|
LEUPROLIDE 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 Commercial |
$965.95
|
| Rate for Payer: Cofinity Commercial |
$786.24
|
| Rate for Payer: Cofinity Commercial |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$941.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$766.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$786.24
|
| 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 |
$766.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$930.24
|
| Rate for Payer: PHP Commercial |
$954.72
|
| Rate for Payer: PHP Commercial |
$930.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.08
|
| Rate for Payer: Priority Health SBD |
$689.47
|
| Rate for Payer: Priority Health SBD |
$707.62
|
| 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 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 |
$94.58 |
| 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 |
$183.51
|
| Rate for Payer: Aetna Medicare |
$183.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.56
|
| Rate for Payer: BCBS Complete |
$99.31
|
| Rate for Payer: BCBS Complete |
$99.31
|
| Rate for Payer: BCBS MAPPO |
$176.45
|
| Rate for Payer: BCBS MAPPO |
$176.45
|
| Rate for Payer: BCN Medicare Advantage |
$176.45
|
| Rate for Payer: BCN Medicare Advantage |
$176.45
|
| Rate for Payer: Cash Price |
$875.52
|
| Rate for Payer: Cash Price |
$898.56
|
| Rate for Payer: Cash Price |
$898.56
|
| Rate for Payer: Cash Price |
$875.52
|
| Rate for Payer: Cofinity Commercial |
$766.08
|
| Rate for Payer: Cofinity Commercial |
$941.18
|
| Rate for Payer: Cofinity Commercial |
$786.24
|
| Rate for Payer: Cofinity Commercial |
$965.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$766.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$786.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$875.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$1,010.88
|
| Rate for Payer: Healthscope Commercial |
$984.96
|
| 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 |
$94.58
|
| Rate for Payer: Mclaren Medicaid |
$94.58
|
| Rate for Payer: Mclaren Medicare |
$176.45
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.27
|
| Rate for Payer: Meridian Medicaid |
$99.31
|
| Rate for Payer: Meridian Medicaid |
$99.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$930.24
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$930.24
|
| Rate for Payer: PHP Commercial |
$954.72
|
| Rate for Payer: PHP Medicare Advantage |
$176.45
|
| Rate for Payer: PHP Medicare Advantage |
$176.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$730.08
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health SBD |
$689.47
|
| Rate for Payer: Priority Health SBD |
$707.62
|
| Rate for Payer: Railroad Medicare Medicare |
$176.45
|
| Rate for Payer: Railroad Medicare Medicare |
$176.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.45
|
| Rate for Payer: UHC Exchange |
$337.21
|
| Rate for Payer: UHC Exchange |
$337.21
|
| Rate for Payer: UHC Medicare Advantage |
$176.45
|
| Rate for Payer: UHC Medicare Advantage |
$176.45
|
| Rate for Payer: UHCCP Medicaid |
$94.58
|
| Rate for Payer: UHCCP Medicaid |
$94.58
|
| Rate for Payer: UMR Bronson Commercial |
$404.93
|
| Rate for Payer: UMR Bronson Commercial |
$415.58
|
| Rate for Payer: VA VA |
$176.45
|
| Rate for Payer: VA VA |
$176.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.80
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$2,209.83
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.58 |
| Max. Negotiated Rate |
$1,988.85 |
| Rate for Payer: Aetna American Axle |
$1,436.39
|
| Rate for Payer: Aetna Commercial |
$1,878.36
|
| Rate for Payer: Aetna Medicare |
$183.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,436.39
|
| 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 |
$1,767.86
|
| Rate for Payer: Cash Price |
$1,767.86
|
| Rate for Payer: Cofinity Commercial |
$1,900.45
|
| Rate for Payer: Cofinity Commercial |
$1,546.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,546.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$1,988.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,546.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,657.37
|
| 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 |
$1,878.36
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$1,878.36
|
| 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 |
$1,436.39
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health SBD |
$1,392.19
|
| 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 |
$817.64
|
| Rate for Payer: VA VA |
$176.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,657.37
|
|
|
LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$2,209.83
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
21108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$972.33 |
| Max. Negotiated Rate |
$1,988.85 |
| Rate for Payer: Aetna American Axle |
$1,436.39
|
| Rate for Payer: Aetna Commercial |
$1,878.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,436.39
|
| Rate for Payer: Cash Price |
$1,767.86
|
| Rate for Payer: Cofinity Commercial |
$1,546.88
|
| Rate for Payer: Cofinity Commercial |
$1,900.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,546.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.86
|
| Rate for Payer: Healthscope Commercial |
$1,988.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,546.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,657.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.36
|
| Rate for Payer: PHP Commercial |
$1,878.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.39
|
| Rate for Payer: Priority Health SBD |
$1,392.19
|
| Rate for Payer: UMR Bronson Commercial |
$972.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,657.37
|
|
|
LEUPROLIDE 30 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$32,949.21
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$29,654.29 |
| Rate for Payer: Aetna American Axle |
$21,416.99
|
| Rate for Payer: Aetna Commercial |
$28,006.83
|
| Rate for Payer: Aetna Medicare |
$1,799.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,416.99
|
| 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 |
$26,359.37
|
| Rate for Payer: Cash Price |
$26,359.37
|
| Rate for Payer: Cofinity Commercial |
$28,336.32
|
| Rate for Payer: Cofinity Commercial |
$23,064.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$23,064.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,359.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$29,654.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,064.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,711.91
|
| 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 |
$28,006.83
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$28,006.83
