|
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 Commercial |
$1,171.29
|
| Rate for Payer: Cofinity Commercial |
$953.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.38
|
| 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: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.28
|
| 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 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 Commercial |
$1,171.29
|
| Rate for Payer: Cofinity Commercial |
$953.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.38
|
| 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: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.28
|
| Rate for Payer: Priority Health SBD |
$858.04
|
| 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
|
$1,501.61
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$1,351.45 |
| Rate for Payer: Aetna American Axle |
$976.05
|
| Rate for Payer: Aetna Commercial |
$1,276.37
|
| Rate for Payer: Aetna Medicare |
$750.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.05
|
| Rate for Payer: BCBS Complete |
$600.64
|
| Rate for Payer: Cash Price |
$1,201.29
|
| Rate for Payer: Cofinity Commercial |
$1,051.13
|
| Rate for Payer: Cofinity Commercial |
$1,291.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,051.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.29
|
| Rate for Payer: Healthscope Commercial |
$1,351.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,051.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,276.37
|
| Rate for Payer: PHP Commercial |
$1,276.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.05
|
| Rate for Payer: Priority Health SBD |
$946.01
|
| Rate for Payer: UMR Bronson Commercial |
$555.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.21
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
IP
|
$1,501.61
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$660.71 |
| Max. Negotiated Rate |
$1,351.45 |
| Rate for Payer: Aetna American Axle |
$976.05
|
| Rate for Payer: Aetna Commercial |
$1,276.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.05
|
| Rate for Payer: Cash Price |
$1,201.29
|
| Rate for Payer: Cofinity Commercial |
$1,051.13
|
| Rate for Payer: Cofinity Commercial |
$1,291.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,051.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.29
|
| Rate for Payer: Healthscope Commercial |
$1,351.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,051.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,276.37
|
| Rate for Payer: PHP Commercial |
$1,276.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.05
|
| Rate for Payer: Priority Health SBD |
$946.01
|
| Rate for Payer: UMR Bronson Commercial |
$660.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.21
|
|
|
NALOXEGOL 25 MG TABLET
|
Facility
|
IP
|
$1,501.61
|
|
|
Service Code
|
NDC 82625880201
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$660.71 |
| Max. Negotiated Rate |
$1,351.45 |
| Rate for Payer: Aetna American Axle |
$976.05
|
| Rate for Payer: Aetna Commercial |
$1,276.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.05
|
| Rate for Payer: Cash Price |
$1,201.29
|
| Rate for Payer: Cofinity Commercial |
$1,051.13
|
| Rate for Payer: Cofinity Commercial |
$1,291.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,051.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.29
|
| Rate for Payer: Healthscope Commercial |
$1,351.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,051.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,276.37
|
| Rate for Payer: PHP Commercial |
$1,276.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.05
|
| Rate for Payer: Priority Health SBD |
$946.01
|
| Rate for Payer: UMR Bronson Commercial |
$660.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.21
|
|
|
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 Commercial |
$1,171.29
|
| Rate for Payer: Cofinity Commercial |
$953.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.38
|
| 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: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.28
|
| Rate for Payer: Priority Health SBD |
$858.04
|
| 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
|
$1,361.97
|
|
|
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 Commercial |
$1,171.29
|
| Rate for Payer: Cofinity Commercial |
$953.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.38
|
| 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: PHP Commercial |
$1,157.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.28
|
| 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
|
$1,501.61
|
|
|
Service Code
|
NDC 82625880201
|
| Hospital Charge Code |
173968
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$555.60 |
| Max. Negotiated Rate |
$1,351.45 |
| Rate for Payer: Aetna American Axle |
$976.05
|
| Rate for Payer: Aetna Commercial |
$1,276.37
|
| Rate for Payer: Aetna Medicare |
$750.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.05
|
| Rate for Payer: BCBS Complete |
$600.64
|
| Rate for Payer: Cash Price |
$1,201.29
|
| Rate for Payer: Cofinity Commercial |
$1,051.13
|
| Rate for Payer: Cofinity Commercial |
$1,291.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,051.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.29
|
| Rate for Payer: Healthscope Commercial |
$1,351.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,051.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,276.37
|
| Rate for Payer: PHP Commercial |
$1,276.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.05
|
| Rate for Payer: Priority Health SBD |
$946.01
|
| Rate for Payer: UMR Bronson Commercial |
$555.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.21
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna American Axle |
$41.32
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Medicare |
$31.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.50
|
| 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: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: UMR Bronson Commercial |
