|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$182.88
|
|
|
Service Code
|
NDC 50268-476-15
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$164.59 |
| Rate for Payer: Aetna American Axle |
$118.87
|
| Rate for Payer: Aetna Commercial |
$155.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.87
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$128.02
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.30
|
| Rate for Payer: Healthscope Commercial |
$164.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.45
|
| Rate for Payer: PHP Commercial |
$155.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.02
|
| Rate for Payer: Priority Health SBD |
$115.21
|
| Rate for Payer: UMR Bronson Commercial |
$80.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.16
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$82.73
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna American Axle |
$53.77
|
| Rate for Payer: Aetna American Axle |
$18.54
|
| Rate for Payer: Aetna American Axle |
$42.90
|
| Rate for Payer: Aetna American Axle |
$46.25
|
| Rate for Payer: Aetna Commercial |
$60.49
|
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: BCBS Complete |
$28.46
|
| Rate for Payer: BCBS Complete |
$33.09
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS Complete |
$11.41
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$49.81
|
| Rate for Payer: Cofinity Commercial |
$61.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.93
|
| Rate for Payer: Healthscope Commercial |
$64.04
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.32
|
| Rate for Payer: PHP Commercial |
$24.25
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$56.10
|
| Rate for Payer: PHP Commercial |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.97
|
| Rate for Payer: Priority Health SBD |
$41.58
|
| Rate for Payer: Priority Health SBD |
$44.83
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: UMR Bronson Commercial |
$24.42
|
| Rate for Payer: UMR Bronson Commercial |
$30.61
|
| Rate for Payer: UMR Bronson Commercial |
$26.33
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.05
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$28.57
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$25.71 |
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna American Axle |
$18.54
|
| Rate for Payer: Aetna American Axle |
$53.77
|
| Rate for Payer: Aetna American Axle |
$42.90
|
| Rate for Payer: Aetna American Axle |
$46.25
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Aetna Commercial |
$60.49
|
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.25
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$56.93
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$49.81
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Healthscope Commercial |
$64.04
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$60.49
|
| Rate for Payer: PHP Commercial |
$56.10
|
| Rate for Payer: PHP Commercial |
$24.25
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.00
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$41.58
|
| Rate for Payer: Priority Health SBD |
$44.83
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$29.04
|
| Rate for Payer: UMR Bronson Commercial |
$12.55
|
| Rate for Payer: UMR Bronson Commercial |
$36.40
|
| Rate for Payer: UMR Bronson Commercial |
$31.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.50
|
|
|
LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$67.02
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
15426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$60.32 |
| Rate for Payer: Aetna American Axle |
$43.56
|
| Rate for Payer: Aetna American Axle |
$25.34
|
| Rate for Payer: Aetna American Axle |
$69.39
|
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna American Axle |
$72.63
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$90.75
|
| Rate for Payer: Aetna Commercial |
$94.98
|
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Aetna Commercial |
$56.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: BCBS Complete |
$44.70
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$26.81
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS Complete |
$42.70
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: Cash Price |
$85.41
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cash Price |
$89.39
|
| Rate for Payer: Cash Price |
$85.41
|
| Rate for Payer: Cash Price |
$89.39
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cofinity Commercial |
$27.29
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| Rate for Payer: Cofinity Commercial |
$91.81
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$96.10
|
| Rate for Payer: Cofinity Commercial |
$78.22
|
