|
ESTRADIOL 0.045 MG-LEVONORGESTREL 0.015 MG/24HR WEEKLY TRANSDERM PATCH
|
Facility
|
IP
|
$900.88
|
|
|
Service Code
|
NDC 50419049101
|
| 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 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$264.72
|
|
|
Service Code
|
NDC 65162099308
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$238.25 |
| Rate for Payer: Aetna American Axle |
$172.07
|
| Rate for Payer: Aetna Commercial |
$225.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.07
|
| Rate for Payer: Cash Price |
$211.78
|
| Rate for Payer: Cofinity Commercial |
$185.30
|
| Rate for Payer: Cofinity Commercial |
$227.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.78
|
| Rate for Payer: Healthscope Commercial |
$238.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.01
|
| Rate for Payer: PHP Commercial |
$225.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.07
|
| Rate for Payer: Priority Health SBD |
$166.77
|
| Rate for Payer: UMR Bronson Commercial |
$116.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.54
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$33.09
|
|
|
Service Code
|
NDC 65162099304
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna American Axle |
$21.51
|
| Rate for Payer: Aetna Commercial |
$28.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.51
|
| Rate for Payer: Cash Price |
$26.47
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$28.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$29.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.13
|
| Rate for Payer: PHP Commercial |
$28.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.51
|
| Rate for Payer: Priority Health SBD |
$20.85
|
| Rate for Payer: UMR Bronson Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.82
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$264.72
|
|
|
Service Code
|
NDC 65162099308
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.95 |
| Max. Negotiated Rate |
$238.25 |
| Rate for Payer: Aetna American Axle |
$172.07
|
| Rate for Payer: Aetna Commercial |
$225.01
|
| Rate for Payer: Aetna Medicare |
$132.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.07
|
| Rate for Payer: BCBS Complete |
$105.89
|
| Rate for Payer: Cash Price |
$211.78
|
| Rate for Payer: Cofinity Commercial |
$185.30
|
| Rate for Payer: Cofinity Commercial |
$227.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.78
|
| Rate for Payer: Healthscope Commercial |
$238.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.01
|
| Rate for Payer: PHP Commercial |
$225.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.07
|
| Rate for Payer: Priority Health SBD |
$166.77
|
| Rate for Payer: UMR Bronson Commercial |
$97.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.54
|
|
|
ESTRADIOL 0.05 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$33.09
|
|
|
Service Code
|
NDC 65162099304
|
| Hospital Charge Code |
27459
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$29.78 |
| Rate for Payer: Aetna American Axle |
$21.51
|
| Rate for Payer: Aetna Commercial |
$28.13
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.51
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: Cash Price |
$26.47
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$28.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.47
|
| Rate for Payer: Healthscope Commercial |
$29.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.13
|
| Rate for Payer: PHP Commercial |
$28.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.51
|
| Rate for Payer: Priority Health SBD |
$20.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.82
|
|
|
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 Commercial |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.17
|
| 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: PHP Commercial |
$58.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.73
|
| 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
|
$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 Commercial |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.17
|
| 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: PHP Commercial |
$58.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.73
|
| Rate for Payer: Priority Health SBD |
$43.36
|
| 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
|
$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 Commercial |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.68
|
| 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: PHP Commercial |
$233.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.92
|
| 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/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 Commercial |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.68
|
| 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: PHP Commercial |
$233.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.92
|
| Rate for Payer: Priority Health SBD |
$173.41
|
| 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 Commercial |
$178.87
|
| Rate for Payer: Cofinity Commercial |
$219.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.87
|
| 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: PHP Commercial |
$217.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.09
|
| Rate for Payer: Priority Health SBD |
$160.98
|
| 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
|
$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 Commercial |
$178.87
|
| Rate for Payer: Cofinity Commercial |
$219.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.87
