|
DICLOFENAC 0.1 % EYE DROPS
|
Facility
|
OP
|
$28.42
|
|
|
Service Code
|
NDC 24208045705
|
| Hospital Charge Code |
19714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: Aetna Commercial |
$25.58
|
| Rate for Payer: Aetna Medicare |
$10.52
|
| Rate for Payer: ASR ASR |
$27.57
|
| Rate for Payer: BCBS Complete |
$11.37
|
| Rate for Payer: BCBS Trust/PPO |
$23.43
|
| Rate for Payer: BCN Commercial |
$23.43
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Healthscope Commercial |
$27.57
|
| Rate for Payer: Healthscope Whirlpool |
$28.42
|
| Rate for Payer: Mclaren Commercial |
$25.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.90
|
| Rate for Payer: Priority Health Narrow Network |
$19.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.01
|
|
|
DICLOFENAC 0.1 % EYE DROPS
|
Facility
|
OP
|
$23.22
|
|
|
Service Code
|
NDC 17478089210
|
| Hospital Charge Code |
19714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$23.22 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: ASR ASR |
$22.52
|
| Rate for Payer: BCBS Complete |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$19.14
|
| Rate for Payer: BCN Commercial |
$19.14
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$21.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$22.52
|
| Rate for Payer: Healthscope Whirlpool |
$23.22
|
| Rate for Payer: Mclaren Commercial |
$20.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.74
|
| Rate for Payer: Nomi Health Commercial |
$19.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.35
|
| Rate for Payer: Priority Health Narrow Network |
$16.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.43
|
|
|
DICLOFENAC 0.1 % EYE DROPS
|
Facility
|
IP
|
$28.42
|
|
|
Service Code
|
NDC 24208045705
|
| Hospital Charge Code |
19714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: Aetna Commercial |
$25.58
|
| Rate for Payer: ASR ASR |
$27.57
|
| Rate for Payer: BCBS Trust/PPO |
$23.34
|
| Rate for Payer: BCN Commercial |
$23.34
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$26.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Healthscope Commercial |
$27.57
|
| Rate for Payer: Healthscope Whirlpool |
$28.42
|
| Rate for Payer: Mclaren Commercial |
$25.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.01
|
|
|
DICLOFENAC 0.1 % EYE DROPS
|
Facility
|
OP
|
$34.20
|
|
|
Service Code
|
NDC 61314001425
|
| Hospital Charge Code |
19714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: ASR ASR |
$33.17
|
| Rate for Payer: BCBS Complete |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$28.19
|
| Rate for Payer: BCN Commercial |
$28.19
|
| Rate for Payer: Cash Price |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$32.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.36
|
| Rate for Payer: Healthscope Commercial |
$33.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.20
|
| Rate for Payer: Mclaren Commercial |
$30.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.07
|
| Rate for Payer: Nomi Health Commercial |
$28.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.96
|
| Rate for Payer: Priority Health Narrow Network |
$23.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.09
|
|
|
DICLOFENAC 0.1 % EYE DROPS
|
Facility
|
IP
|
$23.22
|
|
|
Service Code
|
NDC 17478089210
|
| Hospital Charge Code |
19714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$23.22 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: ASR ASR |
$22.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.07
|
| Rate for Payer: BCN Commercial |
$19.07
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$21.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$22.52
|
| Rate for Payer: Healthscope Whirlpool |
$23.22
|
| Rate for Payer: Mclaren Commercial |
$20.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.74
|
| Rate for Payer: Nomi Health Commercial |
$19.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.43
|
|
|
DICLOFENAC 0.1 % EYE DROPS
|
Facility
|
IP
|
$34.20
|
|
|
Service Code
|
NDC 61314001425
|
| Hospital Charge Code |
19714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$30.78
|
| Rate for Payer: ASR ASR |
$33.17
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: Cash Price |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$32.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.36
|
| Rate for Payer: Healthscope Commercial |
$33.17
|
| Rate for Payer: Healthscope Whirlpool |
$34.20
|
| Rate for Payer: Mclaren Commercial |
$30.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.07
|
| Rate for Payer: Nomi Health Commercial |
