|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$404.70
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
32893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$574.27 |
| Rate for Payer: Aetna American Axle |
$263.06
|
| Rate for Payer: Aetna American Axle |
$269.98
|
| Rate for Payer: Aetna Commercial |
$344.00
|
| Rate for Payer: Aetna Commercial |
$353.05
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$574.27
|
| Rate for Payer: BCBS Trust/PPO |
$574.27
|
| Rate for Payer: BCN Commercial |
$574.27
|
| Rate for Payer: BCN Commercial |
$574.27
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: Cash Price |
$332.28
|
| Rate for Payer: Cash Price |
$323.76
|
| Rate for Payer: Cash Price |
$323.76
|
| Rate for Payer: Cash Price |
$332.28
|
| Rate for Payer: Cofinity Advantage |
$290.75
|
| Rate for Payer: Cofinity Advantage |
$283.29
|
| Rate for Payer: Cofinity Commercial |
$348.04
|
| Rate for Payer: Cofinity Commercial |
$357.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$364.23
|
| Rate for Payer: Healthscope Commercial |
$373.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.52
|
| Rate for Payer: Mclaren Medicaid |
$176.20
|
| Rate for Payer: Mclaren Medicaid |
$176.20
|
| Rate for Payer: Mclaren Medicare |
$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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$185.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.00
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.51
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$344.00
|
| Rate for Payer: PHP Commercial |
$353.05
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.15
|
| 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 Cigna Priority Health/HMO/PPO/Narrow Network |
$556.52
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health SBD |
$261.67
|
| Rate for Payer: Priority Health SBD |
$254.96
|
| Rate for Payer: Priority Health Tiered Network |
$445.22
|
| Rate for Payer: Priority Health Tiered Network |
$445.22
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.79
|
| Rate for Payer: UHC Core |
$281.79
|
| Rate for Payer: UHC Core |
$281.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$281.79
|
| Rate for Payer: UHC Exchange |
$281.79
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: UMR Bronson Commercial |
$149.74
|
| Rate for Payer: UMR Bronson Commercial |
$153.68
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.51
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$643.51
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$283.14 |
| Max. Negotiated Rate |
$579.16 |
| Rate for Payer: Aetna American Axle |
$418.28
|
| Rate for Payer: Aetna Commercial |
$546.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.28
|
| Rate for Payer: Cash Price |
$514.81
|
| Rate for Payer: Cofinity Advantage |
$450.46
|
| Rate for Payer: Cofinity Commercial |
$553.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.81
|
| Rate for Payer: Healthscope Commercial |
$579.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$450.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.63
|
| Rate for Payer: PHP Commercial |
$546.98
|
| Rate for Payer: Priority Health SBD |
$405.41
|
| Rate for Payer: UMR Bronson Commercial |
$283.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.63
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$643.51
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$579.16 |
| Rate for Payer: Aetna American Axle |
$418.28
|
| Rate for Payer: Aetna Commercial |
$546.98
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.28
|
| 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 |
$514.81
|
| Rate for Payer: Cash Price |
$514.81
|
| Rate for Payer: Cofinity Advantage |
$450.46
|
| Rate for Payer: Cofinity Commercial |
$553.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$579.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$450.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.63
|
| 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 |
$546.98
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.63
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$546.98
|
| 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 |
$405.41
|
| 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 |
$238.10
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.63
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT
|
Facility
|
OP
|
$15,071.15
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
27123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$923.39 |
| Max. Negotiated Rate |
$13,564.03 |
| Rate for Payer: Aetna American Axle |
$9,796.25
|
| Rate for Payer: Aetna Commercial |
$12,810.48
|
| Rate for Payer: Aetna Medicare |
$1,836.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,796.25
|
| 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 |
$12,056.92
|
| Rate for Payer: Cash Price |
$12,056.92
|
| Rate for Payer: Cofinity Advantage |
$10,549.81
|
| Rate for Payer: Cofinity Commercial |
$12,961.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,056.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,765.57
