|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
NDC 00093762056
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna American Axle |
$51.69
|
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| 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: 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: UMR Bronson Commercial |
$34.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.64
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$26.93
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$24.24 |
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$24.59
|
| 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 Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: Aetna Medicare |
$14.27
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna Medicare |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS Complete |
$11.41
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Complete |
$33.09
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cofinity Advantage |
$26.48
|
| Rate for Payer: Cofinity Advantage |
$19.97
|
| Rate for Payer: Cofinity Advantage |
$20.00
|
| Rate for Payer: Cofinity Advantage |
$57.91
|
| Rate for Payer: Cofinity Advantage |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.97
|
| 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 |
$26.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.05
|
| Rate for Payer: PHP Commercial |
$24.25
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$14.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| Rate for Payer: UMR Bronson Commercial |
$30.61
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$82.73
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$74.46 |
| Rate for Payer: Aetna American Axle |
$53.77
|
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$18.54
|
| Rate for Payer: Aetna American Axle |
$24.59
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Advantage |
$57.91
|
| Rate for Payer: Cofinity Advantage |
$20.00
|
| Rate for Payer: Cofinity Advantage |
$18.85
|
| Rate for Payer: Cofinity Advantage |
$19.97
|
| Rate for Payer: Cofinity Advantage |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.18
|
| 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 |
$21.54
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.48
|
| 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 |
$19.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.05
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.25
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: UMR Bronson Commercial |
$36.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: UMR Bronson Commercial |
$12.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
|
|
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 Advantage |
$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 |
$50.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.27
|
| Rate for Payer: PHP Commercial |
$56.97
|
| 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 |
$50.27
|
|
|
LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$38.99
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
15426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$35.09 |
| Rate for Payer: Aetna American Axle |
$25.34
|
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna American Axle |
$35.00
|
| Rate for Payer: Aetna American Axle |
$37.20
|
| Rate for Payer: Aetna American Axle |
$43.56
|
| Rate for Payer: Aetna American Axle |
$45.73
|
| Rate for Payer: Aetna Commercial |
$45.77
|
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$56.97
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Aetna Medicare |
$33.51
|
| Rate for Payer: Aetna Medicare |
$26.93
|
| Rate for Payer: Aetna Medicare |
$35.18
|
| Rate for Payer: Aetna Medicare |
$82.75
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.00
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS Complete |
$28.14
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$26.81
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$56.29
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cash Price |
$43.08
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cash Price |
$43.08
|
| Rate for Payer: Cash Price |
$56.29
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cofinity Advantage |
$27.29
|
| Rate for Payer: Cofinity Advantage |
$115.85
|
| Rate for Payer: Cofinity Advantage |
$37.70
|
| Rate for Payer: Cofinity Advantage |
$40.06
|
| Rate for Payer: Cofinity Advantage |
$46.91
|
| Rate for Payer: Cofinity Advantage |
$49.25
|
| Rate for Payer: Cofinity Commercial |
$60.51
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Cofinity Commercial |
$46.31
|
| Rate for Payer: Cofinity Commercial |
$49.22
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.08
|
| Rate for Payer: Healthscope Commercial |
$63.32
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Healthscope Commercial |
$60.32
|
| Rate for Payer: Healthscope Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Healthscope Commercial |
$51.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.27
|
| Rate for Payer: PHP Commercial |
$48.65
|
| Rate for Payer: PHP Commercial |
$56.97
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$33.14
|
| Rate for Payer: PHP Commercial |
$45.77
|
| Rate for Payer: PHP Commercial |
$59.81
|
| Rate for Payer: Priority Health SBD |
$104.27
|
| Rate for Payer: Priority Health SBD |
$36.05
|
| Rate for Payer: Priority Health SBD |
$44.33
|
| Rate for Payer: Priority Health SBD |
$42.22
|
| Rate for Payer: Priority Health SBD |
$33.93
|
| Rate for Payer: Priority Health SBD |
$24.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UMR Bronson Commercial |
