|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$10.25
|
|
|
Service Code
|
NDC 0338-9540-02
|
| Hospital Charge Code |
191280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: Aetna American Axle |
$6.66
|
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.66
|
| Rate for Payer: Cash Price |
$8.20
|
| Rate for Payer: Cofinity Commercial |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.20
|
| Rate for Payer: Healthscope Commercial |
$9.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.71
|
| Rate for Payer: PHP Commercial |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.18
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.69
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 0338-9540-07
|
| Hospital Charge Code |
191280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna American Axle |
$8.45
|
| Rate for Payer: Aetna Commercial |
$11.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.45
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$11.18
|
| Rate for Payer: Cofinity Commercial |
$9.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$11.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.05
|
| Rate for Payer: PHP Commercial |
$11.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health SBD |
$8.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.75
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
NDC 63323-820-74
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna American Axle |
$14.62
|
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.62
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cofinity Commercial |
$15.75
|
| Rate for Payer: Cofinity Commercial |
$19.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.00
|
| Rate for Payer: Healthscope Commercial |
$20.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.12
|
| Rate for Payer: PHP Commercial |
$19.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.75
|
| Rate for Payer: Priority Health SBD |
$14.18
|
| Rate for Payer: UMR Bronson Commercial |
$9.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
NDC 63323-820-10
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna American Axle |
$35.75
|
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.75
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$38.50
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health SBD |
$34.65
|
| Rate for Payer: UMR Bronson Commercial |
$24.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.25
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$18.90
|
|
|
Service Code
|
NDC 63323-820-00
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna American Axle |
$12.28
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.23
|
| Rate for Payer: Priority Health SBD |
$11.91
|
| Rate for Payer: UMR Bronson Commercial |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.18
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
NDC 63323-820-05
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna American Axle |
$35.75
|
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.75
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$38.50
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health SBD |
$34.65
|
| Rate for Payer: UMR Bronson Commercial |
$24.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.25
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$32.50
|
|
|
Service Code
|
NDC 63323-820-50
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna American Axle |
$21.12
|
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.62
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health SBD |
$20.48
|
| Rate for Payer: UMR Bronson Commercial |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.38
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$53.32
|
|
|
Service Code
|
NDC 9900-0010-15
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$47.99 |
| Rate for Payer: Aetna American Axle |
$34.66
|
| Rate for Payer: Aetna Commercial |
$45.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.66
|
| Rate for Payer: Cash Price |
$42.66
|
| Rate for Payer: Cofinity Commercial |
$37.32
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.66
|
| Rate for Payer: Healthscope Commercial |
$47.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.32
|
| Rate for Payer: PHP Commercial |
$45.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.32
|
| Rate for Payer: Priority Health SBD |
$33.59
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.99
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$53.92
|
|
|
Service Code
|
NDC 9900-0010-17
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$48.53 |
| Rate for Payer: Aetna American Axle |
$35.05
|
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.05
|
| Rate for Payer: Cash Price |
$43.14
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$46.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.14
|
| Rate for Payer: Healthscope Commercial |
$48.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.83
|
| Rate for Payer: PHP Commercial |
$45.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.74
|
| Rate for Payer: Priority Health SBD |
$33.97
|
| Rate for Payer: UMR Bronson Commercial |
$23.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.44
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$77.58
|
|
|
Service Code
|
NDC 9900-0010-20
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$69.82 |
| Rate for Payer: Aetna American Axle |
$50.43
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.94
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: UMR Bronson Commercial |
$34.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.18