|
| Rate for Payer: Healthscope Commercial |
$13,564.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,549.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,303.36
|
| 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 |
$12,810.48
|
| Rate for Payer: Nomi Health Commercial |
$5,296.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,303.36
|
| Rate for Payer: PACE Medicare |
$1,677.29
|
| Rate for Payer: PACE SWMI |
$1,765.57
|
| Rate for Payer: PHP Commercial |
$12,810.48
|
| 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 |
$9,494.82
|
| 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 |
$5,576.33
|
| Rate for Payer: VA VA |
$1,765.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,303.36
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT
|
Facility
|
IP
|
$15,071.15
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
27123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,631.31 |
| Max. Negotiated Rate |
$13,564.03 |
| Rate for Payer: Aetna American Axle |
$9,796.25
|
| Rate for Payer: Aetna Commercial |
$12,810.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,796.25
|
| Rate for Payer: Cash Price |
$12,056.92
|
| Rate for Payer: Cofinity Advantage |
$10,549.81
|
| Rate for Payer: Cofinity Commercial |
$12,961.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,056.92
|
| Rate for Payer: Healthscope Commercial |
$13,564.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,549.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,303.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,810.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11,303.36
|
| Rate for Payer: PHP Commercial |
$12,810.48
|
| Rate for Payer: Priority Health SBD |
$9,494.82
|
| Rate for Payer: UMR Bronson Commercial |
$6,631.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,303.36
|
|
|
LEUPROLIDE ACETATE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$22,606.73
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
21044
|
|
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 ACETATE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$1,740.26
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$1,566.23 |
| Rate for Payer: Aetna American Axle |
$1,131.17
|
| Rate for Payer: Aetna Commercial |
$1,479.22
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.17
|
| 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 |
$1,392.21
|
| Rate for Payer: Cash Price |
$1,392.21
|
| Rate for Payer: Cofinity Advantage |
$1,218.18
|
| Rate for Payer: Cofinity Commercial |
$1,496.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,392.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$1,566.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.19
|
| 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 |
$1,479.22
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,305.19
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$1,479.22
|
| 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 |
$1,096.36
|
| 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 |
$643.90
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.19
|
|
|
LEUPROLIDE ACETATE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$1,740.26
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$765.71 |
| Max. Negotiated Rate |
$1,566.23 |
| Rate for Payer: Aetna American Axle |
$1,131.17
|
| Rate for Payer: Aetna Commercial |
$1,479.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.17
|
| Rate for Payer: Cash Price |
$1,392.21
|
| Rate for Payer: Cofinity Advantage |
$1,218.18
|
| Rate for Payer: Cofinity Commercial |
$1,496.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,392.21
|
| Rate for Payer: Healthscope Commercial |
$1,566.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,218.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,305.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,479.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,305.19
|
| Rate for Payer: PHP Commercial |
$1,479.22
|
| Rate for Payer: Priority Health SBD |
$1,096.36
|
| Rate for Payer: UMR Bronson Commercial |
$765.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,305.19
|
|
|
LEUPROLIDE ACETATE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$1,123.20
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
33669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$1,010.88 |
| Rate for Payer: Aetna American Axle |
$730.08
|
| Rate for Payer: Aetna American Axle |
$711.36
|
| Rate for Payer: Aetna Commercial |
$930.24
|
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.25
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS Complete |
$96.77
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS MAPPO |
$176.20
|
| Rate for Payer: BCBS Trust/PPO |
$574.27
|
| Rate for Payer: BCBS Trust/PPO |
$574.27
|
| Rate for Payer: BCN Commercial |
$574.27
|
| Rate for Payer: BCN Commercial |
$574.27
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: BCN Medicare Advantage |
$176.20
|
| Rate for Payer: Cash Price |
$875.52
|
| Rate for Payer: Cash Price |
$898.56
|
| Rate for Payer: Cash Price |
$898.56
|
