|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,456.65
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$988.96
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,456.65
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$988.96
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,456.65
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$988.96
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH NASAL CATHETER PH ELECTRODE(S) PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$1,456.65
|
|
|
Service Code
|
CPT 91034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$988.96
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$277.37
|
| Rate for Payer: VA VA |
$517.48
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
OP
|
$521.28
|
|
|
Service Code
|
NDC 15310002001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.87 |
| Max. Negotiated Rate |
$469.15 |
| Rate for Payer: Aetna American Axle |
$338.83
|
| Rate for Payer: Aetna Commercial |
$443.09
|
| Rate for Payer: Aetna Medicare |
$260.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.83
|
| Rate for Payer: BCBS Complete |
$208.51
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Cofinity Commercial |
$364.90
|
| Rate for Payer: Cofinity Commercial |
$448.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.02
|
| Rate for Payer: Healthscope Commercial |
$469.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.09
|
| Rate for Payer: PHP Commercial |
$443.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.83
|
| Rate for Payer: Priority Health SBD |
$328.41
|
| Rate for Payer: UMR Bronson Commercial |
$192.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.96
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
IP
|
$521.28
|
|
|
Service Code
|
NDC 15310002001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.36 |
| Max. Negotiated Rate |
$469.15 |
| Rate for Payer: Aetna American Axle |
$338.83
|
| Rate for Payer: Aetna Commercial |
$443.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.83
|
| Rate for Payer: Cash Price |
$417.02
|
| Rate for Payer: Cofinity Commercial |
$364.90
|
| Rate for Payer: Cofinity Commercial |
$448.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$364.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.02
|
| Rate for Payer: Healthscope Commercial |
$469.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$364.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.09
|
| Rate for Payer: PHP Commercial |
$443.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.83
|
| Rate for Payer: Priority Health SBD |
$328.41
|
| Rate for Payer: UMR Bronson Commercial |
$229.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.96
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
OP
|
$974.95
|
|
|
Service Code
|
NDC 62559015001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.73 |
| Max. Negotiated Rate |
$877.46 |
| Rate for Payer: Aetna American Axle |
$633.72
|
| Rate for Payer: Aetna Commercial |
$828.71
|
| Rate for Payer: Aetna Medicare |
$487.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.72
|
| Rate for Payer: BCBS Complete |
$389.98
|
| Rate for Payer: Cash Price |
$779.96
|
| Rate for Payer: Cofinity Commercial |
$682.47
|
| Rate for Payer: Cofinity Commercial |
$838.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.96
|
| Rate for Payer: Healthscope Commercial |
$877.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$682.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.71
|
| Rate for Payer: PHP Commercial |
$828.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.72
|
| Rate for Payer: Priority Health SBD |
$614.22
|
| Rate for Payer: UMR Bronson Commercial |
$360.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.21
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 0.625 MG-1.25 MG TABLET
|
Facility
|
IP
|
$974.95
|
|
|
Service Code
|
NDC 62559015001
|
| Hospital Charge Code |
9959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$877.46 |
| Rate for Payer: Aetna American Axle |
$633.72
|
| Rate for Payer: Aetna Commercial |
$828.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.72
|
| Rate for Payer: Cash Price |
$779.96
|
| Rate for Payer: Cofinity Commercial |
$682.47
|
| Rate for Payer: Cofinity Commercial |
$838.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$682.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.96
|
| Rate for Payer: Healthscope Commercial |
$877.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$682.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.71
|
| Rate for Payer: PHP Commercial |
$828.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.72
|
| Rate for Payer: Priority Health SBD |
$614.22
|
| Rate for Payer: UMR Bronson Commercial |
$428.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.21
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET
|
Facility
|
IP
|
$1,037.85
|
|
|
Service Code
|
NDC 11528001001
|
| Hospital Charge Code |
9960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$456.65 |
| Max. Negotiated Rate |
$934.07 |
| Rate for Payer: Aetna American Axle |
$674.60
|
| Rate for Payer: Aetna Commercial |
$882.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.60
|
| Rate for Payer: Cash Price |
$830.28
|
| Rate for Payer: Cofinity Commercial |
$726.50
|
| Rate for Payer: Cofinity Commercial |
$892.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$830.28
|
| Rate for Payer: Healthscope Commercial |
$934.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$726.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$882.17
|
| Rate for Payer: PHP Commercial |
$882.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.60
|
| Rate for Payer: Priority Health SBD |
$653.85
|
| Rate for Payer: UMR Bronson Commercial |
$456.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.39
|
|
|
ESTERIFIED ESTROGENS-METHYLTESTOSTERONE 1.25 MG-2.5 MG TABLET
|
Facility
|
OP
|
$1,037.85
|
|
|
Service Code
|
NDC 11528001001
|
| Hospital Charge Code |
9960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$934.07 |
| Rate for Payer: Aetna American Axle |
$674.60
|
| Rate for Payer: Aetna Commercial |
