|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.80
|
|
|
Service Code
|
NDC 0143-9506-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna American Axle |
$12.22
|
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.22
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$16.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.98
|
| Rate for Payer: PHP Commercial |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: UMR Bronson Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.10
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219-445-10
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna American Axle |
$11.98
|
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.67
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.90
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: UMR Bronson Commercial |
$8.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 0409-6695-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna American Axle |
$14.90
|
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.48
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UMR Bronson Commercial |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.01
|
|
|
Service Code
|
NDC 23155-160-31
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$20.71 |
| Rate for Payer: Aetna American Axle |
$14.96
|
| Rate for Payer: Aetna Commercial |
$19.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.96
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$19.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$20.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.56
|
| Rate for Payer: PHP Commercial |
$19.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health SBD |
$14.50
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.26
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.87
|
|
|
Service Code
|
NDC 72572-160-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$24.18 |
| Rate for Payer: Aetna American Axle |
$17.47
|
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.47
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$23.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$24.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.84
|
| Rate for Payer: PHP Commercial |
$22.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.81
|
| Rate for Payer: Priority Health SBD |
$16.93
|
| Rate for Payer: UMR Bronson Commercial |
$11.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.15
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.24
|
|
|
Service Code
|
NDC 0517-0780-10
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna American Axle |
$20.31
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.31
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.55
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.87
|
| Rate for Payer: Priority Health SBD |
$19.68
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 0409-6695-01
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna American Axle |
$14.90
|
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.48
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UMR Bronson Commercial |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$31.24
|
|
|
Service Code
|
NDC 0517-0780-10
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna American Axle |
$20.31
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.31
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.55
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.87
|
| Rate for Payer: Priority Health SBD |
$19.68
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$66.44
|
|
|
Service Code
|
NDC 0409-8062-01
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna American Axle |
$43.19
|
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.19
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Commercial |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$59.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.47
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.51
|
| Rate for Payer: Priority Health SBD |
$41.86
|
| Rate for Payer: UMR Bronson Commercial |
$29.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.83
|
|
|
ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS J7307
|
| Min. Negotiated Rate |
$614.56 |
| Max. Negotiated Rate |
$1,214.09 |
| Rate for Payer: Aetna Commercial |
$1,092.48
|
| Rate for Payer: BCBS Complete |
$1,214.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.77
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Meridian Medicaid |
$1,214.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,156.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.20
|
| Rate for Payer: UMR Bronson Commercial |
$614.56
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$415.13
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
10000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$373.62 |
| Rate for Payer: Aetna American Axle |
$269.83
|
| Rate for Payer: Aetna American Axle |
$127.52
|
| Rate for Payer: Aetna American Axle |
$116.06
|
| Rate for Payer: Aetna American Axle |
$405.85
|
| Rate for Payer: Aetna Commercial |
$530.72
|
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: Aetna Commercial |
$166.76
|
| Rate for Payer: Aetna Commercial |
$352.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.06
|
| Rate for Payer: BCBS Complete |
$78.48
|
| Rate for Payer: BCBS Complete |
$166.05
|
| Rate for Payer: BCBS Complete |
$249.75
|
| Rate for Payer: BCBS Complete |
$71.42
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$156.95
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cash Price |
$156.95
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cofinity Commercial |
$124.99
|
| Rate for Payer: Cofinity Commercial |
$137.33
|
| Rate for Payer: Cofinity Commercial |
$168.72
|
| Rate for Payer: Cofinity Commercial |
$536.97
|
| Rate for Payer: Cofinity Commercial |
$437.07
|
| Rate for Payer: Cofinity Commercial |
$290.59
|
| Rate for Payer: Cofinity Commercial |
$357.01
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.10
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$176.57
|
| Rate for Payer: Healthscope Commercial |
$373.62
|
| Rate for Payer: Healthscope Commercial |
$561.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$437.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$352.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$530.72
|
| Rate for Payer: PHP Commercial |
$530.72
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: PHP Commercial |
$166.76
|
| Rate for Payer: PHP Commercial |
$352.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.99
|
| Rate for Payer: Priority Health SBD |
$261.53
|
| Rate for Payer: Priority Health SBD |
$393.36
|
| Rate for Payer: Priority Health SBD |
$123.60
|
| Rate for Payer: Priority Health SBD |
$112.49
|
| Rate for Payer: UMR Bronson Commercial |
$66.07
|
| Rate for Payer: UMR Bronson Commercial |
$72.59
|
| Rate for Payer: UMR Bronson Commercial |
$231.02
|
| Rate for Payer: UMR Bronson Commercial |
$153.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.28
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$178.56
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
10000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.57 |
| Max. Negotiated Rate |
$160.70 |
| Rate for Payer: Aetna American Axle |
$116.06
|
| Rate for Payer: Aetna American Axle |
$127.52
|
| Rate for Payer: Aetna Commercial |
$166.76
|
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.06
|
| Rate for Payer: Cash Price |
$156.95
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cofinity Commercial |
$124.99
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Cofinity Commercial |
$168.72
|
| Rate for Payer: Cofinity Commercial |
$137.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.85
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$176.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.78
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: PHP Commercial |
$166.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.99
|
| Rate for Payer: Priority Health SBD |
$112.49
|
| Rate for Payer: Priority Health SBD |