| Rate for Payer: Cash Price |
$875.52
|
| Rate for Payer: Cofinity Advantage |
$786.24
|
| Rate for Payer: Cofinity Advantage |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$941.18
|
| Rate for Payer: Cofinity Commercial |
$965.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$984.96
|
| Rate for Payer: Healthscope Commercial |
$1,010.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$766.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.40
|
| Rate for Payer: Mclaren Medicaid |
$176.20
|
| Rate for Payer: Mclaren Medicaid |
$176.20
|
| Rate for Payer: Mclaren Medicare |
$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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$185.01
|
| Rate for Payer: Meridian Medicaid |
$185.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$930.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.72
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$842.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$820.80
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$930.24
|
| Rate for Payer: PHP Commercial |
$954.72
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: PHP Medicare Advantage |
$176.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.15
|
| 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 Cigna Priority Health/HMO/PPO/Narrow Network |
$556.52
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health Medicare |
$176.20
|
| Rate for Payer: Priority Health SBD |
$689.47
|
| Rate for Payer: Priority Health SBD |
$707.62
|
| Rate for Payer: Priority Health Tiered Network |
$445.22
|
| Rate for Payer: Priority Health Tiered Network |
$445.22
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: Railroad Medicare Medicare |
$176.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.79
|
| Rate for Payer: UHC Core |
$281.79
|
| Rate for Payer: UHC Core |
$281.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.20
|
| Rate for Payer: UHC Exchange |
$281.79
|
| Rate for Payer: UHC Exchange |
$281.79
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHC Medicaid |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: UHCCP Medicaid |
$92.15
|
| Rate for Payer: UMR Bronson Commercial |
$404.93
|
| Rate for Payer: UMR Bronson Commercial |
$415.58
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.80
|
|
|
LEUPROLIDE ACETATE 22.5 MG (3 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$1,094.40
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
33669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$481.54 |
| Max. Negotiated Rate |
$984.96 |
| Rate for Payer: Aetna American Axle |
$711.36
|
| Rate for Payer: Aetna American Axle |
$730.08
|
| Rate for Payer: Aetna Commercial |
$930.24
|
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.08
|
| Rate for Payer: Cash Price |
$875.52
|
| Rate for Payer: Cash Price |
$898.56
|
| Rate for Payer: Cofinity Advantage |
$786.24
|
| Rate for Payer: Cofinity Advantage |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$965.95
|
| Rate for Payer: Cofinity Commercial |
$941.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.56
|
| Rate for Payer: Healthscope Commercial |
$984.96
|
| Rate for Payer: Healthscope Commercial |
$1,010.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$766.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$930.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$820.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$842.40
|
| Rate for Payer: PHP Commercial |
$930.24
|
| Rate for Payer: PHP Commercial |
$954.72
|
| Rate for Payer: Priority Health SBD |
$707.62
|
| Rate for Payer: Priority Health SBD |
$689.47
|
| Rate for Payer: UMR Bronson Commercial |
$481.54
|
| Rate for Payer: UMR Bronson Commercial |
$494.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.40
|
|
|
LEUPROLIDE ACETATE 45 MG (6 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$2,188.80
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
40801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$1,969.92 |
| Rate for Payer: Aetna American Axle |
$1,422.72
|
| Rate for Payer: Aetna Commercial |
$1,860.48
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.72
|
| 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 |
$1,751.04
|
| Rate for Payer: Cash Price |
$1,751.04
|
| Rate for Payer: Cofinity Advantage |
$1,532.16
|
| Rate for Payer: Cofinity Commercial |
$1,882.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$1,969.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,532.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,641.60
|
| 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 |
$1,860.48
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.60
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$1,860.48
|
| 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 |
$1,378.94
|
| 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 |
$809.86
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,641.60
|
|
|
LEUPROLIDE ACETATE 45 MG (6 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$2,188.80
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
