|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
NDC 16729003410
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.16
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 51991075933
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UMR Bronson Commercial |
$40.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$98.70
|
|
|
Service Code
|
NDC 16729003410
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.89
|
| Rate for Payer: Aetna Medicare |
$49.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: BCBS Complete |
$39.48
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.89
|
| Rate for Payer: PHP Commercial |
$83.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.16
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.03
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 50268047611
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$185.73
|
|
|
Service Code
|
NDC 50268047615
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$167.16 |
| Rate for Payer: Aetna American Axle |
$120.72
|
| Rate for Payer: Aetna Commercial |
$157.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.72
|
| Rate for Payer: Cash Price |
$148.58
|
| Rate for Payer: Cofinity Commercial |
$130.01
|
| Rate for Payer: Cofinity Commercial |
$159.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.58
|
| Rate for Payer: Healthscope Commercial |
$167.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.87
|
| Rate for Payer: PHP Commercial |
$157.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.72
|
| Rate for Payer: Priority Health SBD |
$117.01
|
| Rate for Payer: UMR Bronson Commercial |
$81.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.30
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$65.55
|
|
|
Service Code
|
NDC 62756051183
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$58.99 |
| Rate for Payer: Aetna American Axle |
$42.61
|
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna Medicare |
$32.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| Rate for Payer: BCBS Complete |
$26.22
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$45.88
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$58.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health SBD |
$41.30
|
| Rate for Payer: UMR Bronson Commercial |
$24.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$49.89
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.95 |
| Max. Negotiated Rate |
$44.90 |
| Rate for Payer: Aetna American Axle |
$32.43
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$18.54
|
| Rate for Payer: Aetna American Axle |
$53.77
|
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna Commercial |
$42.41
|
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| 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) |
$18.54
|
| Rate for Payer: Cash Price |
$39.91
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$42.91
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.91
|
| 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 |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$44.90
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| 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 |
$57.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.05
|
| 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: Multiplan/Beech St/PHCS Commercial |
$42.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$42.41
|
| Rate for Payer: PHP Commercial |
$24.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$31.43
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: UMR Bronson Commercial |
$12.55
|
| Rate for Payer: UMR Bronson Commercial |
$21.95
|
| Rate for Payer: UMR Bronson Commercial |
$36.40
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.42
|
|
|
LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$28.53
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4392
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$25.68 |
| Rate for Payer: Aetna American Axle |
$18.54
|
| Rate for Payer: Aetna American Axle |
$32.43
|
| Rate for Payer: Aetna American Axle |
$53.77
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$70.32
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Commercial |
$42.41
|
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: Aetna Medicare |
$24.95
|
| Rate for Payer: Aetna Medicare |
$14.27
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.43
|
| Rate for Payer: BCBS Complete |
$33.09
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS Complete |
$19.96
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Complete |
$11.41
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$39.91
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$42.91
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| 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 |
$39.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$44.90
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.91
|
| 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 |
$21.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.42
|
| 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 |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$42.41
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$24.25
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.54
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$31.43
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: UMR Bronson Commercial |
$30.61
|
| Rate for Payer: UMR Bronson Commercial |
$18.46
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| 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 |
