|
NAPROXEN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,562.04
|
|
|
Service Code
|
NDC 69238173002
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$577.95 |
| Max. Negotiated Rate |
$1,405.84 |
| Rate for Payer: Aetna American Axle |
$1,015.33
|
| Rate for Payer: Aetna Commercial |
$1,327.73
|
| Rate for Payer: Aetna Medicare |
$781.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.33
|
| Rate for Payer: BCBS Complete |
$624.82
|
| Rate for Payer: Cash Price |
$1,249.63
|
| Rate for Payer: Cofinity Advantage |
$1,093.43
|
| Rate for Payer: Cofinity Commercial |
$1,343.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.63
|
| Rate for Payer: Healthscope Commercial |
$1,405.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,093.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,171.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,249.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,171.53
|
| Rate for Payer: PHP Commercial |
$1,327.73
|
| Rate for Payer: Priority Health SBD |
$984.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,015.33
|
| Rate for Payer: UHC Core |
$813.82
|
| Rate for Payer: UHC Exchange |
$613.88
|
| Rate for Payer: UMR Bronson Commercial |
$577.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,171.53
|
|
|
NAPROXEN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,189.76
|
|
|
Service Code
|
NDC 42192061916
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$963.49 |
| Max. Negotiated Rate |
$1,970.78 |
| Rate for Payer: Aetna American Axle |
$1,423.34
|
| Rate for Payer: Aetna Commercial |
$1,861.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,423.34
|
| Rate for Payer: Cash Price |
$1,751.81
|
| Rate for Payer: Cofinity Advantage |
$1,532.83
|
| Rate for Payer: Cofinity Commercial |
$1,883.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.81
|
| Rate for Payer: Healthscope Commercial |
$1,970.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,532.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,642.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,861.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,642.32
|
| Rate for Payer: PHP Commercial |
$1,861.30
|
| Rate for Payer: Priority Health SBD |
$1,379.55
|
| Rate for Payer: UMR Bronson Commercial |
$963.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,642.32
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Advantage |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.29
|
| Rate for Payer: UHC Core |
$79.58
|
| Rate for Payer: UHC Exchange |
$60.03
|
| Rate for Payer: UMR Bronson Commercial |
$56.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Advantage |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UMR Bronson Commercial |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 68462018801
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Advantage |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.67
|
| Rate for Payer: UHC Core |
$96.72
|
| Rate for Payer: UHC Exchange |
$72.96
|
| Rate for Payer: UMR Bronson Commercial |
$68.69
|
| 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 |
$81.69 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Advantage |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
NAPROXEN 375 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 70010013801
|
| Hospital Charge Code |
5392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UMR Bronson Commercial |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
NAPROXEN 375 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 70010013801
|
| Hospital Charge Code |
5392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.79
|
| Rate for Payer: UHC Core |
$57.54
|
| Rate for Payer: UHC Exchange |
$43.41
|
| Rate for Payer: UMR Bronson Commercial |
$40.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
NAPROXEN 375 MG TABLET
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
NDC 68462018901
|
| Hospital Charge Code |
5392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$200.93 |
| 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 Advantage |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.93
|
| 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 Commercial |
$189.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.44
|
| Rate for Payer: PHP Commercial |
$189.76
|
| 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
|
|
|
NAPROXEN 375 MG TABLET
|
Facility
|
OP
|
$223.25
|
|
|
Service Code
|
NDC 68462018901
|
| Hospital Charge Code |
5392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna Medicare |
$111.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: BCBS Complete |
$89.30
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Advantage |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.44
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.11
|
| Rate for Payer: UHC Core |
$116.31
|
| Rate for Payer: UHC Exchange |
$87.74
|
| Rate for Payer: UMR Bronson Commercial |
$82.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$643.18
|
|
|
Service Code
|
CPT 31231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$643.18 |
| Rate for Payer: Aetna Medicare |
$206.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.61
|
| Rate for Payer: BCBS Complete |
$109.23
|
| Rate for Payer: BCBS MAPPO |
$198.89
|
| Rate for Payer: BCBS Trust/PPO |
$120.51
|
| Rate for Payer: BCN Commercial |
$120.51
|
| Rate for Payer: BCN Medicare Advantage |
$198.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.89
|
| Rate for Payer: Mclaren Medicaid |
$198.89
|