40801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$963.07 |
| Max. Negotiated Rate |
$1,969.92 |
| Rate for Payer: Aetna American Axle |
$1,422.72
|
| Rate for Payer: Aetna Commercial |
$1,860.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.72
|
| Rate for Payer: Cash Price |
$1,751.04
|
| Rate for Payer: Cofinity Advantage |
$1,532.16
|
| Rate for Payer: Cofinity Commercial |
$1,882.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.04
|
| Rate for Payer: Healthscope Commercial |
$1,969.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,532.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,641.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,860.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.60
|
| Rate for Payer: PHP Commercial |
$1,860.48
|
| Rate for Payer: Priority Health SBD |
$1,378.94
|
| Rate for Payer: UMR Bronson Commercial |
$963.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,641.60
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$3,480.55
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.15 |
| Max. Negotiated Rate |
$3,132.49 |
| Rate for Payer: Aetna American Axle |
$2,262.36
|
| Rate for Payer: Aetna Commercial |
$2,958.47
|
| Rate for Payer: Aetna Medicare |
$183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,262.36
|
| 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 |
$2,784.44
|
| Rate for Payer: Cash Price |
$2,784.44
|
| Rate for Payer: Cofinity Advantage |
$2,436.39
|
| Rate for Payer: Cofinity Commercial |
$2,993.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,784.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.20
|
| Rate for Payer: Healthscope Commercial |
$3,132.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,436.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,610.41
|
| 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 |
$2,958.47
|
| Rate for Payer: Nomi Health Commercial |
$528.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,610.41
|
| Rate for Payer: PACE Medicare |
$167.39
|
| Rate for Payer: PACE SWMI |
$176.20
|
| Rate for Payer: PHP Commercial |
$2,958.47
|
| 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 |
$2,192.75
|
| 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 |
$1,287.80
|
| Rate for Payer: VA VA |
$176.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,610.41
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$3,480.55
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,531.44 |
| Max. Negotiated Rate |
$3,132.49 |
| Rate for Payer: Aetna American Axle |
$2,262.36
|
| Rate for Payer: Aetna Commercial |
$2,958.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,262.36
|
| Rate for Payer: Cash Price |
$2,784.44
|
| Rate for Payer: Cofinity Advantage |
$2,436.39
|
| Rate for Payer: Cofinity Commercial |
$2,993.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,784.44
|
| Rate for Payer: Healthscope Commercial |
$3,132.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,436.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,610.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,958.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,610.41
|
| Rate for Payer: PHP Commercial |
$2,958.47
|
| Rate for Payer: Priority Health SBD |
$2,192.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,531.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,610.41
|
|
|
LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
HCPCS J7614
|
| Hospital Charge Code |
24915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna American Axle |
$3.16
|
| Rate for Payer: Aetna American Axle |
$3.48
|
| Rate for Payer: Aetna American Axle |
$4.65
|
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Aetna Medicare |
$2.43
|
| Rate for Payer: Aetna Medicare |
$2.68
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.16
|
| Rate for Payer: BCBS Complete |
$1.94
|
| Rate for Payer: BCBS Complete |
$2.86
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cofinity Advantage |
$3.75
|
| Rate for Payer: Cofinity Advantage |
$5.00
|
| Rate for Payer: Cofinity Advantage |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Cofinity Commercial |
$4.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$6.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.02
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: PHP Commercial |
$4.13
|
| Rate for Payer: PHP Commercial |
$6.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.08
|
| Rate for Payer: Priority Health SBD |
$4.50
|
| Rate for Payer: Priority Health SBD |
$3.38
|
| Rate for Payer: Priority Health SBD |
$3.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Tiered Network |
$0.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.65
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: UHC Core |
$3.73
|
| Rate for Payer: UHC Core |
$2.79
|
| Rate for Payer: UHC Exchange |
$2.11
|
| Rate for Payer: UHC Exchange |
$2.81
|
| Rate for Payer: UHC Exchange |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.65
|
|
|
LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$4.86
|
|
|
Service Code
|
HCPCS J7614
|
| Hospital Charge Code |