$37.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
|
|
LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$67.02
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
15426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$60.32 |
| Rate for Payer: Aetna American Axle |
$43.56
|
| Rate for Payer: Aetna Commercial |
$56.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cofinity Commercial |
$46.91
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.91
|
| 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: PHP Commercial |
$56.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.56
|
| 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
|
$111.74
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
15426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$100.57 |
| Rate for Payer: Aetna American Axle |
$72.63
|
| Rate for Payer: Aetna American Axle |
$36.34
|
| Rate for Payer: Aetna American Axle |
$25.34
|
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna American Axle |
$43.56
|
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Aetna Commercial |
$56.97
|
| Rate for Payer: Aetna Commercial |
$94.98
|
| Rate for Payer: Aetna Medicare |
$82.75
|
| Rate for Payer: Aetna Medicare |
$33.51
|
| Rate for Payer: Aetna Medicare |
$55.87
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Aetna Medicare |
$27.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.34
|
| Rate for Payer: BCBS Complete |
$26.81
|
| Rate for Payer: BCBS Complete |
$22.36
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS Complete |
$44.70
|
| Rate for Payer: Cash Price |
$89.39
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$44.72
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cofinity Commercial |
$96.10
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$78.22
|
| Rate for Payer: Cofinity Commercial |
$39.13
|
| Rate for Payer: Cofinity Commercial |
$27.29
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| Rate for Payer: Cofinity Commercial |
$46.91
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.72
|
| Rate for Payer: Healthscope Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$50.31
|
| Rate for Payer: Healthscope Commercial |
$100.57
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Healthscope Commercial |
$60.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.98
|
| 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 |
$47.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.97
|
| Rate for Payer: PHP Commercial |
$56.97
|
| Rate for Payer: PHP Commercial |
$33.14
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$94.98
|
| Rate for Payer: PHP Commercial |
$47.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.34
|
| Rate for Payer: Priority Health SBD |
$42.22
|
| Rate for Payer: Priority Health SBD |
$70.40
|
| Rate for Payer: Priority Health SBD |
$35.22
|
| Rate for Payer: Priority Health SBD |
$24.56
|
| Rate for Payer: Priority Health SBD |
$104.27
|
| Rate for Payer: UMR Bronson Commercial |
$14.43
|
| Rate for Payer: UMR Bronson Commercial |
$20.68
|
| Rate for Payer: UMR Bronson Commercial |
$41.34
|
| Rate for Payer: UMR Bronson Commercial |
$61.23
|
| Rate for Payer: UMR Bronson Commercial |
$24.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.92
|
| 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
|
IP
|
$575.58
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$253.26 |
| Max. Negotiated Rate |
$518.02 |
| Rate for Payer: Aetna American Axle |
$374.13
|
| Rate for Payer: Aetna American Axle |
$340.12
|
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna American Axle |
$503.67
|
| Rate for Payer: Aetna Commercial |
$489.24
|
| Rate for Payer: Aetna Commercial |
$658.65
|
| Rate for Payer: Aetna Commercial |
$444.77
|
| Rate for Payer: Aetna Commercial |
$24.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.13
|
| Rate for Payer: Cash Price |
$418.61
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$619.90
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$542.42
|
| Rate for Payer: Cofinity Commercial |
$402.91
|
| Rate for Payer: Cofinity Commercial |
$366.28
|
| Rate for Payer: Cofinity Commercial |
$450.00
|
| Rate for Payer: Cofinity Commercial |
$495.00
|
| Rate for Payer: Cofinity Commercial |
$24.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$366.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$402.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.61
|
| Rate for Payer: Healthscope Commercial |
$518.02
|
| Rate for Payer: Healthscope Commercial |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$470.93
|
| Rate for Payer: Healthscope Commercial |
$697.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$402.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$431.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.24
|
| Rate for Payer: PHP Commercial |
$489.24
|
| Rate for Payer: PHP Commercial |
$658.65
|
| Rate for Payer: PHP Commercial |
$24.46
|
| Rate for Payer: PHP Commercial |
$444.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$488.17
|
| Rate for Payer: Priority Health SBD |
$18.13
|
| Rate for Payer: Priority Health SBD |
$329.65
|
| Rate for Payer: Priority Health SBD |
$362.62
|
| Rate for Payer: UMR Bronson Commercial |
$253.26
|
| Rate for Payer: UMR Bronson Commercial |
$340.95
|
| Rate for Payer: UMR Bronson Commercial |
$230.23
|
| Rate for Payer: UMR Bronson Commercial |
$12.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$431.69
|
|
|
LEUCOVORIN CALCIUM 25 MG TABLET
|
Facility
|
OP
|
$523.26
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$193.61 |
