|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
OP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.98 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna Medicare |
$409.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.74
|
| Rate for Payer: BCBS Complete |
$291.86
|
| Rate for Payer: BCBS MAPPO |
$394.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.25
|
| Rate for Payer: BCN Commercial |
$1,296.25
|
| Rate for Payer: BCN Medicare Advantage |
$394.19
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.19
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.57
|
| Rate for Payer: Mclaren Medicaid |
$277.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.90
|
| Rate for Payer: Meridian Medicaid |
$291.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$433.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Nomi Health Commercial |
$1,292.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PACE Senior Care Partners |
$374.48
|
| Rate for Payer: PACE SWMI |
$394.19
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: PHP Medicare Advantage |
$394.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,371.78
|
| Rate for Payer: Priority Health Medicare |
$398.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,097.42
|
| Rate for Payer: Railroad Medicare Medicare |
$394.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,387.55
|
| Rate for Payer: UHC Core |
$1,316.59
|
| Rate for Payer: UHC Exchange |
$394.19
|
| Rate for Payer: UHC Medicaid |
$277.98
|
| Rate for Payer: UHC Medicare Advantage |
$394.19
|
| Rate for Payer: UHCCP Medicaid |
$277.98
|
| Rate for Payer: VA VA |
$394.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.57
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$63.57
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.94
|
| Rate for Payer: UHC Core |
$53.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Medicare |
$16.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.87
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: BCBS MAPPO |
$15.89
|
| Rate for Payer: BCBS Trust/PPO |
$52.26
|
| Rate for Payer: BCN Commercial |
$52.26
|
| Rate for Payer: BCN Medicare Advantage |
$15.89
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.89
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Mclaren Medicaid |
$11.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.69
|
| Rate for Payer: Meridian Medicaid |
$11.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: PACE Senior Care Partners |
$15.10
|
| Rate for Payer: PACE SWMI |
$15.89
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Medicare Advantage |
$15.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.31
|
| Rate for Payer: Priority Health Medicare |
$16.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.24
|
| Rate for Payer: Railroad Medicare Medicare |
$15.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.94
|
| Rate for Payer: UHC Core |
$53.08
|
| Rate for Payer: UHC Exchange |
$15.89
|
| Rate for Payer: UHC Medicaid |
$11.21
|
| Rate for Payer: UHC Medicare Advantage |
$15.89
|
| Rate for Payer: UHCCP Medicaid |
$11.21
|
| Rate for Payer: VA VA |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.88
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$23.70
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna Medicare |
$4.39
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Aetna Medicare |
$16.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.28
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS MAPPO |
$4.22
|
| Rate for Payer: BCBS MAPPO |
$5.17
|
| Rate for Payer: BCBS MAPPO |
$15.89
|
| Rate for Payer: BCBS MAPPO |
$6.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.92
|
| Rate for Payer: BCBS Trust/PPO |
$13.88
|
| Rate for Payer: BCBS Trust/PPO |
$52.26
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCN Commercial |
$22.92
|
| Rate for Payer: BCN Commercial |
$52.26
|
| Rate for Payer: BCN Commercial |
$17.02
|
| Rate for Payer: BCN Commercial |
$13.88
|
| Rate for Payer: BCN Medicare Advantage |
$6.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.89
|
| Rate for Payer: BCN Medicare Advantage |
$4.22
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.97
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Mclaren Medicaid |
$4.92
|
| Rate for Payer: Mclaren Medicaid |
$3.65
|
| Rate for Payer: Mclaren Medicaid |
$2.98
|
| Rate for Payer: Mclaren Medicaid |
$11.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.43
|
| Rate for Payer: Meridian Medicaid |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$5.16
|
| Rate for Payer: Meridian Medicaid |
$11.77
|
| Rate for Payer: Meridian Medicaid |
$3.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$22.86
|
| Rate for Payer: Nomi Health Commercial |
$13.84
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.66
|
| Rate for Payer: PACE Senior Care Partners |
$6.62
|
| Rate for Payer: PACE Senior Care Partners |
$15.10
|
| Rate for Payer: PACE Senior Care Partners |
$4.01
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE SWMI |
$4.22
|
| Rate for Payer: PACE SWMI |
$15.89
|
| Rate for Payer: PACE SWMI |
$5.17
|
