|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$853.22
|
|
|
Service Code
|
NDC 68968-0514-8
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.42 |
| Max. Negotiated Rate |
$767.90 |
| Rate for Payer: Aetna American Axle |
$554.59
|
| Rate for Payer: Aetna Commercial |
$725.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.59
|
| Rate for Payer: Cash Price |
$682.58
|
| Rate for Payer: Cofinity Commercial |
$597.25
|
| Rate for Payer: Cofinity Commercial |
$733.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.58
|
| Rate for Payer: Healthscope Commercial |
$767.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.24
|
| Rate for Payer: PHP Commercial |
$725.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.25
|
| Rate for Payer: Priority Health SBD |
$537.53
|
| Rate for Payer: UMR Bronson Commercial |
$375.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.92
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$853.22
|
|
|
Service Code
|
NDC 68968-0525-8
|
| Hospital Charge Code |
27465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.42 |
| Max. Negotiated Rate |
$767.90 |
| Rate for Payer: Aetna American Axle |
$554.59
|
| Rate for Payer: Aetna Commercial |
$725.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.59
|
| Rate for Payer: Cash Price |
$682.58
|
| Rate for Payer: Cofinity Commercial |
$597.25
|
| Rate for Payer: Cofinity Commercial |
$733.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.58
|
| Rate for Payer: Healthscope Commercial |
$767.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.24
|
| Rate for Payer: PHP Commercial |
$725.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.25
|
| Rate for Payer: Priority Health SBD |
$537.53
|
| Rate for Payer: UMR Bronson Commercial |
$375.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.92
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$106.66
|
|
|
Service Code
|
NDC 68968-0525-1
|
| Hospital Charge Code |
27465
|
|
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
|
|
|
ESTRADIOL 0.06 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$262.56
|
|
|
Service Code
|
NDC 50419-459-04
|
| Hospital Charge Code |
36268
|
|
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 0.06 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$261.05
|
|
|
Service Code
|
NDC 0378-3361-99
|
| Hospital Charge Code |
36268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$234.94 |
| Rate for Payer: Aetna American Axle |
$169.68
|
| Rate for Payer: Aetna Commercial |
$221.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.68
|
| Rate for Payer: Cash Price |
$208.84
|
| Rate for Payer: Cofinity Commercial |
$182.74
|
| Rate for Payer: Cofinity Commercial |
$224.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.84
|
| Rate for Payer: Healthscope Commercial |
$234.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.89
|
| Rate for Payer: PHP Commercial |
$221.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.74
|
| Rate for Payer: Priority Health SBD |
$164.46
|
| Rate for Payer: UMR Bronson Commercial |
$114.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.79
|
|
|
ESTRADIOL 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$262.56
|
|
|
Service Code
|
NDC 50419-453-04
|
| Hospital Charge Code |
27463
|
|
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 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$65.64
|
|
|
Service Code
|
NDC 50419-453-01
|
| Hospital Charge Code |
27463
|
|
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 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$34.24
|
|
|
Service Code
|
NDC 0781-7167-58
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$30.82 |
| Rate for Payer: Aetna American Axle |
$22.26
|
| Rate for Payer: Aetna Commercial |
$29.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.26
|
| Rate for Payer: Cash Price |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$29.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$30.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.10
|
| Rate for Payer: PHP Commercial |
$29.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.97
|
| Rate for Payer: Priority Health SBD |
$21.57
|
| Rate for Payer: UMR Bronson Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.68
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$273.89
|
|
|
Service Code
|
NDC 0781-7167-83
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Aetna American Axle |
$178.03
|
| Rate for Payer: Aetna Commercial |
$232.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.03
|
| Rate for Payer: Cash Price |
$219.11
|
| Rate for Payer: Cofinity Commercial |
$191.72
|
| Rate for Payer: Cofinity Commercial |
$235.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.11
|
| Rate for Payer: Healthscope Commercial |
$246.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.81
|
| Rate for Payer: PHP Commercial |
$232.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.72
|
| Rate for Payer: Priority Health SBD |
$172.55
|
| Rate for Payer: UMR Bronson Commercial |
$120.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.42
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$63.89
|
|
|
Service Code
|
NDC 0378-3352-16
|
| Hospital Charge Code |
109872
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna American Axle |
$41.53
|
| Rate for Payer: Aetna Commercial |
$54.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.53
|
| Rate for Payer: Cash Price |
$51.11
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Cofinity Commercial |
$54.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.11
|
| Rate for Payer: Healthscope Commercial |
$57.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.31
|
| Rate for Payer: PHP Commercial |
$54.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.72
|
| Rate for Payer: Priority Health SBD |
$40.25
|
| Rate for Payer: UMR Bronson Commercial |
$28.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.92
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$255.53
|
|
|
Service Code
|
NDC 0378-3352-99
|
| Hospital Charge Code |
109872
|
|
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 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$262.56
|
|
|
Service Code
|
NDC 50419-452-04
|
| Hospital Charge Code |
109872
|
|
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 1 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 0555-0886-02
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.94
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.19
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 0378-1454-01
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.41 |
| Max. Negotiated Rate |