| Max. Negotiated Rate |
$470.93 |
| Rate for Payer: Aetna American Axle |
$340.12
|
| Rate for Payer: Aetna American Axle |
$503.67
|
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna American Axle |
$374.13
|
| Rate for Payer: Aetna Commercial |
$658.65
|
| Rate for Payer: Aetna Commercial |
$444.77
|
| Rate for Payer: Aetna Commercial |
$489.24
|
| Rate for Payer: Aetna Commercial |
$24.46
|
| Rate for Payer: Aetna Medicare |
$287.79
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Aetna Medicare |
$387.44
|
| Rate for Payer: Aetna Medicare |
$261.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: BCBS Complete |
$11.51
|
| Rate for Payer: BCBS Complete |
$309.95
|
| Rate for Payer: BCBS Complete |
$230.23
|
| Rate for Payer: BCBS Complete |
$209.30
|
| Rate for Payer: Cash Price |
$418.61
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$619.90
|
| Rate for Payer: Cofinity Commercial |
$450.00
|
| Rate for Payer: Cofinity Commercial |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$495.00
|
| Rate for Payer: Cofinity Commercial |
$402.91
|
| Rate for Payer: Cofinity Commercial |
$542.42
|
| Rate for Payer: Cofinity Commercial |
$24.75
|
| Rate for Payer: Cofinity Commercial |
$366.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$366.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$402.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$619.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.61
|
| Rate for Payer: Healthscope Commercial |
$518.02
|
| Rate for Payer: Healthscope Commercial |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$470.93
|
| Rate for Payer: Healthscope Commercial |
$697.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$402.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$431.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.24
|
| Rate for Payer: PHP Commercial |
$489.24
|
| Rate for Payer: PHP Commercial |
$444.77
|
| Rate for Payer: PHP Commercial |
$658.65
|
| Rate for Payer: PHP Commercial |
$24.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$362.62
|
| Rate for Payer: Priority Health SBD |
$488.17
|
| Rate for Payer: Priority Health SBD |
$329.65
|
| Rate for Payer: Priority Health SBD |
$18.13
|
| Rate for Payer: UMR Bronson Commercial |
$212.96
|
| Rate for Payer: UMR Bronson Commercial |
$193.61
|
| Rate for Payer: UMR Bronson Commercial |
$286.71
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$431.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.44
|
|
|
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 Commercial |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$160.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.33
|
| 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: PHP Commercial |
$158.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.02
|
| 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 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$257.52
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
23617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.28 |
| Max. Negotiated Rate |
$231.77 |
| Rate for Payer: Aetna American Axle |
$167.39
|
| Rate for Payer: Aetna American Axle |
$114.34
|
| 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 |
$149.52
|
| Rate for Payer: Aetna Medicare |
$128.76
|
| Rate for Payer: Aetna Medicare |
$93.09
|
| Rate for Payer: Aetna Medicare |
$87.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.34
|
| Rate for Payer: BCBS Complete |
$70.36
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS Complete |
$103.01
|
| Rate for Payer: Cash Price |
$206.02
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$140.73
|
| Rate for Payer: Cofinity Commercial |
$160.12
|
| Rate for Payer: Cofinity Commercial |
$123.14
|
| Rate for Payer: Cofinity Commercial |
$151.28
|
| Rate for Payer: Cofinity Commercial |
$221.47
|
| Rate for Payer: Cofinity Commercial |
$180.26
|
| Rate for Payer: Cofinity Commercial |
$130.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.02
|
| Rate for Payer: Healthscope Commercial |
$158.32
|
| Rate for Payer: Healthscope Commercial |
$167.57
|
| Rate for Payer: Healthscope Commercial |
$231.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.89
|
| Rate for Payer: PHP Commercial |
$149.52
|
| Rate for Payer: PHP Commercial |
$158.26
|
| Rate for Payer: PHP Commercial |
$218.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.34
|
| Rate for Payer: Priority Health SBD |
$117.30
|
| Rate for Payer: Priority Health SBD |
$110.82
|
| Rate for Payer: Priority Health SBD |
$162.24
|
| Rate for Payer: UMR Bronson Commercial |
$95.28
|
| Rate for Payer: UMR Bronson Commercial |
$65.09
|
| Rate for Payer: UMR Bronson Commercial |
$68.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.14
|
|
|
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 |
$5.00 |
| Rate for Payer: Aetna American Axle |
$3.61
|
| 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 |
$127.18
|
| Rate for Payer: Aetna Medicare |
$2.78
|
| Rate for Payer: Aetna Medicare |
$138.96
|
| Rate for Payer: Aetna Medicare |
$74.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.25
|
| Rate for Payer: BCBS Complete |
$59.85
|
| Rate for Payer: BCBS Complete |
$111.17
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cofinity Commercial |
$239.01
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Cofinity Commercial |
$128.67
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Commercial |
$194.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.89
|
| 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: Healthscope Commercial |
$134.66
|
