|
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
|
$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
|
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 |
$99.02
|
| 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 |
$99.02
|
| Rate for Payer: PHP Commercial |
$99.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.72
|
| Rate for Payer: Priority Health SBD |
$73.40
|
| Rate for Payer: UMR Bronson Commercial |
$51.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.38
|
|
|
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
|
|
|
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 |
$2.21 |
| 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 |
$4.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,269.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.15
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS MAPPO |
$4.12
|
| Rate for Payer: BCBS Trust/PPO |
$11.11
|
| Rate for Payer: BCN Commercial |
$11.11
|
| Rate for Payer: BCN Medicare Advantage |
$4.12
|
| 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 |
$4.12
|
| 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 |
$2.21
|
| Rate for Payer: Mclaren Medicare |
$4.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.33
|
| Rate for Payer: Meridian Medicaid |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,275.90
|
| Rate for Payer: Nomi Health Commercial |
$12.36
|
| Rate for Payer: PACE Medicare |
$3.91
|
| Rate for Payer: PACE SWMI |
$4.12
|
| Rate for Payer: PHP Commercial |
$4,275.90
|
| Rate for Payer: PHP Medicare Advantage |
$4.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,269.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.86
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Narrow Network |
$9.49
|
| Rate for Payer: Priority Health SBD |
$3,169.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.12
|
| Rate for Payer: UHC Exchange |
$7.87
|
| Rate for Payer: UHC Medicare Advantage |
$4.12
|
| Rate for Payer: UHCCP Medicaid |
$2.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,861.27
|
| Rate for Payer: VA VA |
$4.12
|
| 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
|
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
|
$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
|
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
|
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 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 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 |
$100.82
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.82
|
| 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 |
$116.32
|
| 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 |
$100.82
|
| 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 |
$116.32
|
|
|
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 |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.82
|
| 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 |
$167.08
|
| 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 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 |
$167.08 |
| 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 |
$167.08
|
| 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
|
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 |
$100.82
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.82
|
| 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 |
$116.32
|
| 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 |
$100.82
|
| 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 |
$116.32
|
|
|
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 |
$200.92 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
|
|
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 |
$200.92 |
| 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 |
$200.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
|
|
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 31231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$197.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.76
|
| Rate for Payer: BCBS Complete |
$107.05
|
| Rate for Payer: BCBS MAPPO |
$190.21
|
| Rate for Payer: BCBS Trust/PPO |
$99.76
|
| Rate for Payer: BCN Commercial |
$99.76
|
| Rate for Payer: BCN Medicare Advantage |
$190.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.21
|
| Rate for Payer: Mclaren Medicaid |
$101.95
|
| Rate for Payer: Mclaren Medicare |
$190.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.72
|
| Rate for Payer: Meridian Medicaid |
$107.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.74
|
| Rate for Payer: Nomi Health Commercial |
$399.44
|
| Rate for Payer: PACE Medicare |
$180.70
|
| Rate for Payer: PACE SWMI |
$190.21
|
| Rate for Payer: PHP Medicare Advantage |
$190.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$597.84
|
| Rate for Payer: Priority Health Medicare |
$190.21
|
| Rate for Payer: Priority Health Narrow Network |
$478.27
|
| Rate for Payer: Railroad Medicare Medicare |
$190.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.36
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.21
|
| Rate for Payer: UHC Exchange |
$62.15
|
| Rate for Payer: UHC Medicare Advantage |
$190.21
|
| Rate for Payer: UHCCP Medicaid |
$101.95
|
| Rate for Payer: VA VA |
$190.21
|
|
|
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 |
$1.60
|
| 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 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
|
|
