|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$5.70
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.71
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.71
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Advantage |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$5.70
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.71
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.71
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Advantage |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UMR Bronson Commercial |
$2.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$22.30
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna American Axle |
$14.49
|
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Advantage |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: Priority Health SBD |
$14.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
NAFCILLIN 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna American Axle |
$14.49
|
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Advantage |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: Priority Health SBD |
$14.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
NAFCILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$22.30
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna American Axle |
$14.49
|
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Advantage |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: Priority Health SBD |
$14.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
NAFCILLIN 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna American Axle |
$14.49
|
| Rate for Payer: Aetna Commercial |
$18.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.49
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Advantage |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.95
|
| Rate for Payer: Priority Health SBD |
$14.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
NAFCILLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.29
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
27285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.89 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Aetna American Axle |
$84.04
|
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.04
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cofinity Advantage |
$90.50
|
| Rate for Payer: Cofinity Commercial |
$111.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.43
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.97
|
| Rate for Payer: PHP Commercial |
$109.90
|
| Rate for Payer: Priority Health SBD |
$81.45
|
| Rate for Payer: UMR Bronson Commercial |
$56.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.97
|
|
|
NAFCILLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.29
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
27285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Aetna American Axle |
$84.04
|
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: Aetna Medicare |
$64.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.04
|
| Rate for Payer: BCBS Complete |
$51.72
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cofinity Advantage |
$90.50
|
| Rate for Payer: Cofinity Commercial |
$111.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.43
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.97
|
| Rate for Payer: PHP Commercial |
$109.90
|
| Rate for Payer: Priority Health SBD |
$81.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.97
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Advantage |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.90
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Advantage |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.90
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$18.79
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Aetna American Axle |
$12.21
|
| Rate for Payer: Aetna American Axle |
$58.38
|
| Rate for Payer: Aetna American Axle |
$17.82
|
| Rate for Payer: Aetna American Axle |
$17.37
|
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$76.34
|
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna Medicare |
$13.37
|
| Rate for Payer: Aetna Medicare |
$9.39
|
| Rate for Payer: Aetna Medicare |
$13.71
|
| Rate for Payer: Aetna Medicare |
$44.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$35.92
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Complete |
$10.69
|
| Rate for Payer: BCBS Complete |
$10.97
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$21.94
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$21.94
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Advantage |
$62.87
|
| Rate for Payer: Cofinity Advantage |
$18.71
|
| Rate for Payer: Cofinity Advantage |
$19.19
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Advantage |
$13.15
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$22.99
|
| Rate for Payer: Cofinity Commercial |
$23.58
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$80.83
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$24.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: PHP Commercial |
$22.72
|
| Rate for Payer: PHP Commercial |
$23.31
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$76.34
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: Priority Health SBD |
$17.27
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: Priority Health SBD |
$56.58
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$16.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$6.95
|
| Rate for Payer: UMR Bronson Commercial |
$33.23
|
| Rate for Payer: UMR Bronson Commercial |
$10.15
|
| Rate for Payer: UMR Bronson Commercial |
$34.45
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$89.81
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$80.83 |
| Rate for Payer: Aetna American Axle |
$58.38
|
| Rate for Payer: Aetna American Axle |
$17.82
|
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna American Axle |
$17.37
|
| Rate for Payer: Aetna American Axle |
$12.21
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Commercial |
$76.34
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$21.94
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Advantage |
$13.15
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Advantage |
$18.71
|
| Rate for Payer: Cofinity Advantage |
$62.87
|
| Rate for Payer: Cofinity Advantage |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$22.99
|
| Rate for Payer: Cofinity Commercial |
$23.58
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$24.06
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Healthscope Commercial |
$80.83
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.36
|
| Rate for Payer: PHP Commercial |
$23.31
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$76.34
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$22.72
|
| Rate for Payer: Priority Health SBD |
$56.58
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$16.84
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: Priority Health SBD |
$17.27
|
| Rate for Payer: UMR Bronson Commercial |
$11.76
|
| Rate for Payer: UMR Bronson Commercial |
$40.97
|
| Rate for Payer: UMR Bronson Commercial |
$12.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$39.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.05
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UMR Bronson Commercial |
$34.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Advantage |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: UMR Bronson Commercial |