| Rate for Payer: Healthscope Commercial |
$250.13
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.54
|
| 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: Multiplan/Beech St/PHCS Commercial |
$236.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$127.18
|
| Rate for Payer: PHP Commercial |
$236.23
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.25
|
| Rate for Payer: Priority Health SBD |
$175.09
|
| Rate for Payer: Priority Health SBD |
$94.26
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| 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 |
$112.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.17
|
|
|
LEUCOVORIN CALCIUM 5 MG TABLET
|
Facility
|
IP
|
$149.62
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
4398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$134.66 |
| Rate for Payer: Aetna American Axle |
$97.25
|
| Rate for Payer: Aetna American Axle |
$180.65
|
| Rate for Payer: Aetna American Axle |
$3.61
|
| Rate for Payer: Aetna Commercial |
$236.23
|
| Rate for Payer: Aetna Commercial |
$127.18
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.65
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cofinity Commercial |
$128.67
|
| Rate for Payer: Cofinity Commercial |
$239.01
|
| Rate for Payer: Cofinity Commercial |
$194.54
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Healthscope Commercial |
$250.13
|
| 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 |
$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 |
$112.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.23
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$236.23
|
| Rate for Payer: PHP Commercial |
$127.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.25
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: Priority Health SBD |
$175.09
|
| Rate for Payer: Priority Health SBD |
$94.26
|
| Rate for Payer: UMR Bronson Commercial |
$65.83
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: UMR Bronson Commercial |
$122.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.44
|
|
|
LEUPROLIDE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$19,492.68
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
21044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$17,543.41 |
| Rate for Payer: Aetna American Axle |
$12,670.24
|
| Rate for Payer: Aetna Commercial |
$16,568.78
|
| Rate for Payer: Aetna Medicare |
$1,799.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,670.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,162.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,162.90
|
| Rate for Payer: BCBS Complete |
$973.82
|
| Rate for Payer: BCBS MAPPO |
$1,730.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,730.32
|
| Rate for Payer: Cash Price |
$15,594.14
|
| Rate for Payer: Cash Price |
$15,594.14
|
| Rate for Payer: Cofinity Commercial |
$16,763.70
|
| Rate for Payer: Cofinity Commercial |
$13,644.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,644.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,594.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$17,543.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,644.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,619.51
|
| Rate for Payer: Mclaren Medicaid |
$927.45
|
| Rate for Payer: Mclaren Medicare |
$1,730.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,816.84
|
| Rate for Payer: Meridian Medicaid |
$973.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,989.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,568.78
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$16,568.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,730.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,670.24
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health SBD |
$12,280.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,730.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,870.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,730.32
|
| Rate for Payer: UHC Exchange |
$3,306.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,730.32
|
| Rate for Payer: UHCCP Medicaid |
$927.45
|
| Rate for Payer: UMR Bronson Commercial |
$7,212.29
|
| Rate for Payer: VA VA |
$1,730.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,619.51
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT
|
Facility
|
IP
|
$9,971.89
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,387.63 |
| Max. Negotiated Rate |
$8,974.70 |
| Rate for Payer: Aetna American Axle |
$6,481.73
|
| Rate for Payer: Aetna Commercial |
$8,476.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,481.73
|
| Rate for Payer: Cash Price |
$7,977.51
|
| Rate for Payer: Cofinity Commercial |
$6,980.32
|
| Rate for Payer: Cofinity Commercial |
$8,575.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,980.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,977.51
|
| Rate for Payer: Healthscope Commercial |
$8,974.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,980.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,478.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,476.11
|
| Rate for Payer: PHP Commercial |
$8,476.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,481.73
|
| Rate for Payer: Priority Health SBD |
$6,282.29
|
| Rate for Payer: UMR Bronson Commercial |
$4,387.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,478.92
|
|
|
LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT
|
Facility
|
OP
|
$9,971.89
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$8,974.70 |
| Rate for Payer: Aetna American Axle |
$6,481.73
|
| Rate for Payer: Aetna Commercial |
$8,476.11
|