$23.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
|
|
NALOXONE 0.4 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
163714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$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 Commercial |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.50
|
| 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: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| 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
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$63.57
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$57.21 |
| Rate for Payer: Aetna American Axle |
$41.32
|
| Rate for Payer: Aetna American Axle |
$12.70
|
| Rate for Payer: Aetna American Axle |
$13.02
|
| Rate for Payer: Aetna American Axle |
$18.12
|
| Rate for Payer: Aetna American Axle |
$162.77
|
| Rate for Payer: Aetna American Axle |
$12.00
|
| Rate for Payer: Aetna American Axle |
$35.23
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: Aetna Commercial |
$46.07
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$23.70
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$212.86
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna Medicare |
$27.10
|
| Rate for Payer: Aetna Medicare |
$31.79
|
| Rate for Payer: Aetna Medicare |
$13.94
|
| Rate for Payer: Aetna Medicare |
$9.77
|
| Rate for Payer: Aetna Medicare |
$125.21
|
| Rate for Payer: Aetna Medicare |
$9.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.77
|
| Rate for Payer: BCBS Complete |
$100.17
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: BCBS Complete |
$7.82
|
| Rate for Payer: BCBS Complete |
$25.43
|
| Rate for Payer: BCBS Complete |
$21.68
|
| Rate for Payer: Cash Price |
$43.36
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cash Price |
$200.34
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$37.94
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$215.36
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$175.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$48.78
|
| Rate for Payer: Healthscope Commercial |
$225.38
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$46.07
|
| Rate for Payer: PHP Commercial |
$23.70
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$212.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.70
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: Priority Health SBD |
$34.15
|
| Rate for Payer: Priority Health SBD |
$157.76
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: Priority Health SBD |
$17.56
|
| Rate for Payer: Priority Health SBD |
$11.63
|
| Rate for Payer: Priority Health SBD |
$12.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.23
|
| Rate for Payer: UMR Bronson Commercial |
$92.66
|
| Rate for Payer: UMR Bronson Commercial |
$7.41
|
| Rate for Payer: UMR Bronson Commercial |
$6.83
|
| Rate for Payer: UMR Bronson Commercial |
$20.05
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$23.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.85
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.46
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$16.61 |
| Rate for Payer: Aetna American Axle |
$12.00
|
| Rate for Payer: Aetna American Axle |
$35.23
|
| Rate for Payer: Aetna American Axle |
$18.12
|
| Rate for Payer: Aetna American Axle |
$12.70
|
| Rate for Payer: Aetna American Axle |
$162.77
|
| Rate for Payer: Aetna American Axle |
$41.32
|
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Commercial |
$16.61
|
| Rate for Payer: Aetna Commercial |
$23.70
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Commercial |
$46.07
|
| Rate for Payer: Aetna Commercial |
$212.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.23
|
| Rate for Payer: Cash Price |
$43.36
|
| Rate for Payer: Cash Price |
$22.30
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Cash Price |
$200.34
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cofinity Commercial |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$12.92
|
| Rate for Payer: Cofinity Commercial |
$23.98
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Cofinity Commercial |
$175.29
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$215.36
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$37.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.86
|
| Rate for Payer: Healthscope Commercial |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$57.21
|
| Rate for Payer: Healthscope Commercial |
$48.78
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$225.38
|
| Rate for Payer: Healthscope Commercial |
$16.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.86
|
| Rate for Payer: PHP Commercial |
$15.69
|
| Rate for Payer: PHP Commercial |
$16.61
|
| Rate for Payer: PHP Commercial |
$23.70
|
| Rate for Payer: PHP Commercial |
$46.07
|
| Rate for Payer: PHP Commercial |
$212.86
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.32
|
| Rate for Payer: Priority Health SBD |
$34.15
|
| Rate for Payer: Priority Health SBD |
$17.56
|
| Rate for Payer: Priority Health SBD |
$11.63
|
| Rate for Payer: Priority Health SBD |
$12.31
|
| Rate for Payer: Priority Health SBD |
$157.76
|
| Rate for Payer: Priority Health SBD |
$40.05
|
| Rate for Payer: UMR Bronson Commercial |
$27.97
|
| Rate for Payer: UMR Bronson Commercial |
$8.60
|
| Rate for Payer: UMR Bronson Commercial |
$110.18
|
| Rate for Payer: UMR Bronson Commercial |
$23.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.27
|
| Rate for Payer: UMR Bronson Commercial |
$8.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.85
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$62.08
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.32 |
| Max. Negotiated Rate |
$55.87 |
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$45.67
|
| Rate for Payer: Aetna American Axle |
$49.78
|
| Rate for Payer: Aetna Commercial |
$59.72
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.67
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$60.42
|
| Rate for Payer: Cofinity Commercial |
$49.18
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Cofinity Commercial |
