|
GELATIN POWDER 1G WITH THROMBIN 5000 UNITS IN 6 ML NS
|
Facility
|
IP
|
$277.21
|
|
|
Service Code
|
NDC 00009000301
|
| Hospital Charge Code |
500530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$121.97 |
| Max. Negotiated Rate |
$249.49 |
| Rate for Payer: Aetna American Axle |
$180.19
|
| Rate for Payer: Aetna Commercial |
$235.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.19
|
| Rate for Payer: Cash Price |
$221.77
|
| Rate for Payer: Cofinity Advantage |
$194.05
|
| Rate for Payer: Cofinity Commercial |
$238.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.77
|
| Rate for Payer: Healthscope Commercial |
$249.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.91
|
| Rate for Payer: PHP Commercial |
$235.63
|
| Rate for Payer: Priority Health SBD |
$174.64
|
| Rate for Payer: UMR Bronson Commercial |
$121.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.91
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$971.54
|
|
|
Service Code
|
NDC 00009034201
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$427.48 |
| Max. Negotiated Rate |
$874.39 |
| Rate for Payer: Aetna American Axle |
$631.50
|
| Rate for Payer: Aetna Commercial |
$825.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.50
|
| Rate for Payer: Cash Price |
$777.23
|
| Rate for Payer: Cofinity Advantage |
$680.08
|
| Rate for Payer: Cofinity Commercial |
$835.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.23
|
| Rate for Payer: Healthscope Commercial |
$874.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$680.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.65
|
| Rate for Payer: PHP Commercial |
$825.81
|
| Rate for Payer: Priority Health SBD |
$612.07
|
| Rate for Payer: UMR Bronson Commercial |
$427.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.65
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
OP
|
$707.59
|
|
|
Service Code
|
NDC 63713001974
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$261.81 |
| Max. Negotiated Rate |
$636.83 |
| Rate for Payer: Aetna American Axle |
$459.93
|
| Rate for Payer: Aetna Commercial |
$601.45
|
| Rate for Payer: Aetna Medicare |
$353.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.93
|
| Rate for Payer: BCBS Complete |
$283.04
|
| Rate for Payer: Cash Price |
$566.07
|
| Rate for Payer: Cofinity Advantage |
$495.31
|
| Rate for Payer: Cofinity Commercial |
$608.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.07
|
| Rate for Payer: Healthscope Commercial |
$636.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$495.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.69
|
| Rate for Payer: PHP Commercial |
$601.45
|
| Rate for Payer: Priority Health SBD |
$445.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.93
|
| Rate for Payer: UHC Core |
$368.65
|
| Rate for Payer: UHC Exchange |
$278.08
|
| Rate for Payer: UMR Bronson Commercial |
$261.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.69
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
IP
|
$707.59
|
|
|
Service Code
|
NDC 63713001974
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$311.34 |
| Max. Negotiated Rate |
$636.83 |
| Rate for Payer: Aetna American Axle |
$459.93
|
| Rate for Payer: Aetna Commercial |
$601.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.93
|
| Rate for Payer: Cash Price |
$566.07
|
| Rate for Payer: Cofinity Advantage |
$495.31
|
| Rate for Payer: Cofinity Commercial |
$608.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.07
|
| Rate for Payer: Healthscope Commercial |
$636.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$495.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.69
|
| Rate for Payer: PHP Commercial |
$601.45
|
| Rate for Payer: Priority Health SBD |
$445.78
|
| Rate for Payer: UMR Bronson Commercial |
$311.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.69
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE
|
Facility
|
OP
|
$971.54
|
|
|
Service Code
|
NDC 00009034201
|
| Hospital Charge Code |
28025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$359.47 |
| Max. Negotiated Rate |
$874.39 |
| Rate for Payer: Aetna American Axle |
$631.50
|
| Rate for Payer: Aetna Commercial |
$825.81
|
| Rate for Payer: Aetna Medicare |
$485.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.50
|
| Rate for Payer: BCBS Complete |
$388.62
|
| Rate for Payer: Cash Price |
$777.23
|
| Rate for Payer: Cofinity Advantage |
$680.08
|
| Rate for Payer: Cofinity Commercial |
$835.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.23
|
| Rate for Payer: Healthscope Commercial |
$874.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$680.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$777.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$728.65