| Rate for Payer: PACE SWMI |
$6.97
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$23.70
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Medicare Advantage |
$4.22
|
| Rate for Payer: PHP Medicare Advantage |
$15.89
|
| Rate for Payer: PHP Medicare Advantage |
$5.17
|
| Rate for Payer: PHP Medicare Advantage |
$6.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.69
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Medicare |
$4.26
|
| Rate for Payer: Priority Health Medicare |
$7.04
|
| Rate for Payer: Priority Health Medicare |
$16.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: Railroad Medicare Medicare |
$6.97
|
| Rate for Payer: Railroad Medicare Medicare |
$4.22
|
| Rate for Payer: Railroad Medicare Medicare |
$15.89
|
| Rate for Payer: Railroad Medicare Medicare |
$5.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.94
|
| Rate for Payer: UHC Core |
$14.09
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$53.08
|
| Rate for Payer: UHC Exchange |
$6.97
|
| Rate for Payer: UHC Exchange |
$5.17
|
| Rate for Payer: UHC Exchange |
$15.89
|
| Rate for Payer: UHC Exchange |
$4.22
|
| Rate for Payer: UHC Medicaid |
$2.98
|
| Rate for Payer: UHC Medicaid |
$3.65
|
| Rate for Payer: UHC Medicaid |
$4.92
|
| Rate for Payer: UHC Medicaid |
$11.21
|
| Rate for Payer: UHC Medicare Advantage |
$5.17
|
| Rate for Payer: UHC Medicare Advantage |
$4.22
|
| Rate for Payer: UHC Medicare Advantage |
$15.89
|
| Rate for Payer: UHC Medicare Advantage |
$6.97
|
| Rate for Payer: UHCCP Medicaid |
$4.92
|
| Rate for Payer: UHCCP Medicaid |
$11.21
|
| Rate for Payer: UHCCP Medicaid |
$3.65
|
| Rate for Payer: UHCCP Medicaid |
$2.98
|
| Rate for Payer: VA VA |
$4.22
|
| Rate for Payer: VA VA |
$15.89
|
| Rate for Payer: VA VA |
$6.97
|
| Rate for Payer: VA VA |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.88
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Aetna Commercial |
$23.70
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: BCBS Trust/PPO |
$23.03
|
| Rate for Payer: BCBS Trust/PPO |
$52.50
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCBS Trust/PPO |
$13.94
|
| Rate for Payer: BCN Commercial |
$23.03
|
| Rate for Payer: BCN Commercial |
$13.94
|
| Rate for Payer: BCN Commercial |
$52.50
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$13.84
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Nomi Health Commercial |
$22.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$23.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.53
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Core |
$53.08
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.91
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$86.71
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$78.04 |
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.84
|
| Rate for Payer: BCBS Trust/PPO |
$71.61
|
| Rate for Payer: BCBS Trust/PPO |
$44.53
|
| Rate for Payer: BCBS Trust/PPO |
$39.07
|
| Rate for Payer: BCBS Trust/PPO |
$38.14
|
| Rate for Payer: BCN Commercial |
$53.84
|
| Rate for Payer: BCN Commercial |
$44.53
|
| Rate for Payer: BCN Commercial |
$38.14
|
| Rate for Payer: BCN Commercial |
$39.07
|
| Rate for Payer: BCN Commercial |
$71.61
|
| Rate for Payer: Cash Price |
$36.94
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$43.14
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$46.37
|
| Rate for Payer: Cofinity Commercial |
$40.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.37
|
| Rate for Payer: Healthscope Commercial |
$42.58
|
| Rate for Payer: Healthscope Commercial |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$41.56
|
| Rate for Payer: Healthscope Commercial |
$58.67
|
| Rate for Payer: Healthscope Commercial |
$78.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Nomi Health Commercial |
$37.87
|
| Rate for Payer: Nomi Health Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$44.21
|
| Rate for Payer: Nomi Health Commercial |
$53.46
|
| Rate for Payer: Nomi Health Commercial |
$71.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.03
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: PHP Commercial |
$45.83
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Commercial |
$39.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.37
|
| Rate for Payer: UHC Core |
$38.56
|
| Rate for Payer: UHC Core |
$39.50
|
| Rate for Payer: UHC Core |
$54.43
|
| Rate for Payer: UHC Core |
$72.40
|
| Rate for Payer: UHC Core |
$45.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.89
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$86.71
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$78.04 |
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare |
$12.30
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Aetna Medicare |
$12.01
|
| Rate for Payer: Aetna Medicare |
$16.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.37
|
| Rate for Payer: BCBS Complete |
$8.76
|
| Rate for Payer: BCBS Complete |
$8.55
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS Complete |
$16.05
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS MAPPO |
$21.68
|
| Rate for Payer: BCBS MAPPO |
$11.83
|
