|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna American Axle |
$14.90
|
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Advantage |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.90
|
| Rate for Payer: UHC Core |
$11.94
|
| Rate for Payer: UHC Exchange |
$9.01
|
| Rate for Payer: UMR Bronson Commercial |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.79
|
|
|
Service Code
|
NDC 70860065210
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$20.51 |
| Rate for Payer: Aetna American Axle |
$14.81
|
| Rate for Payer: Aetna Commercial |
$19.37
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.81
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cofinity Advantage |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$19.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.23
|
| Rate for Payer: Healthscope Commercial |
$20.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.09
|
| Rate for Payer: PHP Commercial |
$19.37
|
| Rate for Payer: Priority Health SBD |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.81
|
| Rate for Payer: UHC Core |
$11.87
|
| Rate for Payer: UHC Exchange |
$8.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.09
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$66.44
|
|
|
Service Code
|
NDC 00409806201
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna American Axle |
$43.19
|
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.19
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Advantage |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$59.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.83
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: Priority Health SBD |
$41.86
|
| Rate for Payer: UMR Bronson Commercial |
$29.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.83
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna American Axle |
$14.90
|
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Advantage |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.90
|
| Rate for Payer: UHC Core |
$11.94
|
| Rate for Payer: UHC Exchange |
$9.01
|
| Rate for Payer: UMR Bronson Commercial |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$31.24
|
|
|
Service Code
|
NDC 00517078010
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna American Axle |
$20.31
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.31
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cofinity Advantage |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.43
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: Priority Health SBD |
$19.68
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$66.44
|
|
|
Service Code
|
NDC 00409806201
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna American Axle |
$43.19
|
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna Medicare |
$33.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.19
|
| Rate for Payer: BCBS Complete |
$26.58
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Advantage |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$59.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.83
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: Priority Health SBD |
$41.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.19
|
| Rate for Payer: UHC Core |
$34.62
|
| Rate for Payer: UHC Exchange |
$26.11
|
| Rate for Payer: UMR Bronson Commercial |
$24.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.83
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$31.24
|
|
|
Service Code
|
NDC 00517078010
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna American Axle |
$20.31
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna Medicare |
$15.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.31
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cofinity Advantage |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.43
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: Priority Health SBD |
$19.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.31
|
| Rate for Payer: UHC Core |
$16.28
|
| Rate for Payer: UHC Exchange |
$12.28
|
| Rate for Payer: UMR Bronson Commercial |
$11.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna American Axle |
$14.90
|
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Advantage |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UMR Bronson Commercial |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$236.25
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
10000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$212.62 |
| Rate for Payer: Aetna American Axle |
$153.56
|
| Rate for Payer: Aetna American Axle |
$224.03
|
| Rate for Payer: Aetna American Axle |
$242.18
|
| Rate for Payer: Aetna American Axle |
$77.17
|
| Rate for Payer: Aetna American Axle |
$116.06
|
| Rate for Payer: Aetna American Axle |
$101.54
|
| Rate for Payer: Aetna American Axle |
$404.35
|
| Rate for Payer: Aetna American Axle |
$182.89
|
| Rate for Payer: Aetna Commercial |
$528.76
|
| Rate for Payer: Aetna Commercial |
$316.70
|
| Rate for Payer: Aetna Commercial |
$200.81
|
| Rate for Payer: Aetna Commercial |
$100.91
|
| Rate for Payer: Aetna Commercial |
$132.78
|
| Rate for Payer: Aetna Commercial |
$292.96
|