$53.61
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.21
|
| Rate for Payer: Healthscope Commercial |
$63.23
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.72
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: PHP Commercial |
$59.72
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health SBD |
$48.25
|
| Rate for Payer: Priority Health SBD |
$44.26
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: UMR Bronson Commercial |
$27.32
|
| Rate for Payer: UMR Bronson Commercial |
$33.70
|
| Rate for Payer: UMR Bronson Commercial |
$30.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.70
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$76.59
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
5374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna American Axle |
$49.78
|
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$45.67
|
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna Commercial |
$59.72
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Medicare |
$38.30
|
| Rate for Payer: Aetna Medicare |
$35.13
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Complete |
$28.10
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cash Price |
$56.21
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$60.42
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Cofinity Commercial |
$53.61
|
| Rate for Payer: Cofinity Commercial |
$49.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$63.23
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$59.72
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health SBD |
$44.26
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$48.25
|
| Rate for Payer: UMR Bronson Commercial |
$28.34
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| Rate for Payer: UMR Bronson Commercial |
$26.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.44
|
|
|
NALOXONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$95.60
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
180148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$86.04 |
| Rate for Payer: Aetna American Axle |
$62.14
|
| Rate for Payer: Aetna Commercial |
$81.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.14
|
| Rate for Payer: Cash Price |
$76.48
|
| Rate for Payer: Cofinity Commercial |
$66.92
|
| Rate for Payer: Cofinity Commercial |
$82.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.48
|
| Rate for Payer: Healthscope Commercial |
$86.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.26
|
| Rate for Payer: PHP Commercial |
$81.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.14
|
| Rate for Payer: Priority Health SBD |
$60.23
|
| Rate for Payer: UMR Bronson Commercial |
$42.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.70
|
|
|
NALOXONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$95.60
|
|
|
Service Code
|
HCPCS J2310
|
| Hospital Charge Code |
180148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.37 |
| Max. Negotiated Rate |
$86.04 |
| Rate for Payer: Aetna American Axle |
$62.14
|
| Rate for Payer: Aetna Commercial |
$81.26
|
| Rate for Payer: Aetna Medicare |
$47.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.14
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: Cash Price |
$76.48
|
| Rate for Payer: Cofinity Commercial |
$66.92
|
| Rate for Payer: Cofinity Commercial |
$82.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.48
|
| Rate for Payer: Healthscope Commercial |
$86.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.26
|
| Rate for Payer: PHP Commercial |
$81.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.14
|
| Rate for Payer: Priority Health SBD |
$60.23
|
| Rate for Payer: UMR Bronson Commercial |
$35.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.70
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$227.09
|
|
|
Service Code
|
NDC 16729008110
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.92 |
| Max. Negotiated Rate |
$204.38 |
| Rate for Payer: Aetna American Axle |
$147.61
|
| Rate for Payer: Aetna Commercial |
$193.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.61
|
| Rate for Payer: Cash Price |
$181.67
|
| Rate for Payer: Cofinity Commercial |
$158.96
|
| Rate for Payer: Cofinity Commercial |
$195.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.67
|
| Rate for Payer: Healthscope Commercial |
$204.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.03
|
| Rate for Payer: PHP Commercial |
$193.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.61
|
| Rate for Payer: Priority Health SBD |
$143.07
|
| Rate for Payer: UMR Bronson Commercial |
$99.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.32
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$261.94
|
|
|
Service Code
|
NDC 00406117003
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.25 |
| Max. Negotiated Rate |
$235.75 |
| Rate for Payer: Aetna American Axle |
$170.26
|
| Rate for Payer: Aetna Commercial |
$222.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.26
|
| Rate for Payer: Cash Price |
$209.55
|
| Rate for Payer: Cofinity Commercial |
$183.36
|
| Rate for Payer: Cofinity Commercial |
$225.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.55
|
| Rate for Payer: Healthscope Commercial |
$235.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.65
|
| Rate for Payer: PHP Commercial |
$222.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.26
|
| Rate for Payer: Priority Health SBD |
$165.02
|
| Rate for Payer: UMR Bronson Commercial |
$115.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.46
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$261.94
|
|
|
Service Code
|
NDC 00406117003
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$235.75 |
| Rate for Payer: Aetna American Axle |
$170.26
|
| Rate for Payer: Aetna Commercial |
$222.65
|
| Rate for Payer: Aetna Medicare |
$130.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.26
|
| Rate for Payer: BCBS Complete |
$104.78
|
| Rate for Payer: Cash Price |
$209.55
|
| Rate for Payer: Cofinity Commercial |
$183.36
|
| Rate for Payer: Cofinity Commercial |
