Payer: Priority Health Medicare |
$48.92
|
| Rate for Payer: Priority Health Medicare |
$48.92
|
| Rate for Payer: Priority Health Narrow Network |
$112.63
|
| Rate for Payer: Priority Health Narrow Network |
$112.63
|
| Rate for Payer: Priority Health SBD |
$494.56
|
| Rate for Payer: Priority Health SBD |
$70.65
|
| Rate for Payer: Railroad Medicare Medicare |
$48.92
|
| Rate for Payer: Railroad Medicare Medicare |
$48.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.92
|
| Rate for Payer: UHC Exchange |
$93.49
|
| Rate for Payer: UHC Exchange |
$93.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$588.76
|
|
|
SOMATROPIN 0.2 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$112.15
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26404
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$100.94 |
| Rate for Payer: UMR Bronson Commercial |
$49.35
|
| Rate for Payer: UMR Bronson Commercial |
$345.40
|
| Rate for Payer: Aetna American Axle |
$72.90
|
| Rate for Payer: Aetna American Axle |
$510.26
|
| Rate for Payer: Aetna Commercial |
$95.33
|
| Rate for Payer: Aetna Commercial |
$667.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.26
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Cash Price |
$628.01
|
| Rate for Payer: Cofinity Commercial |
$675.11
|
| Rate for Payer: Cofinity Commercial |
$549.51
|
| Rate for Payer: Cofinity Commercial |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$96.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$549.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.01
|
| Rate for Payer: Healthscope Commercial |
$100.94
|
| Rate for Payer: Healthscope Commercial |
$706.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$549.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$588.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.33
|
| Rate for Payer: PHP Commercial |
$667.26
|
| Rate for Payer: PHP Commercial |
$95.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.26
|
| Rate for Payer: Priority Health SBD |
$70.65
|
| Rate for Payer: Priority Health SBD |
$494.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$588.76
|
|
|
SOMATROPIN 0.4 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$1,570.22
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$1,413.20 |
| Rate for Payer: Aetna American Axle |
$1,020.64
|
| Rate for Payer: Aetna Commercial |
$1,334.69
|
| Rate for Payer: Aetna Medicare |
$50.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.15
|
| Rate for Payer: BCBS Complete |
$27.53
|
| Rate for Payer: BCBS MAPPO |
$48.92
|
| Rate for Payer: BCN Medicare Advantage |
$48.92
|
| Rate for Payer: Cash Price |
$1,256.18
|
| Rate for Payer: Cash Price |
$1,256.18
|
| Rate for Payer: Cofinity Commercial |
$1,350.39
|
| Rate for Payer: Cofinity Commercial |
$1,099.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,099.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,256.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.92
|
| Rate for Payer: Healthscope Commercial |
$1,413.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,099.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,177.66
|
| Rate for Payer: Mclaren Medicaid |
$26.22
|
| Rate for Payer: Mclaren Medicare |
$48.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.37
|
| Rate for Payer: Meridian Medicaid |
$27.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,334.69
|
| Rate for Payer: Nomi Health Commercial |
$146.76
|
| Rate for Payer: PACE Medicare |
$46.47
|
| Rate for Payer: PACE SWMI |
$48.92
|
| Rate for Payer: PHP Commercial |
$1,334.69
|
| Rate for Payer: PHP Medicare Advantage |
$48.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.79
|
| Rate for Payer: Priority Health Medicare |
$48.92
|
| Rate for Payer: Priority Health Narrow Network |
$112.63
|
| Rate for Payer: Priority Health SBD |
$989.24
|
| Rate for Payer: Railroad Medicare Medicare |
$48.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.92
|
| Rate for Payer: UHC Exchange |
$93.49
|
| Rate for Payer: UHC Medicare Advantage |
$48.92
|
| Rate for Payer: UHCCP Medicaid |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$580.98
|
| Rate for Payer: VA VA |
$48.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,177.66
|
|
|
SOMATROPIN 0.4 MG/0.25 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$1,570.22
|
|
|
Service Code
|
HCPCS J2941
|
| Hospital Charge Code |
26405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$690.90 |
| Max. Negotiated Rate |
$1,413.20 |
| Rate for Payer: Aetna American Axle |
$1,020.64
|
| Rate for Payer: Aetna Commercial |
$1,334.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.64
|
| Rate for Payer: Cash Price |
$1,256.18
|
| Rate for Payer: Cofinity Commercial |
$1,099.15
|
| Rate for Payer: Cofinity Commercial |
$1,350.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,099.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,256.18
|
| Rate for Payer: Healthscope Commercial |
$1,413.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,099.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,177.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,334.69
|
| Rate for Payer: PHP Commercial |
$1,334.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,020.64
|
| Rate for Payer: Priority Health SBD |
$989.24
|
| Rate for Payer: UMR Bronson Commercial |
$690.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,177.66
|
|
|
SORAFENIB 200 MG TABLET
|
Facility
|
IP
|
$41,326.64
|
|
|
Service Code
|
NDC 00378120178
