|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$252.42
|
|
|
Service Code
|
NDC 68094085362
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$227.18 |
| Rate for Payer: Aetna Commercial |
$214.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.07
|
| Rate for Payer: Cash Price |
$201.94
|
| Rate for Payer: Cofinity Advantage |
$176.69
|
| Rate for Payer: Cofinity Commercial |
$217.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.94
|
| Rate for Payer: Healthscope Commercial |
$227.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.31
|
| Rate for Payer: PHP Commercial |
$214.56
|
| Rate for Payer: Priority Health SBD |
$159.02
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$377.28
|
|
|
Service Code
|
NDC 51224020650
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.27 |
| Max. Negotiated Rate |
$339.55 |
| Rate for Payer: Aetna Commercial |
$320.69
|
| Rate for Payer: Aetna Medicare |
$188.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.23
|
| Rate for Payer: BCBS Complete |
$150.91
|
| Rate for Payer: Cash Price |
$301.82
|
| Rate for Payer: Cofinity Advantage |
$264.10
|
| Rate for Payer: Cofinity Commercial |
$324.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.82
|
| Rate for Payer: Healthscope Commercial |
$339.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.96
|
| Rate for Payer: PHP Commercial |
$320.69
|
| Rate for Payer: Priority Health SBD |
$237.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.23
|
| Rate for Payer: UHC Core |
$196.56
|
| Rate for Payer: UHC Exchange |
$148.27
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$9.52
|
|
|
Service Code
|
NDC 68084029111
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Aetna Medicare |
$4.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.19
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Advantage |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.14
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health SBD |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.19
|
| Rate for Payer: UHC Core |
$4.96
|
| Rate for Payer: UHC Exchange |
$3.74
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$142.28
|
|
|
Service Code
|
NDC 47335032683
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.64 |
| Max. Negotiated Rate |
$128.05 |
| Rate for Payer: Aetna Commercial |
$120.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.48
|
| Rate for Payer: Cash Price |
$113.82
|
| Rate for Payer: Cofinity Advantage |
$99.60
|
| Rate for Payer: Cofinity Commercial |
$122.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.82
|
| Rate for Payer: Healthscope Commercial |
$128.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.71
|
| Rate for Payer: PHP Commercial |
$120.94
|
| Rate for Payer: Priority Health SBD |
$89.64
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$377.28
|
|
|
Service Code
|
NDC 51224020650
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.69 |
| Max. Negotiated Rate |
$339.55 |
| Rate for Payer: Aetna Commercial |
$320.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.23
|
| Rate for Payer: Cash Price |
$301.82
|
| Rate for Payer: Cofinity Advantage |
$264.10
|
| Rate for Payer: Cofinity Commercial |
$324.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.82
|
| Rate for Payer: Healthscope Commercial |
$339.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.96
|
| Rate for Payer: PHP Commercial |
$320.69
|
| Rate for Payer: Priority Health SBD |
$237.69
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$116.50
|
|
|
Service Code
|
NDC 51224020630
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$104.85 |
| Rate for Payer: Aetna Commercial |
$99.03
|
| Rate for Payer: Aetna Medicare |
$58.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.72
|
| Rate for Payer: BCBS Complete |
$46.60
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cofinity Advantage |
$81.55
|
| Rate for Payer: Cofinity Commercial |
$100.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$104.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.38
|
| Rate for Payer: PHP Commercial |
$99.03
|
| Rate for Payer: Priority Health SBD |
$73.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.72
|
| Rate for Payer: UHC Core |
$60.70
|
| Rate for Payer: UHC Exchange |
$45.78
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$238.90
|
|
|
Service Code
|
NDC 00904703604
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.51 |
| Max. Negotiated Rate |
$215.01 |
| Rate for Payer: Aetna Commercial |
$203.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.28
|
| Rate for Payer: Cash Price |
$191.12
|
| Rate for Payer: Cofinity Advantage |
$167.23
|
| Rate for Payer: Cofinity Commercial |