|
| Rate for Payer: PHP Commercial |
$825.81
|
| Rate for Payer: Priority Health SBD |
$612.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.50
|
| Rate for Payer: UHC Core |
$506.17
|
| Rate for Payer: UHC Exchange |
$381.82
|
| Rate for Payer: UMR Bronson Commercial |
$359.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.65
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$407.42
|
|
|
Service Code
|
NDC 00009031508
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna American Axle |
$264.82
|
| Rate for Payer: Aetna Commercial |
$346.31
|
| Rate for Payer: Aetna Medicare |
$203.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.82
|
| Rate for Payer: BCBS Complete |
$162.97
|
| Rate for Payer: Cash Price |
$325.94
|
| Rate for Payer: Cofinity Advantage |
$285.19
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.94
|
| Rate for Payer: Healthscope Commercial |
$366.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.56
|
| Rate for Payer: PHP Commercial |
$346.31
|
| Rate for Payer: Priority Health SBD |
$256.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.82
|
| Rate for Payer: UHC Core |
$212.27
|
| Rate for Payer: UHC Exchange |
$160.12
|
| Rate for Payer: UMR Bronson Commercial |
$150.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.56
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$407.42
|
|
|
Service Code
|
NDC 00009031508
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$179.26 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Aetna American Axle |
$264.82
|
| Rate for Payer: Aetna Commercial |
$346.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.82
|
| Rate for Payer: Cash Price |
$325.94
|
| Rate for Payer: Cofinity Advantage |
$285.19
|
| Rate for Payer: Cofinity Commercial |
$350.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.94
|
| Rate for Payer: Healthscope Commercial |
$366.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.56
|
| Rate for Payer: PHP Commercial |
$346.31
|
| Rate for Payer: Priority Health SBD |
$256.67
|
| Rate for Payer: UMR Bronson Commercial |
$179.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.56
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
IP
|
$289.89
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$260.90 |
| Rate for Payer: Aetna American Axle |
$188.43
|
| Rate for Payer: Aetna Commercial |
$246.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.43
|
| Rate for Payer: Cash Price |
$231.91
|
| Rate for Payer: Cofinity Advantage |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.91
|
| Rate for Payer: Healthscope Commercial |
$260.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.42
|
| Rate for Payer: PHP Commercial |
$246.41
|
| Rate for Payer: Priority Health SBD |
$182.63
|
| Rate for Payer: UMR Bronson Commercial |
$127.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.42
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE
|
Facility
|
OP
|
$289.89
|
|
|
Service Code
|
NDC 63713001972
|
| Hospital Charge Code |
28018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.26 |
| Max. Negotiated Rate |
$260.90 |
| Rate for Payer: Aetna American Axle |
$188.43
|
| Rate for Payer: Aetna Commercial |
$246.41
|
| Rate for Payer: Aetna Medicare |
$144.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.43
|
| Rate for Payer: BCBS Complete |
$115.96
|
| Rate for Payer: Cash Price |
$231.91
|
| Rate for Payer: Cofinity Advantage |
$202.92
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.91
|
| Rate for Payer: Healthscope Commercial |
$260.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.42
|
| Rate for Payer: PHP Commercial |
$246.41
|
| Rate for Payer: Priority Health SBD |
$182.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.43
|
| Rate for Payer: UHC Core |
$151.03
|
| Rate for Payer: UHC Exchange |
$113.93
|
| Rate for Payer: UMR Bronson Commercial |
$107.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.42
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
OP
|
$437.91
|
|
|
Service Code
|
NDC 00009032301
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$162.03 |
| Max. Negotiated Rate |
$394.12 |
| Rate for Payer: Aetna American Axle |
$284.64
|
| Rate for Payer: Aetna Commercial |
$372.22
|
| Rate for Payer: Aetna Medicare |
$218.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.64
|
| Rate for Payer: BCBS Complete |
$175.16
|
| Rate for Payer: Cash Price |
$350.33
|
| Rate for Payer: Cofinity Advantage |
$306.54
|
| Rate for Payer: Cofinity Commercial |
$376.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.33
|
| Rate for Payer: Healthscope Commercial |
$394.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.43
|
| Rate for Payer: PHP Commercial |
