|
NEGATIVE PRESSURE WOUND THERAPY, (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DISPOSABLE, NON-DURABLE MEDICAL EQUIPMENT INCLUDING PROVISION OF EXUDATE MANAGEMENT COLLECTION SYSTEM, TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTIONS FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 97607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 97606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 97605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 97605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,851.60
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
70267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$6,166.44 |
| Rate for Payer: Aetna American Axle |
$4,453.54
|
| Rate for Payer: Aetna American Axle |
$9,260.88
|
| Rate for Payer: Aetna American Axle |
$4,493.58
|
| Rate for Payer: Aetna American Axle |
$3,910.89
|
| Rate for Payer: Aetna American Axle |
$3,407.87
|
| Rate for Payer: Aetna American Axle |
$4,458.09
|
| Rate for Payer: Aetna American Axle |
$4,531.80
|
| Rate for Payer: Aetna Commercial |
$12,110.38
|
| Rate for Payer: Aetna Commercial |
$5,823.86
|
| Rate for Payer: Aetna Commercial |
$5,876.22
|
| Rate for Payer: Aetna Commercial |
$5,829.81
|
| Rate for Payer: Aetna Commercial |
$5,926.20
|
| Rate for Payer: Aetna Commercial |
$5,114.24
|
| Rate for Payer: Aetna Commercial |
$4,456.45
|
| Rate for Payer: Aetna Medicare |
$83.05
|
| Rate for Payer: Aetna Medicare |
$83.05
|
| Rate for Payer: Aetna Medicare |
$83.05
|
| Rate for Payer: Aetna Medicare |
$83.05
|
| Rate for Payer: Aetna Medicare |
$83.05
|
| Rate for Payer: Aetna Medicare |
$83.05
|
| Rate for Payer: Aetna Medicare |
$83.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,493.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,910.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,260.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,453.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,458.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,531.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,407.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.83
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS MAPPO |
$79.86
|
| Rate for Payer: BCBS MAPPO |
$79.86
|
| Rate for Payer: BCBS MAPPO |
$79.86
|
| Rate for Payer: BCBS MAPPO |
$79.86
|
| Rate for Payer: BCBS MAPPO |
$79.86
|
| Rate for Payer: BCBS MAPPO |
$79.86
|
| Rate for Payer: BCBS MAPPO |
$79.86
|
| Rate for Payer: BCN Medicare Advantage |
$79.86
|
| Rate for Payer: BCN Medicare Advantage |
$79.86
|
| Rate for Payer: BCN Medicare Advantage |
$79.86
|
| Rate for Payer: BCN Medicare Advantage |
$79.86
|
| Rate for Payer: BCN Medicare Advantage |
$79.86
|
| Rate for Payer: BCN Medicare Advantage |
$79.86
|
| Rate for Payer: BCN Medicare Advantage |
$79.86
|
| Rate for Payer: Cash Price |
$5,486.88
|
| Rate for Payer: Cash Price |
$4,194.30
|
| Rate for Payer: Cash Price |
$5,481.28
|
| Rate for Payer: Cash Price |
$5,577.60
|
| Rate for Payer: Cash Price |
$5,577.60
|
| Rate for Payer: Cash Price |
$5,486.88
|
| Rate for Payer: Cash Price |
$5,481.28
|
| Rate for Payer: Cash Price |
$5,530.56
|
| Rate for Payer: Cash Price |
$4,194.30
|
| Rate for Payer: Cash Price |
$4,813.40
|
| Rate for Payer: Cash Price |
$5,530.56
|
| Rate for Payer: Cash Price |
$4,813.40
|
| Rate for Payer: Cash Price |
$11,398.00
|
| Rate for Payer: Cash Price |
$11,398.00
|
| Rate for Payer: Cofinity Commercial |
$5,892.38
|
| Rate for Payer: Cofinity Commercial |
$5,945.35
|
| Rate for Payer: Cofinity Commercial |
$5,174.40
|
| Rate for Payer: Cofinity Commercial |
$4,801.02
|
| Rate for Payer: Cofinity Commercial |
$5,898.40
|
| Rate for Payer: Cofinity Commercial |
$4,880.40
|
| Rate for Payer: Cofinity Commercial |
$5,995.92
|
| Rate for Payer: Cofinity Commercial |
$12,252.85
|
| Rate for Payer: Cofinity Commercial |
$4,796.12
|
| Rate for Payer: Cofinity Commercial |
$4,508.88
|
| Rate for Payer: Cofinity Commercial |
$3,670.02
|
| Rate for Payer: Cofinity Commercial |
$4,211.73
|
| Rate for Payer: Cofinity Commercial |
$9,973.25
|
| Rate for Payer: Cofinity Commercial |
$4,839.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,211.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,796.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,973.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,880.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,839.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,670.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,801.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,481.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,486.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,530.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,577.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,398.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,194.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.86
|
| Rate for Payer: Healthscope Commercial |
$6,274.80
|
| Rate for Payer: Healthscope Commercial |
$5,415.07
|
| Rate for Payer: Healthscope Commercial |
$6,172.74
|
| Rate for Payer: Healthscope Commercial |
$6,166.44
|
| Rate for Payer: Healthscope Commercial |
