|
ARIPIPRAZOLE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$669.60
|
|
|
Service Code
|
NDC 66689073505
|
| Hospital Charge Code |
40446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.75 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Aetna American Axle |
$435.24
|
| Rate for Payer: Aetna Commercial |
$569.16
|
| Rate for Payer: Aetna Medicare |
$334.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.24
|
| Rate for Payer: BCBS Complete |
$267.84
|
| Rate for Payer: Cash Price |
$535.68
|
| Rate for Payer: Cofinity Advantage |
$468.72
|
| Rate for Payer: Cofinity Commercial |
$575.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.68
|
| Rate for Payer: Healthscope Commercial |
$602.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$535.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.20
|
| Rate for Payer: PHP Commercial |
$569.16
|
| Rate for Payer: Priority Health SBD |
$421.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.24
|
| Rate for Payer: UHC Core |
$348.86
|
| Rate for Payer: UHC Exchange |
$263.15
|
| Rate for Payer: UMR Bronson Commercial |
$247.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.20
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000613
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$883.91 |
| Max. Negotiated Rate |
$1,807.99 |
| Rate for Payer: Aetna American Axle |
$1,305.77
|
| Rate for Payer: Aetna Commercial |
$1,707.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.77
|
| Rate for Payer: Cash Price |
$1,607.10
|
| Rate for Payer: Cofinity Advantage |
$1,406.22
|
| Rate for Payer: Cofinity Commercial |
$1,727.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,607.10
|
| Rate for Payer: Healthscope Commercial |
$1,807.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,406.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,506.66
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health SBD |
$1,265.59
|
| Rate for Payer: UMR Bronson Commercial |
$883.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.66
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$2,008.88
|
|
|
Service Code
|
NDC 59148000613
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$743.29 |
| Max. Negotiated Rate |
$1,807.99 |
| Rate for Payer: Aetna American Axle |
$1,305.77
|
| Rate for Payer: Aetna Commercial |
$1,707.55
|
| Rate for Payer: Aetna Medicare |
$1,004.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.77
|
| Rate for Payer: BCBS Complete |
$803.55
|
| Rate for Payer: Cash Price |
$1,607.10
|
| Rate for Payer: Cofinity Advantage |
$1,406.22
|
| Rate for Payer: Cofinity Commercial |
$1,727.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,607.10
|
| Rate for Payer: Healthscope Commercial |
$1,807.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,406.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,506.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,607.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,707.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,506.66
|
| Rate for Payer: PHP Commercial |
$1,707.55
|
| Rate for Payer: Priority Health SBD |
$1,265.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,305.77
|
| Rate for Payer: UHC Core |
$1,046.63
|
| Rate for Payer: UHC Exchange |
$789.49
|
| Rate for Payer: UMR Bronson Commercial |
$743.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,506.66
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Advantage |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
IP
|
$200.31
|
|
|
Service Code
|
NDC 60505307503
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.14 |
| Max. Negotiated Rate |
$180.28 |
| Rate for Payer: Aetna American Axle |
$130.20
|
| Rate for Payer: Aetna Commercial |
$170.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.20
|
| Rate for Payer: Cash Price |
$160.25
|
| Rate for Payer: Cofinity Advantage |
$140.22
|
| Rate for Payer: Cofinity Commercial |
$172.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.25
|
| Rate for Payer: Healthscope Commercial |
$180.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.23
|
| Rate for Payer: PHP Commercial |
$170.26
|
| Rate for Payer: Priority Health SBD |
$126.20
|
| Rate for Payer: UMR Bronson Commercial |
$88.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.23
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$57.57
|
|
|
Service Code
|
NDC 65162089603
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna Medicare |
$28.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: BCBS Complete |
$23.03
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Advantage |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.42
|
| Rate for Payer: UHC Core |
$29.99
|
| Rate for Payer: UHC Exchange |
$22.63
|
| Rate for Payer: UMR Bronson Commercial |
$21.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
ARIPIPRAZOLE 2 MG TABLET
|
Facility
|
OP
|
$200.31
|
|
|
Service Code
|
NDC 60505307503
|
| Hospital Charge Code |
70306
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$180.28 |
| Rate for Payer: Aetna American Axle |
$130.20
|
| Rate for Payer: Aetna Commercial |
$170.26
|
| Rate for Payer: Aetna Medicare |
$100.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.20
|
| Rate for Payer: BCBS Complete |
$80.12
|
| Rate for Payer: Cash Price |
$160.25
|
| Rate for Payer: Cofinity Advantage |
$140.22
|
| Rate for Payer: Cofinity Commercial |
$172.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.25