$372.22
|
| Rate for Payer: Priority Health SBD |
$275.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.64
|
| Rate for Payer: UHC Core |
$228.15
|
| Rate for Payer: UHC Exchange |
$172.10
|
| Rate for Payer: UMR Bronson Commercial |
$162.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.43
|
|
|
GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 50 TOPICAL SPONGE
|
Facility
|
IP
|
$437.91
|
|
|
Service Code
|
NDC 00009032301
|
| Hospital Charge Code |
28024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$394.12 |
| Rate for Payer: Aetna American Axle |
$284.64
|
| Rate for Payer: Aetna Commercial |
$372.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.64
|
| Rate for Payer: Cash Price |
$350.33
|
| Rate for Payer: Cofinity Advantage |
$306.54
|
| Rate for Payer: Cofinity Commercial |
$376.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.33
|
| Rate for Payer: Healthscope Commercial |
$394.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$306.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.43
|
| Rate for Payer: PHP Commercial |
$372.22
|
| Rate for Payer: Priority Health SBD |
$275.88
|
| Rate for Payer: UMR Bronson Commercial |
$192.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.43
|
|
|
GELATIN SPONGE,ABSORBABLE TOPICAL SYRINGE
|
Facility
|
OP
|
$456.23
|
|
|
Service Code
|
NDC 00009104001
|
| Hospital Charge Code |
189527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.81 |
| Max. Negotiated Rate |
$410.61 |
| Rate for Payer: Aetna American Axle |
$296.55
|
| Rate for Payer: Aetna Commercial |
$387.80
|
| Rate for Payer: Aetna Medicare |
$228.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.55
|
| Rate for Payer: BCBS Complete |
$182.49
|
| Rate for Payer: Cash Price |
$364.98
|
| Rate for Payer: Cofinity Advantage |
$319.36
|
| Rate for Payer: Cofinity Commercial |
$392.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.98
|
| Rate for Payer: Healthscope Commercial |
$410.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$364.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.17
|
| Rate for Payer: PHP Commercial |
$387.80
|
| Rate for Payer: Priority Health SBD |
$287.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.55
|
| Rate for Payer: UHC Core |
$237.70
|
| Rate for Payer: UHC Exchange |
$179.30
|
| Rate for Payer: UMR Bronson Commercial |
$168.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.17
|
|
|
GELATIN SPONGE,ABSORBABLE TOPICAL SYRINGE
|
Facility
|
OP
|
$2,737.35
|
|
|
Service Code
|
NDC 00009104006
|
| Hospital Charge Code |
189527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,012.82 |
| Max. Negotiated Rate |
$2,463.61 |
| Rate for Payer: Aetna American Axle |
$1,779.28
|
| Rate for Payer: Aetna Commercial |
$2,326.75
|
| Rate for Payer: Aetna Medicare |
$1,368.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,779.28
|
| Rate for Payer: BCBS Complete |
$1,094.94
|
| Rate for Payer: Cash Price |
$2,189.88
|
| Rate for Payer: Cofinity Advantage |
$1,916.14
|
| Rate for Payer: Cofinity Commercial |
$2,354.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,189.88
|
| Rate for Payer: Healthscope Commercial |
$2,463.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,916.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,053.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,189.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,326.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,053.01
|
| Rate for Payer: PHP Commercial |
$2,326.75
|
| Rate for Payer: Priority Health SBD |
$1,724.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,779.28
|
| Rate for Payer: UHC Core |
$1,426.16
|
| Rate for Payer: UHC Exchange |
$1,075.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,012.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,053.01
|
|
|
GELATIN SPONGE,ABSORBABLE TOPICAL SYRINGE
|
Facility
|
IP
|
$456.23
|
|
|
Service Code
|
NDC 00009104001
|
| Hospital Charge Code |
189527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$410.61 |
| Rate for Payer: Aetna American Axle |
$296.55
|
| Rate for Payer: Aetna Commercial |
$387.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.55
|
| Rate for Payer: Cash Price |
$364.98
|
| Rate for Payer: Cofinity Advantage |
$319.36
|
| Rate for Payer: Cofinity Commercial |
$392.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.98
|
| Rate for Payer: Healthscope Commercial |
$410.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.17
|
| Rate for Payer: PHP Commercial |
$387.80
|
| Rate for Payer: Priority Health SBD |
$287.42
|
| Rate for Payer: UMR Bronson Commercial |
$200.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.17
|
|
|
GELATIN SPONGE,ABSORBABLE TOPICAL SYRINGE
|
Facility
