|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$861.95
|
|
|
Service Code
|
NDC 00013830304
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$379.26 |
| Max. Negotiated Rate |
$775.75 |
| Rate for Payer: Aetna American Axle |
$560.27
|
| Rate for Payer: Aetna Commercial |
$732.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.27
|
| Rate for Payer: Cash Price |
$689.56
|
| Rate for Payer: Cofinity Advantage |
$603.37
|
| Rate for Payer: Cofinity Commercial |
$741.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.56
|
| Rate for Payer: Healthscope Commercial |
$775.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$646.46
|
| Rate for Payer: PHP Commercial |
$732.66
|
| Rate for Payer: Priority Health SBD |
$543.03
|
| Rate for Payer: UMR Bronson Commercial |
$379.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.46
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
NDC 24208046325
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna Medicare |
$14.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Advantage |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.47
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: UHC Exchange |
$11.77
|
| Rate for Payer: UMR Bronson Commercial |
$11.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
NDC 50268047811
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Advantage |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.21
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$527.25
|
|
|
Service Code
|
NDC 00955173730
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.08 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna American Axle |
$342.71
|
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna Medicare |
$263.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: BCBS Complete |
$210.90
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Advantage |
$369.07
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.80
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.44
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health SBD |
$332.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.71
|
| Rate for Payer: UHC Core |
$274.70
|
| Rate for Payer: UHC Exchange |
$207.21
|
| Rate for Payer: UMR Bronson Commercial |
$195.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.44
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$413.76
|
|
|
Service Code
|
NDC 50268047815
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.09 |
| Max. Negotiated Rate |
$372.38 |
| Rate for Payer: Aetna American Axle |
$268.94
|
| Rate for Payer: Aetna Commercial |
$351.70
|
| Rate for Payer: Aetna Medicare |
$206.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.94
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Cofinity Advantage |
$289.63
|
| Rate for Payer: Cofinity Commercial |
$355.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.01
|
| Rate for Payer: Healthscope Commercial |
$372.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.32
|
| Rate for Payer: PHP Commercial |
$351.70
|
| Rate for Payer: Priority Health SBD |
$260.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.94
|
| Rate for Payer: UHC Core |
$215.57
|
| Rate for Payer: UHC Exchange |
$162.61
|
| Rate for Payer: UMR Bronson Commercial |
$153.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.32
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$527.25
|
|
|
Service Code
|
NDC 00955173730
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna American Axle |
$342.71
|
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Advantage |
$369.07
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.80
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.44
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health SBD |
$332.17
|
| Rate for Payer: UMR Bronson Commercial |
$231.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.44
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$285.61
|
|
|
Service Code
|
NDC 60505250301
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$257.05 |
| Rate for Payer: Aetna American Axle |
$185.65
|
| Rate for Payer: Aetna Commercial |
$242.77
|
| Rate for Payer: Aetna Medicare |
$142.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.65
|
| Rate for Payer: BCBS Complete |
$114.24
|
| Rate for Payer: Cash Price |
$228.49
|
| Rate for Payer: Cofinity Advantage |
$199.93
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.49
|
| Rate for Payer: Healthscope Commercial |
$257.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.21
|
| Rate for Payer: PHP Commercial |
$242.77
|
| Rate for Payer: Priority Health SBD |
$179.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.65
|
| Rate for Payer: UHC Core |
$148.80
|
| Rate for Payer: UHC Exchange |
$112.24
|
| Rate for Payer: UMR Bronson Commercial |
$105.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.21
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$94.04
|
|
|
Service Code
|
NDC 23155004403
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna American Axle |
$61.13
|
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: BCBS Complete |
$37.62
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.23
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.53
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.13
|
| Rate for Payer: UHC Core |
$48.99
|
| Rate for Payer: UHC Exchange |
$36.96
|
| Rate for Payer: UMR Bronson Commercial |
$34.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.53
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
NDC 50268047811
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Advantage |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.21
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.38
|
| Rate for Payer: UHC Core |
$4.31
|
| Rate for Payer: UHC Exchange |
$3.25
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$94.04
|
|
|
Service Code
|
NDC 23155004403
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna American Axle |
$61.13
|
| Rate for Payer: Aetna Commercial |
$79.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$75.23
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.23
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.53
|
| Rate for Payer: PHP Commercial |
$79.93
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: UMR Bronson Commercial |
$41.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.53
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$413.76
|
|
|
Service Code
|
NDC 50268047815
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.05 |
| Max. Negotiated Rate |
$372.38 |
| Rate for Payer: Aetna American Axle |
$268.94
|
| Rate for Payer: Aetna Commercial |
$351.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.94
|
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Cofinity Advantage |
$289.63
|
| Rate for Payer: Cofinity Commercial |
$355.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.01
|
| Rate for Payer: Healthscope Commercial |
$372.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.32