$6,221.88
|
| Rate for Payer: Healthscope Commercial |
$12,822.75
|
| Rate for Payer: Healthscope Commercial |
$4,718.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,670.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,801.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,880.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,211.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,973.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,839.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,796.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,143.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,932.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,184.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,229.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,685.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,138.70
|
| Rate for Payer: Mclaren Medicaid |
$42.80
|
| Rate for Payer: Mclaren Medicaid |
$42.80
|
| Rate for Payer: Mclaren Medicaid |
$42.80
|
| Rate for Payer: Mclaren Medicaid |
$42.80
|
| Rate for Payer: Mclaren Medicaid |
$42.80
|
| Rate for Payer: Mclaren Medicaid |
$42.80
|
| Rate for Payer: Mclaren Medicaid |
$42.80
|
| Rate for Payer: Mclaren Medicare |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$79.86
|
| Rate for Payer: Mclaren Medicare |
$79.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.85
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,876.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,926.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,110.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,823.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,456.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,829.81
|
| Rate for Payer: PACE Medicare |
$75.87
|
| Rate for Payer: PACE Medicare |
$75.87
|
| Rate for Payer: PACE Medicare |
$75.87
|
| Rate for Payer: PACE Medicare |
$75.87
|
| Rate for Payer: PACE Medicare |
$75.87
|
| Rate for Payer: PACE Medicare |
$75.87
|
| Rate for Payer: PACE Medicare |
$75.87
|
| Rate for Payer: PACE SWMI |
$79.86
|
| Rate for Payer: PACE SWMI |
$79.86
|
| Rate for Payer: PACE SWMI |
$79.86
|
| Rate for Payer: PACE SWMI |
$79.86
|
| Rate for Payer: PACE SWMI |
$79.86
|
| Rate for Payer: PACE SWMI |
$79.86
|
| Rate for Payer: PACE SWMI |
$79.86
|
| Rate for Payer: PHP Commercial |
$5,876.22
|
| Rate for Payer: PHP Commercial |
$4,456.45
|
| Rate for Payer: PHP Commercial |
$5,926.20
|
| Rate for Payer: PHP Commercial |
$5,823.86
|
| Rate for Payer: PHP Commercial |
$12,110.38
|
| Rate for Payer: PHP Commercial |
$5,114.24
|
| Rate for Payer: PHP Commercial |
$5,829.81
|
| Rate for Payer: PHP Medicare Advantage |
$79.86
|
| Rate for Payer: PHP Medicare Advantage |
$79.86
|
| Rate for Payer: PHP Medicare Advantage |
$79.86
|
| Rate for Payer: PHP Medicare Advantage |
$79.86
|
| Rate for Payer: PHP Medicare Advantage |
$79.86
|
| Rate for Payer: PHP Medicare Advantage |
$79.86
|
| Rate for Payer: PHP Medicare Advantage |
$79.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,910.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,260.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,493.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,407.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,531.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,453.54
|
| Rate for Payer: Priority Health Medicare |
$79.86
|
| Rate for Payer: Priority Health Medicare |
$79.86
|
| Rate for Payer: Priority Health Medicare |
$79.86
|
| Rate for Payer: Priority Health Medicare |
$79.86
|
| Rate for Payer: Priority Health Medicare |
$79.86
|
| Rate for Payer: Priority Health Medicare |
$79.86
|
| Rate for Payer: Priority Health Medicare |
$79.86
|
| Rate for Payer: Priority Health SBD |
$4,392.36
|
| Rate for Payer: Priority Health SBD |
$4,316.51
|
| Rate for Payer: Priority Health SBD |
$3,790.55
|
| Rate for Payer: Priority Health SBD |
$4,320.92
|
| Rate for Payer: Priority Health SBD |
$3,303.01
|
| Rate for Payer: Priority Health SBD |
$4,355.32
|
| Rate for Payer: Priority Health SBD |
$8,975.92
|
| Rate for Payer: Railroad Medicare Medicare |
$79.86
|
| Rate for Payer: Railroad Medicare Medicare |
$79.86
|
| Rate for Payer: Railroad Medicare Medicare |
$79.86
|
| Rate for Payer: Railroad Medicare Medicare |
$79.86
|
| Rate for Payer: Railroad Medicare Medicare |
$79.86
|
| Rate for Payer: Railroad Medicare Medicare |
$79.86
|
| Rate for Payer: Railroad Medicare Medicare |
$79.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.86
|
| Rate for Payer: UHC Exchange |
$152.62
|
| Rate for Payer: UHC Exchange |
$152.62
|
| Rate for Payer: UHC Exchange |
$152.62
|
| Rate for Payer: UHC Exchange |
$152.62
|
| Rate for Payer: UHC Exchange |
$152.62
|
| Rate for Payer: UHC Exchange |
$152.62
|
| Rate for Payer: UHC Exchange |
$152.62
|
| Rate for Payer: UHC Medicare Advantage |
$79.86
|
| Rate for Payer: UHC Medicare Advantage |
$79.86
|
| Rate for Payer: UHC Medicare Advantage |
$79.86
|
| Rate for Payer: UHC Medicare Advantage |
$79.86
|
| Rate for Payer: UHC Medicare Advantage |
$79.86
|
| Rate for Payer: UHC Medicare Advantage |
$79.86
|
| Rate for Payer: UHC Medicare Advantage |
