|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
IP
|
$1,501.61
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$976.05 |
| Max. Negotiated Rate |
$1,351.45 |
| Rate for Payer: Aetna Commercial |
$1,276.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.76
|
| Rate for Payer: BCN Commercial |
$1,160.44
|
| Rate for Payer: Cash Price |
$1,201.29
|
| Rate for Payer: Cofinity Commercial |
$1,291.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.29
|
| Rate for Payer: Healthscope Commercial |
$1,351.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,276.37
|
| Rate for Payer: Nomi Health Commercial |
$1,231.32
|
| Rate for Payer: PHP Commercial |
$1,276.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,306.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,006.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,321.42
|
| Rate for Payer: UHC Core |
$1,253.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.21
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
OP
|
$1,501.61
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.63 |
| Max. Negotiated Rate |
$1,351.45 |
| Rate for Payer: Aetna Commercial |
$1,276.37
|
| Rate for Payer: Aetna Medicare |
$390.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$469.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$469.25
|
| Rate for Payer: BCBS Complete |
$600.64
|
| Rate for Payer: BCBS MAPPO |
$375.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.47
|
| Rate for Payer: BCN Commercial |
$1,167.50
|
| Rate for Payer: BCN Medicare Advantage |
$375.40
|
| Rate for Payer: Cash Price |
$1,201.29
|
| Rate for Payer: Cofinity Commercial |
$1,291.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.40
|
| Rate for Payer: Healthscope Commercial |
$1,351.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$394.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$431.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,276.37
|
| Rate for Payer: Nomi Health Commercial |
$1,231.32
|
| Rate for Payer: PACE Senior Care Partners |
$356.63
|
| Rate for Payer: PACE SWMI |
$375.40
|
| Rate for Payer: PHP Commercial |
$1,276.37
|
| Rate for Payer: PHP Medicare Advantage |
$375.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,306.40
|
| Rate for Payer: Priority Health Medicare |
$379.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,006.08
|
| Rate for Payer: Railroad Medicare Medicare |
$375.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,321.42
|
| Rate for Payer: UHC Core |
$1,253.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.40
|
| Rate for Payer: UHC Exchange |
$375.40
|
| Rate for Payer: UHC Medicare Advantage |
$375.40
|
| Rate for Payer: VA VA |
$375.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.21
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.10 |
| 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 |
$25.43
|
| Rate for Payer: BCBS MAPPO |
$15.89
|
| Rate for Payer: BCBS Trust/PPO |
$52.26
|
| Rate for Payer: BCN Commercial |
$49.43
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| 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 Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health HMO/PPO |
$55.31
|
| Rate for Payer: Priority Health Medicare |
$16.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.59
|
| 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 Dual Complete DSNP |
$15.89
|
| Rate for Payer: UHC Exchange |
$15.89
|
| Rate for Payer: UHC Medicare Advantage |
$15.89
|
| Rate for Payer: VA VA |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: BCBS Trust/PPO |
$51.89
|
| Rate for Payer: BCN Commercial |
$49.13
|
| 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: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health HMO/PPO |
$55.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.59
|
| 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 SOLUTION
|
Facility
|
OP
|
$18.46
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$16.61 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$23.70
|
| Rate for Payer: Aetna Commercial |
$16.63
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Aetna Medicare |
$16.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.11
|
| 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 |
$5.77
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Complete |
$7.82
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS MAPPO |
$4.89
|
| Rate for Payer: BCBS MAPPO |
$15.89
|
| Rate for Payer: BCBS MAPPO |
$6.97
|
| Rate for Payer: BCBS Trust/PPO |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$52.26
|
| Rate for Payer: BCBS Trust/PPO |
$16.08
|
| Rate for Payer: BCBS Trust/PPO |
$22.92
|
| Rate for Payer: BCN Commercial |
$14.35
|
| Rate for Payer: BCN Commercial |
$21.68
|
| Rate for Payer: BCN Commercial |
$15.21