$123.60
|
| Rate for Payer: UMR Bronson Commercial |
$86.32
|
| Rate for Payer: UMR Bronson Commercial |
$78.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.14
|
|
|
ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$830.45
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
17451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$747.40 |
| Rate for Payer: Aetna American Axle |
$539.79
|
| Rate for Payer: Aetna Commercial |
$705.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.79
|
| Rate for Payer: BCBS Complete |
$332.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cofinity Commercial |
$581.32
|
| Rate for Payer: Cofinity Commercial |
$714.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$664.36
|
| Rate for Payer: Healthscope Commercial |
$747.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$581.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$622.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$705.88
|
| Rate for Payer: PHP Commercial |
$705.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.32
|
| Rate for Payer: Priority Health SBD |
$523.18
|
| Rate for Payer: UMR Bronson Commercial |
$307.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$622.84
|
|
|
ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$830.45
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
17451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$747.40 |
| Rate for Payer: Aetna American Axle |
$539.79
|
| Rate for Payer: Aetna Commercial |
$705.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.79
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cofinity Commercial |
$581.32
|
| Rate for Payer: Cofinity Commercial |
$714.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$664.36
|
| Rate for Payer: Healthscope Commercial |
$747.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$581.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$622.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$705.88
|
| Rate for Payer: PHP Commercial |
$705.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.32
|
| Rate for Payer: Priority Health SBD |
$523.18
|
| Rate for Payer: UMR Bronson Commercial |
$365.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$622.84
|
|
|
ETRAVIRINE 200 MG TABLET
|
Facility
|
IP
|
$5,297.81
|
|
|
Service Code
|
NDC 59676-571-01
|
| Hospital Charge Code |
151955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,331.04 |
| Max. Negotiated Rate |
$4,768.03 |
| Rate for Payer: Aetna American Axle |
$3,443.58
|
| Rate for Payer: Aetna Commercial |
$4,503.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,443.58
|
| Rate for Payer: Cash Price |
$4,238.25
|
| Rate for Payer: Cofinity Commercial |
$4,556.12
|
| Rate for Payer: Cofinity Commercial |
$3,708.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,238.25
|
| Rate for Payer: Healthscope Commercial |
$4,768.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,708.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,973.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,503.14
|
| Rate for Payer: PHP Commercial |
$4,503.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,708.47
|
| Rate for Payer: Priority Health SBD |
$3,337.62
|
| Rate for Payer: UMR Bronson Commercial |
$2,331.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,973.36
|
|
|
EUFLEXXA INJ PER DOSE
|
Professional
|
Both
|
$289.30
|
|
|
Service Code
|
HCPCS J7323
|
| Min. Negotiated Rate |
$115.72 |
| Max. Negotiated Rate |
$202.51 |
| Rate for Payer: Aetna Commercial |
$131.12
|
| Rate for Payer: BCBS Complete |
$115.72
|
| Rate for Payer: BCBS Trust/PPO |
$129.70
|
| Rate for Payer: Cash Price |
$231.44
|
| Rate for Payer: Cash Price |
$231.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.51
|
| Rate for Payer: UMR Bronson Commercial |
$133.08
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
IP
|
$860.25
|
|
|
Service Code
|
NDC 67877-718-31
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.51 |
| Max. Negotiated Rate |
$774.22 |
| Rate for Payer: Aetna American Axle |
$559.16
|
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.16
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Commercial |
$602.18
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Healthscope Commercial |
$774.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.21
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.18
|
| Rate for Payer: Priority Health SBD |
$541.96
|
| Rate for Payer: UMR Bronson Commercial |
$378.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 67877-718-33
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna American Axle |
$9.32
|
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.19
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UMR Bronson Commercial |
$6.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET
|
Facility
|
IP
|
$2,580.75
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
104556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,135.53 |
| Max. Negotiated Rate |
$2,322.68 |
| Rate for Payer: Aetna American Axle |
$1,677.49
|
| Rate for Payer: Aetna American Axle |
$27.96
|
| Rate for Payer: Aetna Commercial |
$36.57
|
| Rate for Payer: Aetna Commercial |
$2,193.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.96
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cofinity Commercial |
$37.00
|
| Rate for Payer: Cofinity Commercial |
$1,806.52
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Cofinity Commercial |
$2,219.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.60
|
| Rate for Payer: Healthscope Commercial |
$2,322.68
|
| Rate for Payer: Healthscope Commercial |
$38.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,193.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.57
|
| Rate for Payer: PHP Commercial |
$2,193.64
|
| Rate for Payer: PHP Commercial |
$36.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.52
|
| Rate for Payer: Priority Health SBD |
$1,625.87
|
| Rate for Payer: Priority Health SBD |
$27.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,135.53
|
| Rate for Payer: UMR Bronson Commercial |
$18.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.26
|
|
|
EXCHANGE OF INTRAOCULAR LENS
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$876.56 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$964.22
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$876.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
EXCISION AURAL POLYP
|
Facility
|
OP
|
$4,267.42
|
|
|
Service Code
|
CPT 69540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.34 |
| Max. Negotiated Rate |
$4,267.42 |
| Rate for Payer: Aetna Medicare |
$1,409.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$203.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,267.42
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,413.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.27
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.58
|
| Rate for Payer: UHC Exchange |
$129.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$4,536.73
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.21 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.33
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$81.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$1,968.76
|
|
|
Service Code
|
CPT 11421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.73 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$694.01
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.50
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$107.73
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$4,536.73
|
|
|
Service Code
|
CPT 11422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.25 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.68
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$134.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$4,536.73
|
|
|
Service Code
|
CPT 11423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.21 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.73
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$155.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