$28.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.09
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$43.40
|
|
|
Service Code
|
NDC 67815202
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Aetna Commercial |
$39.06
|
| Rate for Payer: ASR ASR |
$42.10
|
| Rate for Payer: BCBS Trust/PPO |
$35.64
|
| Rate for Payer: BCN Commercial |
$35.64
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Cofinity Commercial |
$40.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.72
|
| Rate for Payer: Healthscope Commercial |
$42.10
|
| Rate for Payer: Healthscope Whirlpool |
$43.40
|
| Rate for Payer: Mclaren Commercial |
$39.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.89
|
| Rate for Payer: Nomi Health Commercial |
$35.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.19
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$43.40
|
|
|
Service Code
|
NDC 67815202
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Aetna Commercial |
$39.06
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: ASR ASR |
$42.10
|
| Rate for Payer: BCBS Complete |
$17.36
|
| Rate for Payer: BCBS Trust/PPO |
$35.78
|
| Rate for Payer: BCN Commercial |
$35.78
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Cofinity Commercial |
$40.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.72
|
| Rate for Payer: Healthscope Commercial |
$42.10
|
| Rate for Payer: Healthscope Whirlpool |
$43.40
|
| Rate for Payer: Mclaren Commercial |
$39.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.89
|
| Rate for Payer: Nomi Health Commercial |
$35.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38.03
|
| Rate for Payer: Priority Health Narrow Network |
$30.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.19
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$28.70
|
|
|
Service Code
|
NDC 536129434
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$25.83
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: ASR ASR |
$27.84
|
| Rate for Payer: BCBS Complete |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$23.66
|
| Rate for Payer: BCN Commercial |
$23.66
|
| Rate for Payer: Cash Price |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$26.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.96
|
| Rate for Payer: Healthscope Commercial |
$27.84
|
| Rate for Payer: Healthscope Whirlpool |
$28.70
|
| Rate for Payer: Mclaren Commercial |
$25.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.39
|
| Rate for Payer: Nomi Health Commercial |
$23.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.15
|
| Rate for Payer: Priority Health Narrow Network |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.26
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
NDC 9629513974
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Commercial |
$18.23
|
| Rate for Payer: ASR ASR |
$19.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.63
|
| Rate for Payer: BCN Commercial |
$16.63
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$19.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.25
|
| Rate for Payer: Mclaren Commercial |
$18.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$16.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.82
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
IP
|
$28.70
|
|
|
Service Code
|
NDC 536129434
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$25.83
|
| Rate for Payer: ASR ASR |
$27.84
|
| Rate for Payer: BCBS Trust/PPO |
$23.57
|
| Rate for Payer: BCN Commercial |
$23.57
|
| Rate for Payer: Cash Price |
$22.96
|
| Rate for Payer: Cofinity Commercial |
$26.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.96
|
| Rate for Payer: Healthscope Commercial |
$27.84
|
| Rate for Payer: Healthscope Whirlpool |
$28.70
|
| Rate for Payer: Mclaren Commercial |
$25.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.39
|
| Rate for Payer: Nomi Health Commercial |
$23.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.26
|
|
|
DICLOFENAC 1 % TOPICAL GEL
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
NDC 9629513974
|
| Hospital Charge Code |
100611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Aetna Commercial |
$18.23
|
| Rate for Payer: Aetna Medicare |
$7.49
|
| Rate for Payer: ASR ASR |
$19.64
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$16.70
|
| Rate for Payer: BCN Commercial |
$16.70
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$19.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.25
|
| Rate for Payer: Mclaren Commercial |
$18.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: Nomi Health Commercial |