|
| Rate for Payer: BCN Commercial |
$49.43
|
| Rate for Payer: BCN Medicare Advantage |
$4.89
|
| Rate for Payer: BCN Medicare Advantage |
$15.89
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: BCN Medicare Advantage |
$6.97
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$15.65
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.97
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$17.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.13
|
| 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 |
$7.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.70
|
| Rate for Payer: Nomi Health Commercial |
$22.86
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Nomi Health Commercial |
$15.14
|
| Rate for Payer: Nomi Health Commercial |
$16.04
|
| Rate for Payer: PACE Senior Care Partners |
$4.38
|
| 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 |
$4.65
|
| Rate for Payer: PACE SWMI |
$4.89
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PACE SWMI |
$6.97
|
| Rate for Payer: PACE SWMI |
$15.89
|
| Rate for Payer: PHP Commercial |
$23.70
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$16.63
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Medicare Advantage |
$4.89
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: PHP Medicare Advantage |
$15.89
|
| Rate for Payer: PHP Medicare Advantage |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health HMO/PPO |
$17.02
|
| Rate for Payer: Priority Health HMO/PPO |
$55.31
|
| Rate for Payer: Priority Health HMO/PPO |
$24.26
|
| Rate for Payer: Priority Health HMO/PPO |
$16.06
|
| Rate for Payer: Priority Health Medicare |
$7.04
|
| Rate for Payer: Priority Health Medicare |
$4.66
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Medicare |
$16.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.89
|
| Rate for Payer: Railroad Medicare Medicare |
$6.97
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: Railroad Medicare Medicare |
$15.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.21
|
| Rate for Payer: UHC Core |
$15.41
|
| Rate for Payer: UHC Core |
$53.08
|
| Rate for Payer: UHC Core |
$16.33
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.89
|
| Rate for Payer: UHC Exchange |
$15.89
|
| Rate for Payer: UHC Exchange |
$4.89
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Exchange |
$6.97
|
| Rate for Payer: UHC Medicare Advantage |
$15.89
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: UHC Medicare Advantage |
$6.97
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: VA VA |
$4.89
|
| Rate for Payer: VA VA |
$15.89
|
| Rate for Payer: VA VA |
$6.97
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.91
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.88
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.12 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Aetna Commercial |
$23.70
|
| Rate for Payer: Aetna Commercial |
$16.63
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: BCBS Trust/PPO |
$22.76
|
| Rate for Payer: BCBS Trust/PPO |
$51.89
|
| Rate for Payer: BCBS Trust/PPO |
$15.97
|
| Rate for Payer: BCBS Trust/PPO |
$15.07
|
| Rate for Payer: BCN Commercial |
$21.55
|
| Rate for Payer: BCN Commercial |
$14.27
|
| Rate for Payer: BCN Commercial |
$49.13
|
| Rate for Payer: BCN Commercial |
$15.12
|
| Rate for Payer: Cash Price |
$15.65
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$17.60
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Nomi Health Commercial |
$15.14
|
| Rate for Payer: Nomi Health Commercial |
$16.04
|
| Rate for Payer: Nomi Health Commercial |
$52.13
|
| Rate for Payer: Nomi Health Commercial |
$22.86
|
| Rate for Payer: PHP Commercial |
$16.63
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$23.70
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.12
|
| Rate for Payer: Priority Health HMO/PPO |
$24.26
|
| Rate for Payer: Priority Health HMO/PPO |
$55.31
|
| Rate for Payer: Priority Health HMO/PPO |
$16.06
|
| Rate for Payer: Priority Health HMO/PPO |
$17.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.21
|
| 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 |
$16.33
|
| Rate for Payer: UHC Core |
$15.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.91
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$53.92
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.05 |
| Max. Negotiated Rate |
$48.53 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: BCBS Trust/PPO |
$44.01
|
| Rate for Payer: BCBS Trust/PPO |
$70.78
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$37.70
|
| Rate for Payer: BCN Commercial |
$41.67
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Commercial |
$67.01
|
| Rate for Payer: BCN Commercial |
$36.56
|
| Rate for Payer: Cash Price |
$37.85
|
| Rate for Payer: Cash Price |
$43.14
|