| Rate for Payer: BCBS MAPPO |
$11.54
|
| Rate for Payer: BCBS MAPPO |
$13.48
|
| Rate for Payer: BCBS MAPPO |
$16.30
|
| Rate for Payer: BCBS Trust/PPO |
$44.33
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCBS Trust/PPO |
$38.89
|
| Rate for Payer: BCBS Trust/PPO |
$71.28
|
| Rate for Payer: BCBS Trust/PPO |
$53.59
|
| Rate for Payer: BCN Commercial |
$44.33
|
| Rate for Payer: BCN Commercial |
$38.89
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Commercial |
$71.28
|
| Rate for Payer: BCN Commercial |
$53.59
|
| Rate for Payer: BCN Medicare Advantage |
$21.68
|
| Rate for Payer: BCN Medicare Advantage |
$16.30
|
| Rate for Payer: BCN Medicare Advantage |
$13.48
|
| Rate for Payer: BCN Medicare Advantage |
$11.83
|
| Rate for Payer: BCN Medicare Advantage |
$11.54
|
| Rate for Payer: Cash Price |
$36.94
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$43.14
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$46.37
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Cofinity Commercial |
$40.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$41.56
|
| Rate for Payer: Healthscope Commercial |
$78.04
|
| Rate for Payer: Healthscope Commercial |
$58.67
|
| Rate for Payer: Healthscope Commercial |
$42.58
|
| Rate for Payer: Healthscope Commercial |
$48.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.44
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Mclaren Medicaid |
$11.49
|
| Rate for Payer: Mclaren Medicaid |
$9.51
|
| Rate for Payer: Mclaren Medicaid |
$15.29
|
| Rate for Payer: Mclaren Medicaid |
$8.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.15
|
| Rate for Payer: Meridian Medicaid |
$8.76
|
| Rate for Payer: Meridian Medicaid |
$8.55
|
| Rate for Payer: Meridian Medicaid |
$9.98
|
| Rate for Payer: Meridian Medicaid |
$12.07
|
| Rate for Payer: Meridian Medicaid |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Nomi Health Commercial |
$71.10
|
| Rate for Payer: Nomi Health Commercial |
$44.21
|
| Rate for Payer: Nomi Health Commercial |
$53.46
|
| Rate for Payer: Nomi Health Commercial |
$37.87
|
| Rate for Payer: Nomi Health Commercial |
$38.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.03
|
| Rate for Payer: PACE Senior Care Partners |
$10.97
|
| Rate for Payer: PACE Senior Care Partners |
$11.24
|
| Rate for Payer: PACE Senior Care Partners |
$20.59
|
| Rate for Payer: PACE Senior Care Partners |
$15.48
|
| Rate for Payer: PACE Senior Care Partners |
$12.81
|
| Rate for Payer: PACE SWMI |
$11.54
|
| Rate for Payer: PACE SWMI |
$11.83
|
| Rate for Payer: PACE SWMI |
$13.48
|
| Rate for Payer: PACE SWMI |
$16.30
|
| Rate for Payer: PACE SWMI |
$21.68
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Commercial |
$39.25
|
| Rate for Payer: PHP Commercial |
$45.83
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: PHP Medicare Advantage |
$11.83
|
| Rate for Payer: PHP Medicare Advantage |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$11.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.30
|
| Rate for Payer: PHP Medicare Advantage |
$13.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.16
|
| Rate for Payer: Priority Health Medicare |
$11.95
|
| Rate for Payer: Priority Health Medicare |
$21.89
|
| Rate for Payer: Priority Health Medicare |
$11.66
|
| Rate for Payer: Priority Health Medicare |
$16.46
|
| Rate for Payer: Priority Health Medicare |
$13.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.14
|
| Rate for Payer: Railroad Medicare Medicare |
$21.68
|
| Rate for Payer: Railroad Medicare Medicare |
$16.30
|
| Rate for Payer: Railroad Medicare Medicare |
$13.48
|
| Rate for Payer: Railroad Medicare Medicare |
$11.54
|
| Rate for Payer: Railroad Medicare Medicare |
$11.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.30
|
| Rate for Payer: UHC Core |
$54.43
|
| Rate for Payer: UHC Core |
$38.56
|
| Rate for Payer: UHC Core |
$72.40
|
| Rate for Payer: UHC Core |
$45.02
|
| Rate for Payer: UHC Core |
$39.50
|
| Rate for Payer: UHC Exchange |
$11.54
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UHC Exchange |
$11.83
|
| Rate for Payer: UHC Exchange |
$21.68
|
| Rate for Payer: UHC Exchange |
$13.48
|
| Rate for Payer: UHC Medicaid |
$15.29
|
| Rate for Payer: UHC Medicaid |
$11.49
|
| Rate for Payer: UHC Medicaid |
$8.34
|
| Rate for Payer: UHC Medicaid |
$9.51
|
| Rate for Payer: UHC Medicaid |
$8.14
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: UHC Medicare Advantage |
$11.54
|
| Rate for Payer: UHC Medicare Advantage |
$21.68
|
| Rate for Payer: UHC Medicare Advantage |
$11.83
|
| Rate for Payer: UHC Medicare Advantage |
$16.30
|
| Rate for Payer: UHCCP Medicaid |
$11.49
|
| Rate for Payer: UHCCP Medicaid |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$9.51
|
| Rate for Payer: UHCCP Medicaid |
$8.14
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$21.68
|
| Rate for Payer: VA VA |
$11.54
|
| Rate for Payer: VA VA |
$16.30
|
| Rate for Payer: VA VA |
$11.83
|
| Rate for Payer: VA VA |
$13.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.63
|
|
|
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 |
$4,643.49 |
| Max. Negotiated Rate |
$6,004.51 |