$16.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17.74
|
| Rate for Payer: Priority Health Narrow Network |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 591079401
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: Aetna Medicare |
$161.73
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS Trust/PPO |
$360.39
|
| Rate for Payer: BCN Commercial |
$360.39
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$423.99
|
| Rate for Payer: Healthscope Whirlpool |
$437.10
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health Narrow Network |
$306.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: ASR ASR |
$3.70
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Healthscope Whirlpool |
$3.82
|
| Rate for Payer: Mclaren Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.35
|
| Rate for Payer: Priority Health Narrow Network |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.36
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: ASR ASR |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.14
|
| Rate for Payer: BCN Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Healthscope Whirlpool |
$3.82
|
| Rate for Payer: Mclaren Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.36
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Aetna Commercial |
$375.35
|
| Rate for Payer: Aetna Medicare |
$154.31
|
| Rate for Payer: ASR ASR |
$404.54
|
| Rate for Payer: BCBS Complete |
$166.82
|
| Rate for Payer: BCBS Trust/PPO |
$343.86
|
| Rate for Payer: BCN Commercial |
$343.86
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$392.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$404.54
|
| Rate for Payer: Healthscope Whirlpool |
$417.05
|
| Rate for Payer: Mclaren Commercial |
$375.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$365.42
|
| Rate for Payer: Priority Health Narrow Network |
$292.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$367.00
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 591079401
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.82 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: BCBS Trust/PPO |
$358.95
|
| Rate for Payer: BCN Commercial |
$358.95
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$423.99
|
| Rate for Payer: Healthscope Whirlpool |
$437.10
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.79 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Aetna Commercial |
$375.35
|
| Rate for Payer: ASR ASR |
$404.54
|
| Rate for Payer: BCBS Trust/PPO |
$342.48
|
| Rate for Payer: BCN Commercial |
$342.48
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$392.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$404.54
|
| Rate for Payer: Healthscope Whirlpool |
$417.05
|
| Rate for Payer: Mclaren Commercial |
$375.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$367.00
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$28.14
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$28.14 |
| Rate for Payer: Aetna Commercial |
$25.33
|
| Rate for Payer: Aetna Commercial |
$249.77
|
| Rate for Payer: Aetna Commercial |
$156.28
|
| Rate for Payer: Aetna Commercial |
$29.24
|
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: Aetna Commercial |
$64.02
|
| Rate for Payer: Aetna Commercial |
$145.26
|
| Rate for Payer: Aetna Medicare |
$102.68
|
| Rate for Payer: Aetna Medicare |
$59.72
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: Aetna Medicare |
$10.41
|
| Rate for Payer: Aetna Medicare |
$64.25
|
| Rate for Payer: ASR ASR |
$27.30
|
| Rate for Payer: ASR ASR |
$168.43
|
| Rate for Payer: ASR ASR |
$156.56
|
| Rate for Payer: ASR ASR |
$269.19
|
| Rate for Payer: ASR ASR |
$32.11
|
| Rate for Payer: ASR ASR |
$69.00
|
| Rate for Payer: ASR ASR |
$31.51
|
| Rate for Payer: BCBS Complete |
$64.56
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Complete |
$28.45
|
| Rate for Payer: BCBS Complete |
$12.99
|
| Rate for Payer: BCBS Complete |
$69.46
|
| Rate for Payer: BCBS Complete |
$111.01
|
| Rate for Payer: BCBS Complete |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$23.20
|
| Rate for Payer: BCBS Trust/PPO |
$228.81
|
| Rate for Payer: BCBS Trust/PPO |
$133.08
|
| Rate for Payer: BCBS Trust/PPO |
$143.17
|
| Rate for Payer: BCBS Trust/PPO |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$27.30
|
| Rate for Payer: BCN Commercial |
$27.30
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: BCN Commercial |
$143.17
|
| Rate for Payer: BCN Commercial |
$133.08
|
| Rate for Payer: BCN Commercial |
$23.20
|
| Rate for Payer: BCN Commercial |