| Rate for Payer: Cash Price |
$69.37
|
| Rate for Payer: Cash Price |
$36.94
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$46.37
|
| Rate for Payer: Cofinity Commercial |
$40.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.94
|
| 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 |
$69.37
|
| Rate for Payer: Healthscope Commercial |
$78.04
|
| Rate for Payer: Healthscope Commercial |
$42.58
|
| Rate for Payer: Healthscope Commercial |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$41.56
|
| 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: Lakeland Regional Health Systems Commercial |
$34.64
|
| 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 |
$40.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Nomi Health Commercial |
$37.87
|
| Rate for Payer: Nomi Health Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$71.10
|
| Rate for Payer: Nomi Health Commercial |
$44.21
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: PHP Commercial |
$39.25
|
| Rate for Payer: PHP Commercial |
$45.83
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.05
|
| Rate for Payer: Priority Health HMO/PPO |
$46.91
|
| Rate for Payer: Priority Health HMO/PPO |
$75.44
|
| Rate for Payer: Priority Health HMO/PPO |
$40.18
|
| Rate for Payer: Priority Health HMO/PPO |
$41.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.45
|
| Rate for Payer: UHC Core |
$45.02
|
| Rate for Payer: UHC Core |
$72.40
|
| Rate for Payer: UHC Core |
$39.50
|
| Rate for Payer: UHC Core |
$38.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.44
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$46.18
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$41.56 |
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: Aetna Commercial |
$73.70
|
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Medicare |
$12.30
|
| Rate for Payer: Aetna Medicare |
$12.01
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.43
|
| Rate for Payer: BCBS Complete |
$18.47
|
| Rate for Payer: BCBS Complete |
$18.92
|
| Rate for Payer: BCBS Complete |
$34.68
|
| Rate for Payer: BCBS Complete |
$21.57
|
| Rate for Payer: BCBS MAPPO |
$11.54
|
| Rate for Payer: BCBS MAPPO |
$11.83
|
| Rate for Payer: BCBS MAPPO |
$21.68
|
| Rate for Payer: BCBS MAPPO |
$13.48
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCBS Trust/PPO |
$71.28
|
| Rate for Payer: BCBS Trust/PPO |
$38.89
|
| Rate for Payer: BCBS Trust/PPO |
$44.33
|
| Rate for Payer: BCN Commercial |
$35.90
|
| Rate for Payer: BCN Commercial |
$41.92
|
| Rate for Payer: BCN Commercial |
$36.78
|
| Rate for Payer: BCN Commercial |
$67.42
|
| Rate for Payer: BCN Medicare Advantage |
$11.83
|
| Rate for Payer: BCN Medicare Advantage |
$21.68
|
| Rate for Payer: BCN Medicare Advantage |
$11.54
|
| Rate for Payer: BCN Medicare Advantage |
$13.48
|
| 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: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$40.69
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Cofinity Commercial |
$46.37
|
| 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 |
$36.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.83
|
| 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 |
$48.53
|
| Rate for Payer: Healthscope Commercial |
$42.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.44
|
| 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 |
$12.42
|
| 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: MI Amish Medical Board Commercial |
$13.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.83
|
| Rate for Payer: Nomi Health Commercial |
$44.21
|
| Rate for Payer: Nomi Health Commercial |
$71.10
|
| Rate for Payer: Nomi Health Commercial |
$37.87
|
| Rate for Payer: Nomi Health Commercial |
$38.79
|
| Rate for Payer: PACE Senior Care Partners |
$10.97
|
| Rate for Payer: PACE Senior Care Partners |
$12.81
|
| Rate for Payer: PACE Senior Care Partners |
$20.59
|
| Rate for Payer: PACE Senior Care Partners |
$11.24
|
| Rate for Payer: PACE SWMI |
$11.83
|
| Rate for Payer: PACE SWMI |
$11.54
|
| Rate for Payer: PACE SWMI |
$13.48
|
| Rate for Payer: PACE SWMI |
$21.68
|
| Rate for Payer: PHP Commercial |
$45.83
|
| Rate for Payer: PHP Commercial |
$73.70
|
| Rate for Payer: PHP Commercial |
$40.21
|
| Rate for Payer: PHP Commercial |
$39.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.83
|
| Rate for Payer: PHP Medicare Advantage |
$11.54
|
| Rate for Payer: PHP Medicare Advantage |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.02
|
| Rate for Payer: Priority Health HMO/PPO |
$41.16
|
| Rate for Payer: Priority Health HMO/PPO |
$75.44
|
| Rate for Payer: Priority Health HMO/PPO |
$46.91
|
| Rate for Payer: Priority Health HMO/PPO |
$40.18
|
| Rate for Payer: Priority Health Medicare |
$13.61
|
| Rate for Payer: Priority Health Medicare |