$79.86
|
| Rate for Payer: UHCCP Medicaid |
$42.80
|
| Rate for Payer: UHCCP Medicaid |
$42.80
|
| Rate for Payer: UHCCP Medicaid |
$42.80
|
| Rate for Payer: UHCCP Medicaid |
$42.80
|
| Rate for Payer: UHCCP Medicaid |
$42.80
|
| Rate for Payer: UHCCP Medicaid |
$42.80
|
| Rate for Payer: UHCCP Medicaid |
$42.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.20
|
| Rate for Payer: UMR Bronson Commercial |
$2,557.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,939.87
|
| Rate for Payer: UMR Bronson Commercial |
$5,271.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,579.64
|
| Rate for Payer: UMR Bronson Commercial |
$2,537.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,535.09
|
| Rate for Payer: VA VA |
$79.86
|
| Rate for Payer: VA VA |
$79.86
|
| Rate for Payer: VA VA |
$79.86
|
| Rate for Payer: VA VA |
$79.86
|
| Rate for Payer: VA VA |
$79.86
|
| Rate for Payer: VA VA |
$79.86
|
| Rate for Payer: VA VA |
$79.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,932.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,184.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,229.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,138.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,143.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,685.62
|
|
|
NELARABINE 250 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,247.50
|
|
|
Service Code
|
HCPCS J9261
|
| Hospital Charge Code |
70267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,268.90 |
| Max. Negotiated Rate |
$12,822.75 |
| Rate for Payer: Aetna American Axle |
$9,260.88
|
| Rate for Payer: Aetna American Axle |
$4,493.58
|
| Rate for Payer: Aetna American Axle |
$4,458.09
|
| Rate for Payer: Aetna American Axle |
$3,910.89
|
| Rate for Payer: Aetna American Axle |
$3,407.87
|
| Rate for Payer: Aetna American Axle |
$4,453.54
|
| Rate for Payer: Aetna American Axle |
$4,531.80
|
| Rate for Payer: Aetna Commercial |
$5,876.22
|
| Rate for Payer: Aetna Commercial |
$4,456.45
|
| Rate for Payer: Aetna Commercial |
$5,823.86
|
| Rate for Payer: Aetna Commercial |
$5,829.81
|
| Rate for Payer: Aetna Commercial |
$5,926.20
|
| Rate for Payer: Aetna Commercial |
$5,114.24
|
| Rate for Payer: Aetna Commercial |
$12,110.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,458.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,260.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,407.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,453.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,910.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,531.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,493.58
|
| Rate for Payer: Cash Price |
$5,481.28
|
| Rate for Payer: Cash Price |
$5,530.56
|
| Rate for Payer: Cash Price |
$4,194.30
|
| Rate for Payer: Cash Price |
$11,398.00
|
| Rate for Payer: Cash Price |
$4,813.40
|
| Rate for Payer: Cash Price |
$5,486.88
|
| Rate for Payer: Cash Price |
$5,577.60
|
| Rate for Payer: Cofinity Commercial |
$5,945.35
|
| Rate for Payer: Cofinity Commercial |
$12,252.85
|
| Rate for Payer: Cofinity Commercial |
$5,892.38
|
| Rate for Payer: Cofinity Commercial |
$4,796.12
|
| Rate for Payer: Cofinity Commercial |
$4,211.73
|
| Rate for Payer: Cofinity Commercial |
$3,670.02
|
| Rate for Payer: Cofinity Commercial |
$4,508.88
|
| Rate for Payer: Cofinity Commercial |
$5,174.40
|
| Rate for Payer: Cofinity Commercial |
$9,973.25
|
| Rate for Payer: Cofinity Commercial |
$4,801.02
|
| Rate for Payer: Cofinity Commercial |
$5,898.40
|
| Rate for Payer: Cofinity Commercial |
$4,839.24
|
| Rate for Payer: Cofinity Commercial |
$4,880.40
|
| Rate for Payer: Cofinity Commercial |
$5,995.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,880.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,211.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,796.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,973.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,839.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,801.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,670.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,530.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,486.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,577.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,194.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,813.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,481.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,398.00
|
| Rate for Payer: Healthscope Commercial |
$6,274.80
|
| Rate for Payer: Healthscope Commercial |
$6,172.74
|
| Rate for Payer: Healthscope Commercial |
$5,415.07
|
| Rate for Payer: Healthscope Commercial |
$6,166.44
|
| Rate for Payer: Healthscope Commercial |
$4,718.59
|
| Rate for Payer: Healthscope Commercial |
$12,822.75
|
| Rate for Payer: Healthscope Commercial |
