|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.38
|
|
|
Service Code
|
NDC 00143978710
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna American Axle |
$12.60
|
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna Medicare |
$9.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: BCBS Complete |
$7.75
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Advantage |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.54
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: Priority Health SBD |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.60
|
| Rate for Payer: UHC Core |
$10.10
|
| Rate for Payer: UHC Exchange |
$7.62
|
| Rate for Payer: UMR Bronson Commercial |
$7.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.42
|
|
|
Service Code
|
NDC 43598007858
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna American Axle |
$19.12
|
| Rate for Payer: Aetna Commercial |
$25.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.12
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Advantage |
$20.59
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$26.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.07
|
| Rate for Payer: PHP Commercial |
$25.01
|
| Rate for Payer: Priority Health SBD |
$18.53
|
| Rate for Payer: UMR Bronson Commercial |
$12.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.42
|
|
|
Service Code
|
NDC 43598007858
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna American Axle |
$19.12
|
| Rate for Payer: Aetna Commercial |
$25.01
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.12
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Advantage |
$20.59
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$26.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.07
|
| Rate for Payer: PHP Commercial |
$25.01
|
| Rate for Payer: Priority Health SBD |
$18.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.12
|
| Rate for Payer: UHC Core |
$15.33
|
| Rate for Payer: UHC Exchange |
$11.56
|
| Rate for Payer: UMR Bronson Commercial |
$10.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.42
|
|
|
Service Code
|
NDC 43598007811
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna American Axle |
$19.12
|
| Rate for Payer: Aetna Commercial |
$25.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.12
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Advantage |
$20.59
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$26.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.07
|
| Rate for Payer: PHP Commercial |
$25.01
|
| Rate for Payer: Priority Health SBD |
$18.53
|
| Rate for Payer: UMR Bronson Commercial |
$12.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.38
|
|
|
Service Code
|
NDC 00143978710
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna American Axle |
$12.60
|
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Advantage |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.54
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: Priority Health SBD |
$12.21
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.54
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.42
|
|
|
Service Code
|
NDC 43598007811
|
| Hospital Charge Code |
9929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$26.48 |
| Rate for Payer: Aetna American Axle |
$19.12
|
| Rate for Payer: Aetna Commercial |
$25.01
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.12
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cofinity Advantage |
$20.59
|
| Rate for Payer: Cofinity Commercial |
$25.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.54
|
| Rate for Payer: Healthscope Commercial |
$26.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.07
|
| Rate for Payer: PHP Commercial |
$25.01
|
| Rate for Payer: Priority Health SBD |
$18.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.12
|
| Rate for Payer: UHC Core |
$15.33
|
| Rate for Payer: UHC Exchange |
$11.56
|
| Rate for Payer: UMR Bronson Commercial |
$10.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.07
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
OP
|
$442.70
|
|
|
Service Code
|
NDC 00904561061
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.75
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.75
|
| Rate for Payer: BCBS Complete |
$177.08
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Advantage |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.02
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.75
|
| Rate for Payer: UHC Core |
$230.65
|
| Rate for Payer: UHC Exchange |
$173.98
|
| Rate for Payer: UMR Bronson Commercial |
$163.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 00904561061
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.79 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.75
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.75
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Advantage |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.02
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$194.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 64679092502