$11.66
|
| Rate for Payer: Priority Health Medicare |
$11.95
|
| Rate for Payer: Priority Health Medicare |
$21.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.83
|
| Rate for Payer: Railroad Medicare Medicare |
$13.48
|
| Rate for Payer: Railroad Medicare Medicare |
$11.54
|
| Rate for Payer: Railroad Medicare Medicare |
$21.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.64
|
| 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 Core |
$38.56
|
| Rate for Payer: UHC Core |
$72.40
|
| Rate for Payer: UHC Core |
$39.50
|
| Rate for Payer: UHC Core |
$45.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.83
|
| Rate for Payer: UHC Exchange |
$21.68
|
| Rate for Payer: UHC Exchange |
$11.83
|
| Rate for Payer: UHC Exchange |
$11.54
|
| Rate for Payer: UHC Exchange |
$13.48
|
| Rate for Payer: UHC Medicare Advantage |
$21.68
|
| Rate for Payer: UHC Medicare Advantage |
$11.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: UHC Medicare Advantage |
$11.83
|
| Rate for Payer: VA VA |
$11.83
|
| Rate for Payer: VA VA |
$21.68
|
| Rate for Payer: VA VA |
$13.48
|
| Rate for Payer: VA VA |
$11.54
|
| 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 |
$34.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.44
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$5,030.47
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4,527.42 |
| Rate for Payer: Aetna Commercial |
$4,275.90
|
| Rate for Payer: Aetna Medicare |
$1,307.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,572.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,572.02
|
| Rate for Payer: BCBS Complete |
$3.13
|
| Rate for Payer: BCBS MAPPO |
$1,257.62
|
| Rate for Payer: BCBS Trust/PPO |
$4,135.55
|
| Rate for Payer: BCN Commercial |
$3,911.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,257.62
|
| 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: Encore Health Key Benefits Commercial |
$4,024.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,257.62
|
| Rate for Payer: Healthscope Commercial |
$4,527.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,772.85
|
| Rate for Payer: Mclaren Medicaid |
$2.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,320.50
|
| Rate for Payer: Meridian Medicaid |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,446.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.90
|
| Rate for Payer: Nomi Health Commercial |
$4,124.99
|
| Rate for Payer: PACE Senior Care Partners |
$1,194.74
|
| Rate for Payer: PACE SWMI |
$1,257.62
|
| Rate for Payer: PHP Commercial |
$4,275.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,257.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.81
|
| Rate for Payer: Priority Health HMO/PPO |
$4,376.51
|
| Rate for Payer: Priority Health Medicare |
$1,270.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,370.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,257.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,426.81
|
| Rate for Payer: UHC Core |
$4,200.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,257.62
|
| Rate for Payer: UHC Exchange |
$1,257.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,257.62
|
| Rate for Payer: UHCCP Medicaid |
$2.98
|
| Rate for Payer: VA VA |
$1,257.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,772.85
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$5,030.47
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,269.81 |
| Max. Negotiated Rate |
$4,527.42 |
| Rate for Payer: Aetna Commercial |
$4,275.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.37
|
| Rate for Payer: BCN Commercial |
$3,887.55
|
| Rate for Payer: Cash Price |
$4,024.38
|
| Rate for Payer: Cofinity Commercial |
$4,326.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.38
|
| Rate for Payer: Healthscope Commercial |
$4,527.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,772.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.90
|
| Rate for Payer: Nomi Health Commercial |
$4,124.99
|
| Rate for Payer: PHP Commercial |
$4,275.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.81
|
| Rate for Payer: Priority Health HMO/PPO |
$4,376.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,370.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,426.81
|
| Rate for Payer: UHC Core |
$4,200.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,772.85
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: BCBS Trust/PPO |
$126.61
|
| Rate for Payer: BCN Commercial |
$119.86
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.82
|
| Rate for Payer: Priority Health HMO/PPO |
$134.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.49
|
| Rate for Payer: UHC Core |
$129.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.32
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.08 |