$336.28 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.56
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$164.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$611.67
|
|
|
Service Code
|
HCPCS J1000
|
| Hospital Charge Code |
2929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.13 |
| Max. Negotiated Rate |
$550.50 |
| Rate for Payer: Aetna American Axle |
$397.59
|
| Rate for Payer: Aetna Commercial |
$519.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.59
|
| Rate for Payer: Cash Price |
$489.34
|
| Rate for Payer: Cofinity Commercial |
$428.17
|
| Rate for Payer: Cofinity Commercial |
$526.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.34
|
| Rate for Payer: Healthscope Commercial |
$550.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$519.92
|
| Rate for Payer: PHP Commercial |
$519.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.17
|
| Rate for Payer: Priority Health SBD |
$385.35
|
| Rate for Payer: UMR Bronson Commercial |
$269.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.75
|
|
|
ESTRADIOL VALERATE 10 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$493.82
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$444.44 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna American Axle |
$357.05
|
| Rate for Payer: Aetna Commercial |
$466.91
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: BCBS Complete |
$197.53
|
| Rate for Payer: BCBS Complete |
$219.72
|
| Rate for Payer: BCBS Trust/PPO |
$29.85
|
| Rate for Payer: BCBS Trust/PPO |
$29.85
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$439.45
|
| Rate for Payer: Cash Price |
$439.45
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cofinity Commercial |
$384.52
|
| Rate for Payer: Cofinity Commercial |
$472.41
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.45
|
| Rate for Payer: Healthscope Commercial |
$494.38
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.75
|
| Rate for Payer: PHP Commercial |
$466.91
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.52
|
| Rate for Payer: Priority Health SBD |
$346.07
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: UMR Bronson Commercial |
$203.24
|
| Rate for Payer: UMR Bronson Commercial |
$182.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.98
|
|
|
ESTRADIOL VALERATE 10 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$493.82
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.28 |
| Max. Negotiated Rate |
$444.44 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna American Axle |
$357.05
|
| Rate for Payer: Aetna Commercial |
$466.91
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.05
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$439.45
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$384.52
|
| Rate for Payer: Cofinity Commercial |
$472.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.45
|
| Rate for Payer: Healthscope Commercial |
$494.38
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.91
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: PHP Commercial |
$466.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.52
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: Priority Health SBD |
$346.07
|
| Rate for Payer: UMR Bronson Commercial |
$241.70
|
| Rate for Payer: UMR Bronson Commercial |
$217.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$774.22
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$340.66 |
| Max. Negotiated Rate |
$696.80 |
| Rate for Payer: Aetna American Axle |
$503.24
|
| Rate for Payer: Aetna Commercial |
$658.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.24
|
| Rate for Payer: Cash Price |
$619.38
|
| Rate for Payer: Cofinity Commercial |
$541.95
|
| Rate for Payer: Cofinity Commercial |
$665.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.38
|
| Rate for Payer: Healthscope Commercial |
$696.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$580.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$658.09
|
| Rate for Payer: PHP Commercial |
$658.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.95
|
| Rate for Payer: Priority Health SBD |
$487.76
|
| Rate for Payer: UMR Bronson Commercial |
$340.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$580.66
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$379.37
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$341.43 |
| Rate for Payer: Aetna American Axle |
$246.59
|
| Rate for Payer: Aetna Commercial |
$322.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.59
|
| Rate for Payer: BCBS Complete |
$151.75
|
| Rate for Payer: BCBS Trust/PPO |
$29.85
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cofinity Commercial |
$265.56
|
| Rate for Payer: Cofinity Commercial |
$326.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.50
|
| Rate for Payer: Healthscope Commercial |
$341.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$322.46
|
| Rate for Payer: PHP Commercial |
$322.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.56
|
| Rate for Payer: Priority Health SBD |
$239.00
|
| Rate for Payer: UMR Bronson Commercial |
$140.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.53
|
|
|
ETEPLIRSEN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20,800.00
|
|
|
Service Code
|
HCPCS J1428
|
| Hospital Charge Code |
180827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$18,720.00 |
| Rate for Payer: Aetna American Axle |
$13,520.00
|
| Rate for Payer: Aetna American Axle |
$3,328.00
|
| Rate for Payer: Aetna Commercial |
$4,352.00
|
| Rate for Payer: Aetna Commercial |
$17,680.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,520.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,328.00
|
| Rate for Payer: BCBS Complete |
$2,048.00
|
| Rate for Payer: BCBS Complete |
$8,320.00
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cofinity Commercial |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$14,560.00
|
| Rate for Payer: Cofinity Commercial |
$3,584.00
|
| Rate for Payer: Cofinity Commercial |
$17,888.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,096.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,640.00
|
| Rate for Payer: Healthscope Commercial |
$18,720.00
|
| Rate for Payer: Healthscope Commercial |
$4,608.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,560.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,584.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,840.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,352.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,680.00
|
| Rate for Payer: PHP Commercial |
$4,352.00
|
| Rate for Payer: PHP Commercial |
$17,680.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,560.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,584.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.60