$205.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.12
|
| Rate for Payer: Healthscope Commercial |
$215.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.18
|
| Rate for Payer: PHP Commercial |
$203.06
|
| Rate for Payer: Priority Health SBD |
$150.51
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$142.28
|
|
|
Service Code
|
NDC 47335032683
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$128.05 |
| Rate for Payer: Aetna Commercial |
$120.94
|
| Rate for Payer: Aetna Medicare |
$71.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.48
|
| Rate for Payer: BCBS Complete |
$56.91
|
| Rate for Payer: Cash Price |
$113.82
|
| Rate for Payer: Cofinity Advantage |
$99.60
|
| Rate for Payer: Cofinity Commercial |
$122.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.82
|
| Rate for Payer: Healthscope Commercial |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.71
|
| Rate for Payer: PHP Commercial |
$120.94
|
| Rate for Payer: Priority Health SBD |
$89.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.48
|
| Rate for Payer: UHC Core |
$74.13
|
| Rate for Payer: UHC Exchange |
$55.92
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$9.52
|
|
|
Service Code
|
NDC 68084029111
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$8.57 |
| Rate for Payer: Aetna Commercial |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.19
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: Cofinity Advantage |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.62
|
| Rate for Payer: Healthscope Commercial |
$8.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.14
|
| Rate for Payer: PHP Commercial |
$8.09
|
| Rate for Payer: Priority Health SBD |
$6.00
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$6,671.68
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$6,004.51 |
| Rate for Payer: Aetna Commercial |
$5,670.93
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,336.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.31
|
| Rate for Payer: BCBS Complete |
$2.33
|
| Rate for Payer: BCBS MAPPO |
$4.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.64
|
| Rate for Payer: BCN Commercial |
$10.64
|
| Rate for Payer: BCN Medicare Advantage |
$4.25
|
| Rate for Payer: Cash Price |
$5,337.34
|
| Rate for Payer: Cash Price |
$5,337.34
|
| Rate for Payer: Cofinity Advantage |
$4,670.18
|
| Rate for Payer: Cofinity Commercial |
$5,737.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,337.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.25
|
| Rate for Payer: Healthscope Commercial |
$6,004.51
|
| Rate for Payer: Mclaren Medicaid |
$2.22
|
| Rate for Payer: Mclaren Medicare |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.46
|
| Rate for Payer: Meridian Medicaid |
$4.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,670.93
|
| Rate for Payer: Nomi Health Commercial |
$12.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,003.76
|
| Rate for Payer: PACE Medicare |
$4.04
|
| Rate for Payer: PACE SWMI |
$4.25
|
| Rate for Payer: PHP Commercial |
$5,670.93
|
| Rate for Payer: PHP Medicare Advantage |
$4.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.38
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health SBD |
$4,203.16
|
| Rate for Payer: Priority Health Tiered Network |
$10.70
|
| Rate for Payer: Railroad Medicare Medicare |
$4.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.00
|
| Rate for Payer: UHC Core |
$7.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.25
|
| Rate for Payer: UHC Exchange |
$7.00
|
| Rate for Payer: UHC Medicaid |
$2.22
|
| Rate for Payer: UHCCP Medicaid |
$2.22
|
| Rate for Payer: VA VA |
$4.25
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$6,671.68
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,203.16 |
| Max. Negotiated Rate |
$6,004.51 |
| Rate for Payer: Aetna Commercial |
$5,670.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,336.59
|
| Rate for Payer: Cash Price |
$5,337.34
|
| Rate for Payer: Cofinity Advantage |
$4,670.18
|
| Rate for Payer: Cofinity Commercial |
$5,737.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,337.34
|
| Rate for Payer: Healthscope Commercial |
$6,004.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,670.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,003.76
|
| Rate for Payer: PHP Commercial |
$5,670.93
|
| Rate for Payer: Priority Health SBD |
$4,203.16
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$229.13
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.35 |
| Max. Negotiated Rate |
$206.22 |
| Rate for Payer: Aetna Commercial |
$194.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.93
|
| Rate for Payer: Cash Price |
$183.30
|
