|
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 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 0.075 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 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 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$273.89
|
|
|
Service Code
|
NDC 00781716783
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Aetna American Axle |
$178.03
|
| Rate for Payer: Aetna Commercial |
$232.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.03
|
| Rate for Payer: Cash Price |
$219.11
|
| Rate for Payer: Cofinity Commercial |
$191.72
|
| Rate for Payer: Cofinity Commercial |
$235.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.11
|
| Rate for Payer: Healthscope Commercial |
$246.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.81
|
| Rate for Payer: PHP Commercial |
$232.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.03
|
| Rate for Payer: Priority Health SBD |
$172.55
|
| Rate for Payer: UMR Bronson Commercial |
$120.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.42
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$273.89
|
|
|
Service Code
|
NDC 00781716783
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.34 |
| Max. Negotiated Rate |
$246.50 |
| Rate for Payer: Aetna American Axle |
$178.03
|
| Rate for Payer: Aetna Commercial |
$232.81
|
| Rate for Payer: Aetna Medicare |
$136.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.03
|
| Rate for Payer: BCBS Complete |
$109.56
|
| Rate for Payer: Cash Price |
$219.11
|
| Rate for Payer: Cofinity Commercial |
$191.72
|
| Rate for Payer: Cofinity Commercial |
$235.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.11
|
| Rate for Payer: Healthscope Commercial |
$246.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.81
|
| Rate for Payer: PHP Commercial |
$232.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.03
|
| Rate for Payer: Priority Health SBD |
$172.55
|
| Rate for Payer: UMR Bronson Commercial |
$101.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.42
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$34.24
|
|
|
Service Code
|
NDC 00781716758
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$30.82 |
| Rate for Payer: Aetna American Axle |
$22.26
|
| Rate for Payer: Aetna Commercial |
$29.10
|
| Rate for Payer: Aetna Medicare |
$17.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.26
|
| Rate for Payer: BCBS Complete |
$13.70
|
| Rate for Payer: Cash Price |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$29.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$30.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.10
|
| Rate for Payer: PHP Commercial |
$29.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.26
|
| Rate for Payer: Priority Health SBD |
$21.57
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.68
|
|
|
ESTRADIOL 0.1 MG/24 HR SEMIWEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$34.24
|
|
|
Service Code
|
NDC 00781716758
|
| Hospital Charge Code |
27461
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$30.82 |
| Rate for Payer: Aetna American Axle |
$22.26
|
| Rate for Payer: Aetna Commercial |
$29.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.26
|
| Rate for Payer: Cash Price |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$29.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$30.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.10
|
| Rate for Payer: PHP Commercial |
$29.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.26
|
| Rate for Payer: Priority Health SBD |
$21.57
|
| Rate for Payer: UMR Bronson Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.68
|
|
|
ESTRADIOL 0.1 MG/24 HR 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 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 0.1 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 Commercial |
$44.72
|
| Rate for Payer: Cofinity Commercial |
$54.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.72
|
| 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: PHP Commercial |
$54.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.53
|
| Rate for Payer: Priority Health SBD |
$40.25
|
| 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
|
$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 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 0.1 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 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 0.1 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 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 0.1 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 Commercial |
$44.72
|
| Rate for Payer: Cofinity Commercial |
$54.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.72
|
| 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: PHP Commercial |
$54.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.53
|
| 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 1 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 00378145401
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.41 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.56
|
| 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: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$164.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
ESTRADIOL 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 Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.56
|
| 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: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| 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 Commercial |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.19
|
| 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: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna Medicare |
$135.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.19
|
| 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: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$100.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$736.49
|
|
|
Service Code
|
HCPCS J1000
|
| Hospital Charge Code |
2929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$324.06 |
| Max. Negotiated Rate |
$662.84 |
| Rate for Payer: Aetna American Axle |
$478.72
|
| Rate for Payer: Aetna Commercial |
$626.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.72
|
| Rate for Payer: Cash Price |
$589.19
|
| Rate for Payer: Cofinity Commercial |
$515.54
|
| Rate for Payer: Cofinity Commercial |
$633.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.19
|
| Rate for Payer: Healthscope Commercial |
$662.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.02
