|
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 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
OP
|
$959.90
|
|
|
Service Code
|
NDC 68968052508
|
| Hospital Charge Code |
27465
|
|
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
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$119.99
|
|
|
Service Code
|
NDC 68968052501
|
| Hospital Charge Code |
27465
|
|
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 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
OP
|
$119.99
|
|
|
Service Code
|
NDC 68968052501
|
| Hospital Charge Code |
27465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$107.99 |
| Rate for Payer: Aetna American Axle |
$77.99
|
| Rate for Payer: Aetna Commercial |
$101.99
|
| Rate for Payer: Aetna Medicare |
$59.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.99
|
| Rate for Payer: BCBS Complete |
$48.00
|
| 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: MI Amish Medical Board Commercial |
$95.99
|
| 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: UHC All Payor (Choice/PPO) |
$77.99
|
| Rate for Payer: UHC Core |
$62.51
|
| Rate for Payer: UHC Exchange |
$47.16
|
| Rate for Payer: UMR Bronson Commercial |
$44.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.99
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$959.90
|
|
|
Service Code
|
NDC 68968052508
|
| Hospital Charge Code |
27465
|
|
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 0.06 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$255.53
|
|
|
Service Code
|
NDC 00378336199
|
| Hospital Charge Code |
36268
|
|
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 0.06 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$275.26
|
|
|
Service Code
|
NDC 50419045904
|
| Hospital Charge Code |
36268
|
|
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 0.06 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$275.26
|
|
|
Service Code
|
NDC 50419045904
|
| Hospital Charge Code |
36268
|
|
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 0.06 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$255.53
|
|
|
Service Code
|
NDC 00378336199
|
| Hospital Charge Code |
36268
|
|
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 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$275.26
|
|
|
Service Code
|
NDC 50419045304
|
| Hospital Charge Code |
27463
|
|
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 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$68.82
|
|
|
Service Code
|
NDC 50419045301
|
| Hospital Charge Code |
27463
|
|
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 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$68.82
|
|
|
Service Code
|
NDC 50419045301
|
| Hospital Charge Code |
27463
|
|
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 0.075 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$275.26
|
|
|
Service Code
|
NDC 50419045304
|
| Hospital Charge Code |
27463
|
|
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 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$37.48
|
|
|
Service Code
|
NDC 00781716758
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$33.73 |
| Rate for Payer: Aetna American Axle |
$24.36
|
| Rate for Payer: Aetna Commercial |
$31.86
|
| Rate for Payer: Aetna Medicare |
$18.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.36
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: Cash Price |
$29.98
|
| Rate for Payer: Cofinity Advantage |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$32.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.98
|
| Rate for Payer: Healthscope Commercial |
$33.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.11
|
| Rate for Payer: PHP Commercial |
$31.86
|
| Rate for Payer: Priority Health SBD |
$23.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.36
|
| Rate for Payer: UHC Core |
$19.53
|
| Rate for Payer: UHC Exchange |
$14.73
|
| Rate for Payer: UMR Bronson Commercial |
$13.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.11
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$299.82
|
|
|
Service Code
|
NDC 00781716783
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.92 |
| Max. Negotiated Rate |
$269.84 |
| Rate for Payer: Aetna American Axle |
$194.88
|
| Rate for Payer: Aetna Commercial |
$254.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.88
|
| Rate for Payer: Cash Price |
$239.86
|
| Rate for Payer: Cofinity Advantage |
$209.87
|
| Rate for Payer: Cofinity Commercial |
$257.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.86
|
| Rate for Payer: Healthscope Commercial |
$269.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.87
|
| Rate for Payer: PHP Commercial |
$254.85
|
| Rate for Payer: Priority Health SBD |
$188.89
|
| Rate for Payer: UMR Bronson Commercial |
$131.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.87
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$37.48
|
|
|
Service Code
|
NDC 00781716758
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$33.73 |
| Rate for Payer: Aetna American Axle |
$24.36
|
| Rate for Payer: Aetna Commercial |
$31.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.36
|
| Rate for Payer: Cash Price |
$29.98
|
| Rate for Payer: Cofinity Advantage |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$32.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.98
|
| Rate for Payer: Healthscope Commercial |
$33.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.11
|
| Rate for Payer: PHP Commercial |
$31.86
|
| Rate for Payer: Priority Health SBD |
$23.61
|
| Rate for Payer: UMR Bronson Commercial |
$16.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.11
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$299.82
|
|
|
Service Code
|
NDC 00781716783
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.93 |
| Max. Negotiated Rate |
$269.84 |
| Rate for Payer: Aetna American Axle |
$194.88
|
| Rate for Payer: Aetna Commercial |
$254.85
|
| Rate for Payer: Aetna Medicare |
$149.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.88
|
| Rate for Payer: BCBS Complete |
$119.93
|
| Rate for Payer: Cash Price |
$239.86
|
| Rate for Payer: Cofinity Advantage |
$209.87
|
| Rate for Payer: Cofinity Commercial |
$257.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.86
|
| Rate for Payer: Healthscope Commercial |
$269.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.87
|
| Rate for Payer: PHP Commercial |
$254.85
|
| Rate for Payer: Priority Health SBD |
$188.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.88
|
| Rate for Payer: UHC Core |
$156.21
|
| Rate for Payer: UHC Exchange |
$117.83
|
| Rate for Payer: UMR Bronson Commercial |
$110.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.87
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$63.89
|
|
|
Service Code
|
NDC 00378335216
|
| Hospital Charge Code |
109872
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Aetna American Axle |
$41.53
|
| Rate for Payer: Aetna Commercial |
$54.31
|
| Rate for Payer: Aetna Medicare |
$31.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.53
|
| Rate for Payer: BCBS Complete |
$25.56
|
| Rate for Payer: Cash Price |
$51.11
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$51.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.92
|
| Rate for Payer: PHP Commercial |
$54.31
|
| Rate for Payer: Priority Health SBD |
$40.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.53
|
| Rate for Payer: UHC Core |
$33.29
|
| Rate for Payer: UHC Exchange |
$25.11
|
| Rate for Payer: UMR Bronson Commercial |
$23.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.92
|
|
|
ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$63.89
|
|
|
Service Code
|
NDC 00378335216
|
| 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 Advantage |
$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 Commercial |
$54.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.92
|
| Rate for Payer: PHP Commercial |
$54.31
|
| 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
|
$275.26
|
|
|
Service Code
|
NDC 50419045204
|
| Hospital Charge Code |
109872
|
|
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 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$275.26
|
|
|
Service Code
|
NDC 50419045204
|
| Hospital Charge Code |
109872
|
|
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 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$255.53
|
|
|
Service Code
|
NDC 00378335299
|
| Hospital Charge Code |
109872
|
|
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 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$255.53
|
|
|
Service Code
|
NDC 00378335299
|
| 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 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 1 MG TABLET
|
Facility
|
OP
|
$373.65
|
|
|
Service Code
|
NDC 00378145401
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna Medicare |
$186.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Advantage |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.24
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.87
|
| Rate for Payer: UHC Core |
$194.67
|
| Rate for Payer: UHC Exchange |
$146.84
|
| Rate for Payer: UMR Bronson Commercial |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| 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 Advantage |
$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 Commercial |
$230.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.78
|
| Rate for Payer: PHP Commercial |
$230.94
|
| 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
|
|
