|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$6.86
|
|
|
Service Code
|
NDC 60687084111
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$6.17 |
| Rate for Payer: Aetna American Axle |
$4.46
|
| Rate for Payer: Aetna Commercial |
$5.83
|
| Rate for Payer: Aetna Medicare |
$3.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.46
|
| Rate for Payer: BCBS Complete |
$2.74
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cofinity Advantage |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.49
|
| Rate for Payer: Healthscope Commercial |
$6.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.14
|
| Rate for Payer: PHP Commercial |
$5.83
|
| Rate for Payer: Priority Health SBD |
$4.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.46
|
| Rate for Payer: UHC Core |
$3.57
|
| Rate for Payer: UHC Exchange |
$2.70
|
| Rate for Payer: UMR Bronson Commercial |
$2.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.14
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$6.86
|
|
|
Service Code
|
NDC 60687084111
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$6.17 |
| Rate for Payer: Aetna American Axle |
$4.46
|
| Rate for Payer: Aetna Commercial |
$5.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.46
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: Cofinity Advantage |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.49
|
| Rate for Payer: Healthscope Commercial |
$6.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.14
|
| Rate for Payer: PHP Commercial |
$5.83
|
| Rate for Payer: Priority Health SBD |
$4.32
|
| Rate for Payer: UMR Bronson Commercial |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.14
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$452.20
|
|
|
Service Code
|
NDC 68084037601
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.31 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna American Axle |
$293.93
|
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: Aetna Medicare |
$226.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.93
|
| Rate for Payer: BCBS Complete |
$180.88
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Advantage |
$316.54
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$361.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health SBD |
$284.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.93
|
| Rate for Payer: UHC Core |
$235.60
|
| Rate for Payer: UHC Exchange |
$177.71
|
| Rate for Payer: UMR Bronson Commercial |
$167.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$751.20
|
|
|
Service Code
|
NDC 00071036924
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.53 |
| Max. Negotiated Rate |
$676.08 |
| Rate for Payer: Aetna American Axle |
$488.28
|
| Rate for Payer: Aetna Commercial |
$638.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.28
|
| Rate for Payer: Cash Price |
$600.96
|
| Rate for Payer: Cofinity Advantage |
$525.84
|
| Rate for Payer: Cofinity Commercial |
$646.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.96
|
| Rate for Payer: Healthscope Commercial |
$676.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$525.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.40
|
| Rate for Payer: PHP Commercial |
$638.52
|
| Rate for Payer: Priority Health SBD |
$473.26
|
| Rate for Payer: UMR Bronson Commercial |
$330.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.40
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
OP
|
$253.44
|
|
|
Service Code
|
NDC 51079090520
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$228.10 |
| Rate for Payer: Aetna American Axle |
$164.74
|
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna Medicare |
$126.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.74
|
| Rate for Payer: BCBS Complete |
$101.38
|
| Rate for Payer: Cash Price |
$202.75
|
| Rate for Payer: Cofinity Advantage |
$177.41
|
| Rate for Payer: Cofinity Commercial |
$217.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.75
|
| Rate for Payer: Healthscope Commercial |
$228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.08
|
| Rate for Payer: PHP Commercial |
$215.42
|
| Rate for Payer: Priority Health SBD |
$159.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$132.04
|
| Rate for Payer: UHC Exchange |
$99.60
|
| Rate for Payer: UMR Bronson Commercial |
$93.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.08
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE
|
Facility
|
IP
|
$253.44
|
|
|
Service Code
|
NDC 51079090520
|
| Hospital Charge Code |
6257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.51 |
| Max. Negotiated Rate |
$228.10 |
| Rate for Payer: Aetna American Axle |
$164.74
|
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.74
|
| Rate for Payer: Cash Price |
$202.75
|
| Rate for Payer: Cofinity Advantage |
$177.41
|
| Rate for Payer: Cofinity Commercial |
$217.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.75
|
| Rate for Payer: Healthscope Commercial |
$228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.08
|
| Rate for Payer: PHP Commercial |
$215.42
|
| Rate for Payer: Priority Health SBD |
$159.67
|
| Rate for Payer: UMR Bronson Commercial |
$111.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.08
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE
|
Facility
|
OP
|
$647.52
|
|
|
Service Code
|
NDC 00071374066
|
| Hospital Charge Code |
11019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$582.77 |
| Rate for Payer: Aetna American Axle |
$420.89
|
| Rate for Payer: Aetna Commercial |
$550.39
|
| Rate for Payer: Aetna Medicare |
$323.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.89
|
| Rate for Payer: BCBS Complete |
$259.01
|