$61.23
|
| Rate for Payer: UMR Bronson Commercial |
$21.18
|
| Rate for Payer: UMR Bronson Commercial |
$19.92
|
| Rate for Payer: UMR Bronson Commercial |
$24.80
|
| Rate for Payer: UMR Bronson Commercial |
$14.43
|
| Rate for Payer: UMR Bronson Commercial |
$26.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.27
|
|
|
LEUCOVORIN CALCIUM 25 MG TABLET
|
Facility
|
OP
|
$769.14
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$692.23 |
| Rate for Payer: Aetna American Axle |
$499.94
|
| Rate for Payer: Aetna American Axle |
$18.84
|
| Rate for Payer: Aetna American Axle |
$340.12
|
| Rate for Payer: Aetna American Axle |
$376.62
|
| Rate for Payer: Aetna Commercial |
$653.77
|
| Rate for Payer: Aetna Commercial |
$492.51
|
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Aetna Commercial |
$444.77
|
| Rate for Payer: Aetna Medicare |
$289.71
|
| Rate for Payer: Aetna Medicare |
$261.63
|
| Rate for Payer: Aetna Medicare |
$384.57
|
| Rate for Payer: Aetna Medicare |
$14.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.62
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS Complete |
$209.30
|
| Rate for Payer: BCBS Complete |
$231.77
|
| Rate for Payer: BCBS Complete |
$307.66
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$463.54
|
| Rate for Payer: Cash Price |
$615.31
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$615.31
|
| Rate for Payer: Cash Price |
$463.54
|
| Rate for Payer: Cash Price |
$418.61
|
| Rate for Payer: Cash Price |
$418.61
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Advantage |
$538.40
|
| Rate for Payer: Cofinity Advantage |
$405.59
|
| Rate for Payer: Cofinity Advantage |
$366.28
|
| Rate for Payer: Cofinity Advantage |
$20.29
|
| Rate for Payer: Cofinity Commercial |
$450.00
|
| Rate for Payer: Cofinity Commercial |
$498.30
|
| Rate for Payer: Cofinity Commercial |
$661.46
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$615.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$521.48
|
| Rate for Payer: Healthscope Commercial |
$26.08
|
| Rate for Payer: Healthscope Commercial |
$470.93
|
| Rate for Payer: Healthscope Commercial |
$692.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$538.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$576.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$615.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$418.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$463.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$653.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$434.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$392.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$576.86
|
| Rate for Payer: PHP Commercial |
$24.63
|
| Rate for Payer: PHP Commercial |
$492.51
|
| Rate for Payer: PHP Commercial |
$653.77
|
| Rate for Payer: PHP Commercial |
$444.77
|
| Rate for Payer: Priority Health SBD |
$365.03
|
| Rate for Payer: Priority Health SBD |
$18.26
|
| Rate for Payer: Priority Health SBD |
$329.65
|
| Rate for Payer: Priority Health SBD |
$484.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UMR Bronson Commercial |
$284.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.72
|
| Rate for Payer: UMR Bronson Commercial |
$193.61
|
| Rate for Payer: UMR Bronson Commercial |
$214.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$576.86
|
|
|
LEUCOVORIN CALCIUM 25 MG TABLET
|
Facility
|
IP
|
$579.42
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.94 |
| Max. Negotiated Rate |
$521.48 |
| Rate for Payer: Aetna American Axle |
$376.62
|
| Rate for Payer: Aetna American Axle |
$340.12
|
| Rate for Payer: Aetna American Axle |
$499.94
|
| Rate for Payer: Aetna American Axle |
$18.84
|
| Rate for Payer: Aetna Commercial |
$653.77
|
| Rate for Payer: Aetna Commercial |
$492.51
|
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Aetna Commercial |
$444.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.84
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$615.31
|
| Rate for Payer: Cash Price |
$418.61
|
| Rate for Payer: Cash Price |
$463.54
|
| Rate for Payer: Cofinity Advantage |
$366.28
|
| Rate for Payer: Cofinity Advantage |
$20.29
|
| Rate for Payer: Cofinity Advantage |
$405.59
|
| Rate for Payer: Cofinity Advantage |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$498.30
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$450.00
|
| Rate for Payer: Cofinity Commercial |
$661.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$615.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.61
|
| Rate for Payer: Healthscope Commercial |
$470.93
|
| Rate for Payer: Healthscope Commercial |
$692.23
|
| Rate for Payer: Healthscope Commercial |
$521.48
|
| Rate for Payer: Healthscope Commercial |
$26.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$538.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$576.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$653.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$576.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$392.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$434.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: PHP Commercial |
$24.63
|
| Rate for Payer: PHP Commercial |
$492.51
|
| Rate for Payer: PHP Commercial |
$444.77
|
| Rate for Payer: PHP Commercial |
$653.77
|
| Rate for Payer: Priority Health SBD |
$484.56
|
| Rate for Payer: Priority Health SBD |
$18.26
|
| Rate for Payer: Priority Health SBD |
$365.03
|
| Rate for Payer: Priority Health SBD |
$329.65
|
| Rate for Payer: UMR Bronson Commercial |
$230.23
|
| Rate for Payer: UMR Bronson Commercial |
$254.94