24915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna American Axle |
$3.16
|
| Rate for Payer: Aetna American Axle |
$4.65
|
| Rate for Payer: Aetna American Axle |
$3.48
|
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Aetna Commercial |
$4.13
|
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.48
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$3.89
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cofinity Advantage |
$5.00
|
| Rate for Payer: Cofinity Advantage |
$3.40
|
| Rate for Payer: Cofinity Advantage |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$4.18
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.72
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$6.43
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.36
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: PHP Commercial |
$4.13
|
| Rate for Payer: PHP Commercial |
$6.08
|
| Rate for Payer: Priority Health SBD |
$3.06
|
| Rate for Payer: Priority Health SBD |
$3.38
|
| Rate for Payer: Priority Health SBD |
$4.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$3.15
|
| Rate for Payer: UMR Bronson Commercial |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.36
|
|
|
LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$9.32
|
|
|
Service Code
|
HCPCS J7612
|
| Hospital Charge Code |
39278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$8.39 |
| Rate for Payer: Aetna American Axle |
$6.06
|
| Rate for Payer: Aetna American Axle |
$11.34
|
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Aetna Medicare |
$4.66
|
| Rate for Payer: Aetna Medicare |
$8.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: BCBS Complete |
$6.98
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$12.21
|
| Rate for Payer: Cofinity Advantage |
$6.52
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Healthscope Commercial |
$8.39
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.99
|
| Rate for Payer: PHP Commercial |
$7.92
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.38
|
| Rate for Payer: Priority Health SBD |
$10.99
|
| Rate for Payer: Priority Health SBD |
$5.87
|
| Rate for Payer: Priority Health Tiered Network |
$0.30
|
| Rate for Payer: Priority Health Tiered Network |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.06
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: UHC Core |
$9.09
|
| Rate for Payer: UHC Exchange |
$6.86
|
| Rate for Payer: UHC Exchange |
$3.66
|
| Rate for Payer: UMR Bronson Commercial |
$3.45
|
| Rate for Payer: UMR Bronson Commercial |
$6.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.99
|
|
|
LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$17.45
|
|
|
Service Code
|
HCPCS J7612
|
| Hospital Charge Code |
39278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Aetna American Axle |
$11.34
|
| Rate for Payer: Aetna American Axle |
$6.06
|
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: Cash Price |
$13.96
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$6.52
|
| Rate for Payer: Cofinity Advantage |
$12.21
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$15.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$8.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.99
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Commercial |
$7.92
|
| Rate for Payer: Priority Health SBD |
$5.87
|
| Rate for Payer: Priority Health SBD |
$10.99
|
| Rate for Payer: UMR Bronson Commercial |
$7.68
|
| Rate for Payer: UMR Bronson Commercial |
$4.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.99
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$155.35
|
|
|
Service Code
|
NDC 63402051001
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.35 |
| Max. Negotiated Rate |
$139.81 |
| Rate for Payer: Aetna American Axle |
$100.98
|
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.98
|
| Rate for Payer: Cash Price |
$124.28
|
| Rate for Payer: Cofinity Advantage |
$108.75
|
| Rate for Payer: Cofinity Commercial |
$133.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.28
|
| Rate for Payer: Healthscope Commercial |
$139.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.51
|
| Rate for Payer: PHP Commercial |
$132.05
|
| Rate for Payer: Priority Health SBD |
$97.87
|
| Rate for Payer: UMR Bronson Commercial |
$68.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.51
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$258.86
|
|
|
Service Code
|
NDC 27437005601
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$232.97 |
| Rate for Payer: Aetna American Axle |
$168.26
|
| Rate for Payer: Aetna Commercial |
$220.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.26
|
| Rate for Payer: Cash Price |
$207.09
|
| Rate for Payer: Cofinity Advantage |
$181.20
|
| Rate for Payer: Cofinity Commercial |
$222.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.09
|
| Rate for Payer: Healthscope Commercial |
$232.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.15
|
| Rate for Payer: PHP Commercial |
$220.03
|
| Rate for Payer: Priority Health SBD |
$163.08
|
| Rate for Payer: UMR Bronson Commercial |