| Rate for Payer: Cofinity Commercial |
$74.73
|
| Rate for Payer: Cofinity Commercial |
$46.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.41
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Healthscope Commercial |
$100.57
|
| Rate for Payer: Healthscope Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$60.32
|
| Rate for Payer: Healthscope Commercial |
$96.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.98
|
| Rate for Payer: PHP Commercial |
$94.98
|
| Rate for Payer: PHP Commercial |
$90.75
|
| Rate for Payer: PHP Commercial |
$33.14
|
| Rate for Payer: PHP Commercial |
$56.97
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.29
|
| Rate for Payer: Priority Health SBD |
$67.26
|
| Rate for Payer: Priority Health SBD |
$104.26
|
| Rate for Payer: Priority Health SBD |
$70.40
|
| Rate for Payer: Priority Health SBD |
$42.22
|
| Rate for Payer: Priority Health SBD |
$24.56
|
| Rate for Payer: UMR Bronson Commercial |
$61.24
|
| Rate for Payer: UMR Bronson Commercial |
$41.34
|
| Rate for Payer: UMR Bronson Commercial |
$14.43
|
| Rate for Payer: UMR Bronson Commercial |
$39.50
|
| Rate for Payer: UMR Bronson Commercial |
$24.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.07
|
|
|
LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$67.02
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
15426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$60.32 |
| Rate for Payer: Aetna American Axle |
$43.56
|
| Rate for Payer: Aetna Commercial |
$56.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cofinity Commercial |
$46.91
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.62
|
| Rate for Payer: Healthscope Commercial |
$60.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.97
|
| Rate for Payer: PHP Commercial |
$56.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.91
|
| Rate for Payer: Priority Health SBD |
$42.22
|
| Rate for Payer: UMR Bronson Commercial |
$29.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.26
|
|
|
LEUCOVORIN CALCIUM 25 MG TABLET
|
Facility
|
IP
|
$28.81
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$25.93 |
| Rate for Payer: Aetna American Axle |
$18.73
|
| Rate for Payer: Aetna American Axle |
$374.51
|
| Rate for Payer: Aetna American Axle |
$503.67
|
| Rate for Payer: Aetna American Axle |
$332.04
|
| Rate for Payer: Aetna Commercial |
$658.65
|
| Rate for Payer: Aetna Commercial |
$24.49
|
| Rate for Payer: Aetna Commercial |
$434.21
|
| Rate for Payer: Aetna Commercial |
$489.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.04
|
| Rate for Payer: Cash Price |
$23.05
|
| Rate for Payer: Cash Price |
$408.66
|
| Rate for Payer: Cash Price |
$460.94
|
| Rate for Payer: Cash Price |
$619.90
|
| Rate for Payer: Cofinity Commercial |
$357.58
|
| Rate for Payer: Cofinity Commercial |
$439.31
|
| Rate for Payer: Cofinity Commercial |
$24.78
|
| Rate for Payer: Cofinity Commercial |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$542.42
|
| Rate for Payer: Cofinity Commercial |
$20.17
|
| Rate for Payer: Cofinity Commercial |
$403.32
|
| Rate for Payer: Cofinity Commercial |
$495.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.94
|
| Rate for Payer: Healthscope Commercial |
$25.93
|
| Rate for Payer: Healthscope Commercial |
$697.39
|
| Rate for Payer: Healthscope Commercial |
$459.75
|
| Rate for Payer: Healthscope Commercial |
$518.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$489.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$658.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.49
|
| Rate for Payer: PHP Commercial |
$658.65
|
| Rate for Payer: PHP Commercial |
$434.21
|
| Rate for Payer: PHP Commercial |
$24.49
|
| Rate for Payer: PHP Commercial |
$489.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.58
|
| Rate for Payer: Priority Health SBD |
$362.99
|
| Rate for Payer: Priority Health SBD |
$321.82
|
| Rate for Payer: Priority Health SBD |
$18.15
|
| Rate for Payer: Priority Health SBD |
$488.17
|
| Rate for Payer: UMR Bronson Commercial |
$253.51
|
| Rate for Payer: UMR Bronson Commercial |
$224.77
|
| Rate for Payer: UMR Bronson Commercial |
$340.95
|
| Rate for Payer: UMR Bronson Commercial |
$12.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.16
|
|
|
LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$305.94
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
23617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$275.35 |
| Rate for Payer: Aetna American Axle |
$198.86
|
| Rate for Payer: Aetna American Axle |
$167.39
|
| Rate for Payer: Aetna Commercial |
$218.89
|
| Rate for Payer: Aetna Commercial |
$260.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.39
|
| Rate for Payer: BCBS Complete |
$103.01
|