|
| Rate for Payer: Healthscope Commercial |
$180.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.23
|
| Rate for Payer: PHP Commercial |
$170.26
|
| Rate for Payer: Priority Health SBD |
$126.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.20
|
| Rate for Payer: UHC Core |
$104.36
|
| Rate for Payer: UHC Exchange |
$78.72
|
| Rate for Payer: UMR Bronson Commercial |
$74.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.23
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.16 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Aetna American Axle |
$49.47
|
| Rate for Payer: Aetna Commercial |
$64.69
|
| Rate for Payer: Aetna Medicare |
$38.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.47
|
| Rate for Payer: BCBS Complete |
$30.44
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cofinity Advantage |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$65.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$68.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.08
|
| Rate for Payer: PHP Commercial |
$64.69
|
| Rate for Payer: Priority Health SBD |
$47.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.47
|
| Rate for Payer: UHC Core |
$39.65
|
| Rate for Payer: UHC Exchange |
$29.91
|
| Rate for Payer: UMR Bronson Commercial |
$28.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.08
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$199.16
|
|
|
Service Code
|
NDC 60505267303
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.69 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna American Axle |
$129.45
|
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna Medicare |
$99.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.45
|
| Rate for Payer: BCBS Complete |
$79.66
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Advantage |
$139.41
|
| Rate for Payer: Cofinity Commercial |
$171.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.33
|
| Rate for Payer: Healthscope Commercial |
$179.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.37
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health SBD |
$125.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.45
|
| Rate for Payer: UHC Core |
$103.76
|
| Rate for Payer: UHC Exchange |
$78.27
|
| Rate for Payer: UMR Bronson Commercial |
$73.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$1,831.87
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$806.02 |
| Max. Negotiated Rate |
$1,648.68 |
| Rate for Payer: Aetna American Axle |
$1,190.72
|
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.72
|
| Rate for Payer: Cash Price |
$1,465.50
|
| Rate for Payer: Cofinity Advantage |
$1,282.31
|
| Rate for Payer: Cofinity Commercial |
$1,575.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.50
|
| Rate for Payer: Healthscope Commercial |
$1,648.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,282.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,557.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,373.90
|
| Rate for Payer: PHP Commercial |
$1,557.09
|
| Rate for Payer: Priority Health SBD |
$1,154.08
|
| Rate for Payer: UMR Bronson Commercial |
$806.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Aetna American Axle |
$49.47
|
| Rate for Payer: Aetna Commercial |
$64.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.47
|
| Rate for Payer: Cash Price |
$60.88
|
| Rate for Payer: Cofinity Advantage |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$65.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$68.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.08
|
| Rate for Payer: PHP Commercial |
$64.69
|
| Rate for Payer: Priority Health SBD |
$47.94
|
| Rate for Payer: UMR Bronson Commercial |
$33.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.08
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$1,831.87
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$677.79 |
| Max. Negotiated Rate |
$1,648.68 |
| Rate for Payer: Aetna American Axle |
$1,190.72
|
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: Aetna Medicare |
$915.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.72
|
| Rate for Payer: BCBS Complete |
$732.75
|
| Rate for Payer: Cash Price |
$1,465.50
|
| Rate for Payer: Cofinity Advantage |
$1,282.31
|
| Rate for Payer: Cofinity Commercial |
$1,575.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.50
|
| Rate for Payer: Healthscope Commercial |
$1,648.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,282.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,465.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,557.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,373.90
|
| Rate for Payer: PHP Commercial |
$1,557.09
|
| Rate for Payer: Priority Health SBD |
$1,154.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.72
|
| Rate for Payer: UHC Core |
$954.40
|
| Rate for Payer: UHC Exchange |
$719.92
|
| Rate for Payer: UMR Bronson Commercial |
$677.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505267303
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna American Axle |
$129.45
|
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.45
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Advantage |
$139.41
|
| Rate for Payer: Cofinity Commercial |
$171.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.33
|
| Rate for Payer: Healthscope Commercial |
$179.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.37
