RX-183063 — Mitomycin 40 Mg X 2 Intra-pyelocalyceal Kit
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). MITOMYCIN 40 MG X 2 INTRA-PYELOCALYCEAL KIT (CDM RX-183063) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/RX-183063?code_type=CDM
MLA (9th ed.)
“MITOMYCIN 40 MG X 2 INTRA-PYELOCALYCEAL KIT (CDM RX-183063) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/RX-183063?code_type=CDM. Accessed .
Chicago (notes-bibliography)
“MITOMYCIN 40 MG X 2 INTRA-PYELOCALYCEAL KIT (CDM RX-183063) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/RX-183063?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $12,697–$54,990 (25th–75th percentile) across 3 hospitals · 15 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM RX-183063 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.
Hospital rates (per row)
Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.
| Hospital | Payer | Plan | Negotiated rate | Gross | Cash | Observed | Source |
|---|---|---|---|---|---|---|---|
| THOMAS HOSPITAL Outpatient | BLUE ADVANTAGE [85293] | TH BLUE ADVANTAGE - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | US DEPARTMENT OF LABOR [5361] | TH DEPT OF LABOR WC - MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | CIGNA HEALTHSPRING MEDICARE ADVANTAGE [85203] | TH HEALTHSPRING - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC HOSPICE [85998] | TH HOSPICE 100% - MEDICARE OUTPT | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | UNITED HEALTHCARE MEDICARE ADVANTAGE [85098] | TH UHC MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | VIVA MEDICARE ADVANTAGE [85132] | TH VIVA MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | US DEPARTMENT OF LABOR [5361] | MI DEPT OF LABOR WC - MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | BLUE ADVANTAGE [85293] | MI BLUE ADVANTAGE - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC COMMERCIAL [85995] | MI MISSISSIPPI PHY. CARE NETWORK (MPCN) - 170% MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC HOSPICE [85998] | MI COMFORTCARE MERCY HOSPICE 90% - MEDICARE OUTPT | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | UNITED HEALTHCARE MEDICARE ADVANTAGE VACCINE [85099] | MI UHC MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | VIVA MEDICARE ADVANTAGE [85132] | MI VIVA MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | CIGNA HEALTHSPRING MEDICARE ADVANTAGE [85203] | MI HEALTHSPRING - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | CIGNA HEALTHSPRING MEDICARE ADVANTAGE [85203] | MI HEALTHSPRING - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | BLUE ADVANTAGE [85293] | MI BLUE ADVANTAGE - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC COMMERCIAL [85995] | MI MISSISSIPPI PHY. CARE NETWORK (MPCN) - 170% MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC HOSPICE [85998] | MI COMFORTCARE MERCY HOSPICE 90% - MEDICARE OUTPT | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | UNITED HEALTHCARE MEDICARE ADVANTAGE VACCINE [85099] | MI UHC MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | VIVA MEDICARE ADVANTAGE [85132] | MI VIVA MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | US DEPARTMENT OF LABOR [5361] | MI DEPT OF LABOR WC - MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | US DEPARTMENT OF LABOR [5361] | TH DEPT OF LABOR WC - MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | BLUE ADVANTAGE [85293] | MI BLUE ADVANTAGE - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC COMMERCIAL [85995] | MI MISSISSIPPI PHY. CARE NETWORK (MPCN) - 170% MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC HOSPICE [85998] | MI COMFORTCARE MERCY HOSPICE 90% - MEDICARE OUTPT | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | UNITED HEALTHCARE MEDICARE ADVANTAGE VACCINE [85099] | MI UHC MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | VIVA MEDICARE ADVANTAGE [85132] | MI VIVA MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | US DEPARTMENT OF LABOR [5361] | MI DEPT OF LABOR WC - MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | CIGNA HEALTHSPRING MEDICARE ADVANTAGE [85203] | TH HEALTHSPRING - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | BLUE ADVANTAGE [85293] | TH BLUE ADVANTAGE - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC HOSPICE [85998] | TH HOSPICE 100% - MEDICARE OUTPT | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | UNITED HEALTHCARE MEDICARE ADVANTAGE [85098] | TH UHC MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | VIVA MEDICARE ADVANTAGE [85132] | TH VIVA MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | CIGNA HEALTHSPRING MEDICARE ADVANTAGE [85203] | MI HEALTHSPRING - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | CIGNA HEALTHSPRING MEDICARE ADVANTAGE [85203] | TH HEALTHSPRING - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | BLUE ADVANTAGE [85293] | TH BLUE ADVANTAGE - MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC HOSPICE [85998] | TH HOSPICE 100% - MEDICARE OUTPT | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | UNITED HEALTHCARE MEDICARE ADVANTAGE [85098] | TH UHC MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | VIVA MEDICARE ADVANTAGE [85132] | TH VIVA MEDICARE ADVANTAGE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | US DEPARTMENT OF LABOR [5361] | TH DEPT OF LABOR WC - MEDICARE | $12,696.84 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | VIVA COMMERCIAL [85130] | TH VIVA | $48,630.40 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | AETNA COMMERCIAL [85189] | MI AETNA | $48,630.40 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | VIVA COMMERCIAL [85130] | TH VIVA | $48,630.40 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | AETNA COMMERCIAL [85189] | MI AETNA | $48,630.40 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | VIVA COMMERCIAL [85130] | TH VIVA | $48,630.40 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | AETNA COMMERCIAL [85189] | MI AETNA | $48,630.40 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | HEALTH CHOICE [85751] | NB/TH HEALTH CHOICE | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| Infirmary Ltac Hospital Outpatient | CIGNA COMMERCIAL [85040] | CIGNA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-11-02 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | CIGNA COMMERCIAL [85040] | CIGNA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | CIGNA COMMERCIAL [85040] | CIGNA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | HUMANA COMMERCIAL [85368] | MI HUMANA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | CIGNA COMMERCIAL [85040] | CIGNA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | HEALTH CHOICE [85751] | MI Health Choice | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | FIRST HEALTH NETWORK [85081] | MI FIRST HEALTH COMMERCIAL | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | HEALTH CHOICE [85751] | NB/TH HEALTH CHOICE | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | CIGNA COMMERCIAL [85040] | CIGNA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | HEALTH CHOICE [85751] | MI Health Choice | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | HUMANA COMMERCIAL [85368] | TH HUMANA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | CIGNA COMMERCIAL [85040] | CIGNA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | HUMANA COMMERCIAL [85368] | TH HUMANA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | CIGNA COMMERCIAL [85040] | CIGNA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | HEALTH CHOICE [85751] | NB/TH HEALTH CHOICE | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| Infirmary Ltac Hospital Outpatient | CIGNA COMMERCIAL [85040] | CIGNA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-11-02 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | HUMANA COMMERCIAL [85368] | MI HUMANA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | HUMANA COMMERCIAL [85368] | MI HUMANA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | HEALTH CHOICE [85751] | MI Health Choice | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | HUMANA COMMERCIAL [85368] | TH HUMANA | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | FIRST HEALTH NETWORK [85081] | MI FIRST HEALTH COMMERCIAL | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | FIRST HEALTH NETWORK [85081] | MI FIRST HEALTH COMMERCIAL | $52,371.20 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | AETNA COMMERCIAL [85189] | TH AETNA | $53,867.52 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | AETNA COMMERCIAL [85189] | TH AETNA | $53,867.52 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | AETNA COMMERCIAL [85189] | TH AETNA | $53,867.52 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC COMMERCIAL [85995] | TH Private Healthcare Systems (PHCS) | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | FIRST HEALTH NETWORK [85081] | TH FIRST HEALTH COMMERCIAL | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC HOME HEALTH [85997] | BAY POINTE EAST POINTE ALTAPOINTE | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC COMMERCIAL [85995] | TH Private Healthcare Systems (PHCS) | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC HOME HEALTH [85997] | BAY POINTE EAST POINTE ALTAPOINTE | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC COMMERCIAL [85995] | TH Private Healthcare Systems (PHCS) | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | FIRST HEALTH NETWORK [85081] | TH FIRST HEALTH COMMERCIAL | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC HOME HEALTH [85997] | BAY POINTE EAST POINTE ALTAPOINTE | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC HOME HEALTH [85997] | BAY POINTE EAST POINTE ALTAPOINTE | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | FIRST HEALTH NETWORK [85081] | TH FIRST HEALTH COMMERCIAL | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| THOMAS HOSPITAL Outpatient | GENERIC HOME HEALTH [85997] | BAY POINTE EAST POINTE ALTAPOINTE | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | GENERIC HOME HEALTH [85997] | BAY POINTE EAST POINTE ALTAPOINTE | $56,112.00 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | MULTIPLAN NETWORK [85552] | MI MULTI PLAN | $59,852.80 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | MULTIPLAN NETWORK [85552] | MI MULTI PLAN | $59,852.80 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | VIVA COMMERCIAL [85130] | MI VIVA | $59,852.80 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | VIVA COMMERCIAL [85130] | MI VIVA | $59,852.80 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| Infirmary Ltac Hospital Outpatient | AETNA COMMERCIAL [85189] | LTCH AETNA | $59,852.80 | $74,816.00 | $15,962.59 | 2025-11-02 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | VIVA COMMERCIAL [85130] | MI VIVA | $59,852.80 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| Infirmary Ltac Hospital Outpatient | AETNA COMMERCIAL [85189] | LTCH AETNA | $59,852.80 | $74,816.00 | $15,962.59 | 2025-11-02 | MRF ↗ |
| MOBILE INFIRMARY MEDICAL CENTER Outpatient | MULTIPLAN NETWORK [85552] | MI MULTI PLAN | $59,852.80 | $74,816.00 | $15,962.59 | 2025-10-30 | MRF ↗ |
| Infirmary Ltac Hospital Outpatient | BLUE ADVANTAGE [85293] | LTCH BLUE ADVANTAGE - MEDICARE ADVANTAGE | $74,816.00 | $74,816.00 | $15,962.59 | 2025-11-02 | MRF ↗ |
| Infirmary Ltac Hospital Outpatient | BLUE ADVANTAGE [85293] | LTCH BLUE ADVANTAGE - MEDICARE ADVANTAGE | $74,816.00 | $74,816.00 | $15,962.59 | 2025-11-02 | MRF ↗ |
| Infirmary Ltac Hospital Outpatient | CIGNA HEALTHSPRING MEDICARE ADVANTAGE [85203] | LTCH HEALTHSPRING - MEDICARE ADVANTAGE | $76,985.66 | $74,816.00 | $15,962.59 | 2025-11-02 | MRF ↗ |
| Infirmary Ltac Hospital Outpatient | CIGNA HEALTHSPRING MEDICARE ADVANTAGE [85203] | LTCH HEALTHSPRING - MEDICARE ADVANTAGE | $76,985.66 | $74,816.00 | $15,962.59 | 2025-11-02 | MRF ↗ |