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
ENALAPRIL MALEATE 10 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 64679092502
|
| Hospital Charge Code |
9924
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE)
|
Facility
|
OP
|
$2,967.88
|
|
|
Service Code
|
CPT 57505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$2,967.88 |
| Rate for Payer: Aetna Medicare |
$954.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,147.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,147.17
|
| Rate for Payer: BCBS Complete |
$504.02
|
| Rate for Payer: BCBS MAPPO |
$917.74
|
| Rate for Payer: BCBS Trust/PPO |
$953.20
|
| Rate for Payer: BCCCP Commercial |
$145.60
|
| Rate for Payer: BCN Commercial |
$953.20
|
| Rate for Payer: BCN Medicare Advantage |
$917.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$917.74
|
| Rate for Payer: Mclaren Medicaid |
$917.74
|
| Rate for Payer: Mclaren Medicare |
$917.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$963.63
|
| Rate for Payer: Meridian Medicaid |
$963.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,055.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,009.51
|
| Rate for Payer: Nomi Health Commercial |
$2,753.22
|
| Rate for Payer: PACE Medicare |
$871.85
|
| Rate for Payer: PACE SWMI |
$917.74
|
| Rate for Payer: PHP Medicare Advantage |
$917.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,967.88
|
| Rate for Payer: Priority Health Medicare |
$917.74
|
| Rate for Payer: Priority Health Tiered Network |
$2,374.30
|
| Rate for Payer: Railroad Medicare Medicare |
$917.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$917.74
|
| Rate for Payer: UHC Medicaid |
$479.98
|
| Rate for Payer: UHCCP Medicaid |
$479.98
|
| Rate for Payer: VA VA |
$917.74
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$20,121.58
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$8,706.48 |
| Max. Negotiated Rate |
$20,121.58 |
| Rate for Payer: Aetna Medicare |
$9,531.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,455.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,455.90
|
| Rate for Payer: BCBS MAPPO |
$9,164.72
|
| Rate for Payer: BCBS Trust/PPO |
$20,121.58
|
| Rate for Payer: BCN Commercial |
$20,121.58
|
| Rate for Payer: BCN Medicare Advantage |
$9,164.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,164.72
|
| Rate for Payer: Mclaren Medicare |
$9,164.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,622.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,539.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,081.19
|
| Rate for Payer: Nomi Health Commercial |
$13,222.50
|
| Rate for Payer: PACE Medicare |
$8,706.48
|
| Rate for Payer: PACE SWMI |
$9,164.72
|
| Rate for Payer: PHP Medicare Advantage |
$9,164.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,525.19
|
| Rate for Payer: Priority Health Medicare |
$9,164.72
|
| Rate for Payer: Priority Health Tiered Network |
$13,220.15
|
| Rate for Payer: Railroad Medicare Medicare |
$9,164.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,707.50
|
| Rate for Payer: UHC Core |
$13,977.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,164.72
|
| Rate for Payer: UHC Exchange |
$11,415.42
|
| Rate for Payer: VA VA |
$9,164.72
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$29,704.73
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$13,640.86 |
| Max. Negotiated Rate |
$29,704.73 |
| Rate for Payer: Aetna Medicare |
$14,933.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,948.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,948.50
|
| Rate for Payer: BCBS MAPPO |
$14,358.80
|
| Rate for Payer: BCBS Trust/PPO |
$29,704.73
|
| Rate for Payer: BCN Commercial |
$29,704.73
|
| Rate for Payer: BCN Medicare Advantage |
$14,358.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,358.80
|
| Rate for Payer: Mclaren Medicare |
$14,358.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,076.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,512.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,794.68
|
| Rate for Payer: Nomi Health Commercial |
$21,234.69
|
| Rate for Payer: PACE Medicare |
$13,640.86
|
| Rate for Payer: PACE SWMI |
$14,358.80
|
| Rate for Payer: PHP Medicare Advantage |
$14,358.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,538.65
|
| Rate for Payer: Priority Health Medicare |
$14,358.80
|
| Rate for Payer: Priority Health Tiered Network |
$21,230.92
|
| Rate for Payer: Railroad Medicare Medicare |
$14,358.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,831.43
|
| Rate for Payer: UHC Core |
$22,447.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,358.80
|
| Rate for Payer: UHC Exchange |
$18,332.62
|
| Rate for Payer: VA VA |
$14,358.80
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,523.29
|
|
|
Service Code
|
MSDRG 645
|
| Min. Negotiated Rate |
$6,667.12 |
| Max. Negotiated Rate |
$12,523.29 |
| Rate for Payer: Aetna Medicare |
$7,298.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,772.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,772.52