$882.17
|
| Rate for Payer: Aetna Medicare |
$518.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.60
|
| Rate for Payer: BCBS Complete |
$415.14
|
| Rate for Payer: Cash Price |
$830.28
|
| Rate for Payer: Cofinity Commercial |
$726.50
|
| Rate for Payer: Cofinity Commercial |
$892.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$726.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$830.28
|
| Rate for Payer: Healthscope Commercial |
$934.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$726.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$778.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$882.17
|
| Rate for Payer: PHP Commercial |
$882.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.60
|
| Rate for Payer: Priority Health SBD |
$653.85
|
| Rate for Payer: UMR Bronson Commercial |
$384.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$778.39
|
|
|
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 Commercial |
$232.72
|
| Rate for Payer: Cofinity Commercial |
$285.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.72
|
| 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: PHP Commercial |
$282.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.10
|
| Rate for Payer: Priority Health SBD |
$209.45
|
| Rate for Payer: UMR Bronson Commercial |
$123.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.34
|
|
|
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 Commercial |
$785.62
|
| Rate for Payer: Cofinity Commercial |
$965.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$785.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.86
|
| Rate for Payer: Healthscope Commercial |
$1,010.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.97
|
| Rate for Payer: PHP Commercial |
$953.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.51
|
| Rate for Payer: Priority Health SBD |
$707.06
|
| 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
|
$82.41
|
|
|
Service Code
|
NDC 66993000210
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$74.17 |
| Rate for Payer: Aetna American Axle |
$53.57
|
| Rate for Payer: Aetna Commercial |
$70.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.57
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Cofinity Commercial |
$57.69
|
| Rate for Payer: Cofinity Commercial |
$70.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.93
|
| Rate for Payer: Healthscope Commercial |
$74.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.05
|
| Rate for Payer: PHP Commercial |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.57
|
| Rate for Payer: Priority Health SBD |
$51.92
|
| Rate for Payer: UMR Bronson Commercial |
$36.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.81
|
|
|
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 Commercial |
$785.62
|
| Rate for Payer: Cofinity Commercial |
$965.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$785.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$897.86
|
| Rate for Payer: Healthscope Commercial |
$1,010.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$785.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$841.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.97
|
| Rate for Payer: PHP Commercial |
$953.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.51
|
| Rate for Payer: Priority Health SBD |
$707.06
|
| Rate for Payer: UMR Bronson Commercial |
$493.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$841.74
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$332.46
|
|
|
Service Code
|
NDC 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 Commercial |
$232.72
|
| Rate for Payer: Cofinity Commercial |
$285.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.72
|
| 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: PHP Commercial |
$282.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.10
|
| 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
|
$82.41
|
|
|
Service Code
|
NDC 66993000210
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$74.17 |
| Rate for Payer: Aetna American Axle |
$53.57
|
| Rate for Payer: Aetna Commercial |
$70.05
|
| Rate for Payer: Aetna Medicare |
$41.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.57
|
| Rate for Payer: BCBS Complete |
$32.96
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Cofinity Commercial |
$57.69
|
| Rate for Payer: Cofinity Commercial |
$70.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.93
|
| Rate for Payer: Healthscope Commercial |
$74.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.05
|
| Rate for Payer: PHP Commercial |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.57
|
| Rate for Payer: Priority Health SBD |
$51.92
|
| Rate for Payer: UMR Bronson Commercial |
$30.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.81
|
|
|
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 Commercial |
$370.37
|
| Rate for Payer: Cofinity Commercial |
$455.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.37
|
| 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: PHP Commercial |
$449.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.92
|
| Rate for Payer: Priority Health SBD |
$333.33
|
| 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
|
OP
|
$33.99
|
|
|
Service Code
|
NDC 65162099204
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna American Axle |
$22.09
|
| Rate for Payer: Aetna Commercial |
$28.89
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.09
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$23.79
|
| Rate for Payer: Cofinity Commercial |
$29.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.19
|
| Rate for Payer: Healthscope Commercial |
$30.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.89
|
| Rate for Payer: PHP Commercial |
$28.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.09
|
| Rate for Payer: Priority Health SBD |
$21.41
|
| Rate for Payer: UMR Bronson Commercial |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.49
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$271.85
|
|
|
Service Code
|
NDC 65162099208
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.61 |
| Max. Negotiated Rate |