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| Rate for Payer: UMR Bronson Commercial |
$338.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$576.86
|
|
|
LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$165.54
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
23617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$148.99 |
| Rate for Payer: Aetna American Axle |
$107.60
|
| Rate for Payer: Aetna American Axle |
$167.39
|
| Rate for Payer: Aetna American Axle |
$121.02
|
| Rate for Payer: Aetna Commercial |
$218.89
|
| Rate for Payer: Aetna Commercial |
$158.26
|
| Rate for Payer: Aetna Commercial |
$140.71
|
| Rate for Payer: Aetna Medicare |
$128.76
|
| Rate for Payer: Aetna Medicare |
$82.77
|
| Rate for Payer: Aetna Medicare |
$93.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.60
|
| Rate for Payer: BCBS Complete |
$103.01
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS Complete |
$66.22
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$206.02
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$206.02
|
| Rate for Payer: Cofinity Advantage |
$115.88
|
| Rate for Payer: Cofinity Advantage |
$180.26
|
| Rate for Payer: Cofinity Advantage |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$142.36
|
| Rate for Payer: Cofinity Commercial |
$221.47
|
| Rate for Payer: Cofinity Commercial |
$160.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.02
|
| Rate for Payer: Healthscope Commercial |
$231.77
|
| Rate for Payer: Healthscope Commercial |
$167.57
|
| Rate for Payer: Healthscope Commercial |
$148.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.64
|
| Rate for Payer: PHP Commercial |
$158.26
|
| Rate for Payer: PHP Commercial |
$218.89
|
| Rate for Payer: PHP Commercial |
$140.71
|
| Rate for Payer: Priority Health SBD |
$104.29
|
| Rate for Payer: Priority Health SBD |
$117.30
|
| Rate for Payer: Priority Health SBD |
$162.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UMR Bronson Commercial |
$68.89
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.64
|
|
|
LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$186.19
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
23617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.92 |
| Max. Negotiated Rate |
$167.57 |
| Rate for Payer: Aetna American Axle |
$121.02
|
| Rate for Payer: Aetna Commercial |
$158.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.02
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cofinity Advantage |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$160.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.95
|
| Rate for Payer: Healthscope Commercial |
$167.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.64
|
| Rate for Payer: PHP Commercial |
$158.26
|
| Rate for Payer: Priority Health SBD |
$117.30
|
| Rate for Payer: UMR Bronson Commercial |
$81.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.64
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET
|
Facility
|
OP
|
$5.56
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$12.44 |
| Rate for Payer: Aetna American Axle |
$3.61
|
| Rate for Payer: Aetna American Axle |
$79.38
|
| Rate for Payer: Aetna American Axle |
$97.25
|
| Rate for Payer: Aetna American Axle |
$180.65
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna Commercial |
$236.23
|
| Rate for Payer: Aetna Commercial |
$103.80
|
| Rate for Payer: Aetna Commercial |
$127.18
|
| Rate for Payer: Aetna Medicare |
$138.96
|
| Rate for Payer: Aetna Medicare |
$74.81
|
| Rate for Payer: Aetna Medicare |
$2.78
|
| Rate for Payer: Aetna Medicare |
$61.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.65
|
| Rate for Payer: BCBS Complete |
$48.85
|
| Rate for Payer: BCBS Complete |
$59.85
|
| Rate for Payer: BCBS Complete |
$111.17
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cash Price |
$97.70
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$97.70
|
| Rate for Payer: Cofinity Advantage |
$3.89
|
| Rate for Payer: Cofinity Advantage |
$194.54
|
| Rate for Payer: Cofinity Advantage |
$104.73
|
| Rate for Payer: Cofinity Advantage |
$85.48
|
| Rate for Payer: Cofinity Commercial |
$128.67
|
| Rate for Payer: Cofinity Commercial |
$239.01
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$105.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.70
|
| Rate for Payer: Healthscope Commercial |
$250.13
|
| Rate for Payer: Healthscope Commercial |
$109.91
|
| Rate for Payer: Healthscope Commercial |
$134.66
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.48
|
| 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 |
$208.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.17
|
| Rate for Payer: PHP Commercial |
$103.80
|
| 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 SBD |
$175.09
|
| Rate for Payer: Priority Health SBD |
$76.94
|
| Rate for Payer: Priority Health SBD |
$94.26
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Core |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| Rate for Payer: UMR Bronson Commercial |
$45.18
|
| Rate for Payer: UMR Bronson Commercial |
$55.36
|
| Rate for Payer: UMR Bronson Commercial |
$102.83
|
| 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 |
$91.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.17
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET
|
Facility
|
IP
|
$277.92
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.28 |
| Max. Negotiated Rate |
$250.13 |
| Rate for Payer: Aetna American Axle |
$180.65
|
| Rate for Payer: Aetna American Axle |
$97.25
|
| Rate for Payer: Aetna American Axle |
$3.61
|
| Rate for Payer: Aetna American Axle |
$79.38
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna Commercial |