|
| 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: PHP Commercial |
$217.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.09
|
| Rate for Payer: Priority Health SBD |
$160.98
|
| Rate for Payer: UMR Bronson Commercial |
$112.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.65
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
OP
|
$111.82
|
|
|
Service Code
|
NDC 68968051401
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$100.64 |
| Rate for Payer: Aetna American Axle |
$72.68
|
| Rate for Payer: Aetna Commercial |
$95.05
|
| Rate for Payer: Aetna Medicare |
$55.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.68
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: Cash Price |
$89.46
|
| Rate for Payer: Cofinity Commercial |
$78.27
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.46
|
| Rate for Payer: Healthscope Commercial |
$100.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.05
|
| Rate for Payer: PHP Commercial |
$95.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.68
|
| Rate for Payer: Priority Health SBD |
$70.45
|
| Rate for Payer: UMR Bronson Commercial |
$41.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.86
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$111.82
|
|
|
Service Code
|
NDC 68968051401
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$100.64 |
| Rate for Payer: Aetna American Axle |
$72.68
|
| Rate for Payer: Aetna Commercial |
$95.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.68
|
| Rate for Payer: Cash Price |
$89.46
|
| Rate for Payer: Cofinity Commercial |
$78.27
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.46
|
| Rate for Payer: Healthscope Commercial |
$100.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.05
|
| Rate for Payer: PHP Commercial |
$95.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.68
|
| Rate for Payer: Priority Health SBD |
$70.45
|
| Rate for Payer: UMR Bronson Commercial |
$49.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.86
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$894.52
|
|
|
Service Code
|
NDC 68968051408
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.59 |
| Max. Negotiated Rate |
$805.07 |
| Rate for Payer: Aetna American Axle |
$581.44
|
| Rate for Payer: Aetna Commercial |
$760.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.44
|
| Rate for Payer: Cash Price |
$715.62
|
| Rate for Payer: Cofinity Commercial |
$626.16
|
| Rate for Payer: Cofinity Commercial |
$769.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.62
|
| Rate for Payer: Healthscope Commercial |
$805.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.34
|
| Rate for Payer: PHP Commercial |
$760.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.44
|
| Rate for Payer: Priority Health SBD |
$563.55
|
| Rate for Payer: UMR Bronson Commercial |
$393.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.89
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.14 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
OP
|
$894.52
|
|
|
Service Code
|
NDC 68968051408
|
| Hospital Charge Code |
27464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.97 |
| Max. Negotiated Rate |
$805.07 |
| Rate for Payer: Aetna American Axle |
$581.44
|
| Rate for Payer: Aetna Commercial |
$760.34
|
| Rate for Payer: Aetna Medicare |
$447.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.44
|
| Rate for Payer: BCBS Complete |
$357.81
|
| Rate for Payer: Cash Price |
$715.62
|
| Rate for Payer: Cofinity Commercial |
$626.16
|
| Rate for Payer: Cofinity Commercial |
$769.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.62
|
| Rate for Payer: Healthscope Commercial |
$805.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.34
|
| Rate for Payer: PHP Commercial |
$760.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.44
|
| Rate for Payer: Priority Health SBD |
$563.55
|
| Rate for Payer: UMR Bronson Commercial |
$330.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.89
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$894.52
|
|
|
Service Code
|
NDC 68968052508
|
| Hospital Charge Code |
27465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.59 |
| Max. Negotiated Rate |
$805.07 |
| Rate for Payer: Aetna American Axle |
$581.44
|
| Rate for Payer: Aetna Commercial |
$760.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.44
|
| Rate for Payer: Cash Price |
$715.62
|
| Rate for Payer: Cofinity Commercial |
$626.16
|
| Rate for Payer: Cofinity Commercial |
$769.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.62
|
| Rate for Payer: Healthscope Commercial |
$805.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.34
|
| Rate for Payer: PHP Commercial |
$760.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.44
|
| Rate for Payer: Priority Health SBD |
$563.55
|
| Rate for Payer: UMR Bronson Commercial |
$393.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.89
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
OP
|
$111.82
|
|
|
Service Code
|
NDC 68968052501
|
| Hospital Charge Code |
27465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$100.64 |
| Rate for Payer: Aetna American Axle |
$72.68
|
| Rate for Payer: Aetna Commercial |
$95.05
|
| Rate for Payer: Aetna Medicare |
$55.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.68
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: Cash Price |
$89.46
|
| Rate for Payer: Cofinity Commercial |
$78.27
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.46
|
| Rate for Payer: Healthscope Commercial |