|
IP
|
$2,737.35
|
|
|
Service Code
|
NDC 00009104006
|
| Hospital Charge Code |
189527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,204.43 |
| Max. Negotiated Rate |
$2,463.61 |
| Rate for Payer: Aetna American Axle |
$1,779.28
|
| Rate for Payer: Aetna Commercial |
$2,326.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,779.28
|
| Rate for Payer: Cash Price |
$2,189.88
|
| Rate for Payer: Cofinity Advantage |
$1,916.14
|
| Rate for Payer: Cofinity Commercial |
$2,354.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,189.88
|
| Rate for Payer: Healthscope Commercial |
$2,463.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,916.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,053.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,326.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,053.01
|
| Rate for Payer: PHP Commercial |
$2,326.75
|
| Rate for Payer: Priority Health SBD |
$1,724.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,204.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,053.01
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$290.61
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.87 |
| Max. Negotiated Rate |
$261.55 |
| Rate for Payer: Aetna American Axle |
$188.90
|
| Rate for Payer: Aetna Commercial |
$247.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.90
|
| Rate for Payer: Cash Price |
$232.49
|
| Rate for Payer: Cofinity Advantage |
$203.43
|
| Rate for Payer: Cofinity Commercial |
$249.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.49
|
| Rate for Payer: Healthscope Commercial |
$261.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.96
|
| Rate for Payer: PHP Commercial |
$247.02
|
| Rate for Payer: Priority Health SBD |
$183.08
|
| Rate for Payer: UMR Bronson Commercial |
$127.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.96
|
|
|
GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$290.61
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$261.55 |
| Rate for Payer: Aetna American Axle |
$188.90
|
| Rate for Payer: Aetna American Axle |
$153.50
|
| Rate for Payer: Aetna Commercial |
$200.73
|
| Rate for Payer: Aetna Commercial |
$247.02
|
| Rate for Payer: Aetna Medicare |
$145.31
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS Complete |
$116.24
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCN Commercial |
$11.43
|
| Rate for Payer: BCN Commercial |
$11.43
|
| Rate for Payer: Cash Price |
$232.49
|
| Rate for Payer: Cash Price |
$188.92
|
| Rate for Payer: Cash Price |
$188.92
|
| Rate for Payer: Cash Price |
$232.49
|
| Rate for Payer: Cofinity Advantage |
$203.43
|
| Rate for Payer: Cofinity Advantage |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$249.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.49
|
| Rate for Payer: Healthscope Commercial |
$261.55
|
| Rate for Payer: Healthscope Commercial |
$212.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.11
|
| Rate for Payer: PHP Commercial |
$200.73
|
| Rate for Payer: PHP Commercial |
$247.02
|
| Rate for Payer: Priority Health SBD |
$183.08
|
| Rate for Payer: Priority Health SBD |
$148.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UMR Bronson Commercial |
$107.53
|
| Rate for Payer: UMR Bronson Commercial |
$87.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.96
|
|
|
GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$259.06
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
155792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$233.15 |
| Rate for Payer: Aetna American Axle |
$168.39
|
| Rate for Payer: Aetna American Axle |
$167.17
|
| Rate for Payer: Aetna American Axle |
$307.09
|
| Rate for Payer: Aetna Commercial |
$220.20
|
| Rate for Payer: Aetna Commercial |
$401.58
|
| Rate for Payer: Aetna Commercial |
$218.60
|
| Rate for Payer: Aetna Medicare |
$129.53
|
| Rate for Payer: Aetna Medicare |
$128.59
|
| Rate for Payer: Aetna Medicare |
$236.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.09
|
| Rate for Payer: BCBS Complete |
$102.87
|
| Rate for Payer: BCBS Complete |
$103.62
|
| Rate for Payer: BCBS Complete |
$188.98
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCN Commercial |
$11.43
|
| Rate for Payer: BCN Commercial |
$11.43
|
| Rate for Payer: BCN Commercial |
$11.43
|
| Rate for Payer: Cash Price |
$205.74
|
| Rate for Payer: Cash Price |
$205.74
|
| Rate for Payer: Cash Price |
$377.96
|
| Rate for Payer: Cash Price |
$377.96
|
| Rate for Payer: Cash Price |
$207.25
|
| Rate for Payer: Cash Price |
$207.25
|
| Rate for Payer: Cofinity Advantage |
$330.71
|
| Rate for Payer: Cofinity Advantage |
$181.34
|
| Rate for Payer: Cofinity Advantage |
$180.03
|
| Rate for Payer: Cofinity Commercial |
$221.17
|