| Rate for Payer: BCBS Complete |
$122.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$206.02
|
| Rate for Payer: Cash Price |
$206.02
|
| Rate for Payer: Cofinity Commercial |
$180.26
|
| Rate for Payer: Cofinity Commercial |
$221.47
|
| Rate for Payer: Cofinity Commercial |
$263.11
|
| Rate for Payer: Cofinity Commercial |
$214.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.02
|
| Rate for Payer: Healthscope Commercial |
$231.77
|
| Rate for Payer: Healthscope Commercial |
$275.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.05
|
| Rate for Payer: PHP Commercial |
$260.05
|
| Rate for Payer: PHP Commercial |
$218.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.16
|
| Rate for Payer: Priority Health SBD |
$192.74
|
| Rate for Payer: Priority Health SBD |
$162.24
|
| Rate for Payer: UMR Bronson Commercial |
$95.28
|
| Rate for Payer: UMR Bronson Commercial |
$113.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.46
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET
|
Facility
|
IP
|
$149.62
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$134.66 |
| Rate for Payer: Aetna American Axle |
$97.25
|
| Rate for Payer: Aetna American Axle |
$180.65
|
| Rate for Payer: Aetna American Axle |
$3.61
|
| Rate for Payer: Aetna Commercial |
$236.23
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna Commercial |
$127.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$239.01
|
| Rate for Payer: Cofinity Commercial |
$194.54
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$128.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$134.66
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$250.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.18
|
| Rate for Payer: PHP Commercial |
$236.23
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$127.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.54
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: Priority Health SBD |
$175.09
|
| Rate for Payer: Priority Health SBD |
$94.26
|
| Rate for Payer: UMR Bronson Commercial |
$65.83
|
| Rate for Payer: UMR Bronson Commercial |
$122.28
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.17
|
|
|
LEUPROLIDE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$15,255.14
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
21044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$855.84 |
| Max. Negotiated Rate |
$13,729.63 |
| Rate for Payer: Aetna American Axle |
$9,915.84
|
| Rate for Payer: Aetna American Axle |
$11,509.97
|
| Rate for Payer: Aetna Commercial |
$12,966.87
|
| Rate for Payer: Aetna Commercial |
$15,051.50
|
| Rate for Payer: Aetna Medicare |
$1,627.19
|
| Rate for Payer: Aetna Medicare |
$1,627.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,509.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,915.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,056.07
|
| Rate for Payer: BCBS Trust/PPO |
$5,056.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$14,166.12
|
| Rate for Payer: Cash Price |
$12,204.11
|
| Rate for Payer: Cash Price |
$12,204.11
|
| Rate for Payer: Cash Price |
$14,166.12
|
| Rate for Payer: Cofinity Commercial |
$15,228.58
|
| Rate for Payer: Cofinity Commercial |
$13,119.42
|
| Rate for Payer: Cofinity Commercial |
$12,395.36
|
| Rate for Payer: Cofinity Commercial |
$10,678.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,204.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,166.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Healthscope Commercial |
$15,936.88
|
| Rate for Payer: Healthscope Commercial |
$13,729.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,678.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,395.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,280.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,441.36
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,966.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,051.50
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PHP Commercial |
$15,051.50
|
| Rate for Payer: PHP Commercial |
$12,966.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,678.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,395.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.78
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,581.42
|
| Rate for Payer: Priority Health Narrow Network |
$3,581.42
|
| Rate for Payer: Priority Health SBD |
$11,155.82
|
| Rate for Payer: Priority Health SBD |
$9,610.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: UMR Bronson Commercial |
$5,644.40
|
| Rate for Payer: UMR Bronson Commercial |
$6,551.83
|
| Rate for Payer: VA VA |
$1,564.60
|
| Rate for Payer: VA VA |
$1,564.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,441.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,280.74