| 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 |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.62
|
| Rate for Payer: BCN Commercial |
$144.34
|
| 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 |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| 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 Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Medicare |
$46.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.39
|
| 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 Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$151.55
|
| Rate for Payer: BCN Commercial |
$143.47
|
| 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 |
$167.08
|
| 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: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.39
|
| 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
|
OP
|
$212.68
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.51 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Aetna Commercial |
$180.78
|
| Rate for Payer: Aetna Medicare |
$55.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.46
|
| Rate for Payer: BCBS Complete |
$85.07
|
| Rate for Payer: BCBS MAPPO |
$53.17
|
| Rate for Payer: BCBS Trust/PPO |
$174.84
|
| Rate for Payer: BCN Commercial |
$165.36
|
| Rate for Payer: BCN Medicare Advantage |
$53.17
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$182.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.17
|
| Rate for Payer: Healthscope Commercial |
$191.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.78
|
| Rate for Payer: Nomi Health Commercial |
$174.40
|
| Rate for Payer: PACE Senior Care Partners |
$50.51
|
| Rate for Payer: PACE SWMI |
$53.17
|
| Rate for Payer: PHP Commercial |
$180.78
|
| Rate for Payer: PHP Medicare Advantage |
$53.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.24
|
| Rate for Payer: Priority Health HMO/PPO |
$185.03
|
| Rate for Payer: Priority Health Medicare |
$53.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.50
|
| Rate for Payer: Railroad Medicare Medicare |
$53.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.16
|
| Rate for Payer: UHC Core |
$177.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.17
|
| Rate for Payer: UHC Exchange |
$53.17
|
| Rate for Payer: UHC Medicare Advantage |
$53.17
|
| Rate for Payer: VA VA |
$53.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.51
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 50268059411
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.33
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Medicare |
$1.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$212.68
|
|
|
Service Code
|
NDC 50268059415
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Aetna Commercial |
$180.78
|
| Rate for Payer: BCBS Trust/PPO |
$173.61
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$182.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Healthscope Commercial |
$191.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.78
|
| Rate for Payer: Nomi Health Commercial |
$174.40
|
| Rate for Payer: PHP Commercial |
$180.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.24
|
| Rate for Payer: Priority Health HMO/PPO |
$185.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.16
|
| Rate for Payer: UHC Core |
$177.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.51
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.47
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: BCBS MAPPO |
$38.78
|
| Rate for Payer: BCBS Trust/PPO |
$127.51
|
| Rate for Payer: BCN Commercial |
$120.59
|
| Rate for Payer: BCN Medicare Advantage |
$38.78
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.78
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: PACE Senior Care Partners |
$36.84
|
| Rate for Payer: PACE SWMI |
$38.78
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: PHP Medicare Advantage |
$38.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.82
|
| Rate for Payer: Priority Health HMO/PPO |
$134.94
|
| Rate for Payer: Priority Health Medicare |
$39.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.92
|
| Rate for Payer: Railroad Medicare Medicare |
$38.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.49
|
| Rate for Payer: UHC Core |
$129.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.78
|
| Rate for Payer: UHC Exchange |
$38.78
|
| Rate for Payer: UHC Medicare Advantage |
$38.78
|
| Rate for Payer: VA VA |
$38.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.32
|
|
|
NAPROXEN 500 MG TABLET
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
5393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.90 |
| 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 |
$168.26
|
| Rate for Payer: BCBS MAPPO |
$105.16
|
| Rate for Payer: BCBS Trust/PPO |
$345.82
|
