|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$83.45
|
|
|
Service Code
|
NDC 66993000210
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$75.11 |
| Rate for Payer: Aetna American Axle |
$54.24
|
| Rate for Payer: Aetna Commercial |
$70.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.24
|
| Rate for Payer: Cash Price |
$66.76
|
| Rate for Payer: Cofinity Advantage |
$58.41
|
| Rate for Payer: Cofinity Commercial |
$71.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.76
|
| Rate for Payer: Healthscope Commercial |
$75.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.59
|
| Rate for Payer: PHP Commercial |
$70.93
|
| Rate for Payer: Priority Health SBD |
$52.57
|
| Rate for Payer: UMR Bronson Commercial |
$36.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.59
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$1,122.32
|
|
|
Service Code
|
NDC 00430375414
|
| 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 Advantage |
$785.62
|
| Rate for Payer: Cofinity Commercial |
$965.20
|
| 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 Commercial |
$953.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$841.74
|
| Rate for Payer: PHP Commercial |
$953.97
|
| 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
|
OP
|
$83.45
|
|
|
Service Code
|
NDC 66993000210
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$75.11 |
| Rate for Payer: Aetna American Axle |
$54.24
|
| Rate for Payer: Aetna Commercial |
$70.93
|
| Rate for Payer: Aetna Medicare |
$41.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.24
|
| Rate for Payer: BCBS Complete |
$33.38
|
| Rate for Payer: Cash Price |
$66.76
|
| Rate for Payer: Cofinity Advantage |
$58.41
|
| Rate for Payer: Cofinity Commercial |
$71.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.76
|
| Rate for Payer: Healthscope Commercial |
$75.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.59
|
| Rate for Payer: PHP Commercial |
$70.93
|
| Rate for Payer: Priority Health SBD |
$52.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.24
|
| Rate for Payer: UHC Core |
$43.48
|
| Rate for Payer: UHC Exchange |
$32.80
|
| Rate for Payer: UMR Bronson Commercial |
$30.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.59
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
OP
|
$1,122.32
|
|
|
Service Code
|
NDC 00430375414
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$415.26 |
| 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 Medicare |
$561.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.51
|
| Rate for Payer: BCBS Complete |
$448.93
|
| Rate for Payer: Cash Price |
$897.86
|
| Rate for Payer: Cofinity Advantage |
$785.62
|
| Rate for Payer: Cofinity Commercial |
$965.20
|
| 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: MI Amish Medical Board Commercial |
$897.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$841.74
|
| Rate for Payer: PHP Commercial |
$953.97
|
| Rate for Payer: Priority Health SBD |
$707.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.51
|
| Rate for Payer: UHC Core |
$584.73
|
| Rate for Payer: UHC Exchange |
$441.07
|
| Rate for Payer: UMR Bronson Commercial |
$415.26
|
| 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 45802009735
|
| 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 Advantage |
$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 Commercial |
$282.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.34
|
| Rate for Payer: PHP Commercial |
$282.59
|
| 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 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
OP
|
$332.46
|
|
|
Service Code
|
NDC 45802009735
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.01 |
| Max. Negotiated Rate |
$299.21 |
| Rate for Payer: Aetna American Axle |
$216.10
|
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Aetna Medicare |
$166.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.10
|
| Rate for Payer: BCBS Complete |
$132.98
|
| Rate for Payer: Cash Price |
$265.97
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$265.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.34
|
| Rate for Payer: PHP Commercial |
$282.59
|
| Rate for Payer: Priority Health SBD |
$209.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.10
|
| Rate for Payer: UHC Core |
$173.21
|
| Rate for Payer: UHC Exchange |
$130.66
|
| Rate for Payer: UMR Bronson Commercial |
$123.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.34
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$34.76
|
|
|
Service Code
|
NDC 65162099204
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna American Axle |
$22.59
|
| Rate for Payer: Aetna Commercial |
$29.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: Cofinity Advantage |
$24.33
|
| Rate for Payer: Cofinity Commercial |
$29.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.81
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.07
|
| Rate for Payer: PHP Commercial |
$29.55
|
| Rate for Payer: Priority Health SBD |
$21.90
|
| Rate for Payer: UMR Bronson Commercial |
$15.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.07
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$34.76
|
|
|
Service Code
|
NDC 65162099204
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna American Axle |