| Rate for Payer: Cash Price |
$518.02
|
| Rate for Payer: Cofinity Advantage |
$453.26
|
| Rate for Payer: Cofinity Commercial |
$556.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.02
|
| Rate for Payer: Healthscope Commercial |
$582.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$453.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$518.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.64
|
| Rate for Payer: PHP Commercial |
$550.39
|
| Rate for Payer: Priority Health SBD |
$407.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.89
|
| Rate for Payer: UHC Core |
$337.36
|
| Rate for Payer: UHC Exchange |
$254.48
|
| Rate for Payer: UMR Bronson Commercial |
$239.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.64
|
|
|
PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE
|
Facility
|
IP
|
$647.52
|
|
|
Service Code
|
NDC 00071374066
|
| Hospital Charge Code |
11019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.91 |
| Max. Negotiated Rate |
$582.77 |
| Rate for Payer: Aetna American Axle |
$420.89
|
| Rate for Payer: Aetna Commercial |
$550.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.89
|
| Rate for Payer: Cash Price |
$518.02
|
| Rate for Payer: Cofinity Advantage |
$453.26
|
| Rate for Payer: Cofinity Commercial |
$556.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.02
|
| Rate for Payer: Healthscope Commercial |
$582.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$453.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.64
|
| Rate for Payer: PHP Commercial |
$550.39
|
| Rate for Payer: Priority Health SBD |
$407.94
|
| Rate for Payer: UMR Bronson Commercial |
$284.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.64
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$258.47
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.73 |
| Max. Negotiated Rate |
$232.62 |
| Rate for Payer: Aetna American Axle |
$168.01
|
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.01
|
| Rate for Payer: Cash Price |
$206.78
|
| Rate for Payer: Cofinity Advantage |
$180.93
|
| Rate for Payer: Cofinity Commercial |
$222.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.78
|
| Rate for Payer: Healthscope Commercial |
$232.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.85
|
| Rate for Payer: PHP Commercial |
$219.70
|
| Rate for Payer: Priority Health SBD |
$162.84
|
| Rate for Payer: UMR Bronson Commercial |
$113.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.85
|
|
|
PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$258.47
|
|
|
Service Code
|
NDC 17478051002
|
| Hospital Charge Code |
6270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$232.62 |
| Rate for Payer: Aetna American Axle |
$168.01
|
| Rate for Payer: Aetna Commercial |
$219.70
|
| Rate for Payer: Aetna Medicare |
$129.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.01
|
| Rate for Payer: BCBS Complete |
$103.39
|
| Rate for Payer: Cash Price |
$206.78
|
| Rate for Payer: Cofinity Advantage |
$180.93
|
| Rate for Payer: Cofinity Commercial |
$222.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.78
|
| Rate for Payer: Healthscope Commercial |
$232.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.85
|
| Rate for Payer: PHP Commercial |
$219.70
|
| Rate for Payer: Priority Health SBD |
$162.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.01
|
| Rate for Payer: UHC Core |
$134.66
|
| Rate for Payer: UHC Exchange |
$101.58
|
| Rate for Payer: UMR Bronson Commercial |
$95.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.85
|
|
|
PHYTONADIONE ORAL SOLUTION 10 MG/ML
|
Facility
|
OP
|
$71.58
|
|
|
Service Code
|
NDC 00409915801
|
| Hospital Charge Code |
150708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$64.42 |
| Rate for Payer: Aetna American Axle |
$46.53
|
| Rate for Payer: Aetna Commercial |
$60.84
|
| Rate for Payer: Aetna Medicare |
$35.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.53
|
| Rate for Payer: BCBS Complete |
$28.63
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cofinity Advantage |
$50.11
|
| Rate for Payer: Cofinity Commercial |
$61.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.26
|
| Rate for Payer: Healthscope Commercial |
$64.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.69
|
| Rate for Payer: PHP Commercial |
$60.84
|
| Rate for Payer: Priority Health SBD |
$45.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.53
|
| Rate for Payer: UHC Core |
$37.29
|
| Rate for Payer: UHC Exchange |
$28.13
|
| Rate for Payer: UMR Bronson Commercial |
$26.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.69
|
|
|
PHYTONADIONE ORAL SOLUTION 10 MG/ML
|
Facility
|
IP
|
$71.58
|
|
|
Service Code
|
NDC 00409915801
|
| Hospital Charge Code |
150708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$64.42 |
| Rate for Payer: Aetna American Axle |
$46.53
|
| Rate for Payer: Aetna Commercial |
$60.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.53
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cofinity Advantage |
$50.11
|
| Rate for Payer: Cofinity Commercial |
$61.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.26
|
| Rate for Payer: Healthscope Commercial |
$64.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.69
|
| Rate for Payer: PHP Commercial |
$60.84
|
| Rate for Payer: Priority Health SBD |
$45.10
|
| Rate for Payer: UMR Bronson Commercial |
$31.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.69
|
|
|
PHYTONADIONE (VITAMIN K1) 1,000 MCG CAPSULE
|
Facility
|
OP
|
$340.75
|
|
|
Service Code
|
NDC 05105010500
|
| Hospital Charge Code |
196288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.08 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna American Axle |
