|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$166.01 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.61
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$166.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL WITH DIVERTICULECTOMY OF HYPOPHARYNX OR CERVICAL ESOPHAGUS (EG, ZENKER'S DIVERTICULUM), WITH CRICOPHARYNGEAL MYOTOMY, INCLUDES USE OF TELESCOPE OR OPERATING MICROSCOPE AND REPAIR, WHEN PERFORMED
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 43180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$538.64 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,027.02
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.50
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$538.64
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
ESOPHAGOSCOPY, RIGID, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 43194
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.99 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.59
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$185.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,499.80
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,499.80 |
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$913.09
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.29
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$446.63
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,499.80
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,499.80 |
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$913.09
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.29
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$446.63
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,499.80
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.60 |
| Max. Negotiated Rate |
$1,499.80 |
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$913.09
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.29
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$446.63
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER PH ELECTRODE(S) PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,499.80
|
|
|
Service Code
|
CPT 91034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$187.95 |
| Max. Negotiated Rate |
$1,499.80 |
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$722.20
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.74
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$187.95
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: VA VA |
$476.42
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
IP
|
$950.16
|
|
|
Service Code
|
NDC 62559-150-01
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.07 |
| Max. Negotiated Rate |
$855.14 |
| Rate for Payer: Aetna American Axle |
$617.60
|
| Rate for Payer: Aetna Commercial |
$807.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.60
|
| Rate for Payer: Cash Price |
$760.13
|
| Rate for Payer: Cofinity Commercial |
$665.11
|
| Rate for Payer: Cofinity Commercial |
$817.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.13
|
| Rate for Payer: Healthscope Commercial |
$855.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$665.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.64
|
| Rate for Payer: PHP Commercial |
$807.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.11
|
| Rate for Payer: Priority Health SBD |
$598.60
|
| Rate for Payer: UMR Bronson Commercial |
$418.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.62
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
IP
|
$521.28
|
|
|
Service Code
|
NDC 15310-020-01
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.36 |
| Max. Negotiated Rate |
$469.15 |
| Rate for Payer: Aetna American Axle |
$338.83
|
| Rate for Payer: Aetna Commercial |
$443.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.83
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Cofinity Commercial |
$364.90
|
| Rate for Payer: Cofinity Commercial |
$448.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.02
|
| Rate for Payer: Healthscope Commercial |
$469.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$443.09
|
| Rate for Payer: PHP Commercial |
$443.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.90
|
| Rate for Payer: Priority Health SBD |
$328.41
|
| Rate for Payer: UMR Bronson Commercial |
$229.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.96
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET
|
Facility
|
IP
|
$1,037.85
|
|
|
Service Code
|
NDC 11528-010-01
|
| Hospital Charge Code |
9960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.65 |
| Max. Negotiated Rate |
$934.06 |
| Rate for Payer: Aetna American Axle |
$674.60
|
| Rate for Payer: Aetna Commercial |
$882.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.60
|
| Rate for Payer: Cash Price |
$830.28
|
| Rate for Payer: Cofinity Commercial |
$726.50
|
| Rate for Payer: Cofinity Commercial |
$892.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$830.28
|
| Rate for Payer: Healthscope Commercial |
$934.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$726.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$882.17
|
| Rate for Payer: PHP Commercial |
$882.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$726.50
|
| Rate for Payer: Priority Health SBD |
$653.85
|
| Rate for Payer: UMR Bronson Commercial |
$456.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.39
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$80.92
|
|
|
Service Code
|
NDC 66993-002-10
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna American Axle |
$52.60
|
| Rate for Payer: Aetna Commercial |
$68.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.60
|
| Rate for Payer: Cash Price |
$64.74
|
| Rate for Payer: Cofinity Commercial |
$69.59
|
| Rate for Payer: Cofinity Commercial |
$56.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.74
|
| Rate for Payer: Healthscope Commercial |
$72.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.78
|
| Rate for Payer: PHP Commercial |
$68.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.64
|
| Rate for Payer: Priority Health SBD |
$50.98
|
| Rate for Payer: UMR Bronson Commercial |
