|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 50268015211
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
NDC 65862001901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.95 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna Medicare |
$198.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: BCBS Complete |
$158.86
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UMR Bronson Commercial |
$146.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: UMR Bronson Commercial |
$56.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$254.60
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$94.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna American Axle |
$83.36
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Medicare |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: UMR Bronson Commercial |
$47.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna American Axle |
$210.79
|
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Medicare |
$162.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.79
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| Rate for Payer: Priority Health SBD |
$204.31
|
| Rate for Payer: UMR Bronson Commercial |
$119.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00093314701
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 50268015211
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
NDC 65862001901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UMR Bronson Commercial |
$174.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 59320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
IP
|
$21,549.94
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,481.97 |
| Max. Negotiated Rate |
$19,394.95 |
| Rate for Payer: Aetna American Axle |
$14,007.46
|
| Rate for Payer: Aetna Commercial |
$18,317.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,007.46
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cofinity Commercial |
$15,084.96
|
| Rate for Payer: Cofinity Commercial |
$18,532.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,084.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,239.95
|
| Rate for Payer: Healthscope Commercial |
$19,394.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,084.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,162.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.45
|
| Rate for Payer: PHP Commercial |
$18,317.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,007.46
|
| Rate for Payer: Priority Health SBD |
$13,576.46
|
| Rate for Payer: UMR Bronson Commercial |
$9,481.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,162.45
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
OP
|
$21,549.94
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$19,394.95 |
| Rate for Payer: Aetna American Axle |
$14,007.46
|
| Rate for Payer: Aetna Commercial |
$18,317.45
|
| Rate for Payer: Aetna Medicare |
$4.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,007.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.89
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$3.91
|
| Rate for Payer: BCN Medicare Advantage |
$3.91
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cofinity Commercial |
$18,532.95
|
| Rate for Payer: Cofinity Commercial |
$15,084.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,084.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,239.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.91
|
| Rate for Payer: Healthscope Commercial |
$19,394.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,084.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,162.45
|
| Rate for Payer: Mclaren Medicaid |
$2.10
|
| Rate for Payer: Mclaren Medicare |
$3.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.11
|
| Rate for Payer: Meridian Medicaid |
$2.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.45
|
| Rate for Payer: PACE Medicare |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.91
|
| Rate for Payer: PHP Commercial |
$18,317.45
|
| Rate for Payer: PHP Medicare Advantage |
$3.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,007.46
|
| Rate for Payer: Priority Health Medicare |
$3.91
|
| Rate for Payer: Priority Health SBD |
$13,576.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.91
|
| Rate for Payer: UHC Exchange |
$7.47
|
| Rate for Payer: UHC Medicare Advantage |
$3.91
|
| Rate for Payer: UHCCP Medicaid |
$2.10
|
| Rate for Payer: UMR Bronson Commercial |
$7,973.48
|
| Rate for Payer: VA VA |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,162.45
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 00904671761
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$90.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$168.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$124.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
CETIRIZINE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$191.76
|
|
|
Service Code
|
NDC 51991083716
|
| Hospital Charge Code |
70838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$172.58 |
| Rate for Payer: Aetna American Axle |
$124.64
|
| Rate for Payer: Aetna Commercial |
$163.00
|
| Rate for Payer: Aetna Medicare |
$95.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.64
|
| Rate for Payer: BCBS Complete |
$76.70
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cofinity Commercial |
$134.23
|
| Rate for Payer: Cofinity Commercial |
$164.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.41
|
| Rate for Payer: Healthscope Commercial |
$172.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.00
|
| Rate for Payer: PHP Commercial |
$163.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.64
|
| Rate for Payer: Priority Health SBD |
$120.81
|
| Rate for Payer: UMR Bronson Commercial |
$70.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.82
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,555.41
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,564.38 |
| Max. Negotiated Rate |
$3,199.87 |
| Rate for Payer: Aetna American Axle |
$2,311.02
|
| Rate for Payer: Aetna Commercial |
$3,022.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,311.02
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cofinity Commercial |
$2,488.79
|
| Rate for Payer: Cofinity Commercial |
$3,057.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.33