|
| Rate for Payer: PHP Commercial |
$351.70
|
| Rate for Payer: Priority Health SBD |
$260.67
|
| Rate for Payer: UMR Bronson Commercial |
$182.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.32
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$285.61
|
|
|
Service Code
|
NDC 60505250301
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$257.05 |
| Rate for Payer: Aetna American Axle |
$185.65
|
| Rate for Payer: Aetna Commercial |
$242.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.65
|
| Rate for Payer: Cash Price |
$228.49
|
| Rate for Payer: Cofinity Advantage |
$199.93
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.49
|
| Rate for Payer: Healthscope Commercial |
$257.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.21
|
| Rate for Payer: PHP Commercial |
$242.77
|
| Rate for Payer: Priority Health SBD |
$179.93
|
| Rate for Payer: UMR Bronson Commercial |
$125.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.21
|
|
|
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; MULTIPLE TENDONS (THROUGH SAME INCISION), EACH
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$5,621.04
|
| Rate for Payer: BCN Commercial |
$5,621.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$3,026.86
|
|
|
Service Code
|
NDC 00078024915
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,331.82 |
| Max. Negotiated Rate |
$2,724.17 |
| Rate for Payer: Aetna American Axle |
$1,967.46
|
| Rate for Payer: Aetna Commercial |
$2,572.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,967.46
|
| Rate for Payer: Cash Price |
$2,421.49
|
| Rate for Payer: Cofinity Advantage |
$2,118.80
|
| Rate for Payer: Cofinity Commercial |
$2,603.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,421.49
|
| Rate for Payer: Healthscope Commercial |
$2,724.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,270.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,572.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,270.14
|
| Rate for Payer: PHP Commercial |
$2,572.83
|
| Rate for Payer: Priority Health SBD |
$1,906.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,331.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,270.14
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$3.99
|
|
|
Service Code
|
NDC 50268047611
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna American Axle |
$2.59
|
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC Core |
$2.08
|
| Rate for Payer: UHC Exchange |
$1.57
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$98.70
|
|
|
Service Code
|
NDC 16729003410
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna Medicare |
$49.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: BCBS Complete |
$39.48
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Advantage |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.03
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.16
|
| Rate for Payer: UHC Core |
$51.42
|
| Rate for Payer: UHC Exchange |
$38.79
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
NDC 50268047615
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.81 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna Medicare |
$99.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: BCBS Complete |
$79.80
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Advantage |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health SBD |
$125.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.68
|
| Rate for Payer: UHC Core |
$103.94
|
| Rate for Payer: UHC Exchange |
$78.40
|
| Rate for Payer: UMR Bronson Commercial |
$73.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 16729003410
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Advantage |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.03
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 50268047611
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna American Axle |
$2.59
|
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 51991075933
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Advantage |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.96
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.03
|
| Rate for Payer: UHC Core |
$56.93
|
| Rate for Payer: UHC Exchange |
$42.95
|
| Rate for Payer: UMR Bronson Commercial |
$40.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
NDC 00093762056
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna American Axle |
$51.69
|
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| Rate for Payer: BCBS Complete |
$31.81
|
| Rate for Payer: Cash Price |
$63.62
|
| Rate for Payer: Cofinity Advantage |
$55.66
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.62
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.64
|
| Rate for Payer: PHP Commercial |
$67.59
|
| Rate for Payer: Priority Health SBD |
$50.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.69
|
| Rate for Payer: UHC Core |
$41.43
|
| Rate for Payer: UHC Exchange |
$31.25
|
| Rate for Payer: UMR Bronson Commercial |
$29.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.64
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 50268047615
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Advantage |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.62
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health SBD |
$125.69
|
| Rate for Payer: UMR Bronson Commercial |
$87.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$109.28
|
|
|
Service Code
|
NDC 51991075933
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.08 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Advantage |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.96
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UMR Bronson Commercial |
$48.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$3,026.86
|
|
|
Service Code
|
NDC 00078024915
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,119.94 |
| Max. Negotiated Rate |
$2,724.17 |
| Rate for Payer: Aetna American Axle |
$1,967.46
|
| Rate for Payer: Aetna Commercial |
$2,572.83
|
| Rate for Payer: Aetna Medicare |
$1,513.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,967.46
|
| Rate for Payer: BCBS Complete |
$1,210.74
|
| Rate for Payer: Cash Price |
$2,421.49
|
| Rate for Payer: Cofinity Advantage |
$2,118.80
|
| Rate for Payer: Cofinity Commercial |
$2,603.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,421.49
|
| Rate for Payer: Healthscope Commercial |
$2,724.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,270.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,421.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,572.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,270.14
|
| Rate for Payer: PHP Commercial |
$2,572.83
|
| Rate for Payer: Priority Health SBD |
$1,906.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,967.46
|
| Rate for Payer: UHC Core |
$1,576.99
|
| Rate for Payer: UHC Exchange |
$1,189.56
|
| Rate for Payer: UMR Bronson Commercial |
$1,119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,270.14
|
|