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health SBD |
$125.47
|
| Rate for Payer: UMR Bronson Commercial |
$87.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE ER 300 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$5,834.47
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
165265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,567.17 |
| Max. Negotiated Rate |
$5,251.02 |
| Rate for Payer: Aetna American Axle |
$3,792.41
|
| Rate for Payer: Aetna Commercial |
$4,959.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,792.41
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cofinity Advantage |
$4,084.13
|
| Rate for Payer: Cofinity Commercial |
$5,017.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,667.58
|
| Rate for Payer: Healthscope Commercial |
$5,251.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,084.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,375.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,959.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,375.85
|
| Rate for Payer: PHP Commercial |
$4,959.30
|
| Rate for Payer: Priority Health SBD |
$3,675.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,567.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,375.85
|
|
|
ARIPIPRAZOLE ER 300 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$5,834.47
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
165265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$5,251.02 |
| Rate for Payer: Aetna American Axle |
$3,792.41
|
| Rate for Payer: Aetna Commercial |
$4,959.30
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,792.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.09
|
| Rate for Payer: BCBS Complete |
$3.99
|
| Rate for Payer: BCBS MAPPO |
$7.27
|
| Rate for Payer: BCBS Trust/PPO |
$23.58
|
| Rate for Payer: BCN Commercial |
$23.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.27
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cofinity Advantage |
$4,084.13
|
| Rate for Payer: Cofinity Commercial |
$5,017.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,667.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.27
|
| Rate for Payer: Healthscope Commercial |
$5,251.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,084.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,375.85
|
| Rate for Payer: Mclaren Medicaid |
$7.27
|
| Rate for Payer: Mclaren Medicare |
$7.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.63
|
| Rate for Payer: Meridian Medicaid |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,959.30
|
| Rate for Payer: Nomi Health Commercial |
$21.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,375.85
|
| Rate for Payer: PACE Medicare |
$6.91
|
| Rate for Payer: PACE SWMI |
$7.27
|
| Rate for Payer: PHP Commercial |
$4,959.30
|
| Rate for Payer: PHP Medicare Advantage |
$7.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.95
|
| Rate for Payer: Priority Health Medicare |
$7.27
|
| Rate for Payer: Priority Health SBD |
$3,675.72
|
| Rate for Payer: Priority Health Tiered Network |
$18.36
|
| Rate for Payer: Railroad Medicare Medicare |
$7.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.01
|
| Rate for Payer: UHC Core |
$12.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.27
|
| Rate for Payer: UHC Exchange |
$12.01
|
| Rate for Payer: UHC Medicaid |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,158.75
|
| Rate for Payer: VA VA |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,375.85
|
|
|
ARIPIPRAZOLE ER 300 MG SUSPENSION, EXTENDED REL. INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$6,009.48
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$5,408.53 |
| Rate for Payer: Aetna American Axle |
$3,906.16
|
| Rate for Payer: Aetna Commercial |
$5,108.06
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,906.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.09
|
| Rate for Payer: BCBS Complete |
$3.99
|
| Rate for Payer: BCBS MAPPO |
$7.27
|
| Rate for Payer: BCBS Trust/PPO |
$23.58
|
| Rate for Payer: BCN Commercial |
$23.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.27
|
| Rate for Payer: Cash Price |
$4,807.58
|
| Rate for Payer: Cash Price |
$4,807.58
|
| Rate for Payer: Cofinity Advantage |
$4,206.64
|
| Rate for Payer: Cofinity Commercial |
$5,168.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,807.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.27
|
| Rate for Payer: Healthscope Commercial |
$5,408.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,206.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,507.11
|
| Rate for Payer: Mclaren Medicaid |
$7.27
|
| Rate for Payer: Mclaren Medicare |
$7.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.63
|
| Rate for Payer: Meridian Medicaid |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,108.06
|
| Rate for Payer: Nomi Health Commercial |
$21.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,507.11
|
| Rate for Payer: PACE Medicare |
$6.91
|
| Rate for Payer: PACE SWMI |
$7.27
|
| Rate for Payer: PHP Commercial |
$5,108.06
|
| Rate for Payer: PHP Medicare Advantage |
$7.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.95
|
| Rate for Payer: Priority Health Medicare |
$7.27
|
| Rate for Payer: Priority Health SBD |
$3,785.97
|
| Rate for Payer: Priority Health Tiered Network |
$18.36
|
| Rate for Payer: Railroad Medicare Medicare |
$7.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.01
|