| Rate for Payer: Cofinity Advantage |
$160.39
|
| Rate for Payer: Cofinity Commercial |
$197.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.30
|
| Rate for Payer: Healthscope Commercial |
$206.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.85
|
| Rate for Payer: PHP Commercial |
$194.76
|
| Rate for Payer: Priority Health SBD |
$144.35
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Exchange |
$1.80
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$229.13
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.05 |
| Max. Negotiated Rate |
$206.22 |
| Rate for Payer: Aetna Commercial |
$194.76
|
| Rate for Payer: Aetna Medicare |
$114.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.93
|
| Rate for Payer: BCBS Complete |
$91.65
|
| Rate for Payer: Cash Price |
$183.30
|
| Rate for Payer: Cofinity Advantage |
$160.39
|
| Rate for Payer: Cofinity Commercial |
$197.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.30
|
| Rate for Payer: Healthscope Commercial |
$206.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.85
|
| Rate for Payer: PHP Commercial |
$194.76
|
| Rate for Payer: Priority Health SBD |
$144.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.93
|
| Rate for Payer: UHC Core |
$119.38
|
| Rate for Payer: UHC Exchange |
$90.05
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.03 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Advantage |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.29
|
| Rate for Payer: UHC Core |
$79.58
|
| Rate for Payer: UHC Exchange |
$60.03
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.23 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Advantage |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health SBD |
$96.23
|
|
|
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$643.18
|
|
|
Service Code
|
CPT 31231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.33 |
| Max. Negotiated Rate |
$643.18 |
| Rate for Payer: Aetna Medicare |
$206.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.61
|
| Rate for Payer: BCBS Complete |
$109.23
|
| Rate for Payer: BCBS MAPPO |
$198.89
|
| Rate for Payer: BCBS Trust/PPO |
$73.33
|
| Rate for Payer: BCN Commercial |
$73.33
|
| Rate for Payer: BCN Medicare Advantage |
$198.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.89
|
| Rate for Payer: Mclaren Medicaid |
$104.02
|
| Rate for Payer: Mclaren Medicare |
$198.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.83
|
| Rate for Payer: Meridian Medicaid |
$208.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.78
|
| Rate for Payer: Nomi Health Commercial |
$596.67
|
| Rate for Payer: PACE Medicare |
$188.95
|
| Rate for Payer: PACE SWMI |
$198.89
|
| Rate for Payer: PHP Medicare Advantage |
$198.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.18
|
| Rate for Payer: Priority Health Medicare |
$198.89
|
| Rate for Payer: Priority Health Tiered Network |
$514.54
|
| Rate for Payer: Railroad Medicare Medicare |
$198.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$198.89
|
| Rate for Payer: UHC Medicaid |
$104.02
|
| Rate for Payer: UHCCP Medicaid |
$104.02
|
| Rate for Payer: VA VA |
$198.89
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Advantage |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health SBD |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.66
|
| Rate for Payer: UHC Exchange |
$1.25
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Advantage |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health SBD |
$2.01
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.58
|
| Rate for Payer: BCN Commercial |
$1,001.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$927.54
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,331.43 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,331.43
|
| Rate for Payer: BCN Commercial |
$3,331.43
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$3,677.78
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,360.35 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,360.35
|
| Rate for Payer: BCN Commercial |
$2,360.35
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$3,677.78
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY, WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,677.78 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$4,128.91
|
| Rate for Payer: BCN Commercial |
$4,128.91
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$3,677.78
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,283.88 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.88
|
| Rate for Payer: BCN Commercial |
$2,283.88
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$3,677.78
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