$236.23
|
| Rate for Payer: Aetna Commercial |
$103.80
|
| Rate for Payer: Aetna Commercial |
$127.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| 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) |
$79.38
|
| Rate for Payer: Cash Price |
$97.70
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cofinity Advantage |
$104.73
|
| Rate for Payer: Cofinity Advantage |
$85.48
|
| Rate for Payer: Cofinity Advantage |
$194.54
|
| Rate for Payer: Cofinity Advantage |
$3.89
|
| Rate for Payer: Cofinity Commercial |
$239.01
|
| Rate for Payer: Cofinity Commercial |
$105.02
|
| Rate for Payer: Cofinity Commercial |
$128.67
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.70
|
| Rate for Payer: Healthscope Commercial |
$134.66
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$250.13
|
| Rate for Payer: Healthscope Commercial |
$109.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.73
|
| 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: Lakeland Regional Health Systems Commercial |
$91.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.59
|
| Rate for Payer: PHP Commercial |
$103.80
|
| Rate for Payer: PHP Commercial |
$236.23
|
| Rate for Payer: PHP Commercial |
$127.18
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: Priority Health SBD |
$76.94
|
| 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 |
$53.73
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.59
|
| 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 INTRAMUSCULAR KIT
|
Facility
|
OP
|
$22,606.73
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$20,346.06 |
| Rate for Payer: Aetna American Axle |
$14,694.37
|
| Rate for Payer: Aetna Commercial |
$19,215.72
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,694.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,206.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,206.96
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,719.58
|
| Rate for Payer: BCN Commercial |
$5,719.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$18,085.38
|
| Rate for Payer: Cash Price |
$18,085.38
|
| Rate for Payer: Cofinity Advantage |
$15,824.71
|
| Rate for Payer: Cofinity Commercial |
$19,441.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,085.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$20,346.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,824.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,955.05
|
| Rate for Payer: Mclaren Medicaid |
$1,765.57
|
| Rate for Payer: Mclaren Medicare |
$1,765.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Meridian Medicaid |
$1,853.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,030.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,215.72
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,955.05
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$19,215.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,457.38
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health SBD |
$14,242.24
|
| Rate for Payer: Priority Health Tiered Network |
$4,365.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,910.39
|
| Rate for Payer: UHC Core |
$2,910.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,910.39
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP Medicaid |
$923.39
|
| Rate for Payer: UMR Bronson Commercial |
$8,364.49
|
| Rate for Payer: VA VA |
$1,765.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,955.05
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT
|
Facility
|
IP
|
$22,606.73
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,946.96 |
| Max. Negotiated Rate |
$20,346.06 |
| Rate for Payer: Aetna American Axle |
$14,694.37
|
| Rate for Payer: Aetna Commercial |
$19,215.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,694.37
|
| Rate for Payer: Cash Price |
$18,085.38
|
| Rate for Payer: Cofinity Advantage |
$15,824.71
|
| Rate for Payer: Cofinity Commercial |
$19,441.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,085.38
|
| Rate for Payer: Healthscope Commercial |
$20,346.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,824.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,955.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,215.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,955.05
|
| Rate for Payer: PHP Commercial |
$19,215.72
|
| Rate for Payer: Priority Health SBD |
$14,242.24
|
| Rate for Payer: UMR Bronson Commercial |
$9,946.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,955.05
|
|
|
LEUPROLIDE 11.25 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$22,606.73
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,946.96 |
| Max. Negotiated Rate |
$20,346.06 |
| Rate for Payer: Aetna American Axle |
$14,694.37
|
| Rate for Payer: Aetna Commercial |
$19,215.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,694.37
|
| Rate for Payer: Cash Price |
$18,085.38
|
| Rate for Payer: Cofinity Advantage |
$15,824.71
|
| Rate for Payer: Cofinity Commercial |
$19,441.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,085.38
|
| Rate for Payer: Healthscope Commercial |
$20,346.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,824.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,955.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,215.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,955.05
|
| Rate for Payer: PHP Commercial |
$19,215.72
|
| Rate for Payer: Priority Health SBD |
$14,242.24
|
| Rate for Payer: UMR Bronson Commercial |
$9,946.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,955.05
|
|
|
LEUPROLIDE 11.25 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$22,606.73
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$20,346.06 |