$35.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.69
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$1,122.32
|
|
|
Service Code
|
NDC 0430-3754-14
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$493.82 |
| Max. Negotiated Rate |
$1,010.09 |
| Rate for Payer: Aetna American Axle |
$729.51
|
| Rate for Payer: Aetna Commercial |
$953.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.51
|
| Rate for Payer: Cash Price |
$897.86
|
| Rate for Payer: Cofinity Commercial |
$965.20
|
| Rate for Payer: Cofinity Commercial |
$785.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.86
|
| Rate for Payer: Healthscope Commercial |
$1,010.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$953.97
|
| Rate for Payer: PHP Commercial |
$953.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.62
|
| Rate for Payer: Priority Health SBD |
$707.06
|
| Rate for Payer: UMR Bronson Commercial |
$493.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.74
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$332.46
|
|
|
Service Code
|
NDC 45802-097-35
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$299.21 |
| Rate for Payer: Aetna American Axle |
$216.10
|
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.10
|
| Rate for Payer: Cash Price |
$265.97
|
| Rate for Payer: Cofinity Commercial |
$232.72
|
| Rate for Payer: Cofinity Commercial |
$285.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.97
|
| Rate for Payer: Healthscope Commercial |
$299.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.59
|
| Rate for Payer: PHP Commercial |
$282.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.72
|
| Rate for Payer: Priority Health SBD |
$209.45
|
| Rate for Payer: UMR Bronson Commercial |
$146.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.34
|
|
|
ESTRADIOL 0.025 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$382.20
|
|
|
Service Code
|
NDC 0078-0365-45
|
| Hospital Charge Code |
27457
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.17 |
| Max. Negotiated Rate |
$343.98 |
| Rate for Payer: Aetna American Axle |
$248.43
|
| Rate for Payer: Aetna Commercial |
$324.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.43
|
| Rate for Payer: Cash Price |
$305.76
|
| Rate for Payer: Cofinity Commercial |
$267.54
|
| Rate for Payer: Cofinity Commercial |
$328.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.76
|
| Rate for Payer: Healthscope Commercial |
$343.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$324.87
|
| Rate for Payer: PHP Commercial |
$324.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.54
|
| Rate for Payer: Priority Health SBD |
$240.79
|
| Rate for Payer: UMR Bronson Commercial |
$168.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.65
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$419.91
|
|
|
Service Code
|
NDC 0078-0343-45
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.76 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna American Axle |
$272.94
|
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.94
|
| Rate for Payer: Cash Price |
$335.93
|
| Rate for Payer: Cofinity Commercial |
$293.94
|
| Rate for Payer: Cofinity Commercial |
$361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.93
|
| Rate for Payer: Healthscope Commercial |
$377.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.92
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.94
|
| Rate for Payer: Priority Health SBD |
$264.54
|
| Rate for Payer: UMR Bronson Commercial |
$184.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.93
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$62.99
|
|
|
Service Code
|
NDC 0078-0343-62
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$56.69 |
| Rate for Payer: Aetna American Axle |
$40.94
|
| Rate for Payer: Aetna Commercial |
$53.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.94
|
| Rate for Payer: Cash Price |
$50.39
|
| Rate for Payer: Cofinity Commercial |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$54.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.39
|
| Rate for Payer: Healthscope Commercial |
$56.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.54
|
| Rate for Payer: PHP Commercial |
$53.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health SBD |
$39.68
|
| Rate for Payer: UMR Bronson Commercial |
$27.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.24
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$503.92
|
|
|
Service Code
|
NDC 0078-0343-42
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.72 |
| Max. Negotiated Rate |
$453.53 |
| Rate for Payer: Aetna American Axle |
$327.55
|
| Rate for Payer: Aetna Commercial |
$428.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.55
|
| Rate for Payer: Cash Price |
$403.14
|
| Rate for Payer: Cofinity Commercial |
$352.74
|
| Rate for Payer: Cofinity Commercial |
$433.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.14
|
| Rate for Payer: Healthscope Commercial |
$453.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$428.33
|
| Rate for Payer: PHP Commercial |
$428.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.74
|
| Rate for Payer: Priority Health SBD |
$317.47
|
| Rate for Payer: UMR Bronson Commercial |
$221.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.94
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH
|
Facility
|
IP
|
$859.29
|
|
|
Service Code
|
NDC 50419-491-04
|
| Hospital Charge Code |
37533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.09 |
| Max. Negotiated Rate |
$773.36 |
| Rate for Payer: Aetna American Axle |
$558.54
|
| Rate for Payer: Aetna Commercial |
$730.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.54
|
| Rate for Payer: Cash Price |
$687.43
|
| Rate for Payer: Cofinity Commercial |
$601.50
|
| Rate for Payer: Cofinity Commercial |
$738.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.43
|
| Rate for Payer: Healthscope Commercial |
$773.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.40
|
| Rate for Payer: PHP Commercial |
$730.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.50
|
| Rate for Payer: Priority Health SBD |
$541.35
|
| Rate for Payer: UMR Bronson Commercial |
