Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NALTREXONE 50 MG TABLET

Facility

$259.97

Service Code	NDC 68084029121
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$103.99
Max. Negotiated Rate	$233.97
Rate for Payer: Aetna Commercial	$220.97
Rate for Payer: Aetna Medicare	$129.99
Rate for Payer: Aetna New Business (MI Preferred)	$168.98
Rate for Payer: BCBS Complete	$103.99
Rate for Payer: Cash Price	$207.98
Rate for Payer: Cofinity Commercial	$181.98
Rate for Payer: Cofinity Commercial	$223.57
Rate for Payer: Cofinity Medicare Advantage	$181.98
Rate for Payer: Encore Health Key Benefits Commercial	$207.98
Rate for Payer: Healthscope Commercial	$233.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$220.97
Rate for Payer: PHP Commercial	$220.97
Rate for Payer: Priority Health Cigna Priority Health	$168.98
Rate for Payer: Priority Health SBD	$163.78

NALTREXONE 50 MG TABLET

Facility

$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 Commercial	$167.23
Rate for Payer: Cofinity Commercial	$205.45
Rate for Payer: Cofinity Medicare Advantage	$167.23
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: PHP Commercial	$203.06
Rate for Payer: Priority Health Cigna Priority Health	$155.28
Rate for Payer: Priority Health SBD	$150.51

NALTREXONE 50 MG TABLET

Facility

$8.67

Service Code	NDC 68084029111
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$7.80
Rate for Payer: Aetna Commercial	$7.37
Rate for Payer: Aetna New Business (MI Preferred)	$5.64
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cofinity Commercial	$6.07
Rate for Payer: Cofinity Commercial	$7.46
Rate for Payer: Cofinity Medicare Advantage	$6.07
Rate for Payer: Encore Health Key Benefits Commercial	$6.94
Rate for Payer: Healthscope Commercial	$7.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.37
Rate for Payer: PHP Commercial	$7.37
Rate for Payer: Priority Health Cigna Priority Health	$5.64
Rate for Payer: Priority Health SBD	$5.46

NALTREXONE 50 MG TABLET

Facility

$259.97

Service Code	NDC 68084029121
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$163.78
Max. Negotiated Rate	$233.97
Rate for Payer: Aetna Commercial	$220.97
Rate for Payer: Aetna New Business (MI Preferred)	$168.98
Rate for Payer: Cash Price	$207.98
Rate for Payer: Cofinity Commercial	$181.98
Rate for Payer: Cofinity Commercial	$223.57
Rate for Payer: Cofinity Medicare Advantage	$181.98
Rate for Payer: Encore Health Key Benefits Commercial	$207.98
Rate for Payer: Healthscope Commercial	$233.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$220.97
Rate for Payer: PHP Commercial	$220.97
Rate for Payer: Priority Health Cigna Priority Health	$168.98
Rate for Payer: Priority Health SBD	$163.78

NALTREXONE 50 MG TABLET

Facility

$8.67

Service Code	NDC 68084029111
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.80
Rate for Payer: Aetna Commercial	$7.37
Rate for Payer: Aetna Medicare	$4.33
Rate for Payer: Aetna New Business (MI Preferred)	$5.64
Rate for Payer: BCBS Complete	$3.47
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cofinity Commercial	$6.07
Rate for Payer: Cofinity Commercial	$7.46
Rate for Payer: Cofinity Medicare Advantage	$6.07
Rate for Payer: Encore Health Key Benefits Commercial	$6.94
Rate for Payer: Healthscope Commercial	$7.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.37
Rate for Payer: PHP Commercial	$7.37
Rate for Payer: Priority Health Cigna Priority Health	$5.64
Rate for Payer: Priority Health SBD	$5.46

NALTREXONE 50 MG TABLET

Facility

$118.08

Service Code	NDC 47335032683
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$74.39
Max. Negotiated Rate	$106.27
Rate for Payer: Aetna Commercial	$100.37
Rate for Payer: Aetna New Business (MI Preferred)	$76.75
Rate for Payer: Cash Price	$94.46
Rate for Payer: Cofinity Commercial	$101.55
Rate for Payer: Cofinity Commercial	$82.66
Rate for Payer: Cofinity Medicare Advantage	$82.66
Rate for Payer: Encore Health Key Benefits Commercial	$94.46
Rate for Payer: Healthscope Commercial	$106.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.37
Rate for Payer: PHP Commercial	$100.37
Rate for Payer: Priority Health Cigna Priority Health	$76.75
Rate for Payer: Priority Health SBD	$74.39