|
| Rate for Payer: PHP Commercial |
$626.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.72
|
| Rate for Payer: Priority Health SBD |
$463.99
|
| Rate for Payer: UMR Bronson Commercial |
$324.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.37
|
|
|
ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$736.49
|
|
|
Service Code
|
HCPCS J1000
|
| Hospital Charge Code |
2929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.50 |
| Max. Negotiated Rate |
$662.84 |
| Rate for Payer: Aetna American Axle |
$478.72
|
| Rate for Payer: Aetna Commercial |
$626.02
|
| Rate for Payer: Aetna Medicare |
$368.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.72
|
| Rate for Payer: BCBS Complete |
$294.60
|
| Rate for Payer: Cash Price |
$589.19
|
| Rate for Payer: Cofinity Commercial |
$515.54
|
| Rate for Payer: Cofinity Commercial |
$633.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.19
|
| Rate for Payer: Healthscope Commercial |
$662.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.02
|
| Rate for Payer: PHP Commercial |
$626.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.72
|
| Rate for Payer: Priority Health SBD |
$463.99
|
| Rate for Payer: UMR Bronson Commercial |
$272.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.37
|
|
|
ESTRADIOL VALERATE 10 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$493.82
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.71 |
| Max. Negotiated Rate |
$444.44 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna American Axle |
$374.32
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna Commercial |
$489.50
|
| Rate for Payer: Aetna Medicare |
$246.91
|
| Rate for Payer: Aetna Medicare |
$287.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.32
|
| Rate for Payer: BCBS Complete |
$230.35
|
| Rate for Payer: BCBS Complete |
$197.53
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$460.70
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Cofinity Commercial |
$495.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.70
|
| Rate for Payer: Healthscope Commercial |
$518.29
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$431.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.50
|
| Rate for Payer: PHP Commercial |
$489.50
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.32
|
| Rate for Payer: Priority Health SBD |
$362.80
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: UMR Bronson Commercial |
$182.71
|
| Rate for Payer: UMR Bronson Commercial |
$213.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$431.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.37
|
|
|
ESTRADIOL VALERATE 10 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$493.82
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.28 |
| Max. Negotiated Rate |
$444.44 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna American Axle |
$374.32
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna Commercial |
$489.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.32
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$460.70
|
| Rate for Payer: Cofinity Commercial |
$495.26
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.70
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Healthscope Commercial |
$518.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$431.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.75
|
| Rate for Payer: PHP Commercial |
$489.50
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.32
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: Priority Health SBD |
$362.80
|
| Rate for Payer: UMR Bronson Commercial |
$217.28
|
| Rate for Payer: UMR Bronson Commercial |
$253.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$431.91
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$811.64
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$357.12 |
| Max. Negotiated Rate |
$730.48 |
| Rate for Payer: Aetna American Axle |
$527.57
|
| Rate for Payer: Aetna Commercial |
$689.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.57
|
| Rate for Payer: Cash Price |
$649.31
|
| Rate for Payer: Cofinity Commercial |
$568.15
|
| Rate for Payer: Cofinity Commercial |
$698.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$568.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.31
|
| Rate for Payer: Healthscope Commercial |
$730.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$568.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.89
|
| Rate for Payer: PHP Commercial |
$689.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.57
|
| Rate for Payer: Priority Health SBD |
$511.33
|
| Rate for Payer: UMR Bronson Commercial |
$357.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.73
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$379.37
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.37 |
| Max. Negotiated Rate |
$341.43 |
| Rate for Payer: Aetna American Axle |
$246.59
|
| Rate for Payer: Aetna American Axle |
$527.57
|
| Rate for Payer: Aetna Commercial |
$322.46
|
| Rate for Payer: Aetna Commercial |
$689.89
|
| Rate for Payer: Aetna Medicare |
$189.69
|
| Rate for Payer: Aetna Medicare |
$405.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.57
|
| Rate for Payer: BCBS Complete |
$151.75
|
| Rate for Payer: BCBS Complete |
$324.66
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cash Price |
$649.31
|
| Rate for Payer: Cofinity Commercial |
$326.26
|
| Rate for Payer: Cofinity Commercial |
$265.56
|
| Rate for Payer: Cofinity Commercial |
$698.01
|
| Rate for Payer: Cofinity Commercial |
$568.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$568.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.50
|
| Rate for Payer: Healthscope Commercial |
$341.43
|
| Rate for Payer: Healthscope Commercial |
$730.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$568.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.46
|
| Rate for Payer: PHP Commercial |
$689.89
|
| Rate for Payer: PHP Commercial |
$322.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.57
|
| Rate for Payer: Priority Health SBD |
$511.33
|
| Rate for Payer: Priority Health SBD |
$239.00
|
| Rate for Payer: UMR Bronson Commercial |
$140.37
|
| Rate for Payer: UMR Bronson Commercial |
$300.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.73
|
|
|
ETEPLIRSEN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,120.00
|
|
|
Service Code
|
HCPCS J1428
|
| Hospital Charge Code |
180827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna American Axle |
$3,328.00
|
| Rate for Payer: Aetna American Axle |
$13,520.00
|