|
| Rate for Payer: Healthscope Commercial |
$3,199.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,488.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,666.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,022.10
|
| Rate for Payer: PHP Commercial |
$3,022.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.02
|
| Rate for Payer: Priority Health SBD |
$2,239.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,564.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,666.56
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,555.41
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$3,199.87 |
| Rate for Payer: Aetna American Axle |
$2,311.02
|
| Rate for Payer: Aetna Commercial |
$3,022.10
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,311.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.96
|
| Rate for Payer: BCBS Complete |
$44.11
|
| Rate for Payer: BCBS MAPPO |
$78.37
|
| Rate for Payer: BCN Medicare Advantage |
$78.37
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cofinity Commercial |
$3,057.65
|
| Rate for Payer: Cofinity Commercial |
$2,488.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.37
|
| Rate for Payer: Healthscope Commercial |
$3,199.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,488.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,666.56
|
| Rate for Payer: Mclaren Medicaid |
$42.01
|
| Rate for Payer: Mclaren Medicare |
$78.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.29
|
| Rate for Payer: Meridian Medicaid |
$44.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,022.10
|
| Rate for Payer: PACE Medicare |
$74.45
|
| Rate for Payer: PACE SWMI |
$78.37
|
| Rate for Payer: PHP Commercial |
$3,022.10
|
| Rate for Payer: PHP Medicare Advantage |
$78.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.02
|
| Rate for Payer: Priority Health Medicare |
$78.37
|
| Rate for Payer: Priority Health SBD |
$2,239.91
|
| Rate for Payer: Railroad Medicare Medicare |
$78.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.37
|
| Rate for Payer: UHC Exchange |
$149.77
|
| Rate for Payer: UHC Medicare Advantage |
$78.37
|
| Rate for Payer: UHCCP Medicaid |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,315.50
|
| Rate for Payer: VA VA |
$78.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,666.56
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,110.37
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,128.56 |
| Max. Negotiated Rate |
$6,399.33 |
| Rate for Payer: Aetna American Axle |
$4,621.74
|
| Rate for Payer: Aetna Commercial |
$6,043.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,621.74
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cofinity Commercial |
$4,977.26
|
| Rate for Payer: Cofinity Commercial |
$6,114.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,977.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,688.30
|
| Rate for Payer: Healthscope Commercial |
$6,399.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,977.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,332.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,043.81
|
| Rate for Payer: PHP Commercial |
$6,043.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,621.74
|
| Rate for Payer: Priority Health SBD |
$4,479.53
|
| Rate for Payer: UMR Bronson Commercial |
$3,128.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,332.78
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,110.37
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$6,399.33 |
| Rate for Payer: Aetna American Axle |
$4,621.74
|
| Rate for Payer: Aetna Commercial |
$6,043.81
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,621.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.96
|
| Rate for Payer: BCBS Complete |
$44.11
|
| Rate for Payer: BCBS MAPPO |
$78.37
|
| Rate for Payer: BCN Medicare Advantage |
$78.37
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cofinity Commercial |
$6,114.92
|
| Rate for Payer: Cofinity Commercial |
$4,977.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,977.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,688.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.37
|
| Rate for Payer: Healthscope Commercial |
$6,399.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,977.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,332.78
|
| Rate for Payer: Mclaren Medicaid |
$42.01
|
| Rate for Payer: Mclaren Medicare |
$78.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.29
|
| Rate for Payer: Meridian Medicaid |
$44.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,043.81
|
| Rate for Payer: PACE Medicare |
$74.45
|
| Rate for Payer: PACE SWMI |
$78.37
|
| Rate for Payer: PHP Commercial |
$6,043.81
|
| Rate for Payer: PHP Medicare Advantage |
$78.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,621.74
|
| Rate for Payer: Priority Health Medicare |
$78.37
|
| Rate for Payer: Priority Health SBD |
$4,479.53
|
| Rate for Payer: Railroad Medicare Medicare |
$78.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.37
|
| Rate for Payer: UHC Exchange |
$149.77
|
| Rate for Payer: UHC Medicare Advantage |
$78.37
|
| Rate for Payer: UHCCP Medicaid |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,630.84
|
| Rate for Payer: VA VA |
$78.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,332.78
|
|
|
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$1,832.42
|
|
|
Service Code
|
CPT 51710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,244.07
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: VA VA |
$650.97
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$667.69
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$453.31
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$127.14
|
| Rate for Payer: VA VA |
$237.20
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$667.69
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$453.31
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$127.14
|
| Rate for Payer: VA VA |
$237.20
|
|
|
CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CONDUIT
|
Facility
|
OP
|
$5,623.80
|
|
|
Service Code
|
CPT 50688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (IE, PROUD FLESH)
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 17250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