$113.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.15
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$190.31
|
|
|
Service Code
|
NDC 00591292754
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.74 |
| Max. Negotiated Rate |
$171.28 |
| Rate for Payer: Aetna American Axle |
$123.70
|
| Rate for Payer: Aetna Commercial |
$161.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.70
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Cofinity Advantage |
$133.22
|
| Rate for Payer: Cofinity Commercial |
$163.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.25
|
| Rate for Payer: Healthscope Commercial |
$171.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.73
|
| Rate for Payer: PHP Commercial |
$161.76
|
| Rate for Payer: Priority Health SBD |
$119.90
|
| Rate for Payer: UMR Bronson Commercial |
$83.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.73
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$258.86
|
|
|
Service Code
|
NDC 27437005601
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.78 |
| Max. Negotiated Rate |
$232.97 |
| Rate for Payer: Aetna American Axle |
$168.26
|
| Rate for Payer: Aetna Commercial |
$220.03
|
| Rate for Payer: Aetna Medicare |
$129.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.26
|
| Rate for Payer: BCBS Complete |
$103.54
|
| Rate for Payer: Cash Price |
$207.09
|
| Rate for Payer: Cofinity Advantage |
$181.20
|
| Rate for Payer: Cofinity Commercial |
$222.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.09
|
| Rate for Payer: Healthscope Commercial |
$232.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.15
|
| Rate for Payer: PHP Commercial |
$220.03
|
| Rate for Payer: Priority Health SBD |
$163.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.26
|
| Rate for Payer: UHC Core |
$134.87
|
| Rate for Payer: UHC Exchange |
$101.73
|
| Rate for Payer: UMR Bronson Commercial |
$95.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.15
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$155.35
|
|
|
Service Code
|
NDC 63402051001
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$139.81 |
| Rate for Payer: Aetna American Axle |
$100.98
|
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Medicare |
$77.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.98
|
| Rate for Payer: BCBS Complete |
$62.14
|
| Rate for Payer: Cash Price |
$124.28
|
| Rate for Payer: Cofinity Advantage |
$108.75
|
| Rate for Payer: Cofinity Commercial |
$133.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.28
|
| Rate for Payer: Healthscope Commercial |
$139.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.51
|
| Rate for Payer: PHP Commercial |
$132.05
|
| Rate for Payer: Priority Health SBD |
$97.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.98
|
| Rate for Payer: UHC Core |
$80.94
|
| Rate for Payer: UHC Exchange |
$61.05
|
| Rate for Payer: UMR Bronson Commercial |
$57.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.51
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$190.31
|
|
|
Service Code
|
NDC 00591292754
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.41 |
| Max. Negotiated Rate |
$171.28 |
| Rate for Payer: Aetna American Axle |
$123.70
|
| Rate for Payer: Aetna Commercial |
$161.76
|
| Rate for Payer: Aetna Medicare |
$95.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.70
|
| Rate for Payer: BCBS Complete |
$76.12
|
| Rate for Payer: Cash Price |
$152.25
|
| Rate for Payer: Cofinity Advantage |
$133.22
|
| Rate for Payer: Cofinity Commercial |
$163.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.25
|
| Rate for Payer: Healthscope Commercial |
$171.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.73
|
| Rate for Payer: PHP Commercial |
$161.76
|
| Rate for Payer: Priority Health SBD |
$119.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.70
|
| Rate for Payer: UHC Core |
$99.15
|
| Rate for Payer: UHC Exchange |
$74.79
|
| Rate for Payer: UMR Bronson Commercial |
$70.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.73
|
|
|
LEVETIRACETAM 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$311.24
|
|
|
Service Code
|
NDC 50383024116
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.16 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Aetna American Axle |
$202.31
|
| Rate for Payer: Aetna Commercial |
$264.55
|
| Rate for Payer: Aetna Medicare |
$155.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.31
|
| Rate for Payer: BCBS Complete |
$124.50
|
| Rate for Payer: Cash Price |
$248.99
|
| Rate for Payer: Cofinity Advantage |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$267.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.99
|
| Rate for Payer: Healthscope Commercial |
$280.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.43
|
| Rate for Payer: PHP Commercial |
$264.55
|
| Rate for Payer: Priority Health SBD |
$196.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.31
|
| Rate for Payer: UHC Core |
$162.16
|
| Rate for Payer: UHC Exchange |
$122.32
|
| Rate for Payer: UMR Bronson Commercial |
$115.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.43
|
|