$6,221.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,973.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,211.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,796.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,670.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,880.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,801.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,839.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,685.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,143.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,932.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,512.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,138.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,184.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,229.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,823.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,114.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,456.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,110.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,926.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,829.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,876.22
|
| Rate for Payer: PHP Commercial |
$5,829.81
|
| Rate for Payer: PHP Commercial |
$5,114.24
|
| Rate for Payer: PHP Commercial |
$5,823.86
|
| Rate for Payer: PHP Commercial |
$12,110.38
|
| Rate for Payer: PHP Commercial |
$4,456.45
|
| Rate for Payer: PHP Commercial |
$5,926.20
|
| Rate for Payer: PHP Commercial |
$5,876.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,493.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,407.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,910.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,453.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,531.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,260.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,458.09
|
| Rate for Payer: Priority Health SBD |
$3,790.55
|
| Rate for Payer: Priority Health SBD |
$3,303.01
|
| Rate for Payer: Priority Health SBD |
$8,975.92
|
| Rate for Payer: Priority Health SBD |
$4,392.36
|
| Rate for Payer: Priority Health SBD |
$4,355.32
|
| Rate for Payer: Priority Health SBD |
$4,320.92
|
| Rate for Payer: Priority Health SBD |
$4,316.51
|
| Rate for Payer: UMR Bronson Commercial |
$3,014.70
|
| Rate for Payer: UMR Bronson Commercial |
$3,067.68
|
| Rate for Payer: UMR Bronson Commercial |
$3,017.78
|
| Rate for Payer: UMR Bronson Commercial |
$3,041.81
|
| Rate for Payer: UMR Bronson Commercial |
$6,268.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,647.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,306.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,932.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,138.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,184.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,512.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,143.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,229.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,685.62
|
|
|
NELFINAVIR 250 MG TABLET
|
Facility
|
IP
|
$4,380.06
|
|
|
Service Code
|
NDC 63010001030
|
| Hospital Charge Code |
20032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,927.23 |
| Max. Negotiated Rate |
$3,942.05 |
| Rate for Payer: Aetna American Axle |
$2,847.04
|
| Rate for Payer: Aetna Commercial |
$3,723.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,847.04
|
| Rate for Payer: Cash Price |
$3,504.05
|
| Rate for Payer: Cofinity Commercial |
$3,066.04
|
| Rate for Payer: Cofinity Commercial |
$3,766.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,066.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,504.05
|
| Rate for Payer: Healthscope Commercial |
$3,942.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,066.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,285.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,723.05
|
| Rate for Payer: PHP Commercial |
$3,723.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,847.04
|
| Rate for Payer: Priority Health SBD |
$2,759.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,927.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,285.05
|
|
|
NELFINAVIR 250 MG TABLET
|
Facility
|
OP
|
$4,380.06
|
|
|
Service Code
|
NDC 63010001030
|
| Hospital Charge Code |
20032
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,620.62 |
| Max. Negotiated Rate |
$3,942.05 |
| Rate for Payer: Aetna American Axle |
$2,847.04
|
| Rate for Payer: Aetna Commercial |
$3,723.05
|
| Rate for Payer: Aetna Medicare |
$2,190.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,847.04
|
| Rate for Payer: BCBS Complete |
$1,752.02
|
| Rate for Payer: Cash Price |
$3,504.05
|
| Rate for Payer: Cofinity Commercial |
$3,066.04
|
| Rate for Payer: Cofinity Commercial |
$3,766.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,066.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,504.05
|
| Rate for Payer: Healthscope Commercial |
$3,942.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,066.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,285.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,723.05
|
| Rate for Payer: PHP Commercial |
$3,723.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,847.04
|
| Rate for Payer: Priority Health SBD |
$2,759.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,620.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,285.05
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