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT
|
Facility
|
IP
|
$9,058.69
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,985.82 |
| Max. Negotiated Rate |
$8,152.82 |
| Rate for Payer: Aetna American Axle |
$5,888.15
|
| Rate for Payer: Aetna Commercial |
$7,699.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,888.15
|
| Rate for Payer: Cash Price |
$7,246.95
|
| Rate for Payer: Cofinity Commercial |
$6,341.08
|
| Rate for Payer: Cofinity Commercial |
$7,790.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,246.95
|
| Rate for Payer: Healthscope Commercial |
$8,152.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,341.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,794.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,699.89
|
| Rate for Payer: PHP Commercial |
$7,699.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,341.08
|
| Rate for Payer: Priority Health SBD |
$5,706.97
|
| Rate for Payer: UMR Bronson Commercial |
$3,985.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,794.02
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT
|
Facility
|
OP
|
$9,058.69
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$855.84 |
| Max. Negotiated Rate |
$8,152.82 |
| Rate for Payer: Aetna American Axle |
$5,888.15
|
| Rate for Payer: Aetna Commercial |
$7,699.89
|
| Rate for Payer: Aetna Medicare |
$1,627.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,888.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,056.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$7,246.95
|
| Rate for Payer: Cash Price |
$7,246.95
|
| Rate for Payer: Cofinity Commercial |
$6,341.08
|
| Rate for Payer: Cofinity Commercial |
$7,790.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,246.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Healthscope Commercial |
$8,152.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,341.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,794.02
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,699.89
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PHP Commercial |
$7,699.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,341.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.78
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,581.42
|
| Rate for Payer: Priority Health SBD |
$5,706.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: UMR Bronson Commercial |
$3,351.72
|
| Rate for Payer: VA VA |
$1,564.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,794.02
|
|
|
LEUPROLIDE 11.25 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$27,176.19
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$855.84 |
| Max. Negotiated Rate |
$24,458.57 |
| Rate for Payer: Aetna American Axle |
$17,664.52
|
| Rate for Payer: Aetna Commercial |
$23,099.76
|
| Rate for Payer: Aetna Medicare |
$1,627.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,664.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,056.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$21,740.95
|
| Rate for Payer: Cash Price |
$21,740.95
|
| Rate for Payer: Cofinity Commercial |
$19,023.33
|
| Rate for Payer: Cofinity Commercial |
$23,371.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,740.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Healthscope Commercial |
$24,458.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,023.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,382.14
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,099.76
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PHP Commercial |
$23,099.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,023.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.78
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,581.42
|
| Rate for Payer: Priority Health SBD |
$17,121.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: UMR Bronson Commercial |
$10,055.19
|
| Rate for Payer: VA VA |
$1,564.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,382.14
|
|
|
LEUPROLIDE 11.25 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$27,176.19
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,957.52 |
| Max. Negotiated Rate |
$24,458.57 |
| Rate for Payer: Aetna American Axle |
$17,664.52
|
| Rate for Payer: Aetna Commercial |
$23,099.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,664.52
|
| Rate for Payer: Cash Price |
$21,740.95
|
| Rate for Payer: Cofinity Commercial |
$19,023.33
|
| Rate for Payer: Cofinity Commercial |
$23,371.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,740.95
|
| Rate for Payer: Healthscope Commercial |
$24,458.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,023.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,382.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,099.76
