|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 68084-618-01
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$187.24 |
| Rate for Payer: Aetna American Axle |
$135.23
|
| Rate for Payer: Aetna Commercial |
$176.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.23
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$145.64
|
| Rate for Payer: Cofinity Commercial |
$178.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$187.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.84
|
| Rate for Payer: PHP Commercial |
$176.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.64
|
| Rate for Payer: Priority Health SBD |
$131.07
|
| Rate for Payer: UMR Bronson Commercial |
$91.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.04
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
NDC 68084-618-11
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna American Axle |
$1.36
|
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.36
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.78
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.46
|
| Rate for Payer: Priority Health SBD |
$1.32
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 0904-6427-61
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna American Axle |
$233.71
|
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$251.68
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.62
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.68
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UMR Bronson Commercial |
$158.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$679.68
|
|
|
Service Code
|
NDC 31722-569-24
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.06 |
| Max. Negotiated Rate |
$611.71 |
| Rate for Payer: Aetna American Axle |
$441.79
|
| Rate for Payer: Aetna Commercial |
$577.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.79
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Commercial |
$475.78
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Healthscope Commercial |
$611.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$577.73
|
| Rate for Payer: PHP Commercial |
$577.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.78
|
| Rate for Payer: Priority Health SBD |
$428.20
|
| Rate for Payer: UMR Bronson Commercial |
$299.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.76
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$927.96
|
|
|
Service Code
|
NDC 65162-705-88
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.30 |
| Max. Negotiated Rate |
$835.16 |
| Rate for Payer: Aetna American Axle |
$603.17
|
| Rate for Payer: Aetna Commercial |
$788.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.17
|
| Rate for Payer: Cash Price |
$742.37
|
| Rate for Payer: Cofinity Commercial |
$649.57
|
| Rate for Payer: Cofinity Commercial |
$798.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.37
|
| Rate for Payer: Healthscope Commercial |
$835.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$788.77
|
| Rate for Payer: PHP Commercial |
$788.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.57
|
| Rate for Payer: Priority Health SBD |
$584.61
|
| Rate for Payer: UMR Bronson Commercial |
$408.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.97
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$714.24
|
|
|
Service Code
|
NDC 54838-551-70
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.27 |
| Max. Negotiated Rate |
$642.82 |
| Rate for Payer: Aetna American Axle |
$464.26
|
| Rate for Payer: Aetna Commercial |
$607.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.26
|
| Rate for Payer: Cash Price |
$571.39
|
| Rate for Payer: Cofinity Commercial |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.39
|
| Rate for Payer: Healthscope Commercial |
$642.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$607.10
|
| Rate for Payer: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.97
|
| Rate for Payer: Priority Health SBD |
$449.97
|
| Rate for Payer: UMR Bronson Commercial |
$314.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.68
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 65862-373-01
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.16 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Aetna American Axle |
$142.06
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$152.98
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.77
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UMR Bronson Commercial |
$96.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 69097-847-05
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.50
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$4,819.25
|
|
|
Service Code
|
NDC 0456-2005-01
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,120.47 |
| Max. Negotiated Rate |
$4,337.32 |
| Rate for Payer: Aetna American Axle |
$3,132.51
|
| Rate for Payer: Aetna Commercial |
$4,096.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,132.51
|
| Rate for Payer: Cash Price |
$3,855.40
|
| Rate for Payer: Cofinity Commercial |
$3,373.48
|
| Rate for Payer: Cofinity Commercial |
$4,144.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,855.40
|
| Rate for Payer: Healthscope Commercial |
$4,337.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,373.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,614.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,096.36
|
| Rate for Payer: PHP Commercial |
$4,096.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,373.48
|
| Rate for Payer: Priority Health SBD |
$3,036.13
|
| Rate for Payer: UMR Bronson Commercial |
$2,120.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,614.44
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 43547-280-10
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.92
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.28
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: UMR Bronson Commercial |
$34.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.82
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna American Axle |
$31.73
|
| Rate for Payer: Aetna American Axle |
$9.77
|
| Rate for Payer: Aetna American Axle |
$38.88
|
| Rate for Payer: Aetna American Axle |
$16.61
|
| Rate for Payer: Aetna Commercial |
$50.84
|
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna Commercial |
$21.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.77
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cash Price |
$20.44
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Cofinity Commercial |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$10.52
|
| Rate for Payer: Cofinity Commercial |
$12.93
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Cofinity Commercial |
$21.97
|
| Rate for Payer: Cofinity Commercial |
$34.17
|
| Rate for Payer: Cofinity Commercial |
$51.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$23.00
|
| Rate for Payer: Healthscope Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Healthscope Commercial |
$53.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.84
|
| Rate for Payer: PHP Commercial |
$21.72
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: PHP Commercial |
$50.84
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.88
|
| Rate for Payer: Priority Health SBD |
$9.47
|
| Rate for Payer: Priority Health SBD |
$16.10
|
| Rate for Payer: Priority Health SBD |
$30.76
|
| Rate for Payer: Priority Health SBD |
$37.68
|
| Rate for Payer: UMR Bronson Commercial |
$6.61
|
| Rate for Payer: UMR Bronson Commercial |
$21.48
|
| Rate for Payer: UMR Bronson Commercial |
$26.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.88 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Aetna American Axle |
$245.05
|