|
| Rate for Payer: BCBS MAPPO |
$7,018.02
|
| Rate for Payer: BCBS Trust/PPO |
$11,587.07
|
| Rate for Payer: BCN Commercial |
$11,587.07
|
| Rate for Payer: BCN Medicare Advantage |
$7,018.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,018.02
|
| Rate for Payer: Mclaren Medicare |
$7,018.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,368.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,070.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,719.82
|
| Rate for Payer: Nomi Health Commercial |
$9,911.07
|
| Rate for Payer: PACE Medicare |
$6,667.12
|
| Rate for Payer: PACE SWMI |
$7,018.02
|
| Rate for Payer: PHP Medicare Advantage |
$7,018.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,386.64
|
| Rate for Payer: Priority Health Medicare |
$7,018.02
|
| Rate for Payer: Priority Health Tiered Network |
$9,909.31
|
| Rate for Payer: Railroad Medicare Medicare |
$7,018.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,523.29
|
| Rate for Payer: UHC Core |
$10,477.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,018.02
|
| Rate for Payer: UHC Exchange |
$8,556.56
|
| Rate for Payer: VA VA |
$7,018.02
|
|
|
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 58353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,357.29
|
| Rate for Payer: BCN Commercial |
$4,357.29
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
ENDOMETRIAL SAMPLING (BIOPSY) PERFORMED IN CONJUNCTION WITH COLPOSCOPY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$207.57
|
|
|
Service Code
|
CPT 58110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$207.57 |
| Rate for Payer: BCBS Trust/PPO |
$207.57
|
| Rate for Payer: BCCCP Commercial |
$49.12
|
| Rate for Payer: BCN Commercial |
$207.57
|
|
|
ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$651.46
|
|
|
Service Code
|
CPT 58100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$97.15 |
| Max. Negotiated Rate |
$651.46 |
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$159.75
|
| Rate for Payer: BCCCP Commercial |
$97.15
|
| Rate for Payer: BCN Commercial |
$159.75
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
ENDOSCOPIC CANNULATION OF PAPILLA WITH DIRECT VISUALIZATION OF PANCREATIC/COMMON BILE DUCT(S) (LIST SEPARATELY IN ADDITION TO CODE(S) FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$537.30
|
|
|
Service Code
|
CPT 43273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.30 |
| Max. Negotiated Rate |
$537.30 |
| Rate for Payer: BCBS Trust/PPO |
$537.30
|
| Rate for Payer: BCN Commercial |
$537.30
|
|
|
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL POUCH (EG, KOCK POUCH, ILEAL RESERVOIR [S OR J]); WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT 44386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,904.64
|
| Rate for Payer: BCN Commercial |
$1,904.64
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$926.61
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLADDER NECK
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 51715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,772.36
|
| Rate for Payer: BCN Commercial |
$3,772.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
ENDOSCOPIC MARKER
|
Facility
|
OP
|
$77.70
|
|
|
Service Code
|
NDC 09900000099
|
| Hospital Charge Code |
2138700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$69.93 |
| Rate for Payer: Aetna American Axle |
$50.51
|
| Rate for Payer: Aetna Commercial |
$66.05
|
| Rate for Payer: Aetna Medicare |
$38.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.51
|
| Rate for Payer: BCBS Complete |
$31.08
|
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Cofinity Advantage |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$66.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.16
|
| Rate for Payer: Healthscope Commercial |
$69.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.27
|
| Rate for Payer: PHP Commercial |
$66.05
|
| Rate for Payer: Priority Health SBD |
$48.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.51
|
| Rate for Payer: UHC Core |
$40.48
|
| Rate for Payer: UHC Exchange |
$30.54
|
| Rate for Payer: UMR Bronson Commercial |
$28.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.27
|
|
|
ENDOSCOPIC MARKER
|
Facility
|
IP
|
$77.70
|
|
|
Service Code
|
NDC 09900000099
|
| Hospital Charge Code |
2138700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$69.93 |
| Rate for Payer: Aetna American Axle |
$50.51
|
| Rate for Payer: Aetna Commercial |
$66.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.51
|
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Cofinity Advantage |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$66.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.16
|
| Rate for Payer: Healthscope Commercial |
$69.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.27
|
| Rate for Payer: PHP Commercial |
$66.05
|
| Rate for Payer: Priority Health SBD |
$48.95
|
| Rate for Payer: UMR Bronson Commercial |
$34.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.27
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$12,423.42