| Rate for Payer: Aetna Commercial |
$17,680.00
|
| Rate for Payer: Aetna Commercial |
$4,352.00
|
| Rate for Payer: Aetna Medicare |
$174.04
|
| Rate for Payer: Aetna Medicare |
$174.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,328.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,520.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.19
|
| Rate for Payer: BCBS Complete |
$94.18
|
| Rate for Payer: BCBS Complete |
$94.18
|
| Rate for Payer: BCBS MAPPO |
$167.35
|
| Rate for Payer: BCBS MAPPO |
$167.35
|
| Rate for Payer: BCN Medicare Advantage |
$167.35
|
| Rate for Payer: BCN Medicare Advantage |
$167.35
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cofinity Commercial |
$14,560.00
|
| Rate for Payer: Cofinity Commercial |
$17,888.00
|
| Rate for Payer: Cofinity Commercial |
$3,584.00
|
| Rate for Payer: Cofinity Commercial |
$4,403.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,560.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,584.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,096.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,640.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.35
|
| Rate for Payer: Healthscope Commercial |
$4,608.00
|
| Rate for Payer: Healthscope Commercial |
$18,720.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,584.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,560.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,600.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,840.00
|
| Rate for Payer: Mclaren Medicaid |
$89.70
|
| Rate for Payer: Mclaren Medicaid |
$89.70
|
| Rate for Payer: Mclaren Medicare |
$167.35
|
| Rate for Payer: Mclaren Medicare |
$167.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.72
|
| Rate for Payer: Meridian Medicaid |
$94.18
|
| Rate for Payer: Meridian Medicaid |
$94.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,352.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,680.00
|
| Rate for Payer: PACE Medicare |
$158.98
|
| Rate for Payer: PACE Medicare |
$158.98
|
| Rate for Payer: PACE SWMI |
$167.35
|
| Rate for Payer: PACE SWMI |
$167.35
|
| Rate for Payer: PHP Commercial |
$17,680.00
|
| Rate for Payer: PHP Commercial |
$4,352.00
|
| Rate for Payer: PHP Medicare Advantage |
$167.35
|
| Rate for Payer: PHP Medicare Advantage |
$167.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,520.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,328.00
|
| Rate for Payer: Priority Health Medicare |
$167.35
|
| Rate for Payer: Priority Health Medicare |
$167.35
|
| Rate for Payer: Priority Health SBD |
$13,104.00
|
| Rate for Payer: Priority Health SBD |
$3,225.60
|
| Rate for Payer: Railroad Medicare Medicare |
$167.35
|
| Rate for Payer: Railroad Medicare Medicare |
$167.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.35
|
| Rate for Payer: UHC Exchange |
$319.82
|
| Rate for Payer: UHC Exchange |
$319.82
|
| Rate for Payer: UHC Medicare Advantage |
$167.35
|
| Rate for Payer: UHC Medicare Advantage |
$167.35
|
| Rate for Payer: UHCCP Medicaid |
$89.70
|
| Rate for Payer: UHCCP Medicaid |
$89.70
|
| Rate for Payer: UMR Bronson Commercial |
$7,696.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,894.40
|
| Rate for Payer: VA VA |
$167.35
|
| Rate for Payer: VA VA |
$167.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,840.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,600.00
|
|
|
ETEPLIRSEN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20,800.00
|
|
|
Service Code
|
HCPCS J1428
|
| Hospital Charge Code |
180827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,152.00 |
| Max. Negotiated Rate |
$18,720.00 |
| Rate for Payer: Aetna American Axle |
$13,520.00
|
| Rate for Payer: Aetna American Axle |
$3,328.00
|
| Rate for Payer: Aetna Commercial |
$17,680.00
|
| Rate for Payer: Aetna Commercial |
$4,352.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,520.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,328.00
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cofinity Commercial |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$3,584.00
|
| Rate for Payer: Cofinity Commercial |
$14,560.00
|
| Rate for Payer: Cofinity Commercial |
$17,888.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,560.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,584.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,640.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,096.00
|
| Rate for Payer: Healthscope Commercial |
$18,720.00
|
| Rate for Payer: Healthscope Commercial |
$4,608.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,560.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,584.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,600.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,840.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,352.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,680.00
|
| Rate for Payer: PHP Commercial |
$4,352.00
|
| Rate for Payer: PHP Commercial |
$17,680.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,520.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,328.00
|
| Rate for Payer: Priority Health SBD |
$13,104.00
|
| Rate for Payer: Priority Health SBD |
$3,225.60
|
| Rate for Payer: UMR Bronson Commercial |
$9,152.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,600.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,840.00
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,195.85
|
|
|
Service Code
|
NDC 25010021027
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,512.46 |
| Max. Negotiated Rate |
$10,976.26 |
| Rate for Payer: Aetna American Axle |
$7,927.30
|
| Rate for Payer: Aetna Commercial |
$10,366.47
|
| Rate for Payer: Aetna Medicare |
$6,097.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,927.30
|
| Rate for Payer: BCBS Complete |
$4,878.34
|
| Rate for Payer: Cash Price |
$9,756.68
|
| Rate for Payer: Cofinity Commercial |
$10,488.43
|
| Rate for Payer: Cofinity Commercial |
$8,537.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,537.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,756.68
|
| Rate for Payer: Healthscope Commercial |
$10,976.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,537.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,146.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,366.47
|
| Rate for Payer: PHP Commercial |
$10,366.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,927.30
|
| Rate for Payer: Priority Health SBD |
$7,683.39
|
| Rate for Payer: UMR Bronson Commercial |
$4,512.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,146.89
|
|