$228.81
|
| Rate for Payer: BCN Commercial |
$58.65
|
| Rate for Payer: Cash Price |
$138.91
|
| Rate for Payer: Cash Price |
$138.91
|
| Rate for Payer: Cash Price |
$56.90
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$22.51
|
| Rate for Payer: Cash Price |
$56.90
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$22.51
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Cofinity Commercial |
$26.45
|
| Rate for Payer: Cofinity Commercial |
$163.22
|
| Rate for Payer: Cofinity Commercial |
$260.87
|
| Rate for Payer: Cofinity Commercial |
$151.72
|
| Rate for Payer: Cofinity Commercial |
$30.54
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$66.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Commercial |
$269.19
|
| Rate for Payer: Healthscope Commercial |
$168.43
|
| Rate for Payer: Healthscope Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$31.51
|
| Rate for Payer: Healthscope Commercial |
$27.30
|
| Rate for Payer: Healthscope Whirlpool |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$28.14
|
| Rate for Payer: Healthscope Whirlpool |
$173.64
|
| Rate for Payer: Healthscope Whirlpool |
$71.13
|
| Rate for Payer: Healthscope Whirlpool |
$161.40
|
| Rate for Payer: Healthscope Whirlpool |
$32.48
|
| Rate for Payer: Healthscope Whirlpool |
$277.52
|
| Rate for Payer: Mclaren Commercial |
$145.26
|
| Rate for Payer: Mclaren Commercial |
$249.77
|
| Rate for Payer: Mclaren Commercial |
$156.28
|
| Rate for Payer: Mclaren Commercial |
$29.24
|
| Rate for Payer: Mclaren Commercial |
$25.33
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Mclaren Commercial |
$64.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$142.38
|
| Rate for Payer: Nomi Health Commercial |
$227.56
|
| Rate for Payer: Nomi Health Commercial |
$58.33
|
| Rate for Payer: Nomi Health Commercial |
$23.08
|
| Rate for Payer: Nomi Health Commercial |
$132.35
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$26.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Narrow Network |
$9.40
|
| Rate for Payer: Priority Health Narrow Network |
$9.40
|
| Rate for Payer: Priority Health Narrow Network |
$9.40
|
| Rate for Payer: Priority Health Narrow Network |
$9.40
|
| Rate for Payer: Priority Health Narrow Network |
$9.40
|
| Rate for Payer: Priority Health Narrow Network |
$9.40
|
| Rate for Payer: Priority Health Narrow Network |
$9.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.03
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$173.64
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.23 |
| Max. Negotiated Rate |
$173.64 |
| Rate for Payer: Aetna Commercial |
$156.28
|
| Rate for Payer: Aetna Commercial |
$145.26
|
| Rate for Payer: Aetna Commercial |
$249.77
|
| Rate for Payer: Aetna Commercial |
$29.24
|
| Rate for Payer: Aetna Commercial |
$64.02
|
| Rate for Payer: Aetna Commercial |
$25.33
|
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$31.51
|
| Rate for Payer: ASR ASR |
$269.19
|
| Rate for Payer: ASR ASR |
$69.00
|
| Rate for Payer: ASR ASR |
$156.56
|
| Rate for Payer: ASR ASR |
$168.43
|
| Rate for Payer: ASR ASR |
$27.30
|
| Rate for Payer: ASR ASR |
$32.11
|
| Rate for Payer: BCBS Trust/PPO |
$58.41
|
| Rate for Payer: BCBS Trust/PPO |
$27.19
|
| Rate for Payer: BCBS Trust/PPO |
$26.68
|
| Rate for Payer: BCBS Trust/PPO |
$142.59
|
| Rate for Payer: BCBS Trust/PPO |
$132.54
|
| Rate for Payer: BCBS Trust/PPO |
$23.11
|
| Rate for Payer: BCBS Trust/PPO |
$227.90
|
| Rate for Payer: BCN Commercial |
$27.19
|
| Rate for Payer: BCN Commercial |
$227.90
|
| Rate for Payer: BCN Commercial |
$142.59
|
| Rate for Payer: BCN Commercial |
$23.11
|
| Rate for Payer: BCN Commercial |
$26.68
|
| Rate for Payer: BCN Commercial |
$132.54
|
| Rate for Payer: BCN Commercial |
$58.41
|
| Rate for Payer: Cash Price |
$138.91
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cash Price |
$222.01
|
| Rate for Payer: Cash Price |
$129.12
|
| Rate for Payer: Cash Price |
$56.90
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$22.51
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$163.22
|
| Rate for Payer: Cofinity Commercial |
$26.45
|
| Rate for Payer: Cofinity Commercial |
$30.54
|
| Rate for Payer: Cofinity Commercial |
$260.87
|
| Rate for Payer: Cofinity Commercial |
$151.72
|
| Rate for Payer: Cofinity Commercial |
$66.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.90
|
| Rate for Payer: Healthscope Commercial |
$168.43
|
| Rate for Payer: Healthscope Commercial |
$269.19
|
| Rate for Payer: Healthscope Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$31.51