| Rate for Payer: Aetna Commercial |
$5,670.93
|
| Rate for Payer: BCBS Trust/PPO |
$5,510.14
|
| Rate for Payer: BCN Commercial |
$5,510.14
|
| Rate for Payer: Cash Price |
$5,337.34
|
| 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: Lakeland Regional Health Systems Commercial |
$5,003.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,670.93
|
| Rate for Payer: Nomi Health Commercial |
$5,470.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,003.76
|
| Rate for Payer: PHP Commercial |
$5,670.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,804.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,643.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,871.08
|
| Rate for Payer: UHC Core |
$5,570.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,003.76
|
|
|
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 |
$1,176.22 |
| Max. Negotiated Rate |
$6,004.51 |
| Rate for Payer: Aetna Commercial |
$5,670.93
|
| Rate for Payer: Aetna Medicare |
$1,734.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,084.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,084.90
|
| Rate for Payer: BCBS Complete |
$1,234.93
|
| Rate for Payer: BCBS MAPPO |
$1,667.92
|
| Rate for Payer: BCBS Trust/PPO |
$5,484.79
|
| Rate for Payer: BCN Commercial |
$5,484.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,667.92
|
| Rate for Payer: Cash Price |
$5,337.34
|
| 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 |
$1,667.92
|
| Rate for Payer: Healthscope Commercial |
$6,004.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,003.76
|
| Rate for Payer: Mclaren Medicaid |
$1,176.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,751.32
|
| Rate for Payer: Meridian Medicaid |
$1,234.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,918.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,834.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,670.93
|
| Rate for Payer: Nomi Health Commercial |
$5,470.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,003.76
|
| Rate for Payer: PACE Senior Care Partners |
$1,584.52
|
| Rate for Payer: PACE SWMI |
$1,667.92
|
| Rate for Payer: PHP Commercial |
$5,670.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,667.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,176.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,804.36
|
| Rate for Payer: Priority Health Medicare |
$1,684.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,643.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,667.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,871.08
|
| Rate for Payer: UHC Core |
$5,570.85
|
| Rate for Payer: UHC Exchange |
$1,667.92
|
| Rate for Payer: UHC Medicaid |
$1,176.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,667.92
|
| Rate for Payer: UHCCP Medicaid |
$1,176.22
|
| Rate for Payer: VA VA |
$1,667.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,003.76
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna Medicare |
$39.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.73
|
| Rate for Payer: BCBS Complete |
$28.27
|
| Rate for Payer: BCBS MAPPO |
$38.19
|
| Rate for Payer: BCBS Trust/PPO |
$125.58
|
| Rate for Payer: BCN Commercial |
$125.58
|
| Rate for Payer: BCN Medicare Advantage |
$38.19
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.19
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Mclaren Medicaid |
$26.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.10
|
| Rate for Payer: Meridian Medicaid |
$28.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PACE Senior Care Partners |
$36.28
|
| Rate for Payer: PACE SWMI |
$38.19
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: PHP Medicare Advantage |
$38.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.89
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.31
|
| Rate for Payer: Railroad Medicare Medicare |
$38.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.42
|
| Rate for Payer: UHC Core |
$127.55
|
| Rate for Payer: UHC Exchange |
$38.19
|
| Rate for Payer: UHC Medicaid |
$26.93
|
| Rate for Payer: UHC Medicare Advantage |
$38.19
|
| Rate for Payer: UHCCP Medicaid |
$26.93
|
| Rate for Payer: VA VA |
$38.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.02
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.62
|
| Rate for Payer: BCN Commercial |
$152.62
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Mclaren Medicaid |
$32.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Meridian Medicaid |
$34.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Medicare |
$46.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$32.73
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: UHCCP Medicaid |
$32.73
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.67
|
| 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: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$229.13
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$206.22 |
| Rate for Payer: Aetna Commercial |
$194.76
|
| Rate for Payer: Aetna Medicare |
$59.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.60
|
| Rate for Payer: BCBS Complete |
$42.41
|
| Rate for Payer: BCBS MAPPO |
$57.28
|