$244.66 |
| Rate for Payer: Aetna American Axle |
$176.70
|
| Rate for Payer: Aetna Commercial |
$231.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.70
|
| Rate for Payer: Cash Price |
$217.48
|
| Rate for Payer: Cofinity Commercial |
$190.29
|
| Rate for Payer: Cofinity Commercial |
$233.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.48
|
| Rate for Payer: Healthscope Commercial |
$244.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.07
|
| Rate for Payer: PHP Commercial |
$231.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.70
|
| Rate for Payer: Priority Health SBD |
$171.27
|
| Rate for Payer: UMR Bronson Commercial |
$119.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.89
|
|
|
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 Commercial |
$370.37
|
| Rate for Payer: Cofinity Commercial |
$455.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.37
|
| 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: PHP Commercial |
$449.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.92
|
| 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
|
IP
|
$33.99
|
|
|
Service Code
|
NDC 65162099204
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$30.59 |
| Rate for Payer: Aetna American Axle |
$22.09
|
| Rate for Payer: Aetna Commercial |
$28.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.09
|
| Rate for Payer: Cash Price |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$23.79
|
| Rate for Payer: Cofinity Commercial |
$29.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.19
|
| Rate for Payer: Healthscope Commercial |
$30.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.89
|
| Rate for Payer: PHP Commercial |
$28.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.09
|
| Rate for Payer: Priority Health SBD |
$21.41
|
| Rate for Payer: UMR Bronson Commercial |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.49
|
|
|
ESTRADIOL 0.0375 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$271.85
|
|
|
Service Code
|
NDC 65162099208
|
| Hospital Charge Code |
27458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.58 |
| Max. Negotiated Rate |
$244.66 |
| Rate for Payer: Aetna American Axle |
$176.70
|
| Rate for Payer: Aetna Commercial |
$231.07
|
| Rate for Payer: Aetna Medicare |
$135.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.70
|
| Rate for Payer: BCBS Complete |
$108.74
|
| Rate for Payer: Cash Price |
$217.48
|
| Rate for Payer: Cofinity Commercial |
$190.29
|
| Rate for Payer: Cofinity Commercial |
$233.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.48
|
| Rate for Payer: Healthscope Commercial |
$244.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.07
|
| Rate for Payer: PHP Commercial |
$231.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.70
|
| Rate for Payer: Priority Health SBD |
$171.27
|
| Rate for Payer: UMR Bronson Commercial |
$100.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.89
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH
|
Facility
|
OP
|
$900.88
|
|
|
Service Code
|
NDC 50419049104
|
| Hospital Charge Code |
37533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.33 |
| Max. Negotiated Rate |
$810.79 |
| Rate for Payer: Aetna American Axle |
$585.57
|
| Rate for Payer: Aetna Commercial |
$765.75
|
| Rate for Payer: Aetna Medicare |
$450.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.57
|
| Rate for Payer: BCBS Complete |
$360.35
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Cofinity Commercial |
$630.62
|
| Rate for Payer: Cofinity Commercial |
$774.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$630.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.70
|
| Rate for Payer: Healthscope Commercial |
$810.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.75
|
| Rate for Payer: PHP Commercial |
$765.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.57
|
| Rate for Payer: Priority Health SBD |
$567.55
|
| Rate for Payer: UMR Bronson Commercial |
$333.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.66
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH
|
Facility
|
IP
|
$900.88
|
|
|
Service Code
|
NDC 50419049104
|
| Hospital Charge Code |
37533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$396.39 |
| Max. Negotiated Rate |
$810.79 |
| Rate for Payer: Aetna American Axle |
$585.57
|
| Rate for Payer: Aetna Commercial |
$765.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.57
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Cofinity Commercial |
$630.62
|
| Rate for Payer: Cofinity Commercial |
$774.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$630.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.70
|
| Rate for Payer: Healthscope Commercial |
$810.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.75
|
| Rate for Payer: PHP Commercial |
$765.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.57
|
| Rate for Payer: Priority Health SBD |
$567.55
|
| Rate for Payer: UMR Bronson Commercial |
$396.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.66
|
|
|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH
|
Facility
|
OP
|
$900.88
|
|
|
Service Code
|
NDC 50419049101
|
| Hospital Charge Code |
37533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.33 |
| Max. Negotiated Rate |
$810.79 |
| Rate for Payer: Aetna American Axle |
$585.57
|
| Rate for Payer: Aetna Commercial |
$765.75
|
| Rate for Payer: Aetna Medicare |
$450.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.57
|
| Rate for Payer: BCBS Complete |
$360.35
|
| Rate for Payer: Cash Price |
$720.70
|
| Rate for Payer: Cofinity Commercial |
$630.62
|
| Rate for Payer: Cofinity Commercial |
$774.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$630.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.70
|
| Rate for Payer: Healthscope Commercial |
$810.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.75
|
| Rate for Payer: PHP Commercial |
$765.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.57
|
| Rate for Payer: Priority Health SBD |
$567.55
|
| Rate for Payer: UMR Bronson Commercial |
$333.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.66
|
|