$221.49
|
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna Medicare |
$170.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: BCBS Complete |
$136.30
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Advantage |
$238.53
|
| Rate for Payer: Cofinity Commercial |
$293.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.56
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health SBD |
$214.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.49
|
| Rate for Payer: UHC Core |
$177.53
|
| Rate for Payer: UHC Exchange |
$133.91
|
| Rate for Payer: UMR Bronson Commercial |
$126.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
PHYTONADIONE (VITAMIN K1) 1,000 MCG CAPSULE
|
Facility
|
IP
|
$340.75
|
|
|
Service Code
|
NDC 05105010500
|
| Hospital Charge Code |
196288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.93 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna American Axle |
$221.49
|
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Advantage |
$238.53
|
| Rate for Payer: Cofinity Commercial |
$293.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.56
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health SBD |
$214.67
|
| Rate for Payer: UMR Bronson Commercial |
$149.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.56
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$86.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$77.48 |
| Rate for Payer: Aetna American Axle |
$55.96
|
| Rate for Payer: Aetna American Axle |
$59.26
|
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna Commercial |
$77.49
|
| Rate for Payer: Aetna Medicare |
$43.05
|
| Rate for Payer: Aetna Medicare |
$45.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.26
|
| Rate for Payer: BCBS Complete |
$36.47
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS Trust/PPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$9.10
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Advantage |
$60.26
|
| Rate for Payer: Cofinity Advantage |
$63.82
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$77.48
|
| Rate for Payer: Healthscope Commercial |
$82.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.57
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: PHP Commercial |
$77.49
|
| Rate for Payer: Priority Health SBD |
$54.24
|
| Rate for Payer: Priority Health SBD |
$57.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UMR Bronson Commercial |
$31.85
|
| Rate for Payer: UMR Bronson Commercial |
$33.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.38
|
|
|
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$86.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
11023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.88 |
| Max. Negotiated Rate |
$77.48 |
| Rate for Payer: Aetna American Axle |
$55.96
|
| Rate for Payer: Aetna American Axle |
$59.26
|
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna Commercial |
$77.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.26
|
| Rate for Payer: Cash Price |
$68.87
|
| Rate for Payer: Cash Price |
$72.94
|
| Rate for Payer: Cofinity Advantage |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$60.26
|
| Rate for Payer: Cofinity Commercial |
$78.41
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.94
|
| Rate for Payer: Healthscope Commercial |
$77.48
|
| Rate for Payer: Healthscope Commercial |
$82.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.38
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: PHP Commercial |
$77.49
|
| Rate for Payer: Priority Health SBD |
$57.44
|
| Rate for Payer: Priority Health SBD |
$54.24
|
| Rate for Payer: UMR Bronson Commercial |
$37.88
|
| Rate for Payer: UMR Bronson Commercial |
$40.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.38
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Advantage |
$20.19
|
| Rate for Payer: Cofinity Advantage |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.63
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$10.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
108266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$9.10
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Advantage |
$16.86
|
| Rate for Payer: Cofinity Advantage |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: UMR Bronson Commercial |
$10.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
OP
|
$641.70
|
|
|
Service Code
|
NDC 69097099902
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.43 |
| Max. Negotiated Rate |
$577.53 |
| Rate for Payer: Aetna American Axle |
$417.11
|
| Rate for Payer: Aetna Commercial |
$545.45
|
| Rate for Payer: Aetna Medicare |
$320.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.11
|
| Rate for Payer: BCBS Complete |
$256.68
|
| Rate for Payer: Cash Price |
$513.36
|
| Rate for Payer: Cofinity Advantage |
$449.19
|
| Rate for Payer: Cofinity Commercial |
$551.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.36
|
| Rate for Payer: Healthscope Commercial |
$577.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$513.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.27
|
| Rate for Payer: PHP Commercial |
$545.45
|
| Rate for Payer: Priority Health SBD |
$404.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$417.11
|
| Rate for Payer: UHC Core |
$334.33
|
| Rate for Payer: UHC Exchange |
$252.19
|
| Rate for Payer: UMR Bronson Commercial |
$237.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.27
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
OP
|
$3,747.70
|
|
|
Service Code
|
NDC 69238105103
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,386.65 |
| Max. Negotiated Rate |
$3,372.93 |
