|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.72 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.49
|
| Rate for Payer: BCN Commercial |
$1,362.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.09
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$153.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.86 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,857.58
|
| Rate for Payer: BCN Commercial |
$1,857.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.15
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$152.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$160.86 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,030.68
|
| Rate for Payer: BCN Commercial |
$2,030.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.95
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$160.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DESTRUCTION BY CRYOABLATION, POSTERIOR NASAL NERVE
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 31243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.31
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$152.10
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH DILATION (EG, BALLOON DILATION); FRONTAL SINUS OSTIUM
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,263.53
|
| Rate for Payer: BCN Commercial |
$2,263.53
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.64
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$172.40
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.94 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,531.88
|
| Rate for Payer: BCN Commercial |
$4,531.88
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.33
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$233.94
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$311.14 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,558.23
|
| Rate for Payer: BCN Commercial |
$4,558.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.25
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$311.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING FRONTAL SINUS EXPLORATION, WITH REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$481.34 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$5,308.70
|
| Rate for Payer: BCN Commercial |
$5,308.70
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.47
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$481.34
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$429.58 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,210.88
|
| Rate for Payer: BCN Commercial |
$3,210.88
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.54
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$429.58
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY, WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$453.78 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$5,616.71
|
| Rate for Payer: BCN Commercial |
$5,616.71
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.16
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$453.78
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.35 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,106.85
|
| Rate for Payer: BCN Commercial |
$3,106.85
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.78
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$364.35
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH LIGATION OF SPHENOPALATINE ARTERY
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 31241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$429.45 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,621.04
|
| Rate for Payer: BCN Commercial |
$1,621.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.40
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$429.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
|
Facility
|
OP
|
$11,353.72
|
|
|
Service Code
|
CPT 31256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.02 |
| Max. Negotiated Rate |
$11,353.72 |
| Rate for Payer: Aetna Medicare |
$3,756.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,515.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,515.50
|
| Rate for Payer: BCBS Complete |
$2,033.06
|
| Rate for Payer: BCBS MAPPO |
$3,612.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.02
|
| Rate for Payer: BCN Commercial |
$2,031.02
|
| Rate for Payer: BCN Medicare Advantage |
$3,612.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,612.40
|
| Rate for Payer: Mclaren Medicaid |
$1,936.25
|
| Rate for Payer: Mclaren Medicare |
$3,612.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,793.02
|
| Rate for Payer: Meridian Medicaid |
$2,033.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,154.26
|
| Rate for Payer: Nomi Health Commercial |
$7,586.04
|
| Rate for Payer: PACE Medicare |
$3,431.78
|
| Rate for Payer: PACE SWMI |
$3,612.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,612.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,936.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,353.72
|
| Rate for Payer: Priority Health Medicare |
$3,612.40
|
| Rate for Payer: Priority Health Narrow Network |
$9,082.98
|
| Rate for Payer: Railroad Medicare Medicare |
$3,612.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.32
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,612.40
|
| Rate for Payer: UHC Exchange |
$173.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,612.40
|
| Rate for Payer: UHCCP Medicaid |
$1,936.25
|
| Rate for Payer: VA VA |
$3,612.40
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.81 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,203.95
|
| Rate for Payer: BCN Commercial |
$4,203.95
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.39
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$255.81
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.47 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,663.00
|
| Rate for Payer: BCN Commercial |
$2,663.00
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.82
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$193.47
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$21,317.27
|
|
|
Service Code
|
CPT 31288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.31 |
| Max. Negotiated Rate |
$21,317.27 |
| Rate for Payer: Aetna Medicare |
$7,053.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,478.12
|
| Rate for Payer: BCBS Complete |
$3,817.19
|
| Rate for Payer: BCBS MAPPO |
$6,782.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,663.00
|
| Rate for Payer: BCN Commercial |
$2,663.00
|
| Rate for Payer: BCN Medicare Advantage |
$6,782.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,782.50
|
| Rate for Payer: Mclaren Medicaid |
$3,635.42
|
| Rate for Payer: Mclaren Medicare |
$6,782.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,121.62
|
| Rate for Payer: Meridian Medicaid |
$3,817.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,799.88
|
| Rate for Payer: Nomi Health Commercial |
$14,243.25
|
| Rate for Payer: PACE Medicare |
$6,443.38
|
| Rate for Payer: PACE SWMI |
$6,782.50
|
| Rate for Payer: PHP Medicare Advantage |
$6,782.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,635.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,317.27
|
| Rate for Payer: Priority Health Medicare |
$6,782.50
|
| Rate for Payer: Priority Health Narrow Network |
$17,053.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,782.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.84
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,782.50
|
| Rate for Payer: UHC Exchange |
$225.31
|
| Rate for Payer: UHC Medicare Advantage |
$6,782.50
|
| Rate for Payer: UHCCP Medicaid |
$3,635.42
|
| Rate for Payer: VA VA |
$6,782.50
|
|
|
NASOPHARYNGOSCOPY, SURGICAL, WITH DILATION OF EUSTACHIAN TUBE (IE, BALLOON DILATION); BILATERAL
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 69706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$234.03 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$5,105.81
|
