|
NALTREXONE ER 380 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$5,030.47
|
|
|
Service Code
|
HCPCS J2315
|
| Hospital Charge Code |
76527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.27 |
| 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 Medicare |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,269.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.30
|
| Rate for Payer: BCBS Complete |
$2.39
|
| Rate for Payer: BCBS MAPPO |
$4.24
|
| Rate for Payer: BCN Medicare Advantage |
$4.24
|
| Rate for Payer: Cash Price |
$4,024.38
|
| Rate for Payer: Cash Price |
$4,024.38
|
| Rate for Payer: Cofinity Commercial |
$4,326.20
|
| Rate for Payer: Cofinity Commercial |
$3,521.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,521.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,024.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.24
|
| 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: Mclaren Medicaid |
$2.27
|
| Rate for Payer: Mclaren Medicare |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.45
|
| Rate for Payer: Meridian Medicaid |
$2.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.90
|
| Rate for Payer: PACE Medicare |
$4.03
|
| Rate for Payer: PACE SWMI |
$4.24
|
| Rate for Payer: PHP Commercial |
$4,275.90
|
| Rate for Payer: PHP Medicare Advantage |
$4.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.81
|
| Rate for Payer: Priority Health Medicare |
$4.24
|
| Rate for Payer: Priority Health SBD |
$3,169.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.24
|
| Rate for Payer: UHC Exchange |
$8.10
|
| Rate for Payer: UHC Medicare Advantage |
$4.24
|
| Rate for Payer: UHCCP Medicaid |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,861.27
|
| Rate for Payer: VA VA |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,772.85
|
|
|
NAPHAZOLINE-PHENIRAMINE 0.02675 %-0.315 % EYE DROPS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 10119002090
|
| Hospital Charge Code |
15058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna American Axle |
$15.60
|
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$8.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
NAPHAZOLINE-PHENIRAMINE 0.02675 %-0.315 % EYE DROPS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 10119002090
|
| Hospital Charge Code |
15058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna American Axle |
$15.60
|
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
NAPROXEN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
NDC 68134020116
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$918.72 |
| Max. Negotiated Rate |
$1,879.20 |
| Rate for Payer: Aetna American Axle |
$1,357.20
|
| Rate for Payer: Aetna Commercial |
$1,774.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Cofinity Commercial |
$1,461.60
|
| Rate for Payer: Cofinity Commercial |
$1,795.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,461.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,670.40
|
| Rate for Payer: Healthscope Commercial |
$1,879.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,461.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,566.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,774.80
|
| Rate for Payer: PHP Commercial |
$1,774.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.20
|
| Rate for Payer: Priority Health SBD |
$1,315.44
|
| Rate for Payer: UMR Bronson Commercial |
$918.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,566.00
|
|
|
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 Commercial |
$1,532.83
|
| Rate for Payer: Cofinity Commercial |
$1,883.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,532.83
|
| 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: PHP Commercial |
$1,861.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.34
|
| 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 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,298.67
|
|
|
Service Code
|
NDC 69238173002
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$571.41 |
| Max. Negotiated Rate |
$1,168.80 |
| Rate for Payer: Aetna American Axle |
$844.14
|
| Rate for Payer: Aetna Commercial |
$1,103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.14
|
| Rate for Payer: Cash Price |
$1,038.94
|
| Rate for Payer: Cofinity Commercial |
$1,116.86
|
| Rate for Payer: Cofinity Commercial |
$909.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$909.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,038.94
|
| Rate for Payer: Healthscope Commercial |
$1,168.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$909.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$974.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.87
|
| Rate for Payer: PHP Commercial |
$1,103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.14
|
| Rate for Payer: Priority Health SBD |
$818.16
|
| Rate for Payer: UMR Bronson Commercial |
$571.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$974.00
|
|
|
NAPROXEN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3,606.96
|
|
|
Service Code
|
NDC 71511070116
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,334.58 |
| Max. Negotiated Rate |
$3,246.26 |
| Rate for Payer: Aetna American Axle |
$2,344.52
|
| Rate for Payer: Aetna Commercial |
$3,065.92
|
| Rate for Payer: Aetna Medicare |
$1,803.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,344.52
|
| Rate for Payer: BCBS Complete |
$1,442.78
|
| Rate for Payer: Cash Price |
$2,885.57
|
| Rate for Payer: Cofinity Commercial |
$2,524.87
|
| Rate for Payer: Cofinity Commercial |
$3,101.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,524.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,885.57
|
| Rate for Payer: Healthscope Commercial |
$3,246.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,524.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,705.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,065.92
|
| Rate for Payer: PHP Commercial |
$3,065.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,344.52
|
| Rate for Payer: Priority Health SBD |
$2,272.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,334.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,705.22
|
|
|
NAPROXEN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2,189.76
|
|
|
Service Code
|
NDC 42192061916
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$810.21 |
| 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 Medicare |
$1,094.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,423.34
|
| Rate for Payer: BCBS Complete |
$875.90
|
| Rate for Payer: Cash Price |
$1,751.81
|
| Rate for Payer: Cofinity Commercial |
$1,532.83
|
| Rate for Payer: Cofinity Commercial |
$1,883.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,532.83
|
| 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: PHP Commercial |
$1,861.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.34
|
| Rate for Payer: Priority Health SBD |
$1,379.55
|
| Rate for Payer: UMR Bronson Commercial |
$810.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,642.32
|
|
|
NAPROXEN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2,088.00
|
|
|
Service Code
|
NDC 68134020116
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$772.56 |
| Max. Negotiated Rate |
$1,879.20 |
| Rate for Payer: Aetna American Axle |
$1,357.20
|
