|
NAPROXEN 375 MG TABLET
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
NDC 68462-189-01
|
| Hospital Charge Code |
5392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$200.92 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.76
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.28
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UMR Bronson Commercial |
$98.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 31231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$183.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.09
|
| Rate for Payer: BCBS Complete |
$101.13
|
| Rate for Payer: BCBS MAPPO |
$176.07
|
| Rate for Payer: BCBS Trust/PPO |
$95.11
|
| Rate for Payer: BCN Medicare Advantage |
$176.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.07
|
| Rate for Payer: Mclaren Medicaid |
$96.31
|
| Rate for Payer: Mclaren Medicare |
$176.07
|
| Rate for Payer: Meridian Medicaid |
$101.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$184.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.48
|
| Rate for Payer: PACE Medicare |
$167.27
|
| Rate for Payer: PACE SWMI |
$176.07
|
| Rate for Payer: PHP Medicare Advantage |
$176.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.27
|
| Rate for Payer: Priority Health Medicare |
$176.07
|
| Rate for Payer: Priority Health Narrow Network |
$443.42
|
| Rate for Payer: Railroad Medicare Medicare |
$176.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.52
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.07
|
| Rate for Payer: UHC Exchange |
$63.20
|
| Rate for Payer: UHC Medicare Advantage |
$181.35
|
| Rate for Payer: VA VA |
$176.07
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 9900-0004-01
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna American Axle |
$2.07
|
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.71
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.01
|
| Rate for Payer: UMR Bronson Commercial |
$1.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,299.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.52
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$156.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.86 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,771.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.45
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$155.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.05 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,936.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.46
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$164.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH DILATION (EG, BALLOON DILATION); FRONTAL SINUS OSTIUM
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.18 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,158.19
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.70
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$175.18
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,320.96
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.14
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$237.40
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.33 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,346.08
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.86
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$315.33
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING FRONTAL SINUS EXPLORATION, WITH REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$487.23 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,061.63
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.95
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$487.23
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$434.84 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,061.45
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$478.32
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$434.84
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY, WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$459.40 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,355.31
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.34
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$459.40
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$369.03 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,962.26
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.93
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$369.03
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH LIGATION OF SPHENOPALATINE ARTERY
|
Facility
|
OP
|
$4,749.35
|
|
|
Service Code
|
CPT 31241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$434.52 |
| Max. Negotiated Rate |
$4,749.35 |
| Rate for Payer: Aetna Medicare |
$1,569.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,885.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,885.82
|
| Rate for Payer: BCBS Complete |
$866.57
|
| Rate for Payer: BCBS MAPPO |
$1,508.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,545.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,508.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,508.66
|
| Rate for Payer: Mclaren Medicaid |
$825.24
|
| Rate for Payer: Mclaren Medicare |
$1,508.66
|
| Rate for Payer: Meridian Medicaid |
$866.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,584.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,734.96
|
| Rate for Payer: PACE Medicare |
$1,433.23
|
| Rate for Payer: PACE SWMI |
$1,508.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,508.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,749.35
|
| Rate for Payer: Priority Health Medicare |
$1,508.66
|
| Rate for Payer: Priority Health Narrow Network |
$3,799.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,508.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.97
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,508.66
|
| Rate for Payer: UHC Exchange |
$434.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,553.92
|
| Rate for Payer: VA VA |
$1,508.66
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
|
Facility
|
OP
|
$10,478.92
|
|
|
Service Code
|
CPT 31256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.84 |
| Max. Negotiated Rate |
$10,478.92 |
| Rate for Payer: Aetna Medicare |
$3,461.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,160.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,160.89
|
| Rate for Payer: BCBS Complete |
$1,912.01
|
| Rate for Payer: BCBS MAPPO |
$3,328.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,936.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,328.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,328.71
|
| Rate for Payer: Mclaren Medicaid |
$1,820.80
|
| Rate for Payer: Mclaren Medicare |
$3,328.71
|
| Rate for Payer: Meridian Medicaid |
$1,912.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,495.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,828.02
|
| Rate for Payer: PACE Medicare |
$3,162.27
|
| Rate for Payer: PACE SWMI |
$3,328.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,328.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,820.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,478.92
|
| Rate for Payer: Priority Health Medicare |
$3,328.71
|
| Rate for Payer: Priority Health Narrow Network |
$8,383.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,328.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.42
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,328.71
|
| Rate for Payer: UHC Exchange |
$175.84
|
| Rate for Payer: UHC Medicare Advantage |
$3,428.57
|
| Rate for Payer: VA VA |
$3,328.71
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$259.33 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,008.29
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.26
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$259.33
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$196.47 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.07
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.12