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: Aetna Commercial |
$239.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.03
|
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$94.98
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cash Price |
$225.10
|
| Rate for Payer: Cash Price |
$275.73
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cofinity Advantage |
$435.45
|
| Rate for Payer: Cofinity Advantage |
$109.35
|
| Rate for Payer: Cofinity Advantage |
$165.38
|
| Rate for Payer: Cofinity Advantage |
$124.99
|
| Rate for Payer: Cofinity Advantage |
$83.10
|
| Rate for Payer: Cofinity Advantage |
$241.26
|
| Rate for Payer: Cofinity Advantage |
$260.81
|
| Rate for Payer: Cofinity Advantage |
$196.96
|
| Rate for Payer: Cofinity Commercial |
$134.34
|
| Rate for Payer: Cofinity Commercial |
$102.10
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Cofinity Commercial |
$203.18
|
| Rate for Payer: Cofinity Commercial |
$534.98
|
| Rate for Payer: Cofinity Commercial |
$241.98
|
| Rate for Payer: Cofinity Commercial |
$320.43
|
| Rate for Payer: Cofinity Commercial |
$296.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.98
|
| Rate for Payer: Healthscope Commercial |
$253.23
|
| Rate for Payer: Healthscope Commercial |
$212.62
|
| Rate for Payer: Healthscope Commercial |
$106.85
|
| Rate for Payer: Healthscope Commercial |
$559.86
|
| Rate for Payer: Healthscope Commercial |
$335.33
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$140.59
|
| Rate for Payer: Healthscope Commercial |
$310.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.55
|
| Rate for Payer: PHP Commercial |
$200.81
|
| Rate for Payer: PHP Commercial |
$239.16
|
| Rate for Payer: PHP Commercial |
$528.76
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: PHP Commercial |
$132.78
|
| Rate for Payer: PHP Commercial |
$100.91
|
| Rate for Payer: PHP Commercial |
$292.96
|
| Rate for Payer: PHP Commercial |
$316.70
|
| Rate for Payer: Priority Health SBD |
$217.14
|
| Rate for Payer: Priority Health SBD |
$234.73
|
| Rate for Payer: Priority Health SBD |
$391.90
|
| Rate for Payer: Priority Health SBD |
$98.41
|
| Rate for Payer: Priority Health SBD |
$74.79
|
| Rate for Payer: Priority Health SBD |
$112.49
|
| Rate for Payer: Priority Health SBD |
$148.84
|
| Rate for Payer: Priority Health SBD |
$177.26
|
| Rate for Payer: UMR Bronson Commercial |
$52.24
|
| Rate for Payer: UMR Bronson Commercial |
$123.80
|
| Rate for Payer: UMR Bronson Commercial |
$78.57
|
| Rate for Payer: UMR Bronson Commercial |
$273.71
|
| Rate for Payer: UMR Bronson Commercial |
$163.94
|
| Rate for Payer: UMR Bronson Commercial |
$103.95
|
| Rate for Payer: UMR Bronson Commercial |
$68.73
|
| Rate for Payer: UMR Bronson Commercial |
$151.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.44
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$178.56
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
10000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$160.70 |
| Rate for Payer: Aetna American Axle |
$116.06
|
| Rate for Payer: Aetna American Axle |
$153.56
|
| Rate for Payer: Aetna American Axle |
$224.03
|
| Rate for Payer: Aetna American Axle |
$182.89
|
| Rate for Payer: Aetna American Axle |
$101.54
|
| Rate for Payer: Aetna American Axle |
$77.17
|
| Rate for Payer: Aetna American Axle |
$405.85
|
| Rate for Payer: Aetna American Axle |
$404.35
|
| Rate for Payer: Aetna American Axle |
$242.18
|
| Rate for Payer: Aetna Commercial |
$239.16
|
| Rate for Payer: Aetna Commercial |
$132.78
|
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: Aetna Commercial |
$100.91
|
| Rate for Payer: Aetna Commercial |
$200.81
|
| Rate for Payer: Aetna Commercial |
$292.96
|
| Rate for Payer: Aetna Commercial |
$316.70
|
| Rate for Payer: Aetna Commercial |
$528.76
|
| Rate for Payer: Aetna Commercial |
$530.72
|
| Rate for Payer: Aetna Medicare |
$89.28
|
| Rate for Payer: Aetna Medicare |
$78.11
|
| Rate for Payer: Aetna Medicare |
$186.29
|
| Rate for Payer: Aetna Medicare |
$59.36
|
| Rate for Payer: Aetna Medicare |
$312.19
|
| Rate for Payer: Aetna Medicare |
$140.69
|
| Rate for Payer: Aetna Medicare |
$118.12
|
| Rate for Payer: Aetna Medicare |
$311.04
|
| Rate for Payer: Aetna Medicare |
$172.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.56
|
| Rate for Payer: BCBS Complete |
$62.48
|
| Rate for Payer: BCBS Complete |
$71.42
|
| Rate for Payer: BCBS Complete |
$137.86
|
| Rate for Payer: BCBS Complete |
$94.50
|
| Rate for Payer: BCBS Complete |
$149.04
|
| Rate for Payer: BCBS Complete |
$112.55
|
| Rate for Payer: BCBS Complete |
$249.75
|
| Rate for Payer: BCBS Complete |
$248.83
|
| Rate for Payer: BCBS Complete |
$47.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$275.73
|
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cash Price |
$225.10
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cash Price |
$94.98
|
| Rate for Payer: Cash Price |
$225.10
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cash Price |
$94.98
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cash Price |
$124.97
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$275.73
|
| Rate for Payer: Cofinity Advantage |
$109.35
|