$22.59
|
| Rate for Payer: Aetna Commercial |
$29.55
|
| Rate for Payer: Aetna Medicare |
$17.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: BCBS Complete |
$13.90
|
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: Cofinity Advantage |
$24.33
|
| Rate for Payer: Cofinity Commercial |
$29.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.81
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.07
|
| Rate for Payer: PHP Commercial |
$29.55
|
| Rate for Payer: Priority Health SBD |
$21.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.59
|
| Rate for Payer: UHC Core |
$18.11
|
| Rate for Payer: UHC Exchange |
$13.66
|
| Rate for Payer: UMR Bronson Commercial |
$12.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.07
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$529.10
|
|
|
Service Code
|
NDC 00078034342
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$476.19 |
| Rate for Payer: Aetna American Axle |
$343.92
|
| Rate for Payer: Aetna Commercial |
$449.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.92
|
| Rate for Payer: Cash Price |
$423.28
|
| Rate for Payer: Cofinity Advantage |
$370.37
|
| Rate for Payer: Cofinity Commercial |
$455.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.28
|
| Rate for Payer: Healthscope Commercial |
$476.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.82
|
| Rate for Payer: PHP Commercial |
$449.74
|
| Rate for Payer: Priority Health SBD |
$333.33
|
| Rate for Payer: UMR Bronson Commercial |
$232.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.82
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$529.10
|
|
|
Service Code
|
NDC 00078034342
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.77 |
| Max. Negotiated Rate |
$476.19 |
| Rate for Payer: Aetna American Axle |
$343.92
|
| Rate for Payer: Aetna Commercial |
$449.74
|
| Rate for Payer: Aetna Medicare |
$264.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.92
|
| Rate for Payer: BCBS Complete |
$211.64
|
| Rate for Payer: Cash Price |
$423.28
|
| Rate for Payer: Cofinity Advantage |
$370.37
|
| Rate for Payer: Cofinity Commercial |
$455.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.28
|
| Rate for Payer: Healthscope Commercial |
$476.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$423.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.82
|
| Rate for Payer: PHP Commercial |
$449.74
|
| Rate for Payer: Priority Health SBD |
$333.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.92
|
| Rate for Payer: UHC Core |
$275.66
|
| Rate for Payer: UHC Exchange |
$207.94
|
| Rate for Payer: UMR Bronson Commercial |
$195.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.82
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$278.07
|
|
|
Service Code
|
NDC 65162099208
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.35 |
| Max. Negotiated Rate |
$250.26 |
| Rate for Payer: Aetna American Axle |
$180.75
|
| Rate for Payer: Aetna Commercial |
$236.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.75
|
| Rate for Payer: Cash Price |
$222.46
|
| Rate for Payer: Cofinity Advantage |
$194.65
|
| Rate for Payer: Cofinity Commercial |
$239.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.46
|
| Rate for Payer: Healthscope Commercial |
$250.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.55
|
| Rate for Payer: PHP Commercial |
$236.36
|
| Rate for Payer: Priority Health SBD |
$175.18
|
| Rate for Payer: UMR Bronson Commercial |
$122.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.55
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$278.07
|
|
|
Service Code
|
NDC 65162099208
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.89 |
| Max. Negotiated Rate |
$250.26 |
| Rate for Payer: Aetna American Axle |
$180.75
|
| Rate for Payer: Aetna Commercial |
$236.36
|
| Rate for Payer: Aetna Medicare |
$139.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.75
|
| Rate for Payer: BCBS Complete |
$111.23
|
| Rate for Payer: Cash Price |
$222.46
|
| Rate for Payer: Cofinity Advantage |
$194.65
|
| Rate for Payer: Cofinity Commercial |
$239.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.46
|
| Rate for Payer: Healthscope Commercial |
$250.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.55
|
| Rate for Payer: PHP Commercial |
$236.36
|
| Rate for Payer: Priority Health SBD |
$175.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.75
|
| Rate for Payer: UHC Core |
$144.87
|
| Rate for Payer: UHC Exchange |
$109.28
|
| Rate for Payer: UMR Bronson Commercial |
$102.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.55
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$269.63
|
|
|
Service Code
|
NDC 65162099308
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.64 |
| Max. Negotiated Rate |
$242.67 |
| Rate for Payer: Aetna American Axle |
$175.26
|
| Rate for Payer: Aetna Commercial |
$229.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.26
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cofinity Advantage |
$188.74
|
| Rate for Payer: Cofinity Commercial |
$231.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.70
|
| Rate for Payer: Healthscope Commercial |
$242.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.22
|
| Rate for Payer: PHP Commercial |