NALTREXONE 50 MG TABLET

Facility

$118.08

Service Code	NDC 47335032683
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$47.23
Max. Negotiated Rate	$106.27
Rate for Payer: Aetna Commercial	$100.37
Rate for Payer: Aetna Medicare	$59.04
Rate for Payer: Aetna New Business (MI Preferred)	$76.75
Rate for Payer: BCBS Complete	$47.23
Rate for Payer: Cash Price	$94.46
Rate for Payer: Cofinity Commercial	$101.55
Rate for Payer: Cofinity Commercial	$82.66
Rate for Payer: Cofinity Medicare Advantage	$82.66
Rate for Payer: Encore Health Key Benefits Commercial	$94.46
Rate for Payer: Healthscope Commercial	$106.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.37
Rate for Payer: PHP Commercial	$100.37
Rate for Payer: Priority Health Cigna Priority Health	$76.75
Rate for Payer: Priority Health SBD	$74.39

NALTREXONE 50 MG TABLET

Facility

$116.50

Service Code	NDC 51224020630
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$73.39
Max. Negotiated Rate	$104.85
Rate for Payer: Aetna Commercial	$99.03
Rate for Payer: Aetna New Business (MI Preferred)	$75.72
Rate for Payer: Cash Price	$93.20
Rate for Payer: Cofinity Commercial	$100.19
Rate for Payer: Cofinity Commercial	$81.55
Rate for Payer: Cofinity Medicare Advantage	$81.55
Rate for Payer: Encore Health Key Benefits Commercial	$93.20
Rate for Payer: Healthscope Commercial	$104.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.03
Rate for Payer: PHP Commercial	$99.03
Rate for Payer: Priority Health Cigna Priority Health	$75.72
Rate for Payer: Priority Health SBD	$73.39

NALTREXONE 50 MG TABLET

Facility

$116.50

Service Code	NDC 51224020630
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$46.60
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 Commercial	$100.19
Rate for Payer: Cofinity Commercial	$81.55
Rate for Payer: Cofinity Medicare Advantage	$81.55
Rate for Payer: Encore Health Key Benefits Commercial	$93.20
Rate for Payer: Healthscope Commercial	$104.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.03
Rate for Payer: PHP Commercial	$99.03
Rate for Payer: Priority Health Cigna Priority Health	$75.72
Rate for Payer: Priority Health SBD	$73.39

NALTREXONE 50 MG TABLET

Facility

$377.28

Service Code	NDC 51224020650
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$150.91
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 Commercial	$264.10
Rate for Payer: Cofinity Commercial	$324.46
Rate for Payer: Cofinity Medicare Advantage	$264.10
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: PHP Commercial	$320.69
Rate for Payer: Priority Health Cigna Priority Health	$245.23
Rate for Payer: Priority Health SBD	$237.69

NALTREXONE 50 MG TABLET

Facility

$238.90

Service Code	NDC 00904703604
Hospital Charge Code	10685
Hospital Revenue Code	637
Min. Negotiated Rate	$95.56
Max. Negotiated Rate	$215.01
Rate for Payer: Aetna Commercial	$203.06
Rate for Payer: Aetna Medicare	$119.45
Rate for Payer: Aetna New Business (MI Preferred)	$155.28
Rate for Payer: BCBS Complete	$95.56
Rate for Payer: Cash Price	$191.12
Rate for Payer: Cofinity Commercial	$167.23
Rate for Payer: Cofinity Commercial	$205.45
Rate for Payer: Cofinity Medicare Advantage	$167.23
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: PHP Commercial	$203.06
Rate for Payer: Priority Health Cigna Priority Health	$155.28
Rate for Payer: Priority Health SBD	$150.51

NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE

Facility

$5,030.47

Service Code	HCPCS J2315
Hospital Charge Code	76527
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$4,527.42
Rate for Payer: Aetna Commercial	$4,275.90
Rate for Payer: Aetna Medicare	$4.41
Rate for Payer: Aetna New Business (MI Preferred)	$3,269.81
Rate for Payer: Allen County Amish Medical Aid Commercial	$5.30
Rate for Payer: Amish Plain Church Group Commercial	$5.30
Rate for Payer: BCBS Complete	$2.39
Rate for Payer: BCBS MAPPO	$4.24
Rate for Payer: BCN Medicare Advantage	$4.24
Rate for Payer: Cash Price	$4,024.38
Rate for Payer: Cash Price	$4,024.38
Rate for Payer: Cofinity Commercial	$4,326.20
Rate for Payer: Cofinity Commercial	$3,521.33
Rate for Payer: Cofinity Medicare Advantage	$3,521.33
Rate for Payer: Encore Health Key Benefits Commercial	$4,024.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.24
Rate for Payer: Healthscope Commercial	$4,527.42
Rate for Payer: Mclaren Medicaid	$2.27
Rate for Payer: Mclaren Medicare	$4.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$4.45
Rate for Payer: Meridian Medicaid	$2.39
Rate for Payer: MI Amish Medical Board Commercial	$4.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,275.90
Rate for Payer: PACE Medicare	$4.03
Rate for Payer: PACE SWMI	$4.24
Rate for Payer: PHP Commercial	$4,275.90
Rate for Payer: PHP Medicare Advantage	$4.24
Rate for Payer: Priority Health Choice Medicaid	$2.27
Rate for Payer: Priority Health Cigna Priority Health	$3,269.81
Rate for Payer: Priority Health Medicare	$4.24
Rate for Payer: Priority Health SBD	$3,169.20
Rate for Payer: Railroad Medicare Medicare	$4.24
Rate for Payer: UHC All Payor (Choice/PPO)	$11.94
Rate for Payer: UHC Dual Complete DSNP	$4.24
Rate for Payer: UHC Medicare Advantage	$4.24
Rate for Payer: UHCCP Medicaid	$2.39
Rate for Payer: VA VA	$4.24

NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE

Facility

$5,030.47

Service Code	HCPCS J2315
Hospital Charge Code	76527
Hospital Revenue Code	636
Min. Negotiated Rate	$3,169.20
Max. Negotiated Rate	$4,527.42
Rate for Payer: Aetna Commercial	$4,275.90
Rate for Payer: Aetna New Business (MI Preferred)	$3,269.81
Rate for Payer: Cash Price	$4,024.38
Rate for Payer: Cofinity Commercial	$3,521.33
Rate for Payer: Cofinity Commercial	$4,326.20
Rate for Payer: Cofinity Medicare Advantage	$3,521.33
Rate for Payer: Encore Health Key Benefits Commercial	$4,024.38
Rate for Payer: Healthscope Commercial	$4,527.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,275.90
Rate for Payer: PHP Commercial	$4,275.90
Rate for Payer: Priority Health Cigna Priority Health	$3,269.81
Rate for Payer: Priority Health SBD	$3,169.20

NAPROXEN 250 MG TABLET

Facility

$155.10

Service Code	NDC 65162018810
Hospital Charge Code	5391
Hospital Revenue Code	637
Min. Negotiated Rate	$62.04
Max. Negotiated Rate	$139.59
Rate for Payer: Aetna Commercial	$131.84
Rate for Payer: Aetna Medicare	$77.55
Rate for Payer: Aetna New Business (MI Preferred)	$100.81
Rate for Payer: BCBS Complete	$62.04
Rate for Payer: Cash Price	$124.08
Rate for Payer: Cofinity Commercial	$108.57
Rate for Payer: Cofinity Commercial	$133.39
Rate for Payer: Cofinity Medicare Advantage	$108.57
Rate for Payer: Encore Health Key Benefits Commercial	$124.08
Rate for Payer: Healthscope Commercial	$139.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$131.84
Rate for Payer: PHP Commercial	$131.84
Rate for Payer: Priority Health Cigna Priority Health	$100.81
Rate for Payer: Priority Health SBD	$97.71