|
| Hospital Charge Code |
43675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18,183.72 |
| Max. Negotiated Rate |
$37,193.98 |
| Rate for Payer: Aetna American Axle |
$26,862.32
|
| Rate for Payer: Aetna Commercial |
$35,127.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,862.32
|
| Rate for Payer: Cash Price |
$33,061.31
|
| Rate for Payer: Cofinity Commercial |
$28,928.65
|
| Rate for Payer: Cofinity Commercial |
$35,540.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$28,928.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,061.31
|
| Rate for Payer: Healthscope Commercial |
$37,193.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,928.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,994.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,127.64
|
| Rate for Payer: PHP Commercial |
$35,127.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,862.32
|
| Rate for Payer: Priority Health SBD |
$26,035.78
|
| Rate for Payer: UMR Bronson Commercial |
$18,183.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,994.98
|
|
|
SORAFENIB 200 MG TABLET
|
Facility
|
OP
|
$94,398.84
|
|
|
Service Code
|
NDC 50419048858
|
| Hospital Charge Code |
43675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34,927.57 |
| Max. Negotiated Rate |
$84,958.96 |
| Rate for Payer: Aetna American Axle |
$61,359.25
|
| Rate for Payer: Aetna Commercial |
$80,239.01
|
| Rate for Payer: Aetna Medicare |
$47,199.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61,359.25
|
| Rate for Payer: BCBS Complete |
$37,759.54
|
| Rate for Payer: Cash Price |
$75,519.07
|
| Rate for Payer: Cofinity Commercial |
$66,079.19
|
| Rate for Payer: Cofinity Commercial |
$81,183.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$66,079.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75,519.07
|
| Rate for Payer: Healthscope Commercial |
$84,958.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66,079.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70,799.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80,239.01
|
| Rate for Payer: PHP Commercial |
$80,239.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61,359.25
|
| Rate for Payer: Priority Health SBD |
$59,471.27
|
| Rate for Payer: UMR Bronson Commercial |
$34,927.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70,799.13
|
|
|
SORAFENIB 200 MG TABLET
|
Facility
|
OP
|
$41,326.64
|
|
|
Service Code
|
NDC 00378120178
|
| Hospital Charge Code |
43675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15,290.86 |
| Max. Negotiated Rate |
$37,193.98 |
| Rate for Payer: Aetna American Axle |
$26,862.32
|
| Rate for Payer: Aetna Commercial |
$35,127.64
|
| Rate for Payer: Aetna Medicare |
$20,663.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,862.32
|
| Rate for Payer: BCBS Complete |
$16,530.66
|
| Rate for Payer: Cash Price |
$33,061.31
|
| Rate for Payer: Cofinity Commercial |
$28,928.65
|
| Rate for Payer: Cofinity Commercial |
$35,540.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$28,928.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,061.31
|
| Rate for Payer: Healthscope Commercial |
$37,193.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,928.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,994.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,127.64
|
| Rate for Payer: PHP Commercial |
$35,127.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,862.32
|
| Rate for Payer: Priority Health SBD |
$26,035.78
|
| Rate for Payer: UMR Bronson Commercial |
$15,290.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,994.98
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
IP
|
$29.76
|
|
|
Service Code
|
NDC 00802391316
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$26.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.30
|
| Rate for Payer: PHP Commercial |
$25.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.34
|
| Rate for Payer: Priority Health SBD |
$18.75
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.32
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
OP
|
$10.51
|
|
|
Service Code
|
NDC 57896043516
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Aetna American Axle |
$6.83
|
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.83
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$9.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.93
|
| Rate for Payer: PHP Commercial |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.83
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
IP
|
$10.51
|
|
|
Service Code
|
NDC 57896043516
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$9.46 |
| Rate for Payer: Aetna American Axle |
$6.83
|
| Rate for Payer: Aetna Commercial |
$8.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.83
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Cofinity Commercial |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$9.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$9.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.93
|
| Rate for Payer: PHP Commercial |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.83
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: UMR Bronson Commercial |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
IP
|
$45.51
|
|
|
Service Code
|
NDC 46287050001
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$40.96 |
| Rate for Payer: Aetna American Axle |
$29.58
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.58
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.58