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$93.09
|
|
|
Service Code
|
NDC 9900-0010-21
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.96 |
| Max. Negotiated Rate |
$83.78 |
| Rate for Payer: Aetna American Axle |
$60.51
|
| Rate for Payer: Aetna Commercial |
$79.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.51
|
| Rate for Payer: Cash Price |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$65.16
|
| Rate for Payer: Cofinity Commercial |
$80.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.47
|
| Rate for Payer: Healthscope Commercial |
$83.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.13
|
| Rate for Payer: PHP Commercial |
$79.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.16
|
| Rate for Payer: Priority Health SBD |
$58.65
|
| Rate for Payer: UMR Bronson Commercial |
$40.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.82
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$107.83
|
|
|
Service Code
|
NDC 9900-0010-19
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: Aetna American Axle |
$70.09
|
| Rate for Payer: Aetna Commercial |
$91.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.09
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Cofinity Commercial |
$75.48
|
| Rate for Payer: Cofinity Commercial |
$92.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.26
|
| Rate for Payer: Healthscope Commercial |
$97.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.66
|
| Rate for Payer: PHP Commercial |
$91.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.48
|
| Rate for Payer: Priority Health SBD |
$67.93
|
| Rate for Payer: UMR Bronson Commercial |
$47.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.87
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$80.87
|
|
|
Service Code
|
NDC 9900-0010-18
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$72.78 |
| Rate for Payer: Aetna American Axle |
$52.57
|
| Rate for Payer: Aetna Commercial |
$68.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.57
|
| Rate for Payer: Cash Price |
$64.70
|
| Rate for Payer: Cofinity Commercial |
$56.61
|
| Rate for Payer: Cofinity Commercial |
$69.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.70
|
| Rate for Payer: Healthscope Commercial |
$72.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.74
|
| Rate for Payer: PHP Commercial |
$68.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.61
|
| Rate for Payer: Priority Health SBD |
$50.95
|
| Rate for Payer: UMR Bronson Commercial |
$35.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.65
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% NEONATAL SYRINGE
|
Facility
|
IP
|
$59.09
|
|
|
Service Code
|
NDC 9900-0010-16
|
| Hospital Charge Code |
200053
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$53.18 |
| Rate for Payer: Aetna American Axle |
$38.41
|
| Rate for Payer: Aetna Commercial |
$50.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.41
|
| Rate for Payer: Cash Price |
$47.27
|
| Rate for Payer: Cofinity Commercial |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$50.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.27
|
| Rate for Payer: Healthscope Commercial |
$53.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.23
|
| Rate for Payer: PHP Commercial |
$50.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.36
|
| Rate for Payer: Priority Health SBD |
$37.23
|
| Rate for Payer: UMR Bronson Commercial |
$26.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.32
|
|
|
FATTY ACID NO.6-FISH OIL-GLYCERIN-PHOSPHOLIPIDS, EGG 10 % IV EMULSION
|
Facility
|
IP
|
$156.60
|
|
|
Service Code
|
HCPCS B4187
|
| Hospital Charge Code |
188923
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$140.94 |
| Rate for Payer: Aetna American Axle |
$101.79
|
| Rate for Payer: Aetna American Axle |
$67.86
|
| Rate for Payer: Aetna American Axle |
$50.90
|
| Rate for Payer: Aetna American Axle |
$33.93
|
| Rate for Payer: Aetna American Axle |
$169.65
|
| Rate for Payer: Aetna American Axle |
$84.82
|
| Rate for Payer: Aetna American Axle |
$8.48
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna American Axle |
$118.30
|
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Aetna Commercial |
$110.92
|
| Rate for Payer: Aetna Commercial |
$221.85
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$154.70
|
| Rate for Payer: Aetna Commercial |
$66.56
|
| Rate for Payer: Aetna Commercial |
$133.11
|
| Rate for Payer: Aetna Commercial |
$11.09
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.93
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$83.52
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$125.28
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$62.64
|
| Rate for Payer: Cofinity Commercial |
$73.08
|
| Rate for Payer: Cofinity Commercial |
$182.70
|
| Rate for Payer: Cofinity Commercial |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$109.62
|
| Rate for Payer: Cofinity Commercial |
$134.68
|
| Rate for Payer: Cofinity Commercial |
$156.52
|
| Rate for Payer: Cofinity Commercial |
$127.40
|
| Rate for Payer: Cofinity Commercial |
$112.23
|
| Rate for Payer: Cofinity Commercial |
$67.34
|
| Rate for Payer: Cofinity Commercial |
$54.81
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$91.35
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$224.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.80
|
| Rate for Payer: Healthscope Commercial |
$117.45
|
| Rate for Payer: Healthscope Commercial |
$234.90
|
| Rate for Payer: Healthscope Commercial |
$70.47
|
| Rate for Payer: Healthscope Commercial |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$93.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.11