NDC 00713062231
|
| Hospital Charge Code |
21070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna American Axle |
$25.70
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: UMR Bronson Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
NDC 00713062231
|
| Hospital Charge Code |
21070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna American Axle |
$25.70
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$19.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: BCBS Complete |
$15.82
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: UMR Bronson Commercial |
$14.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.66
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
OP
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.48 |
| Max. Negotiated Rate |
$149.53 |
| Rate for Payer: Aetna American Axle |
$108.00
|
| Rate for Payer: Aetna Commercial |
$141.23
|
| Rate for Payer: Aetna Medicare |
$83.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.00
|
| Rate for Payer: BCBS Complete |
$66.46
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Cofinity Commercial |
$142.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$149.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: PHP Commercial |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health SBD |
$104.67
|
| Rate for Payer: UMR Bronson Commercial |
$61.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.61
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$149.53 |
| Rate for Payer: Aetna American Axle |
$108.00
|
| Rate for Payer: Aetna Commercial |
$141.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.00
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Cofinity Commercial |
$142.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$149.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: PHP Commercial |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health SBD |
$104.67
|
| Rate for Payer: UMR Bronson Commercial |
$73.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.61
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$41.34
|
|
|
Service Code
|
NDC 00574416035
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna American Axle |
$26.87
|
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.14
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.87
|
| Rate for Payer: Priority Health SBD |
$26.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$46.73
|
|
|
Service Code
|
NDC 24208079535
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$42.06 |
| Rate for Payer: Aetna American Axle |
$30.37
|
| Rate for Payer: Aetna Commercial |
$39.72
|
| Rate for Payer: Aetna Medicare |
$23.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.37
|
| Rate for Payer: BCBS Complete |
$18.69
|
| Rate for Payer: Cash Price |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$32.71
|
| Rate for Payer: Cofinity Commercial |
$40.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.38
|
| Rate for Payer: Healthscope Commercial |
$42.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.72
|
| Rate for Payer: PHP Commercial |
$39.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.37
|
| Rate for Payer: Priority Health SBD |
$29.44
|
| Rate for Payer: UMR Bronson Commercial |
$17.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.05
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$733.42
|
|
|
Service Code
|
NDC 00078077101
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.37 |
| Max. Negotiated Rate |
$660.08 |
| Rate for Payer: Aetna American Axle |
$476.72
|
| Rate for Payer: Aetna Commercial |
$623.41
|
| Rate for Payer: Aetna Medicare |
$366.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.72
|
| Rate for Payer: BCBS Complete |
$293.37
|
| Rate for Payer: Cash Price |
$586.74
|
| Rate for Payer: Cofinity Commercial |
$513.39
|
| Rate for Payer: Cofinity Commercial |
$630.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.74
|
| Rate for Payer: Healthscope Commercial |
$660.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.41
|
| Rate for Payer: PHP Commercial |
$623.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.72
|
| Rate for Payer: Priority Health SBD |
$462.05
|
| Rate for Payer: UMR Bronson Commercial |
$271.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.07
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$41.34
|
|
|
Service Code
|
NDC 00574416035
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna American Axle |
$26.87
|
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare |
$20.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.14
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.87
|
| Rate for Payer: Priority Health SBD |
$26.04
|
| Rate for Payer: UMR Bronson Commercial |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$733.42
|
|
|
Service Code
|
NDC 00078077101
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$660.08 |
| Rate for Payer: Aetna American Axle |
$476.72
|
| Rate for Payer: Aetna Commercial |
$623.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.72
|
| Rate for Payer: Cash Price |
$586.74
|
| Rate for Payer: Cofinity Commercial |
$513.39
|
| Rate for Payer: Cofinity Commercial |