$229.19
|
| Rate for Payer: Priority Health SBD |
$169.87
|
| Rate for Payer: UMR Bronson Commercial |
$118.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.22
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$33.71
|
|
|
Service Code
|
NDC 65162099304
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: Aetna American Axle |
$21.91
|
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.91
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cofinity Advantage |
$23.60
|
| Rate for Payer: Cofinity Commercial |
$28.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$30.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: PHP Commercial |
$28.65
|
| Rate for Payer: Priority Health SBD |
$21.24
|
| Rate for Payer: UMR Bronson Commercial |
$14.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.28
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$269.63
|
|
|
Service Code
|
NDC 65162099308
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$242.67 |
| Rate for Payer: Aetna American Axle |
$175.26
|
| Rate for Payer: Aetna Commercial |
$229.19
|
| Rate for Payer: Aetna Medicare |
$134.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.26
|
| Rate for Payer: BCBS Complete |
$107.85
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cofinity Advantage |
$188.74
|
| Rate for Payer: Cofinity Commercial |
$231.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.70
|
| Rate for Payer: Healthscope Commercial |
$242.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.22
|
| Rate for Payer: PHP Commercial |
$229.19
|
| Rate for Payer: Priority Health SBD |
$169.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.26
|
| Rate for Payer: UHC Core |
$140.48
|
| Rate for Payer: UHC Exchange |
$105.96
|
| Rate for Payer: UMR Bronson Commercial |
$99.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.22
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$33.71
|
|
|
Service Code
|
NDC 65162099304
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: Aetna American Axle |
$21.91
|
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$16.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.91
|
| Rate for Payer: BCBS Complete |
$13.48
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cofinity Advantage |
$23.60
|
| Rate for Payer: Cofinity Commercial |
$28.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$30.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: PHP Commercial |
$28.65
|
| Rate for Payer: Priority Health SBD |
$21.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.91
|
| Rate for Payer: UHC Core |
$17.56
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.28
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$68.82
|
|
|
Service Code
|
NDC 50419045101
|
| Hospital Charge Code |
108427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$61.94 |
| Rate for Payer: Aetna American Axle |
$44.73
|
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna Medicare |
$34.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: BCBS Complete |
$27.53
|
| Rate for Payer: Cash Price |
$55.06
|
| Rate for Payer: Cofinity Advantage |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.06
|
| Rate for Payer: Healthscope Commercial |
$61.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.62
|
| Rate for Payer: PHP Commercial |
$58.50
|
| Rate for Payer: Priority Health SBD |
$43.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.73
|
| Rate for Payer: UHC Core |
$35.86
|
| Rate for Payer: UHC Exchange |
$27.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.62
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$255.53
|
|
|
Service Code
|
NDC 00378335099
|
| 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 Advantage |
$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 Commercial |
$217.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.65
|
| Rate for Payer: PHP Commercial |
$217.20
|
| 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/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$68.82
|
|
|
Service Code
|
NDC 50419045101
|
| Hospital Charge Code |
108427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$61.94 |
| Rate for Payer: Aetna American Axle |
$44.73
|
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: Cash Price |
$55.06
|
| Rate for Payer: Cofinity Advantage |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.06
|
| Rate for Payer: Healthscope Commercial |
$61.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.62
|
| Rate for Payer: PHP Commercial |
$58.50
|
| Rate for Payer: Priority Health SBD |
$43.36
|
| Rate for Payer: UMR Bronson Commercial |
$30.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.62
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$275.26
|
|
|
Service Code
|
NDC 50419045104
|
| Hospital Charge Code |
108427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.85 |
| Max. Negotiated Rate |
$247.73 |
| Rate for Payer: Aetna American Axle |
$178.92
|
| Rate for Payer: Aetna Commercial |
$233.97
|
| Rate for Payer: Aetna Medicare |
$137.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.92
|
| Rate for Payer: BCBS Complete |
$110.10
|
| Rate for Payer: Cash Price |
$220.21
|
| Rate for Payer: Cofinity Advantage |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.21