|
| Rate for Payer: Priority Health SBD |
$28.67
|
| Rate for Payer: UMR Bronson Commercial |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
OP
|
$29.76
|
|
|
Service Code
|
NDC 00802391316
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna American Axle |
$19.34
|
| Rate for Payer: Aetna Commercial |
$25.30
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.34
|
| Rate for Payer: BCBS Complete |
$11.90
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$25.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$26.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.30
|
| Rate for Payer: PHP Commercial |
$25.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.34
|
| Rate for Payer: Priority Health SBD |
$18.75
|
| Rate for Payer: UMR Bronson Commercial |
$11.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.32
|
|
|
SORBITOL 70 % SOLUTION
|
Facility
|
OP
|
$45.51
|
|
|
Service Code
|
NDC 46287050001
|
| Hospital Charge Code |
7413
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$40.96 |
| Rate for Payer: Aetna American Axle |
$29.58
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.58
|
| Rate for Payer: BCBS Complete |
$18.20
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.58
|
| Rate for Payer: Priority Health SBD |
$28.67
|
| Rate for Payer: UMR Bronson Commercial |
$16.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
OP
|
$338.20
|
|
|
Service Code
|
NDC 00093106001
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.13 |
| Max. Negotiated Rate |
$304.38 |
| Rate for Payer: Aetna American Axle |
$219.83
|
| Rate for Payer: Aetna Commercial |
$287.47
|
| Rate for Payer: Aetna Medicare |
$169.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.83
|
| Rate for Payer: BCBS Complete |
$135.28
|
| Rate for Payer: Cash Price |
$270.56
|
| Rate for Payer: Cofinity Commercial |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$290.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.56
|
| Rate for Payer: Healthscope Commercial |
$304.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.47
|
| Rate for Payer: PHP Commercial |
$287.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.83
|
| Rate for Payer: Priority Health SBD |
$213.07
|
| Rate for Payer: UMR Bronson Commercial |
$125.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.65
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
OP
|
$242.05
|
|
|
Service Code
|
NDC 60505015900
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.56 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna American Axle |
$157.33
|
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna Medicare |
$121.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: BCBS Complete |
$96.82
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.33
|
| Rate for Payer: Priority Health SBD |
$152.49
|
| Rate for Payer: UMR Bronson Commercial |
$89.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.54
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
IP
|
$242.05
|
|
|
Service Code
|
NDC 60505015900
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna American Axle |
$157.33
|
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.74
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.33
|
| Rate for Payer: Priority Health SBD |
$152.49
|
| Rate for Payer: UMR Bronson Commercial |
$106.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.54
|
|
|
SOTALOL 120 MG TABLET
|
Facility
|
IP
|
$338.20
|
|
|
Service Code
|
NDC 00093106001
|
| Hospital Charge Code |
15723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.81 |
| Max. Negotiated Rate |
$304.38 |
| Rate for Payer: Aetna American Axle |
$219.83
|
| Rate for Payer: Aetna Commercial |
$287.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.83
|
| Rate for Payer: Cash Price |
$270.56
|
| Rate for Payer: Cofinity Commercial |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$290.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.56
|
| Rate for Payer: Healthscope Commercial |
$304.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.47
|
| Rate for Payer: PHP Commercial |
$287.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.83
|
| Rate for Payer: Priority Health SBD |
$213.07
|
| Rate for Payer: UMR Bronson Commercial |
$148.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.65
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$409.92
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.36 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna American Axle |
$266.45
|
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.45
|
| Rate for Payer: Cash Price |
$327.94
|
| Rate for Payer: Cofinity Commercial |
$286.94
|
| Rate for Payer: Cofinity Commercial |
$352.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.94
|
| Rate for Payer: Healthscope Commercial |
$368.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health SBD |
$258.25
|
| Rate for Payer: UMR Bronson Commercial |
$180.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
NDC 00245001201
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna American Axle |
$288.60
|
| Rate for Payer: Aetna Commercial |
$377.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.60
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$399.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.40
|
| Rate for Payer: PHP Commercial |
$377.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: UMR Bronson Commercial |
$195.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.00
|
|
