|
LEFLUNOMIDE 10 MG TABLET
|
Facility
|
IP
|
$98.21
|
|
|
Service Code
|
NDC 59651034830
|
| Hospital Charge Code |
23872
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.87 |
| Max. Negotiated Rate |
$88.39 |
| Rate for Payer: Aetna Commercial |
$83.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.84
|
| Rate for Payer: Cash Price |
$78.57
|
| Rate for Payer: Cofinity Advantage |
$68.75
|
| Rate for Payer: Cofinity Commercial |
$84.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.57
|
| Rate for Payer: Healthscope Commercial |
$88.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.66
|
| Rate for Payer: PHP Commercial |
$83.48
|
| Rate for Payer: Priority Health SBD |
$61.87
|
|
|
LEFLUNOMIDE 10 MG TABLET
|
Facility
|
OP
|
$98.21
|
|
|
Service Code
|
NDC 59651034830
|
| Hospital Charge Code |
23872
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$88.39 |
| Rate for Payer: Aetna Commercial |
$83.48
|
| Rate for Payer: Aetna Medicare |
$49.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.84
|
| Rate for Payer: BCBS Complete |
$39.28
|
| Rate for Payer: Cash Price |
$78.57
|
| Rate for Payer: Cofinity Advantage |
$68.75
|
| Rate for Payer: Cofinity Commercial |
$84.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.57
|
| Rate for Payer: Healthscope Commercial |
$88.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.66
|
| Rate for Payer: PHP Commercial |
$83.48
|
| Rate for Payer: Priority Health SBD |
$61.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.84
|
| Rate for Payer: UHC Core |
$51.17
|
| Rate for Payer: UHC Exchange |
$38.60
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$5,391.39
|
|
|
Service Code
|
NDC 00088216130
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,396.58 |
| Max. Negotiated Rate |
$4,852.25 |
| Rate for Payer: Aetna Commercial |
$4,582.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,504.40
|
| Rate for Payer: Cash Price |
$4,313.11
|
| Rate for Payer: Cofinity Advantage |
$3,773.97
|
| Rate for Payer: Cofinity Commercial |
$4,636.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,313.11
|
| Rate for Payer: Healthscope Commercial |
$4,852.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,582.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,043.54
|
| Rate for Payer: PHP Commercial |
$4,582.68
|
| Rate for Payer: Priority Health SBD |
$3,396.58
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$527.25
|
|
|
Service Code
|
NDC 00955173730
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna Medicare |
$263.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: BCBS Complete |
$210.90
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Advantage |
$369.07
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.80
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.44
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health SBD |
$332.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.71
|
| Rate for Payer: UHC Core |
$274.70
|
| Rate for Payer: UHC Exchange |
$207.21
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$5,391.39
|
|
|
Service Code
|
NDC 00088216130
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,118.82 |
| Max. Negotiated Rate |
$4,852.25 |
| Rate for Payer: Aetna Commercial |
$4,582.68
|
| Rate for Payer: Aetna Medicare |
$2,695.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,504.40
|
| Rate for Payer: BCBS Complete |
$2,156.56
|
| Rate for Payer: Cash Price |
$4,313.11
|
| Rate for Payer: Cofinity Advantage |
$3,773.97
|
| Rate for Payer: Cofinity Commercial |
$4,636.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,313.11
|
| Rate for Payer: Healthscope Commercial |
$4,852.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,313.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,582.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,043.54
|
| Rate for Payer: PHP Commercial |
$4,582.68
|
| Rate for Payer: Priority Health SBD |
$3,396.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,504.40
|
| Rate for Payer: UHC Core |
$2,808.91
|
| Rate for Payer: UHC Exchange |
$2,118.82
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$527.25
|
|
|
Service Code
|
NDC 00955173730
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.17 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Advantage |
$369.07
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.80
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.44
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health SBD |
$332.17
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$3.99
|
|
|
Service Code
|
NDC 50268047611
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC Core |
$2.08
|
| Rate for Payer: UHC Exchange |
$1.57
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
NDC 00093762056
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.25 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| Rate for Payer: BCBS Complete |
$31.81
|
| Rate for Payer: Cash Price |
$63.62
|
| Rate for Payer: Cofinity Advantage |
$55.66
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.62
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.64
|
| Rate for Payer: PHP Commercial |
$67.59
|
| Rate for Payer: Priority Health SBD |
$50.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.69
|
| Rate for Payer: UHC Core |
$41.43
|
| Rate for Payer: UHC Exchange |
$31.25
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$98.70
|
|
|
Service Code
|
NDC 16729003410
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna Medicare |
$49.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: BCBS Complete |
$39.48
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Advantage |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.03
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.16
|
| Rate for Payer: UHC Core |
$51.42
|
| Rate for Payer: UHC Exchange |
$38.79
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$3,026.86
|
|
|
Service Code
|
NDC 00078024915
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,189.56 |
| Max. Negotiated Rate |