|
| Rate for Payer: Priority Health Narrow Network |
$135.68
|
| Rate for Payer: Priority Health Narrow Network |
$135.68
|
| Rate for Payer: Priority Health SBD |
$3,225.60
|
| Rate for Payer: Priority Health SBD |
$13,104.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,894.40
|
| Rate for Payer: UMR Bronson Commercial |
$7,696.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,600.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,840.00
|
|
|
ETEPLIRSEN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,120.00
|
|
|
Service Code
|
HCPCS J1428
|
| Hospital Charge Code |
180827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,252.80 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna American Axle |
$3,328.00
|
| Rate for Payer: Aetna American Axle |
$13,520.00
|
| Rate for Payer: Aetna Commercial |
$4,352.00
|
| Rate for Payer: Aetna Commercial |
$17,680.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,520.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,328.00
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cofinity Commercial |
$17,888.00
|
| Rate for Payer: Cofinity Commercial |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$3,584.00
|
| Rate for Payer: Cofinity Commercial |
$14,560.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,096.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,640.00
|
| Rate for Payer: Healthscope Commercial |
$18,720.00
|
| Rate for Payer: Healthscope Commercial |
$4,608.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,584.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,560.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,600.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,840.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,352.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,680.00
|
| Rate for Payer: PHP Commercial |
$17,680.00
|
| Rate for Payer: PHP Commercial |
$4,352.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,560.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,584.00
|
| Rate for Payer: Priority Health SBD |
$13,104.00
|
| Rate for Payer: Priority Health SBD |
$3,225.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,252.80
|
| Rate for Payer: UMR Bronson Commercial |
$9,152.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,600.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,840.00
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,763.19
|
|
|
Service Code
|
NDC 42023-157-89
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,415.80 |
| Max. Negotiated Rate |
$6,986.87 |
| Rate for Payer: Aetna American Axle |
$5,046.07
|
| Rate for Payer: Aetna Commercial |
$6,598.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,046.07
|
| Rate for Payer: Cash Price |
$6,210.55
|
| Rate for Payer: Cofinity Commercial |
$5,434.23
|
| Rate for Payer: Cofinity Commercial |
$6,676.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,210.55
|
| Rate for Payer: Healthscope Commercial |
$6,986.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,434.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,822.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,598.71
|
| Rate for Payer: PHP Commercial |
$6,598.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,434.23
|
| Rate for Payer: Priority Health SBD |
$4,890.81
|
| Rate for Payer: UMR Bronson Commercial |
$3,415.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,822.39
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,188.40
|
|
|
Service Code
|
NDC 42023-157-01
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,042.90 |
| Max. Negotiated Rate |
$8,269.56 |
| Rate for Payer: Aetna American Axle |
$5,972.46
|
| Rate for Payer: Aetna Commercial |
$7,810.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,972.46
|
| Rate for Payer: Cash Price |
$7,350.72
|
| Rate for Payer: Cofinity Commercial |
$6,431.88
|
| Rate for Payer: Cofinity Commercial |
$7,902.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,350.72
|
| Rate for Payer: Healthscope Commercial |
$8,269.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,431.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,891.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,810.14
|
| Rate for Payer: PHP Commercial |
$7,810.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,431.88
|
| Rate for Payer: Priority Health SBD |
$5,788.69
|
| Rate for Payer: UMR Bronson Commercial |
$4,042.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,891.30
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,125.44
|
|
|
Service Code
|
NDC 25010-210-27
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5,335.19 |
| Max. Negotiated Rate |
$10,912.90 |
| Rate for Payer: Aetna American Axle |
$7,881.54
|
| Rate for Payer: Aetna Commercial |
$10,306.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,881.54
|
| Rate for Payer: Cash Price |
$9,700.35
|
| Rate for Payer: Cofinity Commercial |
$10,427.88
|
| Rate for Payer: Cofinity Commercial |
$8,487.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,700.35
|
| Rate for Payer: Healthscope Commercial |
$10,912.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,487.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,094.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,306.62
|
| Rate for Payer: PHP Commercial |
$10,306.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,487.81
|
| Rate for Payer: Priority Health SBD |
$7,639.03
|
| Rate for Payer: UMR Bronson Commercial |
$5,335.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,094.08
|
|
|
ETHACRYNIC ACID 25 MG TABLET
|
Facility
|
IP
|
$619.68
|
|
|
Service Code
|
NDC 68180-159-01
|
| Hospital Charge Code |
9980
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.66 |
| Max. Negotiated Rate |
$557.71 |
| Rate for Payer: Aetna American Axle |
$402.79
|
| Rate for Payer: Aetna Commercial |
$526.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.79
|
| Rate for Payer: Cash Price |
$495.74
|
| Rate for Payer: Cofinity Commercial |
$433.78
|
| Rate for Payer: Cofinity Commercial |
$532.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$495.74
|
| Rate for Payer: Healthscope Commercial |
$557.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$433.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$464.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$526.73
|
| Rate for Payer: PHP Commercial |
$526.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$433.78
|
| Rate for Payer: Priority Health SBD |
$390.40
|
| Rate for Payer: UMR Bronson Commercial |
$272.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$464.76
|
|