|
|
|
Service Code
|
CPT 43260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,009.16 |
| Max. Negotiated Rate |
$12,423.42 |
| Rate for Payer: Aetna Medicare |
$3,995.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,802.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,802.01
|
| Rate for Payer: BCBS Complete |
$2,109.81
|
| Rate for Payer: BCBS MAPPO |
$3,841.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,992.71
|
| Rate for Payer: BCN Commercial |
$3,992.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,841.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,841.61
|
| Rate for Payer: Mclaren Medicaid |
$3,841.61
|
| Rate for Payer: Mclaren Medicare |
$3,841.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,033.69
|
| Rate for Payer: Meridian Medicaid |
$4,033.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,417.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,225.77
|
| Rate for Payer: Nomi Health Commercial |
$11,524.83
|
| Rate for Payer: PACE Medicare |
$3,649.53
|
| Rate for Payer: PACE SWMI |
$3,841.61
|
| Rate for Payer: PHP Medicare Advantage |
$3,841.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,009.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,423.42
|
| Rate for Payer: Priority Health Medicare |
$3,841.61
|
| Rate for Payer: Priority Health Tiered Network |
$9,938.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,841.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,841.61
|
| Rate for Payer: UHC Medicaid |
$2,009.16
|
| Rate for Payer: UHCCP Medicaid |
$2,009.16
|
| Rate for Payer: VA VA |
$3,841.61
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$12,423.42
|
|
|
Service Code
|
CPT 43261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,009.16 |
| Max. Negotiated Rate |
$12,423.42 |
| Rate for Payer: Aetna Medicare |
$3,995.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,802.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,802.01
|
| Rate for Payer: BCBS Complete |
$2,109.81
|
| Rate for Payer: BCBS MAPPO |
$3,841.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,135.74
|
| Rate for Payer: BCN Commercial |
$2,135.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,841.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,841.61
|
| Rate for Payer: Mclaren Medicaid |
$3,841.61
|
| Rate for Payer: Mclaren Medicare |
$3,841.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,033.69
|
| Rate for Payer: Meridian Medicaid |
$4,033.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,417.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,225.77
|
| Rate for Payer: Nomi Health Commercial |
$11,524.83
|
| Rate for Payer: PACE Medicare |
$3,649.53
|
| Rate for Payer: PACE SWMI |
$3,841.61
|
| Rate for Payer: PHP Medicare Advantage |
$3,841.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,009.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,423.42
|
| Rate for Payer: Priority Health Medicare |
$3,841.61
|
| Rate for Payer: Priority Health Tiered Network |
$9,938.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,841.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,841.61
|
| Rate for Payer: UHC Medicaid |
$2,009.16
|
| Rate for Payer: UHCCP Medicaid |
$2,009.16
|
| Rate for Payer: VA VA |
$3,841.61
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH DESTRUCTION OF CALCULI, ANY METHOD (EG, MECHANICAL, ELECTROHYDRAULIC, LITHOTRIPSY)
|
Facility
|
OP
|
$19,562.14
|
|
|
Service Code
|
CPT 43265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,163.66 |
| Max. Negotiated Rate |
$19,562.14 |
| Rate for Payer: Aetna Medicare |
$6,291.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,561.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,561.34
|
| Rate for Payer: BCBS Complete |
$3,322.15
|
| Rate for Payer: BCBS MAPPO |
$6,049.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,297.00
|
| Rate for Payer: BCN Commercial |
$3,297.00
|
| Rate for Payer: BCN Medicare Advantage |
$6,049.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,049.07
|
| Rate for Payer: Mclaren Medicaid |
$6,049.07
|
| Rate for Payer: Mclaren Medicare |
$6,049.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,351.52
|
| Rate for Payer: Meridian Medicaid |
$6,351.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,956.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,653.98
|
| Rate for Payer: Nomi Health Commercial |
$18,147.21
|
| Rate for Payer: PACE Medicare |
$5,746.62
|
| Rate for Payer: PACE SWMI |
$6,049.07
|
| Rate for Payer: PHP Medicare Advantage |
$6,049.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,163.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,562.14
|
| Rate for Payer: Priority Health Medicare |
$6,049.07
|
| Rate for Payer: Priority Health Tiered Network |
$15,649.71
|
| Rate for Payer: Railroad Medicare Medicare |
$6,049.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,049.07
|
| Rate for Payer: UHC Medicaid |
$3,163.66
|
| Rate for Payer: UHCCP Medicaid |
$3,163.66
|
| Rate for Payer: VA VA |
$6,049.07
|
|