| Rate for Payer: Cofinity Advantage |
$124.99
|
| Rate for Payer: Cofinity Advantage |
$83.10
|
| Rate for Payer: Cofinity Advantage |
$165.38
|
| Rate for Payer: Cofinity Advantage |
$196.96
|
| Rate for Payer: Cofinity Advantage |
$241.26
|
| Rate for Payer: Cofinity Advantage |
$260.81
|
| Rate for Payer: Cofinity Advantage |
$435.45
|
| Rate for Payer: Cofinity Advantage |
$437.07
|
| Rate for Payer: Cofinity Commercial |
$134.34
|
| Rate for Payer: Cofinity Commercial |
$534.98
|
| Rate for Payer: Cofinity Commercial |
$320.43
|
| Rate for Payer: Cofinity Commercial |
$102.10
|
| Rate for Payer: Cofinity Commercial |
$241.98
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Cofinity Commercial |
$536.97
|
| Rate for Payer: Cofinity Commercial |
$203.18
|
| Rate for Payer: Cofinity Commercial |
$296.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.85
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$140.59
|
| Rate for Payer: Healthscope Commercial |
$106.85
|
| Rate for Payer: Healthscope Commercial |
$561.94
|
| Rate for Payer: Healthscope Commercial |
$212.62
|
| Rate for Payer: Healthscope Commercial |
$559.86
|
| Rate for Payer: Healthscope Commercial |
$335.33
|
| Rate for Payer: Healthscope Commercial |
$310.19
|
| Rate for Payer: Healthscope Commercial |
$253.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$437.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$499.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$497.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.55
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: PHP Commercial |
$200.81
|
| Rate for Payer: PHP Commercial |
$239.16
|
| Rate for Payer: PHP Commercial |
$530.72
|
| Rate for Payer: PHP Commercial |
$292.96
|
| Rate for Payer: PHP Commercial |
$100.91
|
| Rate for Payer: PHP Commercial |
$132.78
|
| Rate for Payer: PHP Commercial |
$316.70
|
| Rate for Payer: PHP Commercial |
$528.76
|
| Rate for Payer: Priority Health SBD |
$177.26
|
| Rate for Payer: Priority Health SBD |
$234.73
|
| Rate for Payer: Priority Health SBD |
$98.41
|
| Rate for Payer: Priority Health SBD |
$112.49
|
| Rate for Payer: Priority Health SBD |
$217.14
|
| Rate for Payer: Priority Health SBD |
$393.36
|
| Rate for Payer: Priority Health SBD |
$74.79
|
| Rate for Payer: Priority Health SBD |
$148.84
|
| Rate for Payer: Priority Health SBD |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UMR Bronson Commercial |
$127.52
|
| Rate for Payer: UMR Bronson Commercial |
$66.07
|
| Rate for Payer: UMR Bronson Commercial |
$104.11
|
| Rate for Payer: UMR Bronson Commercial |
$137.86
|
| Rate for Payer: UMR Bronson Commercial |
$230.17
|
| Rate for Payer: UMR Bronson Commercial |
$231.02
|
| Rate for Payer: UMR Bronson Commercial |
$43.93
|
| Rate for Payer: UMR Bronson Commercial |
$57.80
|
| Rate for Payer: UMR Bronson Commercial |
$87.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.16
|
|
|
ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$830.45
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
17451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$747.40 |
| Rate for Payer: Aetna American Axle |
$539.79
|
| Rate for Payer: Aetna Commercial |
$705.88
|
| Rate for Payer: Aetna Medicare |
$415.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.79
|
| Rate for Payer: BCBS Complete |
$332.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cofinity Advantage |
$581.32
|
| Rate for Payer: Cofinity Commercial |
$714.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$664.36
|
| Rate for Payer: Healthscope Commercial |
$747.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$581.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$622.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$664.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$705.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$622.84
|
| Rate for Payer: PHP Commercial |
$705.88
|
| Rate for Payer: Priority Health SBD |
$523.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.72
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.72
|
| Rate for Payer: UMR Bronson Commercial |
$307.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$622.84
|
|
|
ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$830.45
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
17451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$747.40 |
| Rate for Payer: Aetna American Axle |
$539.79
|
| Rate for Payer: Aetna Commercial |
$705.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.79
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cofinity Advantage |
$581.32
|
| Rate for Payer: Cofinity Commercial |
$714.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$664.36
|
| Rate for Payer: Healthscope Commercial |
$747.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$581.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$622.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$705.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$622.84
|
| Rate for Payer: PHP Commercial |
$705.88
|
| Rate for Payer: Priority Health SBD |
$523.18
|
| Rate for Payer: UMR Bronson Commercial |
$365.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$622.84
|
|
|
ETRAVIRINE 200 MG TABLET