| Rate for Payer: Aetna American Axle |
$62.65
|
| Rate for Payer: Aetna American Axle |
$324.26
|
| Rate for Payer: Aetna Commercial |
$424.03
|
| Rate for Payer: Aetna Commercial |
$320.45
|
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.65
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$399.09
|
| Rate for Payer: Cofinity Commercial |
$263.90
|
| Rate for Payer: Cofinity Commercial |
$349.20
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$324.22
|
| Rate for Payer: Cofinity Commercial |
$429.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.60
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Healthscope Commercial |
$339.30
|
| Rate for Payer: Healthscope Commercial |
$448.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.45
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: PHP Commercial |
$320.45
|
| Rate for Payer: PHP Commercial |
$424.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.47
|
| Rate for Payer: Priority Health SBD |
$60.73
|
| Rate for Payer: Priority Health SBD |
$237.51
|
| Rate for Payer: Priority Health SBD |
$314.28
|
| Rate for Payer: UMR Bronson Commercial |
$165.88
|
| Rate for Payer: UMR Bronson Commercial |
$42.41
|
| Rate for Payer: UMR Bronson Commercial |
$219.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$2,840.83
|
|
|
Service Code
|
NDC 0186-5020-54
|
| Hospital Charge Code |
29745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,249.97 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Commercial |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,414.71
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,988.58
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,249.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$2,840.83
|
|
|
Service Code
|
NDC 0186-5040-54
|
| Hospital Charge Code |
29746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,249.97 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Commercial |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,414.71
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,988.58
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,249.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
IP
|
$987.46
|
|
|
Service Code
|
NDC 0186-4010-01
|
| Hospital Charge Code |
91031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$839.34
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$691.22
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$434.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 20 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
IP
|
$987.46
|
|
|
Service Code
|
NDC 0186-4020-01
|
| Hospital Charge Code |
78615
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$839.34
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$691.22
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$434.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 40 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
IP
|
$987.46
|
|
|
Service Code
|
NDC 0186-4040-01
|
| Hospital Charge Code |
78616
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$839.34
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$691.22
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$434.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.37
|
|
|
Service Code
|
NDC 55150-185-05
|
| Hospital Charge Code |
41174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna American Axle |
$15.19
|
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.86
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$10.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.53
|
|
|
ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY WITH INTERPRETATION AND REPORT;
|
Facility
|
OP
|
$1,499.80
|
|
|
Service Code
|
CPT 91010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$1,499.80 |
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$794.23
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.80
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$217.09
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$21,638.58
|
|
|
Service Code
|
MS-DRG 391
|
| Min. Negotiated Rate |
$9,825.79 |
| Max. Negotiated Rate |
$21,638.58 |
| Rate for Payer: Aetna Medicare |
$10,756.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,928.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,928.68
|
| Rate for Payer: BCBS MAPPO |
$10,342.94
|
| Rate for Payer: BCBS Trust/PPO |
$21,638.58
|
| Rate for Payer: BCN Medicare Advantage |
$10,342.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,342.94
|
| Rate for Payer: Mclaren Medicare |
$10,342.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,860.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,894.38
|
| Rate for Payer: PACE Medicare |
$9,825.79
|
| Rate for Payer: PACE SWMI |
$10,342.94
|
| Rate for Payer: PHP Medicare Advantage |
$10,342.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,306.19
|
| Rate for Payer: Priority Health Medicare |
$10,342.94
|
| Rate for Payer: Priority Health Narrow Network |
$14,644.95
|
| Rate for Payer: Railroad Medicare Medicare |
$10,342.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,459.53
|
| Rate for Payer: UHC Core |
$15,956.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,342.94
|
| Rate for Payer: UHC Exchange |
$12,685.56
|
| Rate for Payer: UHC Medicare Advantage |
$10,653.23
|
| Rate for Payer: VA VA |
$10,342.94
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$13,222.88
|
|
|
Service Code
|
MS-DRG 392
|
| Min. Negotiated Rate |
$6,237.90 |
| Max. Negotiated Rate |
$13,222.88 |
| Rate for Payer: Aetna Medicare |
$6,828.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,207.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,207.76
|
| Rate for Payer: BCBS MAPPO |
$6,566.21
|
| Rate for Payer: BCBS Trust/PPO |
$13,222.88
|
| Rate for Payer: BCN Medicare Advantage |
$6,566.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,566.21
|
| Rate for Payer: Mclaren Medicare |
$6,566.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,894.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,551.14
|
| Rate for Payer: PACE Medicare |
$6,237.90
|
| Rate for Payer: PACE SWMI |
$6,566.21
|
| Rate for Payer: PHP Medicare Advantage |
$6,566.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.30
|
| Rate for Payer: Priority Health Medicare |
$6,566.21
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.64
|
| Rate for Payer: Railroad Medicare Medicare |
$6,566.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,983.54
|
| Rate for Payer: UHC Core |
$9,826.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,566.21
|
| Rate for Payer: UHC Exchange |
$7,812.01
|
| Rate for Payer: UHC Medicare Advantage |
$6,763.20
|
| Rate for Payer: VA VA |
$6,566.21
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.86 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.08
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.75
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$118.86
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.86 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.08
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.75
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$118.86
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$216.44 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,394.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.08
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$216.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BAND LIGATION OF ESOPHAGEAL/GASTRIC VARICES
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,509.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.05
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$236.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