$2,724.17 |
| Rate for Payer: Aetna Commercial |
$2,572.83
|
| Rate for Payer: Aetna Medicare |
$1,513.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,967.46
|
| Rate for Payer: BCBS Complete |
$1,210.74
|
| Rate for Payer: Cash Price |
$2,421.49
|
| Rate for Payer: Cofinity Advantage |
$2,118.80
|
| Rate for Payer: Cofinity Commercial |
$2,603.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,421.49
|
| Rate for Payer: Healthscope Commercial |
$2,724.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,421.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,572.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,270.14
|
| Rate for Payer: PHP Commercial |
$2,572.83
|
| Rate for Payer: Priority Health SBD |
$1,906.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,967.46
|
| Rate for Payer: UHC Core |
$1,576.99
|
| Rate for Payer: UHC Exchange |
$1,189.56
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
NDC 50268047615
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna Medicare |
$99.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: BCBS Complete |
$79.80
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Advantage |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health SBD |
$125.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.68
|
| Rate for Payer: UHC Core |
$103.94
|
| Rate for Payer: UHC Exchange |
$78.40
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 50268047615
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.69 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Advantage |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health SBD |
$125.69
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
NDC 00093762056
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| Rate for Payer: Cash Price |
$63.62
|
| Rate for Payer: Cofinity Advantage |
$55.66
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.62
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.64
|
| Rate for Payer: PHP Commercial |
$67.59
|
| Rate for Payer: Priority Health SBD |
$50.10
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$3,026.86
|
|
|
Service Code
|
NDC 00078024915
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,906.92 |
| Max. Negotiated Rate |
$2,724.17 |
| Rate for Payer: Aetna Commercial |
$2,572.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,967.46
|
| Rate for Payer: Cash Price |
$2,421.49
|
| Rate for Payer: Cofinity Advantage |
$2,118.80
|
| Rate for Payer: Cofinity Commercial |
$2,603.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,421.49
|
| Rate for Payer: Healthscope Commercial |
$2,724.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,572.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,270.14
|
| Rate for Payer: PHP Commercial |
$2,572.83
|
| Rate for Payer: Priority Health SBD |
$1,906.92
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 16729003410
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Advantage |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.03
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health SBD |
$62.18
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 50268047611
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health SBD |
$2.51
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Advantage |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health SBD |
$23.83
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$28.57
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$25.71 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna Medicare |
$18.91
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: BCBS Complete |
$33.09
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Advantage |
$26.48
|
| Rate for Payer: Cofinity Advantage |
$20.00
|
| Rate for Payer: Cofinity Advantage |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.05
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
|
|
LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$67.02
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
15426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$60.32 |
| Rate for Payer: Aetna Commercial |
$56.97
|
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Aetna Medicare |
$33.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.20
|
| Rate for Payer: BCBS Complete |
$26.81
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cofinity Advantage |
$46.91
|
| Rate for Payer: Cofinity Advantage |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| Rate for Payer: Cofinity Commercial |
$49.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.62
|
| Rate for Payer: Healthscope Commercial |
$51.51
|
| Rate for Payer: Healthscope Commercial |
$60.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.27
|
| Rate for Payer: PHP Commercial |
$56.97
|
| Rate for Payer: PHP Commercial |
$48.65
|
| Rate for Payer: Priority Health SBD |
$42.22
|
| Rate for Payer: Priority Health SBD |
$36.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
|
|
LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$67.02
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
15426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$60.32 |
| Rate for Payer: Aetna Commercial |
$56.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cofinity Advantage |
$46.91
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.62
|
| Rate for Payer: Healthscope Commercial |
$60.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.27
|
| Rate for Payer: PHP Commercial |
$56.97
|
| Rate for Payer: Priority Health SBD |
$42.22
|
|
|
LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$76.59
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.25 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna Commercial |
$44.68
|
| Rate for Payer: Aetna Commercial |
$66.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.16
|
| Rate for Payer: Cash Price |
$62.73
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cash Price |
$42.05
|
| Rate for Payer: Cofinity Advantage |
$53.61
|
| Rate for Payer: Cofinity Advantage |
$36.79
|