| Rate for Payer: Mclaren Medicare |
$198.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.83
|
| Rate for Payer: Meridian Medicaid |
$208.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.78
|
| Rate for Payer: Nomi Health Commercial |
$596.67
|
| Rate for Payer: PACE Medicare |
$188.95
|
| Rate for Payer: PACE SWMI |
$198.89
|
| Rate for Payer: PHP Medicare Advantage |
$198.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.18
|
| Rate for Payer: Priority Health Medicare |
$198.89
|
| Rate for Payer: Priority Health Tiered Network |
$514.54
|
| Rate for Payer: Railroad Medicare Medicare |
$198.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$198.89
|
| Rate for Payer: UHC Medicaid |
$104.02
|
| Rate for Payer: UHCCP Medicaid |
$104.02
|
| Rate for Payer: VA VA |
$198.89
|
|
|
NASAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| 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 Advantage |
$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 Commercial |
$2.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PHP Commercial |
$2.71
|
| 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 MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 09900000401
|
| Hospital Charge Code |
169209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna American Axle |
$2.07
|
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.39
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health SBD |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.66
|
| Rate for Payer: UHC Exchange |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,646.01
|
| Rate for Payer: BCN Commercial |
$1,646.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,244.14
|
| Rate for Payer: BCN Commercial |
$2,244.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,453.25
|
| Rate for Payer: BCN Commercial |
$2,453.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DESTRUCTION BY CRYOABLATION, POSTERIOR NASAL NERVE
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 31243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH DILATION (EG, BALLOON DILATION); MAXILLARY SINUS OSTIUM, TRANSNASAL OR VIA CANINE FOSSA
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,677.78 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,202.31
|
| Rate for Payer: BCN Commercial |
$5,202.31
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$7,032.08
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,677.78 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,474.95
|
| Rate for Payer: BCN Commercial |
$5,474.95
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$7,032.08
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,677.78 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,506.77
|
| Rate for Payer: BCN Commercial |
$5,506.77
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$7,032.08
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
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
|
$22,741.12
|
|
|
Service Code
|
CPT 31253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,677.78 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$6,413.42
|
| Rate for Payer: BCN Commercial |
$6,413.42
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$7,032.08
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,677.78 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,879.05
|
| Rate for Payer: BCN Commercial |
$3,879.05
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$7,032.08
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY, WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,677.78 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$6,785.53
|
| Rate for Payer: BCN Commercial |
$6,785.53
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$7,032.08
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$22,741.12
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,677.78 |
| Max. Negotiated Rate |
$22,741.12 |
| Rate for Payer: Aetna Medicare |
$7,313.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,790.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,790.10
|
| Rate for Payer: BCBS Complete |
$3,862.02
|
| Rate for Payer: BCBS MAPPO |
$7,032.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,753.38
|
| Rate for Payer: BCN Commercial |
$3,753.38
|
| Rate for Payer: BCN Medicare Advantage |
$7,032.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,032.08
|
| Rate for Payer: Mclaren Medicaid |
$7,032.08
|
| Rate for Payer: Mclaren Medicare |
$7,032.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,383.68
|
| Rate for Payer: Meridian Medicaid |
$7,383.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,086.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,735.29
|
| Rate for Payer: Nomi Health Commercial |
$21,096.24
|
| Rate for Payer: PACE Medicare |
$6,680.48
|
| Rate for Payer: PACE SWMI |
$7,032.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,032.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,741.12
|
| Rate for Payer: Priority Health Medicare |
$7,032.08
|
| Rate for Payer: Priority Health Tiered Network |
$18,192.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,032.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,032.08
|
| Rate for Payer: UHC Medicaid |
$3,677.78
|
| Rate for Payer: UHCCP Medicaid |
$3,677.78
|
| Rate for Payer: VA VA |
$7,032.08
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH LIGATION OF SPHENOPALATINE ARTERY
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,958.37
|
| Rate for Payer: BCN Commercial |
$1,958.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