$378.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.47
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH
|
Facility
|
IP
|
$859.29
|
|
|
Service Code
|
NDC 50419049101
|
| Hospital Charge Code |
37533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.09 |
| Max. Negotiated Rate |
$773.36 |
| Rate for Payer: Aetna American Axle |
$558.54
|
| Rate for Payer: Aetna Commercial |
$730.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.54
|
| Rate for Payer: Cash Price |
$687.43
|
| Rate for Payer: Cofinity Commercial |
$601.50
|
| Rate for Payer: Cofinity Commercial |
$738.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.43
|
| Rate for Payer: Healthscope Commercial |
$773.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.40
|
| Rate for Payer: PHP Commercial |
$730.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.50
|
| Rate for Payer: Priority Health SBD |
$541.35
|
| Rate for Payer: UMR Bronson Commercial |
$378.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.47
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$29.32
|
|
|
Service Code
|
NDC 65162-993-04
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$26.39 |
| Rate for Payer: Aetna American Axle |
$19.06
|
| Rate for Payer: Aetna Commercial |
$24.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.06
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$26.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.92
|
| Rate for Payer: PHP Commercial |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.52
|
| Rate for Payer: Priority Health SBD |
$18.47
|
| Rate for Payer: UMR Bronson Commercial |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.99
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$234.56
|
|
|
Service Code
|
NDC 65162-993-08
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.21 |
| Max. Negotiated Rate |
$211.10 |
| Rate for Payer: Aetna American Axle |
$152.46
|
| Rate for Payer: Aetna Commercial |
$199.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.46
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cofinity Commercial |
$164.19
|
| Rate for Payer: Cofinity Commercial |
$201.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.65
|
| Rate for Payer: Healthscope Commercial |
$211.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.38
|
| Rate for Payer: PHP Commercial |
$199.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.19
|
| Rate for Payer: Priority Health SBD |
$147.77
|
| Rate for Payer: UMR Bronson Commercial |
$103.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.92
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$262.56
|
|
|
Service Code
|
NDC 50419-451-04
|
| Hospital Charge Code |
108427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.53 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Aetna American Axle |
$170.66
|
| Rate for Payer: Aetna Commercial |
$223.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.66
|
| Rate for Payer: Cash Price |
$210.05
|
| Rate for Payer: Cofinity Commercial |
$183.79
|
| Rate for Payer: Cofinity Commercial |
$225.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.05
|
| Rate for Payer: Healthscope Commercial |
$236.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.18
|
| Rate for Payer: PHP Commercial |
$223.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.79
|
| Rate for Payer: Priority Health SBD |
$165.41
|
| Rate for Payer: UMR Bronson Commercial |
$115.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.92
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$65.64
|
|
|
Service Code
|
NDC 50419-451-01
|
| Hospital Charge Code |
108427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$59.08 |
| Rate for Payer: Aetna American Axle |
$42.67
|
| Rate for Payer: Aetna Commercial |
$55.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.67
|
| Rate for Payer: Cash Price |
$52.51
|
| Rate for Payer: Cofinity Commercial |
$45.95
|
| Rate for Payer: Cofinity Commercial |
$56.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.51
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.79
|
| Rate for Payer: PHP Commercial |
$55.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.95
|
| Rate for Payer: Priority Health SBD |
$41.35
|
| Rate for Payer: UMR Bronson Commercial |
$28.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.23
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$255.53
|
|
|
Service Code
|
NDC 0378-3350-99
|
| Hospital Charge Code |
108427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.43 |
| Max. Negotiated Rate |
$229.98 |
| Rate for Payer: Aetna American Axle |
$166.09
|
| Rate for Payer: Aetna Commercial |
$217.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.09
|
| Rate for Payer: Cash Price |
$204.42
|
| Rate for Payer: Cofinity Commercial |
$178.87
|
| Rate for Payer: Cofinity Commercial |
$219.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.42
|
| Rate for Payer: Healthscope Commercial |
$229.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.20
|
| Rate for Payer: PHP Commercial |
$217.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.87
|
| Rate for Payer: Priority Health SBD |
$160.98
|
| Rate for Payer: UMR Bronson Commercial |
$112.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.65
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$106.66
|
|
|
Service Code
|
NDC 68968-0514-1
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.93 |
| Max. Negotiated Rate |
$95.99 |
| Rate for Payer: Aetna American Axle |
$69.33
|
| Rate for Payer: Aetna Commercial |
$90.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.33
|
| Rate for Payer: Cash Price |
$85.33
|
| Rate for Payer: Cofinity Commercial |
$74.66
|
| Rate for Payer: Cofinity Commercial |
$91.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.33
|
| Rate for Payer: Healthscope Commercial |
$95.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.66
|
| Rate for Payer: PHP Commercial |
$90.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.66
|
| Rate for Payer: Priority Health SBD |
$67.20
|
| Rate for Payer: UMR Bronson Commercial |
$46.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.00
|
|