| Rate for Payer: Aetna American Axle |
$14,694.37
|
| Rate for Payer: Aetna Commercial |
$19,215.72
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,694.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,206.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,206.96
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,719.58
|
| Rate for Payer: BCN Commercial |
$5,719.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$18,085.38
|
| Rate for Payer: Cash Price |
$18,085.38
|
| Rate for Payer: Cofinity Advantage |
$15,824.71
|
| Rate for Payer: Cofinity Commercial |
$19,441.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,085.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$20,346.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,824.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,955.05
|
| Rate for Payer: Mclaren Medicaid |
$1,765.57
|
| Rate for Payer: Mclaren Medicare |
$1,765.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Meridian Medicaid |
$1,853.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,030.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,215.72
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,955.05
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$19,215.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,457.38
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health SBD |
$14,242.24
|
| Rate for Payer: Priority Health Tiered Network |
$4,365.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,910.39
|
| Rate for Payer: UHC Core |
$2,910.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,910.39
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP Medicaid |
$923.39
|
| Rate for Payer: UMR Bronson Commercial |
$8,364.49
|
| Rate for Payer: VA VA |
$1,765.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,955.05
|
|
|
LEUPROLIDE 15 MG INTRAMUSCULAR KIT
|
Facility
|
IP
|
$30,142.30
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,262.61 |
| Max. Negotiated Rate |
$27,128.07 |
| Rate for Payer: Aetna American Axle |
$19,592.49
|
| Rate for Payer: Aetna Commercial |
$25,620.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,592.49
|
| Rate for Payer: Cash Price |
$24,113.84
|
| Rate for Payer: Cofinity Advantage |
$21,099.61
|
| Rate for Payer: Cofinity Commercial |
$25,922.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,113.84
|
| Rate for Payer: Healthscope Commercial |
$27,128.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,099.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,606.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,620.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,606.72
|
| Rate for Payer: PHP Commercial |
$25,620.96
|
| Rate for Payer: Priority Health SBD |
$18,989.65
|
| Rate for Payer: UMR Bronson Commercial |
$13,262.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,606.72
|
|
|
LEUPROLIDE 15 MG INTRAMUSCULAR KIT
|
Facility
|
OP
|
$30,142.30
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$27,128.07 |
| Rate for Payer: Aetna American Axle |
$19,592.49
|
| Rate for Payer: Aetna Commercial |
$25,620.96
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,592.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,206.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,206.96
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,719.58
|
| Rate for Payer: BCN Commercial |
$5,719.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$24,113.84
|
| Rate for Payer: Cash Price |
$24,113.84
|
| Rate for Payer: Cofinity Advantage |
$21,099.61
|
| Rate for Payer: Cofinity Commercial |
$25,922.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,113.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$27,128.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,099.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,606.72
|
| Rate for Payer: Mclaren Medicaid |
$1,765.57
|
| Rate for Payer: Mclaren Medicare |
$1,765.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Meridian Medicaid |
$1,853.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,030.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,620.96
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,606.72
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$25,620.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,457.38
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health SBD |
$18,989.65
|
| Rate for Payer: Priority Health Tiered Network |
$4,365.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,910.39
|
| Rate for Payer: UHC Core |
$2,910.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,910.39
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP Medicaid |
$923.39
|
| Rate for Payer: UMR Bronson Commercial |
$11,152.65
|
| Rate for Payer: VA VA |
$1,765.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,606.72
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$2,320.32
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$2,088.29 |
| Rate for Payer: Aetna American Axle |
$1,508.21
|
| Rate for Payer: Aetna Commercial |
$1,972.27
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$574.27
|
| Rate for Payer: BCN Commercial |
$574.27
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: Cash Price |
$1,856.26
|
| Rate for Payer: Cash Price |
$1,856.26
|
| Rate for Payer: Cofinity Advantage |
$1,624.22
|
| Rate for Payer: Cofinity Commercial |
$1,995.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,856.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$2,088.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,624.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,740.24
|
| Rate for Payer: Mclaren Medicaid |