$100.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.05
|
| Rate for Payer: PHP Commercial |
$95.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.68
|
| Rate for Payer: Priority Health SBD |
$70.45
|
| Rate for Payer: UMR Bronson Commercial |
$41.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.86
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
OP
|
$894.52
|
|
|
Service Code
|
NDC 68968052508
|
| Hospital Charge Code |
27465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.97 |
| Max. Negotiated Rate |
$805.07 |
| Rate for Payer: Aetna American Axle |
$581.44
|
| Rate for Payer: Aetna Commercial |
$760.34
|
| Rate for Payer: Aetna Medicare |
$447.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.44
|
| Rate for Payer: BCBS Complete |
$357.81
|
| Rate for Payer: Cash Price |
$715.62
|
| Rate for Payer: Cofinity Commercial |
$626.16
|
| Rate for Payer: Cofinity Commercial |
$769.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.62
|
| Rate for Payer: Healthscope Commercial |
$805.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.34
|
| Rate for Payer: PHP Commercial |
$760.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.44
|
| Rate for Payer: Priority Health SBD |
$563.55
|
| Rate for Payer: UMR Bronson Commercial |
$330.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.89
|
|
|
ESTRADIOL 0.05 MG-NORETHINDRONE 0.25 MG/24 HR SEMIWKLY TRANSDERM PATCH
|
Facility
|
IP
|
$111.82
|
|
|
Service Code
|
NDC 68968052501
|
| Hospital Charge Code |
27465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$100.64 |
| Rate for Payer: Aetna American Axle |
$72.68
|
| Rate for Payer: Aetna Commercial |
$95.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.68
|
| Rate for Payer: Cash Price |
$89.46
|
| Rate for Payer: Cofinity Commercial |
$78.27
|
| Rate for Payer: Cofinity Commercial |
$96.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.46
|
| Rate for Payer: Healthscope Commercial |
$100.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.05
|
| Rate for Payer: PHP Commercial |
$95.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.68
|
| Rate for Payer: Priority Health SBD |
$70.45
|
| Rate for Payer: UMR Bronson Commercial |
$49.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.86
|
|
|
ESTRADIOL 0.06 MG/24 HR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$261.05
|
|
|
Service Code
|
NDC 00378336199
|
| Hospital Charge Code |
36268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.59 |
| Max. Negotiated Rate |
$234.94 |
| Rate for Payer: Aetna American Axle |
$169.68
|
| Rate for Payer: Aetna Commercial |
$221.89
|
| Rate for Payer: Aetna Medicare |
$130.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.68
|
| Rate for Payer: BCBS Complete |
$104.42
|
| Rate for Payer: Cash Price |
$208.84
|
| Rate for Payer: Cofinity Commercial |
$182.74
|
| Rate for Payer: Cofinity Commercial |
$224.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.84
|
| Rate for Payer: Healthscope Commercial |
$234.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.89
|
| Rate for Payer: PHP Commercial |
$221.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.68
|
| Rate for Payer: Priority Health SBD |
$164.46
|
| Rate for Payer: UMR Bronson Commercial |
$96.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.79
|
|
|
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 Commercial |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.68
|
| 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: PHP Commercial |
$233.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.92
|
| 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
|
IP
|
$261.05
|
|
|
Service Code
|
NDC 00378336199
|
| Hospital Charge Code |
36268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$234.94 |
| Rate for Payer: Aetna American Axle |
$169.68
|
| Rate for Payer: Aetna Commercial |
$221.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.68
|
| Rate for Payer: Cash Price |
$208.84
|
| Rate for Payer: Cofinity Commercial |
$182.74
|
| Rate for Payer: Cofinity Commercial |
$224.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.84
|
| Rate for Payer: Healthscope Commercial |
$234.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.89
|
| Rate for Payer: PHP Commercial |
$221.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.68
|
| Rate for Payer: Priority Health SBD |
$164.46
|
| Rate for Payer: UMR Bronson Commercial |
$114.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.79
|
|
|
ESTRADIOL 0.06 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 Commercial |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.68
|
| 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: PHP Commercial |
$233.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.92
|
| Rate for Payer: Priority Health SBD |
$173.41
|
| 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 Commercial |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.17
|
| 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: PHP Commercial |
$58.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.73
|
| 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 Commercial |
$48.17
|
| Rate for Payer: Cofinity Commercial |
$59.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.17
|
| 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: PHP Commercial |
$58.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.73
|
| Rate for Payer: Priority Health SBD |
$43.36
|
| Rate for Payer: UMR Bronson Commercial |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.62
|
|