| Rate for Payer: BCBS Trust/PPO |
$188.37
|
| Rate for Payer: BCN Commercial |
$188.37
|
| Rate for Payer: BCN Medicare Advantage |
$57.28
|
| Rate for Payer: Cash Price |
$183.30
|
| Rate for Payer: Cofinity Commercial |
$197.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.28
|
| Rate for Payer: Healthscope Commercial |
$206.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.85
|
| Rate for Payer: Mclaren Medicaid |
$40.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.15
|
| Rate for Payer: Meridian Medicaid |
$42.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.76
|
| Rate for Payer: Nomi Health Commercial |
$187.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.85
|
| Rate for Payer: PACE Senior Care Partners |
$54.42
|
| Rate for Payer: PACE SWMI |
$57.28
|
| Rate for Payer: PHP Commercial |
$194.76
|
| Rate for Payer: PHP Medicare Advantage |
$57.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.34
|
| Rate for Payer: Priority Health Medicare |
$57.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.47
|
| Rate for Payer: Railroad Medicare Medicare |
$57.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.63
|
| Rate for Payer: UHC Core |
$191.32
|
| Rate for Payer: UHC Exchange |
$57.28
|
| Rate for Payer: UHC Medicaid |
$40.40
|
| Rate for Payer: UHC Medicare Advantage |
$57.28
|
| Rate for Payer: UHCCP Medicaid |
$40.40
|
| Rate for Payer: VA VA |
$57.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.85
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.77
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Mclaren Medicaid |
$0.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: Meridian Medicaid |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicaid |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.31 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: BCBS Trust/PPO |
$126.16
|
| Rate for Payer: BCN Commercial |
$126.16
|
| Rate for Payer: Cash Price |
$122.20
|
| 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: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Nomi Health Commercial |
$125.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.42
|
| Rate for Payer: UHC Core |
$127.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.33
|
| Rate for Payer: BCN Commercial |
$153.33
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$229.13
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.47 |
| Max. Negotiated Rate |
$206.22 |
| Rate for Payer: Aetna Commercial |
$194.76
|
| Rate for Payer: BCBS Trust/PPO |
$189.24
|
| Rate for Payer: BCN Commercial |
$189.24
|
| Rate for Payer: Cash Price |
$183.30
|
| 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: Lakeland Regional Health Systems Commercial |
$171.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.76
|
| Rate for Payer: Nomi Health Commercial |
$187.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.85
|
| Rate for Payer: PHP Commercial |
$194.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$199.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.63
|
| Rate for Payer: UHC Core |
$191.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.85
|
|
|
NAPROXEN 500 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
5393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.77 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: BCBS Trust/PPO |
$347.41
|
| Rate for Payer: BCN Commercial |
$347.41
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.17
|
| Rate for Payer: UHC Core |
$351.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
NAPROXEN 500 MG TABLET
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
5393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.16 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$109.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.45
|
| Rate for Payer: BCBS Complete |
$77.86
|
| Rate for Payer: BCBS MAPPO |
$105.16
|
| Rate for Payer: BCBS Trust/PPO |
$345.82
|
| Rate for Payer: BCN Commercial |
$345.82
|
| Rate for Payer: BCN Medicare Advantage |
$105.16
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.16
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Mclaren Medicaid |
$74.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.42
|
| Rate for Payer: Meridian Medicaid |
$77.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PACE Senior Care Partners |
$99.90
|
| Rate for Payer: PACE SWMI |
$105.16
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: PHP Medicare Advantage |
$105.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Medicare |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.77
|
| Rate for Payer: Railroad Medicare Medicare |
$105.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.17
|
| Rate for Payer: UHC Core |
$351.24
|
| Rate for Payer: UHC Exchange |
$105.16
|
| Rate for Payer: UHC Medicaid |
$74.16
|
| Rate for Payer: UHC Medicare Advantage |
$105.16
|
| Rate for Payer: UHCCP Medicaid |
$74.16
|
| Rate for Payer: VA VA |
$105.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: BCBS MAPPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.80
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Mclaren Medicaid |