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Healthscope Whirlpool |
$32.48
|
| Rate for Payer: Healthscope Whirlpool |
$161.40
|
| Rate for Payer: Healthscope Whirlpool |
$173.64
|
| Rate for Payer: Healthscope Whirlpool |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$277.52
|
| Rate for Payer: Healthscope Whirlpool |
$71.13
|
| Rate for Payer: Healthscope Whirlpool |
$28.14
|
| Rate for Payer: Mclaren Commercial |
$145.26
|
| Rate for Payer: Mclaren Commercial |
$25.33
|
| Rate for Payer: Mclaren Commercial |
$156.28
|
| Rate for Payer: Mclaren Commercial |
$29.24
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Mclaren Commercial |
$249.77
|
| Rate for Payer: Mclaren Commercial |
$64.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Nomi Health Commercial |
$132.35
|
| Rate for Payer: Nomi Health Commercial |
$26.64
|
| Rate for Payer: Nomi Health Commercial |
$227.56
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$58.33
|
| Rate for Payer: Nomi Health Commercial |
$142.38
|
| Rate for Payer: Nomi Health Commercial |
$23.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.59
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$5,002.64
|
|
|
Service Code
|
APR-DRG 2401
|
| Min. Negotiated Rate |
$4,522.99 |
| Max. Negotiated Rate |
$5,002.64 |
| Rate for Payer: BCBS Complete |
$5,002.64
|
| Rate for Payer: Mclaren Medicaid |
$4,764.42
|
| Rate for Payer: Meridian Medicaid |
$5,002.64
|
| Rate for Payer: PHP Medicaid |
$4,522.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,764.42
|
| Rate for Payer: UHC Medicaid |
$4,764.42
|
| Rate for Payer: UHCCP Medicaid |
$4,764.42
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$6,090.91
|
|
|
Service Code
|
APR-DRG 2402
|
| Min. Negotiated Rate |
$5,506.91 |
| Max. Negotiated Rate |
$6,090.91 |
| Rate for Payer: BCBS Complete |
$6,090.91
|
| Rate for Payer: Mclaren Medicaid |
$5,800.86
|
| Rate for Payer: Meridian Medicaid |
$6,090.91
|
| Rate for Payer: PHP Medicaid |
$5,506.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,800.86
|
| Rate for Payer: UHC Medicaid |
$5,800.86
|
| Rate for Payer: UHCCP Medicaid |
$5,800.86
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$12,079.36
|
|
|
Service Code
|
APR-DRG 2404
|
| Min. Negotiated Rate |
$10,921.19 |
| Max. Negotiated Rate |
$12,079.36 |
| Rate for Payer: BCBS Complete |
$12,079.36
|
| Rate for Payer: Mclaren Medicaid |
$11,504.15
|
| Rate for Payer: Meridian Medicaid |
$12,079.36
|
| Rate for Payer: PHP Medicaid |
$10,921.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,504.15
|
| Rate for Payer: UHC Medicaid |
$11,504.15
|
| Rate for Payer: UHCCP Medicaid |
$11,504.15
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$8,739.91
|
|
|
Service Code
|
APR-DRG 2403
|
| Min. Negotiated Rate |
$7,901.92 |
| Max. Negotiated Rate |
$8,739.91 |
| Rate for Payer: BCBS Complete |
$8,739.91
|
| Rate for Payer: Mclaren Medicaid |
$8,323.72
|
| Rate for Payer: Meridian Medicaid |
$8,739.91
|
| Rate for Payer: PHP Medicaid |
$7,901.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,323.72
|
| Rate for Payer: UHC Medicaid |
$8,323.72
|
| Rate for Payer: UHCCP Medicaid |
$8,323.72
|
|
|
DIGESTIVE MALIGNANCY WITH CC
|
Facility
|
IP
|
$16,618.45
|
|
|
Service Code
|
MSDRG 375
|
| Min. Negotiated Rate |
$9,941.83 |
| Max. Negotiated Rate |
$16,618.45 |
| Rate for Payer: Aetna Medicare |
$10,465.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,081.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,081.35
|
| Rate for Payer: BCBS MAPPO |
$10,465.08
|
| Rate for Payer: BCN Medicare Advantage |
$10,465.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,465.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,465.08
|
| Rate for Payer: Mclaren Medicare |
$10,465.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,988.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,034.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,511.59
|
| Rate for Payer: PACE Medicare |
$9,941.83
|
| Rate for Payer: PACE SWMI |
$10,465.08
|
| Rate for Payer: PHP Commercial |
$11,511.59
|
| Rate for Payer: PHP Medicare Advantage |
$10,465.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,618.45
|
| Rate for Payer: Priority Health Medicare |
$10,465.08
|
| Rate for Payer: Priority Health Narrow Network |
$13,294.76
|
| Rate for Payer: Railroad Medicare Medicare |
$10,465.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,465.08
|
| Rate for Payer: UHC Exchange |
$16,220.87
|
| Rate for Payer: UHCCP DNSP |
$10,465.08
|
| Rate for Payer: VA VA |
$10,465.08
|
|