$176.20
|
| Rate for Payer: Mclaren Medicare |
$176.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$185.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,972.27
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,740.24
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$1,972.27
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$556.52
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health SBD |
$1,461.80
|
| Rate for Payer: Priority Health Tiered Network |
$445.22
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.79
|
| Rate for Payer: UHC Core |
$281.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$281.79
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: UMR Bronson Commercial |
$858.52
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,740.24
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$2,320.32
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,020.94 |
| Max. Negotiated Rate |
$2,088.29 |
| Rate for Payer: Aetna American Axle |
$1,508.21
|
| Rate for Payer: Aetna Commercial |
$1,972.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,508.21
|
| Rate for Payer: Cash Price |
$1,856.26
|
| Rate for Payer: Cofinity Advantage |
$1,624.22
|
| Rate for Payer: Cofinity Commercial |
$1,995.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,856.26
|
| Rate for Payer: Healthscope Commercial |
$2,088.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,624.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,740.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,972.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,740.24
|
| Rate for Payer: PHP Commercial |
$1,972.27
|
| Rate for Payer: Priority Health SBD |
$1,461.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,020.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,740.24
|
|
|
LEUPROLIDE 30 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$60,284.60
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$54,256.14 |
| Rate for Payer: Aetna American Axle |
$39,184.99
|
| Rate for Payer: Aetna Commercial |
$51,241.91
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39,184.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,206.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,206.96
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,719.58
|
| Rate for Payer: BCN Commercial |
$5,719.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$48,227.68
|
| Rate for Payer: Cash Price |
$48,227.68
|
| Rate for Payer: Cofinity Advantage |
$42,199.22
|
| Rate for Payer: Cofinity Commercial |
$51,844.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48,227.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$54,256.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42,199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45,213.45
|
| Rate for Payer: Mclaren Medicaid |
$1,765.57
|
| Rate for Payer: Mclaren Medicare |
$1,765.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Meridian Medicaid |
$1,853.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,030.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51,241.91
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45,213.45
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$51,241.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,457.38
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health SBD |
$37,979.30
|
| Rate for Payer: Priority Health Tiered Network |
$4,365.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,910.39
|
| Rate for Payer: UHC Core |
$2,910.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,910.39
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP Medicaid |
$923.39
|
| Rate for Payer: UMR Bronson Commercial |
$22,305.30
|
| Rate for Payer: VA VA |
$1,765.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45,213.45
|
|
|
LEUPROLIDE 30 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$60,284.60
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26,525.22 |
| Max. Negotiated Rate |
$54,256.14 |
| Rate for Payer: Aetna American Axle |
$39,184.99
|
| Rate for Payer: Aetna Commercial |
$51,241.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39,184.99
|
| Rate for Payer: Cash Price |
$48,227.68
|
| Rate for Payer: Cofinity Advantage |
$42,199.22
|
| Rate for Payer: Cofinity Commercial |
$51,844.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48,227.68
|
| Rate for Payer: Healthscope Commercial |
$54,256.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42,199.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45,213.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51,241.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45,213.45
|
| Rate for Payer: PHP Commercial |
$51,241.91
|
| Rate for Payer: Priority Health SBD |
$37,979.30
|
| Rate for Payer: UMR Bronson Commercial |
$26,525.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45,213.45
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$7,535.58
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
13691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,315.66 |
| Max. Negotiated Rate |
$6,782.02 |
| Rate for Payer: Aetna American Axle |
$4,898.13
|
| Rate for Payer: Aetna Commercial |
$6,405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,898.13
|
| Rate for Payer: Cash Price |
$6,028.46
|
| Rate for Payer: Cofinity Advantage |
$5,274.91
|
| Rate for Payer: Cofinity Commercial |
$6,480.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,028.46
|
| Rate for Payer: Healthscope Commercial |
$6,782.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,274.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,651.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,405.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,651.69