NAPROXEN 250 MG TABLET

Facility

$155.10

Service Code	NDC 65162018810
Hospital Charge Code	5391
Hospital Revenue Code	637
Min. Negotiated Rate	$97.71
Max. Negotiated Rate	$139.59
Rate for Payer: Aetna Commercial	$131.84
Rate for Payer: Aetna New Business (MI Preferred)	$100.81
Rate for Payer: Cash Price	$124.08
Rate for Payer: Cofinity Commercial	$108.57
Rate for Payer: Cofinity Commercial	$133.39
Rate for Payer: Cofinity Medicare Advantage	$108.57
Rate for Payer: Encore Health Key Benefits Commercial	$124.08
Rate for Payer: Healthscope Commercial	$139.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$131.84
Rate for Payer: PHP Commercial	$131.84
Rate for Payer: Priority Health Cigna Priority Health	$100.81
Rate for Payer: Priority Health SBD	$97.71

NAPROXEN 250 MG TABLET

Facility

$4.26

Service Code	NDC 50268059411
Hospital Charge Code	5391
Hospital Revenue Code	637
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna New Business (MI Preferred)	$2.77
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cofinity Commercial	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Cofinity Medicare Advantage	$2.98
Rate for Payer: Encore Health Key Benefits Commercial	$3.41
Rate for Payer: Healthscope Commercial	$3.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.62
Rate for Payer: PHP Commercial	$3.62
Rate for Payer: Priority Health Cigna Priority Health	$2.77
Rate for Payer: Priority Health SBD	$2.68

NAPROXEN 250 MG TABLET

Facility

$212.68

Service Code	NDC 50268059415
Hospital Charge Code	5391
Hospital Revenue Code	637
Min. Negotiated Rate	$133.99
Max. Negotiated Rate	$191.41
Rate for Payer: Aetna Commercial	$180.78
Rate for Payer: Aetna New Business (MI Preferred)	$138.24
Rate for Payer: Cash Price	$170.14
Rate for Payer: Cofinity Commercial	$148.88
Rate for Payer: Cofinity Commercial	$182.90
Rate for Payer: Cofinity Medicare Advantage	$148.88
Rate for Payer: Encore Health Key Benefits Commercial	$170.14
Rate for Payer: Healthscope Commercial	$191.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.78
Rate for Payer: PHP Commercial	$180.78
Rate for Payer: Priority Health Cigna Priority Health	$138.24
Rate for Payer: Priority Health SBD	$133.99

NAPROXEN 250 MG TABLET

Facility

$212.68

Service Code	NDC 50268059415
Hospital Charge Code	5391
Hospital Revenue Code	637
Min. Negotiated Rate	$85.07
Max. Negotiated Rate	$191.41
Rate for Payer: Aetna Commercial	$180.78
Rate for Payer: Aetna Medicare	$106.34
Rate for Payer: Aetna New Business (MI Preferred)	$138.24
Rate for Payer: BCBS Complete	$85.07
Rate for Payer: Cash Price	$170.14
Rate for Payer: Cofinity Commercial	$148.88
Rate for Payer: Cofinity Commercial	$182.90
Rate for Payer: Cofinity Medicare Advantage	$148.88
Rate for Payer: Encore Health Key Benefits Commercial	$170.14
Rate for Payer: Healthscope Commercial	$191.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.78
Rate for Payer: PHP Commercial	$180.78
Rate for Payer: Priority Health Cigna Priority Health	$138.24
Rate for Payer: Priority Health SBD	$133.99

NAPROXEN 250 MG TABLET

Facility

$4.26

Service Code	NDC 50268059411
Hospital Charge Code	5391
Hospital Revenue Code	637
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna Medicare	$2.13
Rate for Payer: Aetna New Business (MI Preferred)	$2.77
Rate for Payer: BCBS Complete	$1.70
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cofinity Commercial	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Cofinity Medicare Advantage	$2.98
Rate for Payer: Encore Health Key Benefits Commercial	$3.41
Rate for Payer: Healthscope Commercial	$3.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.62
Rate for Payer: PHP Commercial	$3.62
Rate for Payer: Priority Health Cigna Priority Health	$2.77
Rate for Payer: Priority Health SBD	$2.68

NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)