| Rate for Payer: BCN Commercial |
$327.06
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| 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 Cigna Priority Health |
$273.42
|
| Rate for Payer: Priority Health HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Medicare |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.84
|
| 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 Dual Complete DSNP |
$105.16
|
| Rate for Payer: UHC Exchange |
$105.16
|
| Rate for Payer: UHC Medicare Advantage |
$105.16
|
| Rate for Payer: VA VA |
$105.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
NAPROXEN 500 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
5393
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.42 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: BCBS Trust/PPO |
$343.38
|
| Rate for Payer: BCN Commercial |
$325.08
|
| 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: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.42
|
| Rate for Payer: Priority Health HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.84
|
| 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
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.60
|
| Rate for Payer: BCN Commercial |
$2.47
|
| 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: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.14
|
| 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
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| 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 |
$1.28
|
| Rate for Payer: BCBS MAPPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.48
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| 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 Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Medicare |
$0.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.14
|
| 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 Dual Complete DSNP |
$0.80
|
| Rate for Payer: UHC Exchange |
$0.80
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: VA VA |
$0.80
|
| 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
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$149.54 |
| Rate for Payer: Aetna Commercial |
$141.23
|
| Rate for Payer: Aetna Medicare |
$43.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.92
|
| Rate for Payer: BCBS Complete |
$66.46
|
| Rate for Payer: BCBS MAPPO |
$41.54
|
| Rate for Payer: BCBS Trust/PPO |
$136.59
|
| Rate for Payer: BCN Commercial |
$129.18
|
| Rate for Payer: BCN Medicare Advantage |
$41.54
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$142.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.54
|
| Rate for Payer: Healthscope Commercial |
$149.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: Nomi Health Commercial |
$136.24
|
| Rate for Payer: PACE Senior Care Partners |
$39.46
|
| Rate for Payer: PACE SWMI |
$41.54
|
| Rate for Payer: PHP Commercial |
$141.23
|
| Rate for Payer: PHP Medicare Advantage |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health HMO/PPO |
$144.55
|
| Rate for Payer: Priority Health Medicare |
$41.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.32
|
| Rate for Payer: Railroad Medicare Medicare |
$41.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.21
|
| Rate for Payer: UHC Core |
$138.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.54
|
| Rate for Payer: UHC Exchange |
$41.54
|
| Rate for Payer: UHC Medicare Advantage |
$41.54
|
| Rate for Payer: VA VA |
$41.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.61
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$166.15
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$149.54 |
| Rate for Payer: Aetna Commercial |
$141.23
|
| Rate for Payer: BCBS Trust/PPO |
$135.63
|
| Rate for Payer: BCN Commercial |
$128.40
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cofinity Commercial |
$142.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$149.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.23
|
| Rate for Payer: Nomi Health Commercial |
$136.24
|
| Rate for Payer: PHP Commercial |
$141.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.00
|
| Rate for Payer: Priority Health HMO/PPO |
$144.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.21
|
| Rate for Payer: UHC Core |
$138.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.61
|
|
|
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 |
$38.09 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: BCBS Trust/PPO |
$47.84
|
| Rate for Payer: BCN Commercial |
$45.29
|
| 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: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.09
|
| Rate for Payer: Priority Health HMO/PPO |
$50.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.26
|
| 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
|
|