|
| Rate for Payer: PHP Commercial |
$6,405.24
|
| Rate for Payer: Priority Health SBD |
$4,747.42
|
| Rate for Payer: UMR Bronson Commercial |
$3,315.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,651.69
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$7,535.58
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
13691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$6,782.02 |
| Rate for Payer: Aetna American Axle |
$4,898.13
|
| Rate for Payer: Aetna Commercial |
$6,405.24
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,898.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,206.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,206.96
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,719.58
|
| Rate for Payer: BCN Commercial |
$5,719.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$6,028.46
|
| Rate for Payer: Cash Price |
$6,028.46
|
| Rate for Payer: Cofinity Advantage |
$5,274.91
|
| Rate for Payer: Cofinity Commercial |
$6,480.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,028.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$6,782.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,274.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,651.69
|
| Rate for Payer: Mclaren Medicaid |
$1,765.57
|
| Rate for Payer: Mclaren Medicare |
$1,765.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Meridian Medicaid |
$1,853.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,030.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,405.24
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,651.69
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$6,405.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,457.38
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health SBD |
$4,747.42
|
| Rate for Payer: Priority Health Tiered Network |
$4,365.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,910.39
|
| Rate for Payer: UHC Core |
$2,910.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,910.39
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP Medicaid |
$923.39
|
| Rate for Payer: UMR Bronson Commercial |
$2,788.16
|
| Rate for Payer: VA VA |
$1,765.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,651.69
|
|
|
LEUPROLIDE 45 MG (PEDIATRIC 6 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$90,426.91
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
203699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$81,384.22 |
| Rate for Payer: Aetna American Axle |
$58,777.49
|
| Rate for Payer: Aetna Commercial |
$76,862.87
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58,777.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,206.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,206.96
|
| Rate for Payer: BCBS Complete |
$969.65
|
| Rate for Payer: BCBS MAPPO |
$1,765.57
|
| Rate for Payer: BCBS Trust/PPO |
$5,719.58
|
| Rate for Payer: BCN Commercial |
$5,719.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,765.57
|
| Rate for Payer: Cash Price |
$72,341.53
|
| Rate for Payer: Cash Price |
$72,341.53
|
| Rate for Payer: Cofinity Advantage |
$63,298.84
|
| Rate for Payer: Cofinity Commercial |
$77,767.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72,341.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$81,384.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63,298.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67,820.18
|
| Rate for Payer: Mclaren Medicaid |
$1,765.57
|
| Rate for Payer: Mclaren Medicare |
$1,765.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,853.85
|
| Rate for Payer: Meridian Medicaid |
$1,853.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,030.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,942.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76,862.87
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67,820.18
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$76,862.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,765.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,457.38
|
| Rate for Payer: Priority Health Medicare |
$1,765.57
|
| Rate for Payer: Priority Health SBD |
$56,968.95
|
| Rate for Payer: Priority Health Tiered Network |
$4,365.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,765.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,910.39
|
| Rate for Payer: UHC Core |
$2,910.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,765.57
|
| Rate for Payer: UHC Exchange |
$2,910.39
|
| Rate for Payer: UHC Medicaid |
$923.39
|
| Rate for Payer: UHCCP Medicaid |
$923.39
|
| Rate for Payer: UMR Bronson Commercial |
$33,457.96
|
| Rate for Payer: VA VA |
$1,765.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67,820.18
|
|
|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$415.35
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
32893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.75 |
| Max. Negotiated Rate |
$373.81 |
| Rate for Payer: Aetna American Axle |
$269.98
|
| Rate for Payer: Aetna Commercial |
$353.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.98
|
| Rate for Payer: Cash Price |
$332.28
|
| Rate for Payer: Cofinity Advantage |
$290.75
|
| Rate for Payer: Cofinity Commercial |
$357.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.28
|
| Rate for Payer: Healthscope Commercial |
$373.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.51
|
| Rate for Payer: PHP Commercial |
$353.05
|
| Rate for Payer: Priority Health SBD |
$261.67
|
| Rate for Payer: UMR Bronson Commercial |
$182.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.51
|
|