|
| Rate for Payer: PHP Commercial |
$23,099.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,023.33
|
| Rate for Payer: Priority Health SBD |
$17,121.00
|
| Rate for Payer: UMR Bronson Commercial |
$11,957.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,382.14
|
|
|
LEUPROLIDE 15 MG INTRAMUSCULAR KIT
|
Facility
|
OP
|
$9,977.24
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$855.84 |
| Max. Negotiated Rate |
$8,979.52 |
| Rate for Payer: Aetna American Axle |
$6,485.21
|
| Rate for Payer: Aetna Commercial |
$8,480.65
|
| Rate for Payer: Aetna Medicare |
$1,627.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,485.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,056.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$7,981.79
|
| Rate for Payer: Cash Price |
$7,981.79
|
| Rate for Payer: Cofinity Commercial |
$6,984.07
|
| Rate for Payer: Cofinity Commercial |
$8,580.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,981.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Healthscope Commercial |
$8,979.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,984.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,482.93
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,480.65
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PHP Commercial |
$8,480.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,984.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.78
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,581.42
|
| Rate for Payer: Priority Health SBD |
$6,285.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: UMR Bronson Commercial |
$3,691.58
|
| Rate for Payer: VA VA |
$1,564.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,482.93
|
|
|
LEUPROLIDE 15 MG INTRAMUSCULAR KIT
|
Facility
|
IP
|
$9,977.24
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,389.99 |
| Max. Negotiated Rate |
$8,979.52 |
| Rate for Payer: Aetna American Axle |
$6,485.21
|
| Rate for Payer: Aetna Commercial |
$8,480.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,485.21
|
| Rate for Payer: Cash Price |
$7,981.79
|
| Rate for Payer: Cofinity Commercial |
$6,984.07
|
| Rate for Payer: Cofinity Commercial |
$8,580.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,981.79
|
| Rate for Payer: Healthscope Commercial |
$8,979.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,984.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,482.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,480.65
|
| Rate for Payer: PHP Commercial |
$8,480.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,984.07
|
| Rate for Payer: Priority Health SBD |
$6,285.66
|
| Rate for Payer: UMR Bronson Commercial |
$4,389.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,482.93
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$1,505.60
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.17 |
| Max. Negotiated Rate |
$1,355.04 |
| Rate for Payer: Aetna American Axle |
$978.64
|
| Rate for Payer: Aetna Commercial |
$1,279.76
|
| Rate for Payer: Aetna Medicare |
$188.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.63
|
| Rate for Payer: BCBS Complete |
$104.14
|
| Rate for Payer: BCBS MAPPO |
$181.30
|
| Rate for Payer: BCBS Trust/PPO |
$607.57
|
| Rate for Payer: BCN Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$1,204.48
|
| Rate for Payer: Cash Price |
$1,204.48
|
| Rate for Payer: Cofinity Commercial |
$1,053.92
|
| Rate for Payer: Cofinity Commercial |
$1,294.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.30
|
| Rate for Payer: Healthscope Commercial |
$1,355.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,053.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.20
|
| Rate for Payer: Mclaren Medicaid |
$99.17
|
| Rate for Payer: Mclaren Medicare |
$181.30
|
| Rate for Payer: Meridian Medicaid |
$104.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$190.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,279.76
|
| Rate for Payer: PACE Medicare |
$172.24
|
| Rate for Payer: PACE SWMI |
$181.30
|
| Rate for Payer: PHP Commercial |
$1,279.76
|
| Rate for Payer: PHP Medicare Advantage |
$181.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$489.52
|
| Rate for Payer: Priority Health Medicare |
$181.30
|
| Rate for Payer: Priority Health Narrow Network |
$391.62
|
| Rate for Payer: Priority Health SBD |
$948.53
|
| Rate for Payer: Railroad Medicare Medicare |
$181.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.30
|
| Rate for Payer: UHC Medicare Advantage |
$186.74
|
| Rate for Payer: UMR Bronson Commercial |
$557.07
|
| Rate for Payer: VA VA |
$181.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.20
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$1,505.60