| Rate for Payer: BCN Commercial |
$5,105.81
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.43
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$234.03
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
NASOPHARYNGOSCOPY, SURGICAL, WITH DILATION OF EUSTACHIAN TUBE (IE, BALLOON DILATION); UNILATERAL
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 69705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.25 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,735.86
|
| Rate for Payer: BCN Commercial |
$4,735.86
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.98
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$167.25
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22,198.06
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
40120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$19,978.25 |
| Rate for Payer: Aetna American Axle |
$14,428.74
|
| Rate for Payer: Aetna Commercial |
$18,868.35
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,428.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$65.10
|
| Rate for Payer: BCN Commercial |
$65.10
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$17,758.45
|
| Rate for Payer: Cash Price |
$17,758.45
|
| Rate for Payer: Cofinity Commercial |
$19,090.33
|
| Rate for Payer: Cofinity Commercial |
$15,538.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,538.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,758.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$19,978.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,538.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,648.54
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,868.35
|
| Rate for Payer: Nomi Health Commercial |
$71.64
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$18,868.35
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,428.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.52
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health Narrow Network |
$55.62
|
| Rate for Payer: Priority Health SBD |
$13,984.78
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$45.64
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$8,213.28
|
| Rate for Payer: VA VA |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,648.54
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22,198.06
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
40120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,767.15 |
| Max. Negotiated Rate |
$19,978.25 |
| Rate for Payer: Aetna American Axle |
$14,428.74
|
| Rate for Payer: Aetna Commercial |
$18,868.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,428.74
|
| Rate for Payer: Cash Price |
$17,758.45
|
| Rate for Payer: Cofinity Commercial |
$15,538.64
|
| Rate for Payer: Cofinity Commercial |
$19,090.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,538.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,758.45
|
| Rate for Payer: Healthscope Commercial |
$19,978.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,538.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,648.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,868.35
|
| Rate for Payer: PHP Commercial |
$18,868.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,428.74
|
| Rate for Payer: Priority Health SBD |
$13,984.78
|
| Rate for Payer: UMR Bronson Commercial |
$9,767.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,648.54
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$264.20
|
|
|
Service Code
|
NDC 16571075809
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$237.78 |
| Rate for Payer: Aetna American Axle |
$171.73
|
| Rate for Payer: Aetna Commercial |
$224.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.73
|
| Rate for Payer: Cash Price |
$211.36
|
| Rate for Payer: Cofinity Commercial |
$184.94
|
| Rate for Payer: Cofinity Commercial |
$227.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.36
|
| Rate for Payer: Healthscope Commercial |
$237.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.57
|
| Rate for Payer: PHP Commercial |
$224.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.73
|
| Rate for Payer: Priority Health SBD |
$166.45
|
| Rate for Payer: UMR Bronson Commercial |
$116.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.15
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
OP
|
$264.20
|
|
|
Service Code
|
NDC 16571075809
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$237.78 |
| Rate for Payer: Aetna American Axle |
$171.73
|
| Rate for Payer: Aetna Commercial |
$224.57
|
| Rate for Payer: Aetna Medicare |
$132.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.73
|
| Rate for Payer: BCBS Complete |
$105.68
|
| Rate for Payer: Cash Price |
$211.36
|
| Rate for Payer: Cofinity Commercial |
$184.94
|
| Rate for Payer: Cofinity Commercial |
$227.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.36
|
| Rate for Payer: Healthscope Commercial |
$237.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.57
|
| Rate for Payer: PHP Commercial |
$224.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.73
|
| Rate for Payer: Priority Health SBD |
$166.45
|
| Rate for Payer: UMR Bronson Commercial |
$97.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.15
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$413.25
|
|
|
Service Code
|
NDC 75834020501
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$371.92 |
| Rate for Payer: Aetna American Axle |
$268.61
|
| Rate for Payer: Aetna Commercial |
$351.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.61
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cofinity Commercial |
$289.28
|
| Rate for Payer: Cofinity Commercial |
$355.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.60
|
| Rate for Payer: Healthscope Commercial |
$371.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.26
|
| Rate for Payer: PHP Commercial |
$351.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.61
|
| Rate for Payer: Priority Health SBD |
$260.35
|
| Rate for Payer: UMR Bronson Commercial |
$181.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.94
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
OP
|
$413.25
|
|
|
Service Code
|
NDC 75834020501
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.90 |
| Max. Negotiated Rate |
$371.92 |
| Rate for Payer: Aetna American Axle |
$268.61
|
| Rate for Payer: Aetna Commercial |
$351.26
|
| Rate for Payer: Aetna Medicare |
$206.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.61
|
| Rate for Payer: BCBS Complete |
$165.30
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cofinity Commercial |
$289.28
|
| Rate for Payer: Cofinity Commercial |
$355.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.60
|
| Rate for Payer: Healthscope Commercial |
$371.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.26
|
| Rate for Payer: PHP Commercial |
$351.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.61
|
| Rate for Payer: Priority Health SBD |
$260.35
|
| Rate for Payer: UMR Bronson Commercial |
$152.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.94
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$530.88
|
|
|
Service Code
|
NDC 49884098401
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.59 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Cofinity Commercial |
$371.62
|
| Rate for Payer: Cofinity Commercial |
$456.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$371.62
|
| Rate for Payer: Aetna American Axle |
$345.07
|
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.07
|
| Rate for Payer: Cash Price |
$424.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.70
|
| Rate for Payer: Healthscope Commercial |
$477.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.25
|
| Rate for Payer: PHP Commercial |
$451.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.07
|
| Rate for Payer: Priority Health SBD |
$334.45
|
| Rate for Payer: UMR Bronson Commercial |
$233.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.16
|
|