|
| Rate for Payer: Healthscope Commercial |
$247.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.44
|
| Rate for Payer: PHP Commercial |
$233.97
|
| Rate for Payer: Priority Health SBD |
$173.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.92
|
| Rate for Payer: UHC Core |
$143.41
|
| Rate for Payer: UHC Exchange |
$108.18
|
| Rate for Payer: UMR Bronson Commercial |
$101.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.44
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$255.53
|
|
|
Service Code
|
NDC 00378335099
|
| Hospital Charge Code |
108427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.55 |
| Max. Negotiated Rate |
$229.98 |
| Rate for Payer: Aetna American Axle |
$166.09
|
| Rate for Payer: Aetna Commercial |
$217.20
|
| Rate for Payer: Aetna Medicare |
$127.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.09
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: Cash Price |
$204.42
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$204.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.65
|
| Rate for Payer: PHP Commercial |
$217.20
|
| Rate for Payer: Priority Health SBD |
$160.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.09
|
| Rate for Payer: UHC Core |
$133.13
|
| Rate for Payer: UHC Exchange |
$100.42
|
| Rate for Payer: UMR Bronson Commercial |
$94.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.65
|
|
|
ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$275.26
|
|
|
Service Code
|
NDC 50419045104
|
| Hospital Charge Code |
108427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.11 |
| Max. Negotiated Rate |
$247.73 |
| Rate for Payer: Aetna American Axle |
$178.92
|
| Rate for Payer: Aetna Commercial |
$233.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.92
|
| Rate for Payer: Cash Price |
$220.21
|
| Rate for Payer: Cofinity Advantage |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.21
|
| Rate for Payer: Healthscope Commercial |
$247.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.44
|
| Rate for Payer: PHP Commercial |
$233.97
|
| Rate for Payer: Priority Health SBD |
$173.41
|
| Rate for Payer: UMR Bronson Commercial |
$121.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.44
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$959.90
|
|
|
Service Code
|
NDC 68968051408
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$422.36 |
| Max. Negotiated Rate |
$863.91 |
| Rate for Payer: Aetna American Axle |
$623.93
|
| Rate for Payer: Aetna Commercial |
$815.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.93
|
| Rate for Payer: Cash Price |
$767.92
|
| Rate for Payer: Cofinity Advantage |
$671.93
|
| Rate for Payer: Cofinity Commercial |
$825.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.92
|
| Rate for Payer: Healthscope Commercial |
$863.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$671.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$719.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$719.92
|
| Rate for Payer: PHP Commercial |
$815.91
|
| Rate for Payer: Priority Health SBD |
$604.74
|
| Rate for Payer: UMR Bronson Commercial |
$422.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$719.92
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$119.99
|
|
|
Service Code
|
NDC 68968051401
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$107.99 |
| Rate for Payer: Aetna American Axle |
$77.99
|
| Rate for Payer: Aetna Commercial |
$101.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.99
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cofinity Advantage |
$83.99
|
| Rate for Payer: Cofinity Commercial |
$103.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.99
|
| Rate for Payer: Healthscope Commercial |
$107.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.99
|
| Rate for Payer: PHP Commercial |
$101.99
|
| Rate for Payer: Priority Health SBD |
$75.59
|
| Rate for Payer: UMR Bronson Commercial |
$52.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.99
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
OP
|
$959.90
|
|
|
Service Code
|
NDC 68968051408
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.16 |
| Max. Negotiated Rate |
$863.91 |
| Rate for Payer: Aetna American Axle |
$623.93
|
| Rate for Payer: Aetna Commercial |
$815.91
|
| Rate for Payer: Aetna Medicare |
$479.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.93
|
| Rate for Payer: BCBS Complete |
$383.96
|
| Rate for Payer: Cash Price |
$767.92
|
| Rate for Payer: Cofinity Advantage |
$671.93
|
| Rate for Payer: Cofinity Commercial |
$825.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.92
|
| Rate for Payer: Healthscope Commercial |
$863.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$671.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$719.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$767.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$719.92
|
| Rate for Payer: PHP Commercial |
$815.91
|
| Rate for Payer: Priority Health SBD |
$604.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.93
|
| Rate for Payer: UHC Core |
$500.11
|
| Rate for Payer: UHC Exchange |
$377.24
|
| Rate for Payer: UMR Bronson Commercial |
$355.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$719.92
|
|