| Rate for Payer: UHC Core |
$12.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.27
|
| Rate for Payer: UHC Exchange |
$12.01
|
| Rate for Payer: UHC Medicaid |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,223.51
|
| Rate for Payer: VA VA |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,507.11
|
|
|
ARIPIPRAZOLE ER 300 MG SUSPENSION, EXTENDED REL. INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$6,009.48
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,644.17 |
| Max. Negotiated Rate |
$5,408.53 |
| Rate for Payer: Aetna American Axle |
$3,906.16
|
| Rate for Payer: Aetna Commercial |
$5,108.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,906.16
|
| Rate for Payer: Cash Price |
$4,807.58
|
| Rate for Payer: Cofinity Advantage |
$4,206.64
|
| Rate for Payer: Cofinity Commercial |
$5,168.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,807.58
|
| Rate for Payer: Healthscope Commercial |
$5,408.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,206.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,507.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,108.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,507.11
|
| Rate for Payer: PHP Commercial |
$5,108.06
|
| Rate for Payer: Priority Health SBD |
$3,785.97
|
| Rate for Payer: UMR Bronson Commercial |
$2,644.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,507.11
|
|
|
ARIPIPRAZOLE ER 400 MG SUSPENSION, EXTENDED REL.INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$6,510.25
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,864.51 |
| Max. Negotiated Rate |
$5,859.23 |
| Rate for Payer: Aetna American Axle |
$4,231.66
|
| Rate for Payer: Aetna Commercial |
$5,533.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,231.66
|
| Rate for Payer: Cash Price |
$5,208.20
|
| Rate for Payer: Cofinity Advantage |
$4,557.18
|
| Rate for Payer: Cofinity Commercial |
$5,598.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,208.20
|
| Rate for Payer: Healthscope Commercial |
$5,859.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,557.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,882.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,533.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,882.69
|
| Rate for Payer: PHP Commercial |
$5,533.71
|
| Rate for Payer: Priority Health SBD |
$4,101.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,864.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,882.69
|
|
|
ARIPIPRAZOLE ER 400 MG SUSPENSION, EXTENDED REL.INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$6,510.25
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$5,859.23 |
| Rate for Payer: Aetna American Axle |
$4,231.66
|
| Rate for Payer: Aetna Commercial |
$5,533.71
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,231.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.09
|
| Rate for Payer: BCBS Complete |
$3.99
|
| Rate for Payer: BCBS MAPPO |
$7.27
|
| Rate for Payer: BCBS Trust/PPO |
$23.58
|
| Rate for Payer: BCN Commercial |
$23.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.27
|
| Rate for Payer: Cash Price |
$5,208.20
|
| Rate for Payer: Cash Price |
$5,208.20
|
| Rate for Payer: Cofinity Advantage |
$4,557.18
|
| Rate for Payer: Cofinity Commercial |
$5,598.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,208.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.27
|
| Rate for Payer: Healthscope Commercial |
$5,859.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,557.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,882.69
|
| Rate for Payer: Mclaren Medicaid |
$7.27
|
| Rate for Payer: Mclaren Medicare |
$7.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.63
|
| Rate for Payer: Meridian Medicaid |
$7.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,533.71
|
| Rate for Payer: Nomi Health Commercial |
$21.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,882.69
|
| Rate for Payer: PACE Medicare |
$6.91
|
| Rate for Payer: PACE SWMI |
$7.27
|
| Rate for Payer: PHP Commercial |
$5,533.71
|
| Rate for Payer: PHP Medicare Advantage |
$7.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.95
|
| Rate for Payer: Priority Health Medicare |
$7.27
|
| Rate for Payer: Priority Health SBD |
$4,101.46
|
| Rate for Payer: Priority Health Tiered Network |
$18.36
|
| Rate for Payer: Railroad Medicare Medicare |
$7.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.01
|
| Rate for Payer: UHC Core |
$12.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.27
|
| Rate for Payer: UHC Exchange |
$12.01
|
| Rate for Payer: UHC Medicaid |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,408.79
|
| Rate for Payer: VA VA |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,882.69
|
|
|
ARMODAFINIL 150 MG TABLET
|
Facility
|
OP
|
$3,763.13
|
|
|
Service Code
|
NDC 63459021530
|
| Hospital Charge Code |
96966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,392.36 |
| Max. Negotiated Rate |
$3,386.82 |
| Rate for Payer: Aetna American Axle |
$2,446.03
|
| Rate for Payer: Aetna Commercial |
$3,198.66
|
| Rate for Payer: Aetna Medicare |
$1,881.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.03
|
| Rate for Payer: BCBS Complete |
$1,505.25
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cofinity Advantage |
$2,634.19
|
| Rate for Payer: Cofinity Commercial |
$3,236.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.50
|
| Rate for Payer: Healthscope Commercial |