| Rate for Payer: Aetna Commercial |
$1,774.80
|
| Rate for Payer: Aetna Medicare |
$1,044.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,357.20
|
| Rate for Payer: BCBS Complete |
$835.20
|
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Cofinity Commercial |
$1,461.60
|
| Rate for Payer: Cofinity Commercial |
$1,795.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,461.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,670.40
|
| Rate for Payer: Healthscope Commercial |
$1,879.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,461.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,566.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,774.80
|
| Rate for Payer: PHP Commercial |
$1,774.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,357.20
|
| Rate for Payer: Priority Health SBD |
$1,315.44
|
| Rate for Payer: UMR Bronson Commercial |
$772.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,566.00
|
|
|
NAPROXEN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,298.67
|
|
|
Service Code
|
NDC 69238173002
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$480.51 |
| Max. Negotiated Rate |
$1,168.80 |
| Rate for Payer: Aetna American Axle |
$844.14
|
| Rate for Payer: Aetna Commercial |
$1,103.87
|
| Rate for Payer: Aetna Medicare |
$649.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.14
|
| Rate for Payer: BCBS Complete |
$519.47
|
| Rate for Payer: Cash Price |
$1,038.94
|
| Rate for Payer: Cofinity Commercial |
$1,116.86
|
| Rate for Payer: Cofinity Commercial |
$909.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$909.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,038.94
|
| Rate for Payer: Healthscope Commercial |
$1,168.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$909.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$974.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.87
|
| Rate for Payer: PHP Commercial |
$1,103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.14
|
| Rate for Payer: Priority Health SBD |
$818.16
|
| Rate for Payer: UMR Bronson Commercial |
$480.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$974.00
|
|
|
NAPROXEN 125 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3,606.96
|
|
|
Service Code
|
NDC 71511070116
|
| Hospital Charge Code |
10691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,587.06 |
| Max. Negotiated Rate |
$3,246.26 |
| Rate for Payer: Aetna American Axle |
$2,344.52
|
| Rate for Payer: Aetna Commercial |
$3,065.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,344.52
|
| Rate for Payer: Cash Price |
$2,885.57
|
| Rate for Payer: Cofinity Commercial |
$2,524.87
|
| Rate for Payer: Cofinity Commercial |
$3,101.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,524.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,885.57
|
| Rate for Payer: Healthscope Commercial |
$3,246.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,524.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,705.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,065.92
|
| Rate for Payer: PHP Commercial |
$3,065.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,344.52
|
| Rate for Payer: Priority Health SBD |
$2,272.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,587.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,705.22
|
|
|
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 Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.96
|
| 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: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| 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 250 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.81
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UMR Bronson Commercial |
$68.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
NAPROXEN 250 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 65162018810
|
| Hospital Charge Code |
5391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.81
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
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 Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.96
|
| 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: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$68.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
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 Commercial |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.28
|
| 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: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.11
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UMR Bronson Commercial |
$82.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
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 Commercial |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.28
|
| 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: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.11
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UMR Bronson Commercial |
$98.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$532.97
|
|
|
Service Code
|
CPT 31231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.49 |
| Max. Negotiated Rate |
$532.97 |
| Rate for Payer: Aetna Medicare |
$196.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.68
|
| Rate for Payer: BCBS Complete |
$106.56
|
| Rate for Payer: BCBS MAPPO |
$189.34
|
| Rate for Payer: BCN Medicare Advantage |
$189.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.34
|
| Rate for Payer: Mclaren Medicaid |
$101.49
|
| Rate for Payer: Mclaren Medicare |
$189.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.81
|
| Rate for Payer: Meridian Medicaid |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.74
|
| Rate for Payer: PACE Medicare |
$179.87
|
| Rate for Payer: PACE SWMI |
$189.34
|
| Rate for Payer: PHP Medicare Advantage |
$189.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.49
|
| Rate for Payer: Priority Health Medicare |
$189.34
|
| Rate for Payer: Railroad Medicare Medicare |
$189.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.34
|
| Rate for Payer: UHC Exchange |
$361.85
|
| Rate for Payer: UHC Medicare Advantage |
$189.34
|
| Rate for Payer: UHCCP Medicaid |
$101.49
|
| Rate for Payer: VA VA |
$189.34
|
|
|
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 Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.23
|
| 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: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| 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 Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.23
|
| 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: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.01
|
| 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
|
$4,734.21
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
|
Facility
|
OP
|
$4,734.21
|
|
|
Service Code
|
CPT 31240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
|
Facility
|
OP
|
$4,734.21
|
|
|
Service Code
|
CPT 31238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DESTRUCTION BY CRYOABLATION, POSTERIOR NASAL NERVE
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 31243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH DILATION (EG, BALLOON DILATION); FRONTAL SINUS OSTIUM
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