| Rate for Payer: Cofinity Advantage |
$54.89
|
| Rate for Payer: Cofinity Commercial |
$67.43
|
| Rate for Payer: Cofinity Commercial |
$45.20
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.73
|
| Rate for Payer: Healthscope Commercial |
$47.30
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$70.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.44
|
| Rate for Payer: PHP Commercial |
$44.68
|
| Rate for Payer: PHP Commercial |
$66.65
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: Priority Health SBD |
$49.40
|
| Rate for Payer: Priority Health SBD |
$33.11
|
| Rate for Payer: Priority Health SBD |
$48.25
|
|
|
LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$52.56
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$47.30 |
| Rate for Payer: Aetna Commercial |
$44.68
|
| Rate for Payer: Aetna Commercial |
$65.10
|
| Rate for Payer: Aetna Commercial |
$66.65
|
| Rate for Payer: Aetna Medicare |
$26.28
|
| Rate for Payer: Aetna Medicare |
$38.30
|
| Rate for Payer: Aetna Medicare |
$39.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.97
|
| Rate for Payer: BCBS Complete |
$31.36
|
| Rate for Payer: BCBS Complete |
$21.02
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: Cash Price |
$62.73
|
| Rate for Payer: Cash Price |
$42.05
|
| Rate for Payer: Cash Price |
$42.05
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cash Price |
$62.73
|
| Rate for Payer: Cash Price |
$61.27
|
| Rate for Payer: Cofinity Advantage |
$53.61
|
| Rate for Payer: Cofinity Advantage |
$36.79
|
| Rate for Payer: Cofinity Advantage |
$54.89
|
| Rate for Payer: Cofinity Commercial |
$45.20
|
| Rate for Payer: Cofinity Commercial |
$65.87
|
| Rate for Payer: Cofinity Commercial |
$67.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.05
|
| Rate for Payer: Healthscope Commercial |
$70.57
|
| Rate for Payer: Healthscope Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$47.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.81
|
| Rate for Payer: PHP Commercial |
$44.68
|
| Rate for Payer: PHP Commercial |
$65.10
|
| Rate for Payer: PHP Commercial |
$66.65
|
| Rate for Payer: Priority Health SBD |
$33.11
|
| Rate for Payer: Priority Health SBD |
$49.40
|
| Rate for Payer: Priority Health SBD |
$48.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
|
|
LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$165.54
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
23617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$148.99 |
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna Commercial |
$158.26
|
| Rate for Payer: Aetna Commercial |
$163.26
|
| Rate for Payer: Aetna Medicare |
$82.77
|
| Rate for Payer: Aetna Medicare |
$93.09
|
| Rate for Payer: Aetna Medicare |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.85
|
| Rate for Payer: BCBS Complete |
$76.83
|
| Rate for Payer: BCBS Complete |
$66.22
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: BCN Commercial |
$9.63
|
| Rate for Payer: Cash Price |
$153.66
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$153.66
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cofinity Advantage |
$130.33
|
| Rate for Payer: Cofinity Advantage |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$134.45
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Cofinity Commercial |
$160.12
|
| Rate for Payer: Cofinity Commercial |
$165.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Healthscope Commercial |
$172.86
|
| Rate for Payer: Healthscope Commercial |
$167.57
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.05
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: PHP Commercial |
$158.26
|
| Rate for Payer: PHP Commercial |
$163.26
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: Priority Health SBD |
$121.00
|
| Rate for Payer: Priority Health SBD |
$117.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
|
|
LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$186.19
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
23617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$167.57 |
| Rate for Payer: Aetna Commercial |
$158.26
|
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.02
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cofinity Advantage |
$130.33
|
| Rate for Payer: Cofinity Advantage |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Cofinity Commercial |
$160.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.95
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: Healthscope Commercial |
$167.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: PHP Commercial |
$158.26
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: Priority Health SBD |
$117.30
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$2,320.32
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$2,088.29 |
| Rate for Payer: Aetna Commercial |
$1,972.27
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$444.32
|
| Rate for Payer: BCN Commercial |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: Cash Price |
$1,856.26
|
| Rate for Payer: Cash Price |
$1,856.26
|
| Rate for Payer: Cofinity Advantage |
$1,624.22
|
| Rate for Payer: Cofinity Commercial |
$1,995.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,856.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$2,088.29
|
| Rate for Payer: Mclaren Medicaid |
$92.15
|
| Rate for Payer: Mclaren Medicare |
$176.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$185.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,972.27
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,740.24
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$1,972.27
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$556.52
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health SBD |
$1,461.80
|
| Rate for Payer: Priority Health Tiered Network |
$445.22
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.79
|
| Rate for Payer: UHC Core |
$281.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$281.79
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: VA VA |
$176.20
|
|