|
| Rate for Payer: PHP Commercial |
$133.11
|
| Rate for Payer: PHP Commercial |
$110.92
|
| Rate for Payer: PHP Commercial |
$154.70
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$88.74
|
| Rate for Payer: PHP Commercial |
$221.85
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$66.56
|
| Rate for Payer: PHP Commercial |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.81
|
| Rate for Payer: Priority Health SBD |
$8.22
|
| Rate for Payer: Priority Health SBD |
$164.43
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$65.77
|
| Rate for Payer: Priority Health SBD |
$114.66
|
| Rate for Payer: Priority Health SBD |
$32.89
|
| Rate for Payer: Priority Health SBD |
$98.66
|
| Rate for Payer: Priority Health SBD |
$82.22
|
| Rate for Payer: Priority Health SBD |
$49.33
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| Rate for Payer: UMR Bronson Commercial |
$68.90
|
| Rate for Payer: UMR Bronson Commercial |
$45.94
|
| Rate for Payer: UMR Bronson Commercial |
$114.84
|
| Rate for Payer: UMR Bronson Commercial |
$57.42
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$5.74
|
| Rate for Payer: UMR Bronson Commercial |
$80.08
|
| Rate for Payer: UMR Bronson Commercial |
$34.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.45
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
IP
|
$1,135.65
|
|
|
Service Code
|
NDC 64764-918-30
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.69 |
| Max. Negotiated Rate |
$1,022.08 |
| Rate for Payer: Aetna American Axle |
$738.17
|
| Rate for Payer: Aetna Commercial |
$965.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.17
|
| Rate for Payer: Cash Price |
$908.52
|
| Rate for Payer: Cofinity Commercial |
$794.96
|
| Rate for Payer: Cofinity Commercial |
$976.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.52
|
| Rate for Payer: Healthscope Commercial |
$1,022.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$794.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$851.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$965.30
|
| Rate for Payer: PHP Commercial |
$965.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.96
|
| Rate for Payer: Priority Health SBD |
$715.46
|
| Rate for Payer: UMR Bronson Commercial |
$499.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$851.74
|
|
|
FEBUXOSTAT 40 MG TABLET
|
Facility
|
IP
|
$137.94
|
|
|
Service Code
|
NDC 0527-2244-32
|
| Hospital Charge Code |
97133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.69 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna American Axle |
$89.66
|
| Rate for Payer: Aetna Commercial |
$117.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.66
|
| Rate for Payer: Cash Price |
$110.35
|
| Rate for Payer: Cofinity Commercial |
$118.63
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.35
|
| Rate for Payer: Healthscope Commercial |
$124.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.25
|
| Rate for Payer: PHP Commercial |
$117.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.56
|
| Rate for Payer: Priority Health SBD |
$86.90
|
| Rate for Payer: UMR Bronson Commercial |
$60.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.46
|
|
|
FECAL MICROBIOTA PRODUCT
|
Facility
|
IP
|
$2,499.70
|
|
|
Service Code
|
NDC 9900-0011-29
|
| Hospital Charge Code |
300149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,099.87 |
| Max. Negotiated Rate |
$2,249.73 |
| Rate for Payer: Aetna American Axle |
$1,624.80
|
| Rate for Payer: Aetna Commercial |
$2,124.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.80
|
| Rate for Payer: Cash Price |
$1,999.76
|
| Rate for Payer: Cofinity Commercial |
$1,749.79
|
| Rate for Payer: Cofinity Commercial |
$2,149.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,999.76
|
| Rate for Payer: Healthscope Commercial |
$2,249.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,874.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,124.74
|
| Rate for Payer: PHP Commercial |
$2,124.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,749.79
|
| Rate for Payer: Priority Health SBD |
$1,574.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,099.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,874.78
|
|
|
FELBAMATE 400 MG TABLET
|
Facility
|
IP
|
$5,057.90
|
|
|
Service Code
|
NDC 0037-0430-01
|
| Hospital Charge Code |
10024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,225.48 |
| Max. Negotiated Rate |
$4,552.11 |
| Rate for Payer: Aetna American Axle |
$3,287.64
|
| Rate for Payer: Aetna Commercial |
$4,299.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,287.64
|
| Rate for Payer: Cash Price |
$4,046.32
|
| Rate for Payer: Cofinity Commercial |
$3,540.53
|
| Rate for Payer: Cofinity Commercial |
$4,349.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,046.32
|
| Rate for Payer: Healthscope Commercial |
$4,552.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,540.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,793.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,299.22
|
| Rate for Payer: PHP Commercial |
$4,299.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,540.53
|
| Rate for Payer: Priority Health SBD |
$3,186.48
|
| Rate for Payer: UMR Bronson Commercial |
$2,225.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,793.42
|
|
|
FELBAMATE 400 MG TABLET
|
Facility
|
IP
|
$743.26
|
|
|
Service Code
|
NDC 53746-734-90
|
| Hospital Charge Code |
10024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.03 |
| Max. Negotiated Rate |
$668.93 |
| Rate for Payer: Aetna American Axle |
$483.12
|
| Rate for Payer: Aetna Commercial |
