|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$223.25
|
|
|
Service Code
|
NDC 62756013902
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna Medicare |
$111.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: BCBS Complete |
$89.30
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Advantage |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.44
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.11
|
| Rate for Payer: UHC Core |
$116.31
|
| Rate for Payer: UHC Exchange |
$87.74
|
| Rate for Payer: UMR Bronson Commercial |
$82.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
OP
|
$250.80
|
|
|
Service Code
|
NDC 00904682361
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna Medicare |
$125.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: BCBS Complete |
$100.32
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Advantage |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.10
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.02
|
| Rate for Payer: UHC Core |
$130.67
|
| Rate for Payer: UHC Exchange |
$98.56
|
| Rate for Payer: UMR Bronson Commercial |
$92.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 68462012601
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Advantage |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UMR Bronson Commercial |
$190.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 68462012601
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Advantage |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.06
|
| Rate for Payer: UHC Core |
$225.28
|
| Rate for Payer: UHC Exchange |
$169.93
|
| Rate for Payer: UMR Bronson Commercial |
$159.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 65862052301
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.73 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$137.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Advantage |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.72
|
| Rate for Payer: UHC Core |
$143.25
|
| Rate for Payer: UHC Exchange |
$108.06
|
| Rate for Payer: UMR Bronson Commercial |
$101.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
IP
|
$276.45
|
|
|
Service Code
|
NDC 60687050701
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.64 |
| Max. Negotiated Rate |
$248.81 |
| Rate for Payer: Aetna American Axle |
$179.69
|
| Rate for Payer: Aetna Commercial |
$234.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.69
|
| Rate for Payer: Cash Price |
$221.16
|
| Rate for Payer: Cofinity Advantage |
$193.51
|
| Rate for Payer: Cofinity Commercial |
$237.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.16
|
| Rate for Payer: Healthscope Commercial |
$248.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.34
|
| Rate for Payer: PHP Commercial |
$234.98
|
| Rate for Payer: Priority Health SBD |
$174.16
|
| Rate for Payer: UMR Bronson Commercial |
$121.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.34
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
IP
|
$250.80
|
|
|
Service Code
|
NDC 00904682361
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna American Axle |
$163.02
|
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.02
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Advantage |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.10
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: Priority Health SBD |
$158.00
|
| Rate for Payer: UMR Bronson Commercial |
$110.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
OP
|
$276.45
|
|
|
Service Code
|
NDC 60687050701
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.29 |
| Max. Negotiated Rate |
$248.81 |
| Rate for Payer: Aetna American Axle |
$179.69
|
| Rate for Payer: Aetna Commercial |
$234.98
|
| Rate for Payer: Aetna Medicare |
$138.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.69
|
| Rate for Payer: BCBS Complete |
$110.58
|
| Rate for Payer: Cash Price |
$221.16
|
| Rate for Payer: Cofinity Advantage |
$193.51
|
| Rate for Payer: Cofinity Commercial |
$237.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.16
|
| Rate for Payer: Healthscope Commercial |
$248.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.34
|
| Rate for Payer: PHP Commercial |
$234.98
|
| Rate for Payer: Priority Health SBD |
$174.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.69
|
| Rate for Payer: UHC Core |
$144.03
|
| Rate for Payer: UHC Exchange |
$108.64
|
| Rate for Payer: UMR Bronson Commercial |
$102.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.34
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
IP
|
$291.36
|
|
|
Service Code
|
NDC 00228263611
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna American Axle |
$189.38
|
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.38
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cofinity Advantage |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.09
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.52
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| Rate for Payer: UMR Bronson Commercial |
$128.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.52
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
NDC 60687050711
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna American Axle |
$1.80
|
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.80
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 71093011104
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna Medicare |
$164.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Advantage |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.85
|
| Rate for Payer: UHC Core |
$171.41
|
| Rate for Payer: UHC Exchange |
$129.30
|
| Rate for Payer: UMR Bronson Commercial |
$121.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
OP
|
$291.36
|
|
|
Service Code
|
NDC 00228263611
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna American Axle |
$189.38
|
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna Medicare |
$145.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.38
|
| Rate for Payer: BCBS Complete |
$116.54
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cofinity Advantage |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.09
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.52
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.38
|
| Rate for Payer: UHC Core |
$151.80
|
| Rate for Payer: UHC Exchange |
$114.50
|
| Rate for Payer: UMR Bronson Commercial |
$107.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.52
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 71093011104
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Advantage |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
NDC 60687050711
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna American Axle |
$1.80
|
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna Medicare |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.80
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Advantage |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.08
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.80
|
| Rate for Payer: UHC Core |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
GABAPENTIN 600 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 65862052301
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna American Axle |
$178.72
|
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.72
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Advantage |
$192.47
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health SBD |
$173.22
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna American Axle |
$83.46
|
| Rate for Payer: Aetna American Axle |
$41.73
|
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Commercial |
$54.57
|
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Medicare |
$16.05
|
| Rate for Payer: Aetna Medicare |
$64.20
|
| Rate for Payer: Aetna Medicare |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.73
|
| Rate for Payer: BCBS Complete |
$51.36
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: BCBS Complete |
$25.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$51.36
|
| Rate for Payer: Cash Price |