Facility

$532.97

Service Code	CPT 31231
Hospital Revenue Code	360
Min. Negotiated Rate	$101.49
Max. Negotiated Rate	$532.97
Rate for Payer: Aetna Medicare	$196.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$236.68
Rate for Payer: Amish Plain Church Group Commercial	$236.68
Rate for Payer: BCBS Complete	$106.56
Rate for Payer: BCBS MAPPO	$189.34
Rate for Payer: BCN Medicare Advantage	$189.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$189.34
Rate for Payer: Mclaren Medicaid	$101.49
Rate for Payer: Mclaren Medicare	$189.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$198.81
Rate for Payer: Meridian Medicaid	$106.56
Rate for Payer: MI Amish Medical Board Commercial	$217.74
Rate for Payer: PACE Medicare	$179.87
Rate for Payer: PACE SWMI	$189.34
Rate for Payer: PHP Medicare Advantage	$189.34
Rate for Payer: Priority Health Choice Medicaid	$101.49
Rate for Payer: Priority Health Medicare	$189.34
Rate for Payer: Railroad Medicare Medicare	$189.34
Rate for Payer: UHC All Payor (Choice/PPO)	$532.97
Rate for Payer: UHC Dual Complete DSNP	$189.34
Rate for Payer: UHC Medicare Advantage	$189.34
Rate for Payer: UHCCP Medicaid	$106.60
Rate for Payer: VA VA	$189.34

NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)

Facility

$4,734.21

Service Code	CPT 31237
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION

Facility

$4,734.21

Service Code	CPT 31240
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE

Facility

$4,734.21

Service Code	CPT 31238
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)

Facility

$19,004.38

Service Code	CPT 31254
Hospital Revenue Code	360
Min. Negotiated Rate	$3,618.72
Max. Negotiated Rate	$19,004.38
Rate for Payer: Aetna Medicare	$7,021.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,439.19
Rate for Payer: Amish Plain Church Group Commercial	$8,439.19
Rate for Payer: BCBS Complete	$3,799.66
Rate for Payer: BCBS MAPPO	$6,751.35
Rate for Payer: BCN Medicare Advantage	$6,751.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,751.35
Rate for Payer: Mclaren Medicaid	$3,618.72
Rate for Payer: Mclaren Medicare	$6,751.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,088.92
Rate for Payer: Meridian Medicaid	$3,799.66
Rate for Payer: MI Amish Medical Board Commercial	$7,764.05
Rate for Payer: PACE Medicare	$6,413.78
Rate for Payer: PACE SWMI	$6,751.35
Rate for Payer: PHP Medicare Advantage	$6,751.35
Rate for Payer: Priority Health Choice Medicaid	$3,618.72
Rate for Payer: Priority Health Medicare	$6,751.35
Rate for Payer: Railroad Medicare Medicare	$6,751.35
Rate for Payer: UHC All Payor (Choice/PPO)	$19,004.38
Rate for Payer: UHC Dual Complete DSNP	$6,751.35
Rate for Payer: UHC Medicare Advantage	$6,751.35
Rate for Payer: UHCCP Medicaid	$3,801.01
Rate for Payer: VA VA	$6,751.35

NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)

Facility

$19,004.38

Service Code	CPT 31255
Hospital Revenue Code	360
Min. Negotiated Rate	$3,618.72
Max. Negotiated Rate	$19,004.38
Rate for Payer: Aetna Medicare	$7,021.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,439.19
Rate for Payer: Amish Plain Church Group Commercial	$8,439.19
Rate for Payer: BCBS Complete	$3,799.66
Rate for Payer: BCBS MAPPO	$6,751.35
Rate for Payer: BCN Medicare Advantage	$6,751.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,751.35
Rate for Payer: Mclaren Medicaid	$3,618.72
Rate for Payer: Mclaren Medicare	$6,751.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,088.92
Rate for Payer: Meridian Medicaid	$3,799.66
Rate for Payer: MI Amish Medical Board Commercial	$7,764.05
Rate for Payer: PACE Medicare	$6,413.78
Rate for Payer: PACE SWMI	$6,751.35
Rate for Payer: PHP Medicare Advantage	$6,751.35
Rate for Payer: Priority Health Choice Medicaid	$3,618.72
Rate for Payer: Priority Health Medicare	$6,751.35
Rate for Payer: Railroad Medicare Medicare	$6,751.35
Rate for Payer: UHC All Payor (Choice/PPO)	$19,004.38
Rate for Payer: UHC Dual Complete DSNP	$6,751.35
Rate for Payer: UHC Medicare Advantage	$6,751.35
Rate for Payer: UHCCP Medicaid	$3,801.01
Rate for Payer: VA VA	$6,751.35

Know your out-of-pocket cost for care.

All Charges