$631.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.12
|
| Rate for Payer: Cash Price |
$594.61
|
| Rate for Payer: Cofinity Commercial |
$520.28
|
| Rate for Payer: Cofinity Commercial |
$639.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.61
|
| Rate for Payer: Healthscope Commercial |
$668.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$631.77
|
| Rate for Payer: PHP Commercial |
$631.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.28
|
| Rate for Payer: Priority Health SBD |
$468.25
|
| Rate for Payer: UMR Bronson Commercial |
$327.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.44
|
|
|
FELBAMATE 400 MG TABLET
|
Facility
|
IP
|
$747.59
|
|
|
Service Code
|
NDC 65162-734-09
|
| Hospital Charge Code |
10024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$328.94 |
| Max. Negotiated Rate |
$672.83 |
| Rate for Payer: Aetna American Axle |
$485.93
|
| Rate for Payer: Aetna Commercial |
$635.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.93
|
| Rate for Payer: Cash Price |
$598.07
|
| Rate for Payer: Cofinity Commercial |
$523.31
|
| Rate for Payer: Cofinity Commercial |
$642.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.07
|
| Rate for Payer: Healthscope Commercial |
$672.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$560.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$635.45
|
| Rate for Payer: PHP Commercial |
$635.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.31
|
| Rate for Payer: Priority Health SBD |
$470.98
|
| Rate for Payer: UMR Bronson Commercial |
$328.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$560.69
|
|
|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,268.38
|
|
|
Service Code
|
NDC 51525-0442-8
|
| Hospital Charge Code |
10023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$998.09 |
| Max. Negotiated Rate |
$2,041.54 |
| Rate for Payer: Aetna American Axle |
$1,474.45
|
| Rate for Payer: Aetna Commercial |
$1,928.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.45
|
| Rate for Payer: Cash Price |
$1,814.70
|
| Rate for Payer: Cofinity Commercial |
$1,587.87
|
| Rate for Payer: Cofinity Commercial |
$1,950.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,814.70
|
| Rate for Payer: Healthscope Commercial |
$2,041.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,587.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,701.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,928.12
|
| Rate for Payer: PHP Commercial |
$1,928.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.87
|
| Rate for Payer: Priority Health SBD |
$1,429.08
|
| Rate for Payer: UMR Bronson Commercial |
$998.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,701.28
|
|
|
FELBAMATE 600 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$6,139.18
|
|
|
Service Code
|
NDC 0037-0442-67
|
| Hospital Charge Code |
10023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,701.24 |
| Max. Negotiated Rate |
$5,525.26 |
| Rate for Payer: Aetna American Axle |
$3,990.47
|
| Rate for Payer: Aetna Commercial |
$5,218.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,990.47
|
| Rate for Payer: Cash Price |
$4,911.34
|
| Rate for Payer: Cofinity Commercial |
$4,297.43
|
| Rate for Payer: Cofinity Commercial |
$5,279.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,911.34
|
| Rate for Payer: Healthscope Commercial |
$5,525.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,297.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,604.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,218.30
|
| Rate for Payer: PHP Commercial |
$5,218.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,297.43
|
| Rate for Payer: Priority Health SBD |
$3,867.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,701.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,604.38
|
|
|
FELBAMATE 600 MG TABLET
|
Facility
|
IP
|
$811.19
|
|
|
Service Code
|
NDC 53746-735-90
|
| Hospital Charge Code |
10025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.92 |
| Max. Negotiated Rate |
$730.07 |
| Rate for Payer: Aetna American Axle |
$527.27
|
| Rate for Payer: Aetna Commercial |
$689.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.27
|
| Rate for Payer: Cash Price |
$648.95
|
| Rate for Payer: Cofinity Commercial |
$567.83
|
| Rate for Payer: Cofinity Commercial |
$697.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.95
|
| Rate for Payer: Healthscope Commercial |
$730.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$689.51
|
| Rate for Payer: PHP Commercial |
$689.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.83
|
| Rate for Payer: Priority Health SBD |
$511.05
|
| Rate for Payer: UMR Bronson Commercial |
$356.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.39
|
|
|
FELBAMATE 600 MG TABLET
|
Facility
|
IP
|
$809.86
|
|
|
Service Code
|
NDC 65162-735-09
|
| Hospital Charge Code |
10025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.34 |
| Max. Negotiated Rate |
$728.87 |
| Rate for Payer: Aetna American Axle |
$526.41
|
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.41
|
| Rate for Payer: Cash Price |
$647.89
|
| Rate for Payer: Cofinity Commercial |
$566.90
|
| Rate for Payer: Cofinity Commercial |
$696.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.89
|
| Rate for Payer: Healthscope Commercial |
$728.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.38
|
| Rate for Payer: PHP Commercial |
$688.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.90
|
| Rate for Payer: Priority Health SBD |
$510.21
|
| Rate for Payer: UMR Bronson Commercial |
$356.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.40
|
|