| Rate for Payer: Aetna Medicare |
$1,799.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,481.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,162.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,162.90
|
| Rate for Payer: BCBS Complete |
$973.82
|
| Rate for Payer: BCBS MAPPO |
$1,730.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,730.32
|
| Rate for Payer: Cash Price |
$7,977.51
|
| Rate for Payer: Cash Price |
$7,977.51
|
| Rate for Payer: Cofinity Commercial |
$8,575.83
|
| Rate for Payer: Cofinity Commercial |
$6,980.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,980.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,977.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$8,974.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,980.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,478.92
|
| Rate for Payer: Mclaren Medicaid |
$927.45
|
| Rate for Payer: Mclaren Medicare |
$1,730.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,816.84
|
| Rate for Payer: Meridian Medicaid |
$973.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,989.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,476.11
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$8,476.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,730.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,481.73
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health SBD |
$6,282.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,730.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,870.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,730.32
|
| Rate for Payer: UHC Exchange |
$3,306.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,730.32
|
| Rate for Payer: UHCCP Medicaid |
$927.45
|
| Rate for Payer: UMR Bronson Commercial |
$3,689.60
|
| Rate for Payer: VA VA |
$1,730.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,478.92
|
|
|
LEUPROLIDE 11.25 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$29,915.73
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$26,924.16 |
| Rate for Payer: Aetna American Axle |
$19,445.22
|
| Rate for Payer: Aetna Commercial |
$25,428.37
|
| Rate for Payer: Aetna Medicare |
$1,799.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,445.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,162.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,162.90
|
| Rate for Payer: BCBS Complete |
$973.82
|
| Rate for Payer: BCBS MAPPO |
$1,730.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,730.32
|
| Rate for Payer: Cash Price |
$23,932.58
|
| Rate for Payer: Cash Price |
$23,932.58
|
| Rate for Payer: Cofinity Commercial |
$25,727.53
|
| Rate for Payer: Cofinity Commercial |
$20,941.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,941.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,932.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$26,924.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,941.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,436.80
|
| Rate for Payer: Mclaren Medicaid |
$927.45
|
| Rate for Payer: Mclaren Medicare |
$1,730.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,816.84
|
| Rate for Payer: Meridian Medicaid |
$973.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,989.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,428.37
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$25,428.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,730.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,445.22
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health SBD |
$18,846.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,730.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,870.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,730.32
|
| Rate for Payer: UHC Exchange |
$3,306.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,730.32
|
| Rate for Payer: UHCCP Medicaid |
$927.45
|
| Rate for Payer: UMR Bronson Commercial |
$11,068.82
|
| Rate for Payer: VA VA |
$1,730.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,436.80
|
|
|
LEUPROLIDE 11.25 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$29,915.73
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,162.92 |
| Max. Negotiated Rate |
$26,924.16 |
| Rate for Payer: Aetna American Axle |
$19,445.22
|
| Rate for Payer: Aetna Commercial |
$25,428.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,445.22
|
| Rate for Payer: Cash Price |
$23,932.58
|
| Rate for Payer: Cofinity Commercial |
$20,941.01
|
| Rate for Payer: Cofinity Commercial |
$25,727.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,941.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,932.58
|
| Rate for Payer: Healthscope Commercial |
$26,924.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,941.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,436.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,428.37
|
| Rate for Payer: PHP Commercial |
$25,428.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,445.22
|
| Rate for Payer: Priority Health SBD |
$18,846.91
|
| Rate for Payer: UMR Bronson Commercial |
$13,162.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,436.80
|
|
|
LEUPROLIDE 15 MG INTRAMUSCULAR KIT
|
Facility
|
IP
|
$10,983.03
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,832.53 |
| Max. Negotiated Rate |
$9,884.73 |
| Rate for Payer: Aetna American Axle |
$7,138.97
|
| Rate for Payer: Aetna Commercial |
$9,335.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,138.97
|
| Rate for Payer: Cash Price |
$8,786.42
|
| Rate for Payer: Cofinity Commercial |
$7,688.12
|
| Rate for Payer: Cofinity Commercial |