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$1,355.04 |
| Rate for Payer: Aetna American Axle |
$978.64
|
| Rate for Payer: Aetna Commercial |
$1,279.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.64
|
| Rate for Payer: Cash Price |
$1,204.48
|
| Rate for Payer: Cofinity Commercial |
$1,053.92
|
| Rate for Payer: Cofinity Commercial |
$1,294.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.48
|
| Rate for Payer: Healthscope Commercial |
$1,355.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,053.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,279.76
|
| Rate for Payer: PHP Commercial |
$1,279.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.92
|
| Rate for Payer: Priority Health SBD |
$948.53
|
| Rate for Payer: UMR Bronson Commercial |
$662.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.20
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$1,094.40
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
33669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.17 |
| Max. Negotiated Rate |
$984.96 |
| Rate for Payer: Aetna American Axle |
$711.36
|
| Rate for Payer: Aetna American Axle |
$730.08
|
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Commercial |
$930.24
|
| Rate for Payer: Aetna Medicare |
$188.55
|
| Rate for Payer: Aetna Medicare |
$188.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.63
|
| Rate for Payer: BCBS Complete |
$104.14
|
| Rate for Payer: BCBS Complete |
$104.14
|
| Rate for Payer: BCBS MAPPO |
$181.30
|
| Rate for Payer: BCBS MAPPO |
$181.30
|
| Rate for Payer: BCBS Trust/PPO |
$607.57
|
| Rate for Payer: BCBS Trust/PPO |
$607.57
|
| Rate for Payer: BCN Medicare Advantage |
$181.30
|
| Rate for Payer: BCN Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$875.52
|
| Rate for Payer: Cash Price |
$898.56
|
| Rate for Payer: Cash Price |
$898.56
|
| Rate for Payer: Cash Price |
$875.52
|
| Rate for Payer: Cofinity Commercial |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$786.24
|
| Rate for Payer: Cofinity Commercial |
$965.95
|
| Rate for Payer: Cofinity Commercial |
$941.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.30
|
| Rate for Payer: Healthscope Commercial |
$1,010.88
|
| Rate for Payer: Healthscope Commercial |
$984.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$766.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.40
|
| Rate for Payer: Mclaren Medicaid |
$99.17
|
| Rate for Payer: Mclaren Medicaid |
$99.17
|
| Rate for Payer: Mclaren Medicare |
$181.30
|
| Rate for Payer: Mclaren Medicare |
$181.30
|
| Rate for Payer: Meridian Medicaid |
$104.14
|
| Rate for Payer: Meridian Medicaid |
$104.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$190.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$190.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$954.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$930.24
|
| Rate for Payer: PACE Medicare |
$172.24
|
| Rate for Payer: PACE Medicare |
$172.24
|
| Rate for Payer: PACE SWMI |
$181.30
|
| Rate for Payer: PACE SWMI |
$181.30
|
| Rate for Payer: PHP Commercial |
$954.72
|
| Rate for Payer: PHP Commercial |
$930.24
|
| Rate for Payer: PHP Medicare Advantage |
$181.30
|
| Rate for Payer: PHP Medicare Advantage |
$181.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$766.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$489.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$489.52
|
| Rate for Payer: Priority Health Medicare |
$181.30
|
| Rate for Payer: Priority Health Medicare |
$181.30
|
| Rate for Payer: Priority Health Narrow Network |
$391.62
|
| Rate for Payer: Priority Health Narrow Network |
$391.62
|
| Rate for Payer: Priority Health SBD |
$707.62
|
| Rate for Payer: Priority Health SBD |
$689.47
|
| Rate for Payer: Railroad Medicare Medicare |
$181.30
|
| Rate for Payer: Railroad Medicare Medicare |
$181.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.30
|
| Rate for Payer: UHC Medicare Advantage |
$186.74
|
| Rate for Payer: UHC Medicare Advantage |
$186.74
|
| Rate for Payer: UMR Bronson Commercial |
$404.93
|
| Rate for Payer: UMR Bronson Commercial |
$415.58
|
| Rate for Payer: VA VA |
$181.30
|
| Rate for Payer: VA VA |
$181.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.40
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$1,123.20
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
33669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$494.21 |
| Max. Negotiated Rate |
$1,010.88 |
| Rate for Payer: Aetna American Axle |
$730.08
|
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.08
|
| Rate for Payer: Cash Price |
$898.56
|
| Rate for Payer: Cofinity Commercial |
$786.24
|
| Rate for Payer: Cofinity Commercial |