|
Facility
|
OP
|
$5,403.71
|
|
|
Service Code
|
NDC 59676057101
|
| Hospital Charge Code |
151955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,999.37 |
| Max. Negotiated Rate |
$4,863.34 |
| Rate for Payer: Aetna American Axle |
$3,512.41
|
| Rate for Payer: Aetna Commercial |
$4,593.15
|
| Rate for Payer: Aetna Medicare |
$2,701.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,512.41
|
| Rate for Payer: BCBS Complete |
$2,161.48
|
| Rate for Payer: Cash Price |
$4,322.97
|
| Rate for Payer: Cofinity Advantage |
$3,782.60
|
| Rate for Payer: Cofinity Commercial |
$4,647.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,322.97
|
| Rate for Payer: Healthscope Commercial |
$4,863.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,782.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,052.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,322.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,593.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,052.78
|
| Rate for Payer: PHP Commercial |
$4,593.15
|
| Rate for Payer: Priority Health SBD |
$3,404.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,512.41
|
| Rate for Payer: UHC Core |
$2,815.33
|
| Rate for Payer: UHC Exchange |
$2,123.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,999.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,052.78
|
|
|
ETRAVIRINE 200 MG TABLET
|
Facility
|
IP
|
$5,403.71
|
|
|
Service Code
|
NDC 59676057101
|
| Hospital Charge Code |
151955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,377.63 |
| Max. Negotiated Rate |
$4,863.34 |
| Rate for Payer: Aetna American Axle |
$3,512.41
|
| Rate for Payer: Aetna Commercial |
$4,593.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,512.41
|
| Rate for Payer: Cash Price |
$4,322.97
|
| Rate for Payer: Cofinity Advantage |
$3,782.60
|
| Rate for Payer: Cofinity Commercial |
$4,647.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,322.97
|
| Rate for Payer: Healthscope Commercial |
$4,863.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,782.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,052.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,593.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,052.78
|
| Rate for Payer: PHP Commercial |
$4,593.15
|
| Rate for Payer: Priority Health SBD |
$3,404.34
|
| Rate for Payer: UMR Bronson Commercial |
$2,377.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,052.78
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
IP
|
$14.42
|
|
|
Service Code
|
NDC 67877071833
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$12.98 |
| Rate for Payer: Aetna American Axle |
$9.37
|
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.37
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.09
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.81
|
| Rate for Payer: PHP Commercial |
$12.26
|
| Rate for Payer: Priority Health SBD |
$9.08
|
| Rate for Payer: UMR Bronson Commercial |
$6.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.81
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
OP
|
$864.92
|
|
|
Service Code
|
NDC 67877071831
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$320.02 |
| Max. Negotiated Rate |
$778.43 |
| Rate for Payer: Aetna American Axle |
$562.20
|
| Rate for Payer: Aetna Commercial |
$735.18
|
| Rate for Payer: Aetna Medicare |
$432.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.20
|
| Rate for Payer: BCBS Complete |
$345.97
|
| Rate for Payer: Cash Price |
$691.94
|
| Rate for Payer: Cofinity Advantage |
$605.44
|
| Rate for Payer: Cofinity Commercial |
$743.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.94
|
| Rate for Payer: Healthscope Commercial |
$778.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$691.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.69
|
| Rate for Payer: PHP Commercial |
$735.18
|
| Rate for Payer: Priority Health SBD |
$544.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$562.20
|
| Rate for Payer: UHC Core |
$450.62
|
| Rate for Payer: UHC Exchange |
$339.91
|
| Rate for Payer: UMR Bronson Commercial |
$320.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.69
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
IP
|
$864.92
|
|
|
Service Code
|
NDC 67877071831
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.56 |
| Max. Negotiated Rate |
$778.43 |
| Rate for Payer: Aetna American Axle |
$562.20
|
| Rate for Payer: Aetna Commercial |
$735.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.20
|
| Rate for Payer: Cash Price |
$691.94
|
| Rate for Payer: Cofinity Advantage |
$605.44
|
| Rate for Payer: Cofinity Commercial |
$743.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.94
|
| Rate for Payer: Healthscope Commercial |
$778.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.69
|
| Rate for Payer: PHP Commercial |
$735.18
|
| Rate for Payer: Priority Health SBD |
$544.90
|
| Rate for Payer: UMR Bronson Commercial |
$380.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.69
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
OP
|
$14.42
|
|
|
Service Code
|
NDC 67877071833
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$12.98 |
| Rate for Payer: Aetna American Axle |