| Rate for Payer: Aetna American Axle |
$2,436.01
|
| Rate for Payer: Aetna Commercial |
$3,185.55
|
| Rate for Payer: Aetna Medicare |
$1,873.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.01
|
| Rate for Payer: BCBS Complete |
$1,499.08
|
| Rate for Payer: Cash Price |
$2,998.16
|
| Rate for Payer: Cofinity Advantage |
$2,623.39
|
| Rate for Payer: Cofinity Commercial |
$3,223.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,998.16
|
| Rate for Payer: Healthscope Commercial |
$3,372.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,623.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,810.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,998.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,810.78
|
| Rate for Payer: PHP Commercial |
$3,185.55
|
| Rate for Payer: Priority Health SBD |
$2,361.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,436.01
|
| Rate for Payer: UHC Core |
$1,952.55
|
| Rate for Payer: UHC Exchange |
$1,472.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,386.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,810.78
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$3,747.70
|
|
|
Service Code
|
NDC 69238105103
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,648.99 |
| Max. Negotiated Rate |
$3,372.93 |
| Rate for Payer: Aetna American Axle |
$2,436.01
|
| Rate for Payer: Aetna Commercial |
$3,185.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.01
|
| Rate for Payer: Cash Price |
$2,998.16
|
| Rate for Payer: Cofinity Advantage |
$2,623.39
|
| Rate for Payer: Cofinity Commercial |
$3,223.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,998.16
|
| Rate for Payer: Healthscope Commercial |
$3,372.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,623.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,810.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,185.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,810.78
|
| Rate for Payer: PHP Commercial |
$3,185.55
|
| Rate for Payer: Priority Health SBD |
$2,361.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,648.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,810.78
|
|
|
PHYTONADIONE (VITAMIN K1) 5 MG TABLET
|
Facility
|
IP
|
$641.70
|
|
|
Service Code
|
NDC 69097099902
|
| Hospital Charge Code |
11024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.35 |
| Max. Negotiated Rate |
$577.53 |
| Rate for Payer: Aetna American Axle |
$417.11
|
| Rate for Payer: Aetna Commercial |
$545.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.11
|
| Rate for Payer: Cash Price |
$513.36
|
| Rate for Payer: Cofinity Advantage |
$449.19
|
| Rate for Payer: Cofinity Commercial |
$551.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.36
|
| Rate for Payer: Healthscope Commercial |
$577.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.27
|
| Rate for Payer: PHP Commercial |
$545.45
|
| Rate for Payer: Priority Health SBD |
$404.27
|
| Rate for Payer: UMR Bronson Commercial |
$282.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.27
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
OP
|
$138.87
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$124.98 |
| Rate for Payer: Aetna American Axle |
$90.27
|
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna Medicare |
$69.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.27
|
| Rate for Payer: BCBS Complete |
$55.55
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cofinity Advantage |
$97.21
|
| Rate for Payer: Cofinity Commercial |
$119.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.10
|
| Rate for Payer: Healthscope Commercial |
$124.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.15
|
| Rate for Payer: PHP Commercial |
$118.04
|
| Rate for Payer: Priority Health SBD |
$87.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.27
|
| Rate for Payer: UHC Core |
$72.35
|
| Rate for Payer: UHC Exchange |
$54.58
|
| Rate for Payer: UMR Bronson Commercial |
$51.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.15
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
IP
|
$138.87
|
|
|
Service Code
|
NDC 61314020315
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$124.98 |
| Rate for Payer: Aetna American Axle |
$90.27
|
| Rate for Payer: Aetna Commercial |
$118.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.27
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cofinity Advantage |
$97.21
|
| Rate for Payer: Cofinity Commercial |
$119.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.10
|
| Rate for Payer: Healthscope Commercial |
$124.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.15
|
| Rate for Payer: PHP Commercial |
$118.04
|
| Rate for Payer: Priority Health SBD |
$87.49
|
| Rate for Payer: UMR Bronson Commercial |
$61.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.15
|
|
|
PILOCARPINE 1 % EYE DROPS
|
Facility
|
IP
|
$156.93
|
|
|
Service Code
|
NDC 17478022312
|
| Hospital Charge Code |
6279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.05 |
| Max. Negotiated Rate |
$141.24 |
| Rate for Payer: Aetna American Axle |
$102.00
|
| Rate for Payer: Aetna Commercial |
$133.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.00
|
| Rate for Payer: Cash Price |
$125.54
|
| Rate for Payer: Cofinity Advantage |
$109.85
|
| Rate for Payer: Cofinity Commercial |
$134.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.54
|
| Rate for Payer: Healthscope Commercial |
$141.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.70
|
| Rate for Payer: PHP Commercial |
$133.39
|
| Rate for Payer: Priority Health SBD |
$98.87
|
| Rate for Payer: UMR Bronson Commercial |
$69.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.70
|
|