$40.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
5339
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$11.17
|
| Rate for Payer: BCN Commercial |
$11.17
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.69
|
| Rate for Payer: UHC Core |
$5.69
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
5339
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
OP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130001
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$503.93 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna American Axle |
$885.28
|
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna Medicare |
$680.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: BCBS Complete |
$544.79
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Advantage |
$953.38
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$953.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,021.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,089.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.48
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health SBD |
$858.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.28
|
| Rate for Payer: UHC Core |
$709.59
|
| Rate for Payer: UHC Exchange |
$535.25
|
| Rate for Payer: UMR Bronson Commercial |
$503.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,021.48
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
OP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna American Axle |
$1,024.89
|
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna Medicare |
$788.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.89
|
| Rate for Payer: BCBS Complete |
$630.70
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Advantage |
$1,103.73
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,103.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,261.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health SBD |
$993.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,024.89
|
| Rate for Payer: UHC Core |
$821.49
|
| Rate for Payer: UHC Exchange |
$619.67
|
| Rate for Payer: UMR Bronson Commercial |
$583.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.57
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
IP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$693.77 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna American Axle |
$1,024.89
|
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.89
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Advantage |
$1,103.73
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,103.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health SBD |
$993.36
|
| Rate for Payer: UMR Bronson Commercial |
$693.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.57
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
IP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130001
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$599.27 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna American Axle |
$885.28
|
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Advantage |
$953.38
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$953.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,021.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.48
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health SBD |
$858.04
|
| Rate for Payer: UMR Bronson Commercial |
$599.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,021.48
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
OP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880201
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$583.40 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna American Axle |
$1,024.89
|
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna Medicare |
$788.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.89
|
| Rate for Payer: BCBS Complete |
$630.70
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Advantage |
$1,103.73
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,103.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,261.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health SBD |
$993.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,024.89
|
| Rate for Payer: UHC Core |
$821.49
|
| Rate for Payer: UHC Exchange |
$619.67
|
| Rate for Payer: UMR Bronson Commercial |
$583.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.57
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
OP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130101
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$503.93 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna American Axle |
$885.28
|
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna Medicare |
$680.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: BCBS Complete |
$544.79
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Advantage |
$953.38
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$953.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,021.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,089.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.48
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health SBD |
$858.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.28
|
| Rate for Payer: UHC Core |
$709.59
|
| Rate for Payer: UHC Exchange |
$535.25
|
| Rate for Payer: UMR Bronson Commercial |
$503.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,021.48
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
IP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880201
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$693.77 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna American Axle |
$1,024.89
|
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.89
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Advantage |
$1,103.73
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,103.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health SBD |
$993.36
|
| Rate for Payer: UMR Bronson Commercial |
$693.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.57
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
IP
|
$1,361.97
|
|
|
Service Code
|
NDC 57841130101
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$599.27 |
| Max. Negotiated Rate |
$1,225.77 |
| Rate for Payer: Aetna American Axle |
$885.28
|
| Rate for Payer: Aetna Commercial |
$1,157.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.28
|
| Rate for Payer: Cash Price |
$1,089.58
|
| Rate for Payer: Cofinity Advantage |
$953.38
|
| Rate for Payer: Cofinity Commercial |
$1,171.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.58
|
| Rate for Payer: Healthscope Commercial |
$1,225.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$953.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,021.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,021.48
|
| Rate for Payer: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health SBD |
$858.04
|
| Rate for Payer: UMR Bronson Commercial |
$599.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,021.48
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$63.57
|
|
|
Service Code
|
HCPCS J2312
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna American Axle |
$41.32
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Advantage |
$44.50
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$44.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.68
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: UMR Bronson Commercial |
$27.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
|