$9.37
|
| Rate for Payer: Aetna Commercial |
$12.26
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.37
|
| Rate for Payer: BCBS Complete |
$5.77
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.09
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.81
|
| Rate for Payer: PHP Commercial |
$12.26
|
| Rate for Payer: Priority Health SBD |
$9.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.37
|
| Rate for Payer: UHC Core |
$7.51
|
| Rate for Payer: UHC Exchange |
$5.67
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.81
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET
|
Facility
|
IP
|
$2,597.40
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
104556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,142.86 |
| Max. Negotiated Rate |
$2,337.66 |
| Rate for Payer: Aetna American Axle |
$1,688.31
|
| Rate for Payer: Aetna American Axle |
$28.14
|
| Rate for Payer: Aetna Commercial |
$2,207.79
|
| Rate for Payer: Aetna Commercial |
$36.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,688.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.14
|
| Rate for Payer: Cash Price |
$2,077.92
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Cofinity Advantage |
$30.30
|
| Rate for Payer: Cofinity Advantage |
$1,818.18
|
| Rate for Payer: Cofinity Commercial |
$37.23
|
| Rate for Payer: Cofinity Commercial |
$2,233.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,077.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.63
|
| Rate for Payer: Healthscope Commercial |
$2,337.66
|
| Rate for Payer: Healthscope Commercial |
$38.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,818.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,948.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,207.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,948.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.47
|
| Rate for Payer: PHP Commercial |
$2,207.79
|
| Rate for Payer: PHP Commercial |
$36.80
|
| Rate for Payer: Priority Health SBD |
$27.27
|
| Rate for Payer: Priority Health SBD |
$1,636.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,142.86
|
| Rate for Payer: UMR Bronson Commercial |
$19.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,948.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.47
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET
|
Facility
|
OP
|
$2,597.40
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
104556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$2,337.66 |
| Rate for Payer: Aetna American Axle |
$1,688.31
|
| Rate for Payer: Aetna American Axle |
$28.14
|
| Rate for Payer: Aetna Commercial |
$2,207.79
|
| Rate for Payer: Aetna Commercial |
$36.80
|
| Rate for Payer: Aetna Medicare |
$1,298.70
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,688.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.14
|
| Rate for Payer: BCBS Complete |
$17.32
|
| Rate for Payer: BCBS Complete |
$1,038.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$2,077.92
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Cash Price |
$2,077.92
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Cofinity Advantage |
$1,818.18
|
| Rate for Payer: Cofinity Advantage |
$30.30
|
| Rate for Payer: Cofinity Commercial |
$2,233.76
|
| Rate for Payer: Cofinity Commercial |
$37.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,077.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.63
|
| Rate for Payer: Healthscope Commercial |
$2,337.66
|
| Rate for Payer: Healthscope Commercial |
$38.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,818.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,948.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,077.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,207.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,948.05
|
| Rate for Payer: PHP Commercial |
$2,207.79
|
| Rate for Payer: PHP Commercial |
$36.80
|
| Rate for Payer: Priority Health SBD |
$1,636.36
|
| Rate for Payer: Priority Health SBD |
$27.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.95
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: UHC Exchange |
$1.95
|
| Rate for Payer: UHC Exchange |
$1.95
|
| Rate for Payer: UMR Bronson Commercial |
$961.04
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,948.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.47
|
|
|
EXCHANGE NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 50435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,513.36
|
| Rate for Payer: BCN Commercial |
$2,513.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.89
|
| Rate for Payer: BCN Commercial |
$2,031.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM
|
Facility
|
OP
|
$2,281.79
|
|
|
Service Code
|
CPT 11421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$879.35
|
| Rate for Payer: BCN Commercial |
$879.35
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 11422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.89
|
| Rate for Payer: BCN Commercial |
$2,031.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 11423
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.89
|
| Rate for Payer: BCN Commercial |
$2,031.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