$51.36
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Advantage |
$44.94
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Advantage |
$89.88
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Cofinity Commercial |
$55.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Healthscope Commercial |
$57.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.15
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Commercial |
$54.57
|
| Rate for Payer: Priority Health SBD |
$80.89
|
| Rate for Payer: Priority Health SBD |
$40.45
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.97
|
| Rate for Payer: UHC Core |
$2.97
|
| Rate for Payer: UHC Core |
$2.97
|
| Rate for Payer: UHC Exchange |
$2.97
|
| Rate for Payer: UHC Exchange |
$2.97
|
| Rate for Payer: UHC Exchange |
$2.97
|
| Rate for Payer: UMR Bronson Commercial |
$23.75
|
| Rate for Payer: UMR Bronson Commercial |
$47.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.15
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
HCPCS A9578
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.48 |
| Max. Negotiated Rate |
$577.80 |
| Rate for Payer: Aetna American Axle |
$417.30
|
| Rate for Payer: Aetna Commercial |
$545.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.30
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Advantage |
$449.40
|
| Rate for Payer: Cofinity Commercial |
$552.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.60
|
| Rate for Payer: Healthscope Commercial |
$577.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.50
|
| Rate for Payer: PHP Commercial |
$545.70
|
| Rate for Payer: Priority Health SBD |
$404.46
|
| Rate for Payer: UMR Bronson Commercial |
$282.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.50
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$128.40
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna American Axle |
$83.46
|
| Rate for Payer: Aetna American Axle |
$41.73
|
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Commercial |
$54.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$51.36
|
| Rate for Payer: Cofinity Advantage |
$44.94
|
| Rate for Payer: Cofinity Advantage |
$89.88
|
| Rate for Payer: Cofinity Advantage |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$55.21
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.36
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Healthscope Commercial |
$57.78
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.15
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Commercial |
$54.57
|
| Rate for Payer: Priority Health SBD |
$80.89
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$40.45
|
| Rate for Payer: UMR Bronson Commercial |
$56.50
|
| Rate for Payer: UMR Bronson Commercial |
$28.25
|
| Rate for Payer: UMR Bronson Commercial |
$14.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.15
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
HCPCS A9578
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$577.80 |
| Rate for Payer: Aetna American Axle |
$417.30
|
| Rate for Payer: Aetna Commercial |
$545.70
|
| Rate for Payer: Aetna Medicare |
$321.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.30
|
| Rate for Payer: BCBS Complete |
$256.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.68
|
| Rate for Payer: BCN Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Advantage |
$449.40
|
| Rate for Payer: Cofinity Commercial |
$552.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.60
|
| Rate for Payer: Healthscope Commercial |
$577.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$513.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.50
|
| Rate for Payer: PHP Commercial |
$545.70
|
| Rate for Payer: Priority Health SBD |
$404.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Core |
$2.90
|
| Rate for Payer: UHC Exchange |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$237.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.50
|
|
|
GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
152500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Advantage |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.46
|
| Rate for Payer: UHC Core |
$0.46
|
| Rate for Payer: UHC Exchange |
$0.46
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
152500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Advantage |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$474.44
|
|
|
Service Code
|
HCPCS A9575
|
| Hospital Charge Code |
167582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.75 |
| Max. Negotiated Rate |
$427.00 |
| Rate for Payer: Aetna American Axle |
$308.39
|
| Rate for Payer: Aetna Commercial |
$403.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.39
|
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cofinity Advantage |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$408.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.55
|
| Rate for Payer: Healthscope Commercial |
$427.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.83
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: Priority Health SBD |
$298.90
|
| Rate for Payer: UMR Bronson Commercial |
$208.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.83
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$474.44
|
|
|
Service Code
|
HCPCS A9575
|
| Hospital Charge Code |
167582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$427.00 |
| Rate for Payer: Aetna American Axle |
$308.39
|
| Rate for Payer: Aetna Commercial |
$403.27
|
| Rate for Payer: Aetna Medicare |
$237.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.39
|
| Rate for Payer: BCBS Complete |
$189.78
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cofinity Advantage |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$408.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.55
|
| Rate for Payer: Healthscope Commercial |
$427.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$379.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.83
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: Priority Health SBD |
$298.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UMR Bronson Commercial |
$175.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.83
|
|
|
GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$285.15
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
10100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$256.63 |
| Rate for Payer: Aetna American Axle |
$185.35
|
| Rate for Payer: Aetna Commercial |
$242.38
|
| Rate for Payer: Aetna Medicare |
$142.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.35
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$228.12
|
| Rate for Payer: Cash Price |
$228.12
|
| Rate for Payer: Cofinity Advantage |
$199.60
|
| Rate for Payer: Cofinity Commercial |
$245.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.12
|
| Rate for Payer: Healthscope Commercial |
$256.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.86
|
| Rate for Payer: PHP Commercial |
$242.38
|
| Rate for Payer: Priority Health SBD |
$179.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.41
|
| Rate for Payer: UHC Exchange |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$105.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.86
|
|
|
GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$285.15
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
10100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.47 |
| Max. Negotiated Rate |
$256.63 |
| Rate for Payer: Aetna American Axle |
$185.35
|
| Rate for Payer: Aetna Commercial |
$242.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.35
|
| Rate for Payer: Cash Price |
$228.12
|
| Rate for Payer: Cofinity Advantage |
$199.60
|
| Rate for Payer: Cofinity Commercial |
$245.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.12
|
| Rate for Payer: Healthscope Commercial |
$256.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.86
|
| Rate for Payer: PHP Commercial |
$242.38
|
| Rate for Payer: Priority Health SBD |
$179.64
|
| Rate for Payer: UMR Bronson Commercial |
$125.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.86
|
|