$9,445.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,688.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,786.42
|
| Rate for Payer: Healthscope Commercial |
$9,884.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,688.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,237.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,335.58
|
| Rate for Payer: PHP Commercial |
$9,335.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,138.97
|
| Rate for Payer: Priority Health SBD |
$6,919.31
|
| Rate for Payer: UMR Bronson Commercial |
$4,832.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,237.27
|
|
|
LEUPROLIDE 15 MG INTRAMUSCULAR KIT
|
Facility
|
OP
|
$10,983.03
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
10391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$9,884.73 |
| Rate for Payer: Aetna American Axle |
$7,138.97
|
| Rate for Payer: Aetna Commercial |
$9,335.58
|
| Rate for Payer: Aetna Medicare |
$1,799.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,138.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,162.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,162.90
|
| Rate for Payer: BCBS Complete |
$973.82
|
| Rate for Payer: BCBS MAPPO |
$1,730.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,730.32
|
| Rate for Payer: Cash Price |
$8,786.42
|
| Rate for Payer: Cash Price |
$8,786.42
|
| Rate for Payer: Cofinity Commercial |
$9,445.41
|
| Rate for Payer: Cofinity Commercial |
$7,688.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,688.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,786.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$9,884.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,688.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,237.27
|
| Rate for Payer: Mclaren Medicaid |
$927.45
|
| Rate for Payer: Mclaren Medicare |
$1,730.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,816.84
|
| Rate for Payer: Meridian Medicaid |
$973.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,989.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,335.58
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$9,335.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,730.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,138.97
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health SBD |
$6,919.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,730.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,870.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,730.32
|
| Rate for Payer: UHC Exchange |
$3,306.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,730.32
|
| Rate for Payer: UHCCP Medicaid |
$927.45
|
| Rate for Payer: UMR Bronson Commercial |
$4,063.72
|
| Rate for Payer: VA VA |
$1,730.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,237.27
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$1,657.38
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$729.25 |
| Max. Negotiated Rate |
$1,491.64 |
| Rate for Payer: Aetna American Axle |
$1,077.30
|
| Rate for Payer: Aetna Commercial |
$1,408.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.30
|
| Rate for Payer: Cash Price |
$1,325.90
|
| Rate for Payer: Cofinity Commercial |
$1,160.17
|
| Rate for Payer: Cofinity Commercial |
$1,425.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,160.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.90
|
| Rate for Payer: Healthscope Commercial |
$1,491.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,160.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.77
|
| Rate for Payer: PHP Commercial |
$1,408.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.30
|
| Rate for Payer: Priority Health SBD |
$1,044.15
|
| Rate for Payer: UMR Bronson Commercial |
$729.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.04
|
|
|
LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$1,657.38
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.58 |
| Max. Negotiated Rate |
$1,491.64 |
| Rate for Payer: Aetna American Axle |
$1,077.30
|
| Rate for Payer: Aetna Commercial |
$1,408.77
|
| Rate for Payer: Aetna Medicare |
$183.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.56
|
| Rate for Payer: BCBS Complete |
$99.31
|
| Rate for Payer: BCBS MAPPO |
$176.45
|
| Rate for Payer: BCN Medicare Advantage |
$176.45
|
| Rate for Payer: Cash Price |
$1,325.90
|
| Rate for Payer: Cash Price |
$1,325.90
|
| Rate for Payer: Cofinity Commercial |
$1,425.35
|
| Rate for Payer: Cofinity Commercial |
$1,160.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,160.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$1,491.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,160.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.04
|
| Rate for Payer: Mclaren Medicaid |
$94.58
|
| Rate for Payer: Mclaren Medicare |
$176.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.27
|
| Rate for Payer: Meridian Medicaid |
$99.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.77
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$1,408.77
|
| Rate for Payer: PHP Medicare Advantage |
$176.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.30
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health SBD |
$1,044.15
|
| Rate for Payer: Railroad Medicare Medicare |
$176.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.45
|
| Rate for Payer: UHC Exchange |
$337.21
|
| Rate for Payer: UHC Medicare Advantage |
$176.45
|
| Rate for Payer: UHCCP Medicaid |
$94.58
|
| Rate for Payer: UMR Bronson Commercial |
$613.23
|
| Rate for Payer: VA VA |
$176.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.04
|
|