$965.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.56
|
| Rate for Payer: Healthscope Commercial |
$1,010.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$954.72
|
| Rate for Payer: PHP Commercial |
$954.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.24
|
| Rate for Payer: Priority Health SBD |
$707.62
|
| Rate for Payer: UMR Bronson Commercial |
$494.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.40
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$2,007.46
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$1,806.71 |
| Rate for Payer: Aetna American Axle |
$1,304.85
|
| Rate for Payer: Aetna Commercial |
$1,706.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,304.85
|
| Rate for Payer: Cash Price |
$1,605.97
|
| Rate for Payer: Cofinity Commercial |
$1,405.22
|
| Rate for Payer: Cofinity Commercial |
$1,726.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,605.97
|
| Rate for Payer: Healthscope Commercial |
$1,806.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,405.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,505.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,706.34
|
| Rate for Payer: PHP Commercial |
$1,706.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.22
|
| Rate for Payer: Priority Health SBD |
$1,264.70
|
| Rate for Payer: UMR Bronson Commercial |
$883.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,505.60
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$2,007.46
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.17 |
| Max. Negotiated Rate |
$1,806.71 |
| Rate for Payer: Aetna American Axle |
$1,304.85
|
| Rate for Payer: Aetna Commercial |
$1,706.34
|
| Rate for Payer: Aetna Medicare |
$188.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,304.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$226.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$226.63
|
| Rate for Payer: BCBS Complete |
$104.14
|
| Rate for Payer: BCBS MAPPO |
$181.30
|
| Rate for Payer: BCBS Trust/PPO |
$607.57
|
| Rate for Payer: BCN Medicare Advantage |
$181.30
|
| Rate for Payer: Cash Price |
$1,605.97
|
| Rate for Payer: Cash Price |
$1,605.97
|
| Rate for Payer: Cofinity Commercial |
$1,405.22
|
| Rate for Payer: Cofinity Commercial |
$1,726.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,605.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.30
|
| Rate for Payer: Healthscope Commercial |
$1,806.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,405.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,505.60
|
| Rate for Payer: Mclaren Medicaid |
$99.17
|
| Rate for Payer: Mclaren Medicare |
$181.30
|
| Rate for Payer: Meridian Medicaid |
$104.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$190.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,706.34
|
| Rate for Payer: PACE Medicare |
$172.24
|
| Rate for Payer: PACE SWMI |
$181.30
|
| Rate for Payer: PHP Commercial |
$1,706.34
|
| Rate for Payer: PHP Medicare Advantage |
$181.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$489.52
|
| Rate for Payer: Priority Health Medicare |
$181.30
|
| Rate for Payer: Priority Health Narrow Network |
$391.62
|
| Rate for Payer: Priority Health SBD |
$1,264.70
|
| Rate for Payer: Railroad Medicare Medicare |
$181.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.30
|
| Rate for Payer: UHC Medicare Advantage |
$186.74
|
| Rate for Payer: UMR Bronson Commercial |
$742.76
|
| Rate for Payer: VA VA |
$181.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,505.60
|
|
|
LEUPROLIDE 30 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$29,931.88
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,170.03 |
| Max. Negotiated Rate |
$26,938.69 |
| Rate for Payer: Aetna American Axle |
$19,455.72
|
| Rate for Payer: Aetna Commercial |
$25,442.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,455.72
|
| Rate for Payer: Cash Price |
$23,945.50
|
| Rate for Payer: Cofinity Commercial |
$20,952.32
|
| Rate for Payer: Cofinity Commercial |
$25,741.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.50
|
| Rate for Payer: Healthscope Commercial |
$26,938.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,952.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,448.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25,442.10
|
| Rate for Payer: PHP Commercial |
$25,442.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,952.32
|
| Rate for Payer: Priority Health SBD |
$18,857.08
|
| Rate for Payer: UMR Bronson Commercial |
$13,170.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,448.91
|
|
|
LEUPROLIDE 30 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$29,931.88
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$855.84 |
| Max. Negotiated Rate |