$630.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.74
|
| Rate for Payer: Healthscope Commercial |
$660.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.41
|
| Rate for Payer: PHP Commercial |
$623.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.72
|
| Rate for Payer: Priority Health SBD |
$462.05
|
| Rate for Payer: UMR Bronson Commercial |
$322.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.07
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna American Axle |
$38.09
|
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna Medicare |
$29.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: BCBS Complete |
$23.44
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.09
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: UMR Bronson Commercial |
$21.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$46.73
|
|
|
Service Code
|
NDC 24208079535
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$42.06 |
| Rate for Payer: Aetna American Axle |
$30.37
|
| Rate for Payer: Aetna Commercial |
$39.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.37
|
| Rate for Payer: Cash Price |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$32.71
|
| Rate for Payer: Cofinity Commercial |
$40.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.38
|
| Rate for Payer: Healthscope Commercial |
$42.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.72
|
| Rate for Payer: PHP Commercial |
$39.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.37
|
| Rate for Payer: Priority Health SBD |
$29.44
|
| Rate for Payer: UMR Bronson Commercial |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.05
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.78 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna American Axle |
$38.09
|
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.09
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: UMR Bronson Commercial |
$25.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$45.22
|
|
|
Service Code
|
NDC 39822120102
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna American Axle |
$29.39
|
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.39
|
| Rate for Payer: Cash Price |
$36.18
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.44
|
| Rate for Payer: PHP Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.39
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.91
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
OP
|
$27.83
|
|
|
Service Code
|
NDC 61570004701
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$25.05 |
| Rate for Payer: Aetna American Axle |
$18.09
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Medicare |
$13.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.09
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: Cash Price |
$22.26
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$23.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.26
|
| Rate for Payer: Healthscope Commercial |
$25.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.09
|
| Rate for Payer: Priority Health SBD |
$17.53
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.87
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$27.83
|
|
|
Service Code
|
NDC 61570004701
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$25.05 |
| Rate for Payer: Aetna American Axle |
$18.09
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.09
|
| Rate for Payer: Cash Price |
$22.26
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$23.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.26
|
| Rate for Payer: Healthscope Commercial |
$25.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.09
|
| Rate for Payer: Priority Health SBD |
$17.53
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.87
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$380.12
|
|
|
Service Code
|
NDC 39822122001
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.25 |
| Max. Negotiated Rate |
$342.11 |
| Rate for Payer: Aetna American Axle |
$247.08
|
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.08
|
| Rate for Payer: Cash Price |
$304.10
|
| Rate for Payer: Cofinity Commercial |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$326.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.10
|
| Rate for Payer: Healthscope Commercial |
$342.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.10
|
| Rate for Payer: PHP Commercial |
$323.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.08
|
| Rate for Payer: Priority Health SBD |
$239.48
|
| Rate for Payer: UMR Bronson Commercial |
$167.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.09
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
OP
|
$45.22
|
|
|
Service Code
|
NDC 39822120101
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna American Axle |
$29.39
|
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna Medicare |
$22.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.39
|
| Rate for Payer: BCBS Complete |
$18.09
|
| Rate for Payer: Cash Price |
$36.18
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.44
|
| Rate for Payer: PHP Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.39
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.91
|
|