$3,386.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,634.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,822.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,010.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,198.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,822.35
|
| Rate for Payer: PHP Commercial |
$3,198.66
|
| Rate for Payer: Priority Health SBD |
$2,370.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,446.03
|
| Rate for Payer: UHC Core |
$1,960.59
|
| Rate for Payer: UHC Exchange |
$1,478.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,392.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,822.35
|
|
|
ARMODAFINIL 150 MG TABLET
|
Facility
|
IP
|
$3,763.13
|
|
|
Service Code
|
NDC 63459021530
|
| Hospital Charge Code |
96966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,655.78 |
| Max. Negotiated Rate |
$3,386.82 |
| Rate for Payer: Aetna American Axle |
$2,446.03
|
| Rate for Payer: Aetna Commercial |
$3,198.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.03
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cofinity Advantage |
$2,634.19
|
| Rate for Payer: Cofinity Commercial |
$3,236.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.50
|
| Rate for Payer: Healthscope Commercial |
$3,386.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,634.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,822.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,198.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,822.35
|
| Rate for Payer: PHP Commercial |
$3,198.66
|
| Rate for Payer: Priority Health SBD |
$2,370.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,655.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,822.35
|
|
|
ARMODAFINIL 50 MG TABLET
|
Facility
|
OP
|
$115.71
|
|
|
Service Code
|
NDC 69339017703
|
| Hospital Charge Code |
96965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$104.14 |
| Rate for Payer: Aetna American Axle |
$75.21
|
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: Aetna Medicare |
$57.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.21
|
| Rate for Payer: BCBS Complete |
$46.28
|
| Rate for Payer: Cash Price |
$92.57
|
| Rate for Payer: Cofinity Advantage |
$81.00
|
| Rate for Payer: Cofinity Commercial |
$99.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.57
|
| Rate for Payer: Healthscope Commercial |
$104.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.78
|
| Rate for Payer: PHP Commercial |
$98.35
|
| Rate for Payer: Priority Health SBD |
$72.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.21
|
| Rate for Payer: UHC Core |
$60.28
|
| Rate for Payer: UHC Exchange |
$45.47
|
| Rate for Payer: UMR Bronson Commercial |
$42.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.78
|
|
|
ARMODAFINIL 50 MG TABLET
|
Facility
|
OP
|
$78.09
|
|
|
Service Code
|
NDC 65862080530
|
| Hospital Charge Code |
96965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$70.28 |
| Rate for Payer: Aetna American Axle |
$50.76
|
| Rate for Payer: Aetna Commercial |
$66.38
|
| Rate for Payer: Aetna Medicare |
$39.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.76
|
| Rate for Payer: BCBS Complete |
$31.24
|
| Rate for Payer: Cash Price |
$62.47
|
| Rate for Payer: Cofinity Advantage |
$54.66
|
| Rate for Payer: Cofinity Commercial |
$67.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.47
|
| Rate for Payer: Healthscope Commercial |
$70.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.57
|
| Rate for Payer: PHP Commercial |
$66.38
|
| Rate for Payer: Priority Health SBD |
$49.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.76
|
| Rate for Payer: UHC Core |
$40.68
|
| Rate for Payer: UHC Exchange |
$30.69
|
| Rate for Payer: UMR Bronson Commercial |
$28.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.57
|
|
|
ARMODAFINIL 50 MG TABLET
|
Facility
|
IP
|
$78.09
|
|
|
Service Code
|
NDC 65862080530
|
| Hospital Charge Code |
96965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$70.28 |
| Rate for Payer: Aetna American Axle |
$50.76
|
| Rate for Payer: Aetna Commercial |
$66.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.76
|
| Rate for Payer: Cash Price |
$62.47
|
| Rate for Payer: Cofinity Advantage |
$54.66
|
| Rate for Payer: Cofinity Commercial |
$67.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.47
|
| Rate for Payer: Healthscope Commercial |
$70.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.57
|
| Rate for Payer: PHP Commercial |
$66.38
|
| Rate for Payer: Priority Health SBD |
$49.20
|
| Rate for Payer: UMR Bronson Commercial |
$34.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.57
|
|
|
ARMODAFINIL 50 MG TABLET
|
Facility
|
IP
|
$115.71
|
|
|
Service Code
|
NDC 69339017703
|
| Hospital Charge Code |
96965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$104.14 |
| Rate for Payer: Aetna American Axle |
$75.21
|
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.21
|
| Rate for Payer: Cash Price |
$92.57
|
| Rate for Payer: Cofinity Advantage |
$81.00
|
| Rate for Payer: Cofinity Commercial |
$99.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.57
|
| Rate for Payer: Healthscope Commercial |
$104.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.78
|
| Rate for Payer: PHP Commercial |
$98.35
|
| Rate for Payer: Priority Health SBD |
$72.90
|
| Rate for Payer: UMR Bronson Commercial |
$50.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.78
|
|