$26,938.69 |
| Rate for Payer: Aetna American Axle |
$19,455.72
|
| Rate for Payer: Aetna Commercial |
$25,442.10
|
| Rate for Payer: Aetna Medicare |
$1,627.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,455.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,056.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$23,945.50
|
| Rate for Payer: Cash Price |
$23,945.50
|
| Rate for Payer: Cofinity Commercial |
$20,952.32
|
| Rate for Payer: Cofinity Commercial |
$25,741.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Healthscope Commercial |
$26,938.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,952.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,448.91
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25,442.10
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PHP Commercial |
$25,442.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,952.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.78
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,581.42
|
| Rate for Payer: Priority Health SBD |
$18,857.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: UMR Bronson Commercial |
$11,074.80
|
| Rate for Payer: VA VA |
$1,564.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,448.91
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$5,104.87
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
13691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$855.84 |
| Max. Negotiated Rate |
$5,056.07 |
| Rate for Payer: Aetna American Axle |
$3,318.17
|
| Rate for Payer: Aetna Commercial |
$4,339.14
|
| Rate for Payer: Aetna Medicare |
$1,627.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,318.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,955.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,955.76
|
| Rate for Payer: BCBS Complete |
$898.71
|
| Rate for Payer: BCBS MAPPO |
$1,564.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,056.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,564.60
|
| Rate for Payer: Cash Price |
$4,083.90
|
| Rate for Payer: Cash Price |
$4,083.90
|
| Rate for Payer: Cofinity Commercial |
$3,573.41
|
| Rate for Payer: Cofinity Commercial |
$4,390.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,083.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,564.60
|
| Rate for Payer: Healthscope Commercial |
$4,594.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,573.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,828.65
|
| Rate for Payer: Mclaren Medicaid |
$855.84
|
| Rate for Payer: Mclaren Medicare |
$1,564.60
|
| Rate for Payer: Meridian Medicaid |
$898.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,642.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,799.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,339.14
|
| Rate for Payer: PACE Medicare |
$1,486.37
|
| Rate for Payer: PACE SWMI |
$1,564.60
|
| Rate for Payer: PHP Commercial |
$4,339.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,564.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$855.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,573.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,476.78
|
| Rate for Payer: Priority Health Medicare |
$1,564.60
|
| Rate for Payer: Priority Health Narrow Network |
$3,581.42
|
| Rate for Payer: Priority Health SBD |
$3,216.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1,564.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,564.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,611.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,888.80
|
| Rate for Payer: VA VA |
$1,564.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,828.65
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$5,104.87
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
13691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,246.14 |
| Max. Negotiated Rate |
$4,594.38 |
| Rate for Payer: Aetna American Axle |
$3,318.17
|
| Rate for Payer: Aetna Commercial |
$4,339.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,318.17
|
| Rate for Payer: Cash Price |
$4,083.90
|
| Rate for Payer: Cofinity Commercial |
$3,573.41
|
| Rate for Payer: Cofinity Commercial |
$4,390.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,083.90
|
| Rate for Payer: Healthscope Commercial |
$4,594.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,573.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,828.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,339.14
|
| Rate for Payer: PHP Commercial |
$4,339.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,573.41
|
| Rate for Payer: Priority Health SBD |
$3,216.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,246.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,828.65
|
|