| Rate for Payer: Cofinity Commercial |
$222.79
|
| Rate for Payer: Cofinity Commercial |
$406.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.25
|
| Rate for Payer: Healthscope Commercial |
$231.46
|
| Rate for Payer: Healthscope Commercial |
$233.15
|
| Rate for Payer: Healthscope Commercial |
$425.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$330.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.34
|
| Rate for Payer: PHP Commercial |
$220.20
|
| Rate for Payer: PHP Commercial |
$218.60
|
| Rate for Payer: PHP Commercial |
$401.58
|
| Rate for Payer: Priority Health SBD |
$162.02
|
| Rate for Payer: Priority Health SBD |
$297.64
|
| Rate for Payer: Priority Health SBD |
$163.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Core |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UMR Bronson Commercial |
$174.81
|
| Rate for Payer: UMR Bronson Commercial |
$95.16
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.34
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Advantage |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health SBD |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.53
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$163.56
|
|
|
Service Code
|
NDC 69097082103
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.97 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna American Axle |
$106.31
|
| Rate for Payer: Aetna Commercial |
$139.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.31
|
| Rate for Payer: Cash Price |
$130.85
|
| Rate for Payer: Cofinity Advantage |
$114.49
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.85
|
| Rate for Payer: Healthscope Commercial |
$147.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.67
|
| Rate for Payer: PHP Commercial |
$139.03
|
| Rate for Payer: Priority Health SBD |
$103.04
|
| Rate for Payer: UMR Bronson Commercial |
$71.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.67
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$117.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.52
|
| Rate for Payer: UHC Core |
$122.25
|
| Rate for Payer: UHC Exchange |
$92.22
|
| Rate for Payer: UMR Bronson Commercial |
$86.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
OP
|
$163.56
|
|
|
Service Code
|
NDC 69097082103
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.52 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna American Axle |
$106.31
|
| Rate for Payer: Aetna Commercial |
$139.03
|
| Rate for Payer: Aetna Medicare |
$81.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.31
|
| Rate for Payer: BCBS Complete |
$65.42
|
| Rate for Payer: Cash Price |
$130.85
|
| Rate for Payer: Cofinity Advantage |
$114.49
|
| Rate for Payer: Cofinity Commercial |
$140.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.85
|
| Rate for Payer: Healthscope Commercial |
$147.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.67
|
| Rate for Payer: PHP Commercial |
$139.03
|
| Rate for Payer: Priority Health SBD |
$103.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.31
|
| Rate for Payer: UHC Core |
$85.21
|
| Rate for Payer: UHC Exchange |
$64.28
|
| Rate for Payer: UMR Bronson Commercial |
$60.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.67
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 60687022411
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Advantage |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health SBD |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 60687022401
|
| Hospital Charge Code |
3378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UMR Bronson Commercial |
$103.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN
|
Facility
|
IP
|
$47,151.96
|
|
|
Service Code
|
HCPCS J9203
|
| Hospital Charge Code |
184519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,746.86 |
| Max. Negotiated Rate |
$42,436.76 |
| Rate for Payer: Aetna American Axle |
$30,648.77
|
| Rate for Payer: Aetna Commercial |
$40,079.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,648.77
|
| Rate for Payer: Cash Price |
$37,721.57
|
| Rate for Payer: Cofinity Advantage |
$33,006.37
|
| Rate for Payer: Cofinity Commercial |
$40,550.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37,721.57
|
| Rate for Payer: Healthscope Commercial |
$42,436.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,006.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,363.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,079.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,363.97
|
| Rate for Payer: PHP Commercial |
$40,079.17
|
| Rate for Payer: Priority Health SBD |
$29,705.73
|
| Rate for Payer: UMR Bronson Commercial |
$20,746.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,363.97
|
|