$0.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.84
|
| Rate for Payer: Meridian Medicaid |
$0.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PACE Senior Care Partners |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.80
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: PHP Medicare Advantage |
$0.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Medicare |
$0.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: UHC Exchange |
$0.80
|
| Rate for Payer: UHC Medicaid |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: UHCCP Medicaid |
$0.56
|
| Rate for Payer: VA VA |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.63
|
| Rate for Payer: BCN Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$2.55
|
| 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: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
OP
|
$167.13
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.47 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Aetna Commercial |
$142.06
|
| Rate for Payer: Aetna Medicare |
$43.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.23
|
| Rate for Payer: BCBS Complete |
$30.94
|
| Rate for Payer: BCBS MAPPO |
$41.78
|
| Rate for Payer: BCBS Trust/PPO |
$137.40
|
| Rate for Payer: BCN Commercial |
$137.40
|
| Rate for Payer: BCN Medicare Advantage |
$41.78
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: Cofinity Commercial |
$143.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.78
|
| Rate for Payer: Healthscope Commercial |
$150.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.35
|
| Rate for Payer: Mclaren Medicaid |
$29.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.87
|
| Rate for Payer: Meridian Medicaid |
$30.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.06
|
| Rate for Payer: Nomi Health Commercial |
$137.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.35
|
| Rate for Payer: PACE Senior Care Partners |
$39.69
|
| Rate for Payer: PACE SWMI |
$41.78
|
| Rate for Payer: PHP Commercial |
$142.06
|
| Rate for Payer: PHP Medicare Advantage |
$41.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.40
|
| Rate for Payer: Priority Health Medicare |
$42.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.32
|
| Rate for Payer: Railroad Medicare Medicare |
$41.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.07
|
| Rate for Payer: UHC Core |
$139.55
|
| Rate for Payer: UHC Exchange |
$41.78
|
| Rate for Payer: UHC Medicaid |
$29.47
|
| Rate for Payer: UHC Medicare Advantage |
$41.78
|
| Rate for Payer: UHCCP Medicaid |
$29.47
|
| Rate for Payer: VA VA |
$41.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.35
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$167.13
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.32 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Aetna Commercial |
$142.06
|
| Rate for Payer: BCBS Trust/PPO |
$138.03
|
| Rate for Payer: BCN Commercial |
$138.03
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: Cofinity Commercial |
$143.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.70
|
| Rate for Payer: Healthscope Commercial |
$150.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.06
|
| Rate for Payer: Nomi Health Commercial |
$137.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.35
|
| Rate for Payer: PHP Commercial |
$142.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.07
|
| Rate for Payer: UHC Core |
$139.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.35
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.79 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: BCBS Trust/PPO |
$48.40
|
| Rate for Payer: BCN Commercial |
$48.40
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: Nomi Health Commercial |
$48.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.95
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.57
|
| Rate for Payer: UHC Core |
$48.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna Medicare |
$15.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.31
|
| Rate for Payer: BCBS Complete |
$10.85
|
| Rate for Payer: BCBS MAPPO |
$14.65
|
| Rate for Payer: BCBS Trust/PPO |
$48.18
|
| Rate for Payer: BCN Commercial |
$48.18
|
| Rate for Payer: BCN Medicare Advantage |
$14.65
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Mclaren Medicaid |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.38
|
| Rate for Payer: Meridian Medicaid |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: Nomi Health Commercial |
$48.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.95
|
| Rate for Payer: PACE Senior Care Partners |
$13.92
|
| Rate for Payer: PACE SWMI |
$14.65
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.98
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.79
|
| Rate for Payer: Railroad Medicare Medicare |
$14.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.57
|
| Rate for Payer: UHC Core |
$48.93
|
| Rate for Payer: UHC Exchange |
$14.65
|
| Rate for Payer: UHC Medicaid |
$10.33
|
| Rate for Payer: UHC Medicare Advantage |
$14.65
|
| Rate for Payer: UHCCP Medicaid |
$10.33
|
| Rate for Payer: VA VA |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