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$196.47
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$19,151.91
|
|
|
Service Code
|
CPT 31288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$19,151.91 |
| Rate for Payer: Aetna Medicare |
$6,327.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,604.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,604.69
|
| Rate for Payer: BCBS Complete |
$3,494.51
|
| Rate for Payer: BCBS MAPPO |
$6,083.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.07
|
| Rate for Payer: BCN Medicare Advantage |
$6,083.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,083.75
|
| Rate for Payer: Mclaren Medicaid |
$3,327.81
|
| Rate for Payer: Mclaren Medicare |
$6,083.75
|
| Rate for Payer: Meridian Medicaid |
$3,494.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,996.31
|
| Rate for Payer: PACE Medicare |
$5,779.56
|
| Rate for Payer: PACE SWMI |
$6,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,083.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,327.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,151.91
|
| Rate for Payer: Priority Health Medicare |
$6,083.75
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,083.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.40
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,083.75
|
| Rate for Payer: UHC Exchange |
$228.55
|
| Rate for Payer: UHC Medicare Advantage |
$6,266.26
|
| Rate for Payer: VA VA |
$6,083.75
|
|
|
NASOPHARYNGOSCOPY, SURGICAL, WITH DILATION OF EUSTACHIAN TUBE (IE, BALLOON DILATION); BILATERAL
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,765.98
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.14
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$237.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
NASOPHARYNGOSCOPY, SURGICAL, WITH DILATION OF EUSTACHIAN TUBE (IE, BALLOON DILATION); UNILATERAL
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$169.94 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,420.65
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.93
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$169.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21,344.31
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
40120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,391.50 |
| Max. Negotiated Rate |
$19,209.88 |
| Rate for Payer: Aetna American Axle |
$13,873.80
|
| Rate for Payer: Aetna Commercial |
$18,142.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,873.80
|
| Rate for Payer: Cash Price |
$17,075.45
|
| Rate for Payer: Cofinity Commercial |
$14,941.02
|
| Rate for Payer: Cofinity Commercial |
$18,356.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,075.45
|
| Rate for Payer: Healthscope Commercial |
$19,209.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,941.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,008.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,142.66
|
| Rate for Payer: PHP Commercial |
$18,142.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,941.02
|
| Rate for Payer: Priority Health SBD |
$13,446.92
|
| Rate for Payer: UMR Bronson Commercial |
$9,391.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,008.23
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21,344.31
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
40120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$19,209.88 |
| Rate for Payer: Aetna American Axle |
$13,873.80
|
| Rate for Payer: Aetna Commercial |
$18,142.66
|
| Rate for Payer: Aetna Medicare |
$25.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,873.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.56
|
| Rate for Payer: BCBS Complete |
$14.05
|
| Rate for Payer: BCBS MAPPO |
$24.45
|
| Rate for Payer: BCBS Trust/PPO |
$79.01
|
| Rate for Payer: BCN Medicare Advantage |
$24.45
|
| Rate for Payer: Cash Price |
$17,075.45
|
| Rate for Payer: Cash Price |
$17,075.45
|
| Rate for Payer: Cofinity Commercial |
$14,941.02
|
| Rate for Payer: Cofinity Commercial |
$18,356.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,075.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.45
|
| Rate for Payer: Healthscope Commercial |
$19,209.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,941.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,008.23
|
| Rate for Payer: Mclaren Medicaid |
$13.38
|
| Rate for Payer: Mclaren Medicare |
$24.45
|
| Rate for Payer: Meridian Medicaid |
$14.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,142.66
|
| Rate for Payer: PACE Medicare |
$23.23
|
| Rate for Payer: PACE SWMI |
$24.45
|
| Rate for Payer: PHP Commercial |
$18,142.66
|
| Rate for Payer: PHP Medicare Advantage |
$24.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,941.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.24
|
| Rate for Payer: Priority Health Medicare |
$24.45
|
| Rate for Payer: Priority Health Narrow Network |
$57.79
|
| Rate for Payer: Priority Health SBD |
$13,446.92
|
| Rate for Payer: Railroad Medicare Medicare |
$24.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.19
|
| Rate for Payer: UMR Bronson Commercial |
$7,897.39
|
| Rate for Payer: VA VA |
$24.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,008.23
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$1,245.05
|
|
|
Service Code
|
NDC 0078-0351-05
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$547.82 |
| Max. Negotiated Rate |
$1,120.54 |
| Rate for Payer: Aetna American Axle |
$809.28
|
| Rate for Payer: Aetna Commercial |
$1,058.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.28
|
| Rate for Payer: Cash Price |
$996.04
|
| Rate for Payer: Cofinity Commercial |
$1,070.74
|
| Rate for Payer: Cofinity Commercial |
$871.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$996.04
|
| Rate for Payer: Healthscope Commercial |
$1,120.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$871.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$933.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,058.29
|
| Rate for Payer: PHP Commercial |
$1,058.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.54
|
| Rate for Payer: Priority Health SBD |
$784.38
|
| Rate for Payer: UMR Bronson Commercial |
$547.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$933.79
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$221.45
|
|
|
Service Code
|
NDC 16571-758-09
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$199.30 |
| Rate for Payer: Aetna American Axle |
$143.94
|
| Rate for Payer: Aetna Commercial |
$188.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.94
|
| Rate for Payer: Cash Price |
$177.16
|
| Rate for Payer: Cofinity Commercial |
$155.02
|
| Rate for Payer: Cofinity Commercial |
$190.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.16
|
| Rate for Payer: Healthscope Commercial |
$199.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.23
|
| Rate for Payer: PHP Commercial |
$188.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.02
|
| Rate for Payer: Priority Health SBD |
$139.51
|
| Rate for Payer: UMR Bronson Commercial |
$97.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.09
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$413.25
|
|
|
Service Code
|
NDC 75834-205-01
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$371.92 |
| Rate for Payer: Aetna American Axle |
$268.61
|
| Rate for Payer: Aetna Commercial |
$351.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.61
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cofinity Commercial |
$289.28
|
| Rate for Payer: Cofinity Commercial |
$355.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.60
|
| Rate for Payer: Healthscope Commercial |
$371.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.26
|
| Rate for Payer: PHP Commercial |
$351.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.28
|
| Rate for Payer: Priority Health SBD |
$260.35
|
| Rate for Payer: UMR Bronson Commercial |
$181.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.94
|
|