$225.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.55
|
| Rate for Payer: Healthscope Commercial |
$235.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.65
|
| Rate for Payer: PHP Commercial |
$222.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.26
|
| Rate for Payer: Priority Health SBD |
$165.02
|
| Rate for Payer: UMR Bronson Commercial |
$96.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.46
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$118.08
|
|
|
Service Code
|
NDC 47335032683
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.69 |
| Max. Negotiated Rate |
$106.27 |
| Rate for Payer: Aetna American Axle |
$76.75
|
| Rate for Payer: Aetna Commercial |
$100.37
|
| Rate for Payer: Aetna Medicare |
$59.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.75
|
| Rate for Payer: BCBS Complete |
$47.23
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cofinity Commercial |
$101.55
|
| Rate for Payer: Cofinity Commercial |
$82.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.46
|
| Rate for Payer: Healthscope Commercial |
$106.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.37
|
| Rate for Payer: PHP Commercial |
$100.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.75
|
| Rate for Payer: Priority Health SBD |
$74.39
|
| Rate for Payer: UMR Bronson Commercial |
$43.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.56
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$116.50
|
|
|
Service Code
|
NDC 51224020630
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.26 |
| Max. Negotiated Rate |
$104.85 |
| Rate for Payer: Aetna American Axle |
$75.72
|
| Rate for Payer: Aetna Commercial |
$99.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.72
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cofinity Commercial |
$100.19
|
| Rate for Payer: Cofinity Commercial |
$81.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$104.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.03
|
| Rate for Payer: PHP Commercial |
$99.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.72
|
| Rate for Payer: Priority Health SBD |
$73.39
|
| Rate for Payer: UMR Bronson Commercial |
$51.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.38
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$116.50
|
|
|
Service Code
|
NDC 51224020630
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$104.85 |
| Rate for Payer: Aetna American Axle |
$75.72
|
| Rate for Payer: Aetna Commercial |
$99.03
|
| Rate for Payer: Aetna Medicare |
$58.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.72
|
| Rate for Payer: BCBS Complete |
$46.60
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cofinity Commercial |
$100.19
|
| Rate for Payer: Cofinity Commercial |
$81.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$104.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.03
|
| Rate for Payer: PHP Commercial |
$99.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.72
|
| Rate for Payer: Priority Health SBD |
$73.39
|
| Rate for Payer: UMR Bronson Commercial |
$43.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.38
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
IP
|
$118.08
|
|
|
Service Code
|
NDC 47335032683
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.96 |
| Max. Negotiated Rate |
$106.27 |
| Rate for Payer: Aetna American Axle |
$76.75
|
| Rate for Payer: Aetna Commercial |
$100.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.75
|
| Rate for Payer: Cash Price |
$94.46
|
| Rate for Payer: Cofinity Commercial |
$101.55
|
| Rate for Payer: Cofinity Commercial |
$82.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.46
|
| Rate for Payer: Healthscope Commercial |
$106.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.37
|
| Rate for Payer: PHP Commercial |
$100.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.75
|
| Rate for Payer: Priority Health SBD |
$74.39
|
| Rate for Payer: UMR Bronson Commercial |
$51.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.56
|
|
|
NALTREXONE 50 MG TABLET
|
Facility
|
OP
|
$227.09
|
|
|
Service Code
|
NDC 16729008110
|
| Hospital Charge Code |
10685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$204.38 |
| Rate for Payer: Aetna American Axle |
$147.61
|
| Rate for Payer: Aetna Commercial |
$193.03
|
| Rate for Payer: Aetna Medicare |
$113.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.61
|
| Rate for Payer: BCBS Complete |
$90.84
|
| Rate for Payer: Cash Price |
$181.67
|
| Rate for Payer: Cofinity Commercial |
$158.96
|
| Rate for Payer: Cofinity Commercial |
$195.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.67
|
| Rate for Payer: Healthscope Commercial |
$204.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.03
|
| Rate for Payer: PHP Commercial |
$193.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.61
|
| Rate for Payer: Priority Health SBD |
$143.07
|
| Rate for Payer: UMR Bronson Commercial |
$84.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.32
|
|
|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$5,030.47
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,213.41 |
| Max. Negotiated Rate |
$4,527.42 |
| Rate for Payer: Aetna American Axle |
$3,269.81
|
| Rate for Payer: Aetna Commercial |
$4,275.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,269.81
|
| Rate for Payer: Cash Price |
$4,024.38
|
| Rate for Payer: Cofinity Commercial |
$3,521.33
|
| Rate for Payer: Cofinity Commercial |
$4,326.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,521.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.38
|
| Rate for Payer: Healthscope Commercial |
$4,527.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,521.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,772.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.90
|
| Rate for Payer: PHP Commercial |
$4,275.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.81
|
| Rate for Payer: Priority Health SBD |
$3,169.20
|
| Rate for Payer: UMR Bronson Commercial |
$2,213.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,772.85
|
|