|
| 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 |
$21,416.99
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health SBD |
$20,758.00
|
| 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 |
$12,191.21
|
| Rate for Payer: VA VA |
$1,730.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,711.91
|
|
|
LEUPROLIDE 30 MG (PEDIATRIC 3 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$32,949.21
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
153367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,497.65 |
| Max. Negotiated Rate |
$29,654.29 |
| Rate for Payer: Aetna American Axle |
$21,416.99
|
| Rate for Payer: Aetna Commercial |
$28,006.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,416.99
|
| Rate for Payer: Cash Price |
$26,359.37
|
| Rate for Payer: Cofinity Commercial |
$23,064.45
|
| Rate for Payer: Cofinity Commercial |
$28,336.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$23,064.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,359.37
|
| Rate for Payer: Healthscope Commercial |
$29,654.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,064.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,711.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,006.83
|
| Rate for Payer: PHP Commercial |
$28,006.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,416.99
|
| Rate for Payer: Priority Health SBD |
$20,758.00
|
| Rate for Payer: UMR Bronson Commercial |
$14,497.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,711.91
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$5,619.46
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
13691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,472.56 |
| Max. Negotiated Rate |
$5,057.51 |
| Rate for Payer: Aetna American Axle |
$3,652.65
|
| Rate for Payer: Aetna Commercial |
$4,776.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,652.65
|
| Rate for Payer: Cash Price |
$4,495.57
|
| Rate for Payer: Cofinity Commercial |
$3,933.62
|
| Rate for Payer: Cofinity Commercial |
$4,832.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,933.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,495.57
|
| Rate for Payer: Healthscope Commercial |
$5,057.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,933.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,776.54
|
| Rate for Payer: PHP Commercial |
$4,776.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,652.65
|
| Rate for Payer: Priority Health SBD |
$3,540.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,472.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,214.60
|
|
|
LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$5,619.46
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
13691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$5,057.51 |
| Rate for Payer: Aetna American Axle |
$3,652.65
|
| Rate for Payer: Aetna Commercial |
$4,776.54
|
| Rate for Payer: Aetna Medicare |
$1,799.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,652.65
|
| 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 |
$4,495.57
|
| Rate for Payer: Cash Price |
$4,495.57
|
| Rate for Payer: Cofinity Commercial |
$3,933.62
|
| Rate for Payer: Cofinity Commercial |
$4,832.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,933.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,495.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$5,057.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,933.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,214.60
|
| 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 |
$4,776.54
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$4,776.54
|
| 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 |
$3,652.65
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health SBD |
$3,540.26
|
| 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 |
$2,079.20
|
| Rate for Payer: VA VA |
$1,730.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,214.60
|
|
|
LEUPROLIDE 45 MG (PEDIATRIC 6 MONTH) INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$65,898.36
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
203699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$59,308.52 |
| Rate for Payer: Aetna American Axle |
$42,833.93
|
| Rate for Payer: Aetna Commercial |
$56,013.61
|
| Rate for Payer: Aetna Medicare |
$1,799.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42,833.93
|
| 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 |
$52,718.69
|
| Rate for Payer: Cash Price |
$52,718.69
|
| Rate for Payer: Cofinity Commercial |
$46,128.85
|
| Rate for Payer: Cofinity Commercial |
$56,672.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$46,128.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52,718.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$59,308.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46,128.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49,423.77
|
| 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 |
$56,013.61
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$56,013.61
|
| 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 |
$42,833.93
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health SBD |
$41,515.97
|
| 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 |
$24,382.39
|
| Rate for Payer: VA VA |
$1,730.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49,423.77
|
|
|
LEUPROLIDE 7.5 MG (1 MONTH) SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$415.35
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
32893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.75 |
| Max. Negotiated Rate |
$373.81 |
| Rate for Payer: Aetna American Axle |
$269.98
|
| Rate for Payer: Aetna Commercial |
$353.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.98
|
| Rate for Payer: Cash Price |
$332.28
|
| Rate for Payer: Cofinity Commercial |
$290.75
|
| Rate for Payer: Cofinity Commercial |
$357.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.28
|
| Rate for Payer: Healthscope Commercial |
$373.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.05
|
| Rate for Payer: PHP Commercial |
$353.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.98
|
| Rate for Payer: Priority Health SBD |
$261.67
|
| Rate for Payer: UMR Bronson Commercial |
$182.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.51
|
|
|
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 |
$94.58 |
| Max. Negotiated Rate |
$496.69 |
| 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 |
$183.51
|
| Rate for Payer: Aetna Medicare |
$183.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.56
|
| Rate for Payer: BCBS Complete |
$99.31
|
| Rate for Payer: BCBS Complete |
$99.31
|
| Rate for Payer: BCBS MAPPO |
$176.45
|
| Rate for Payer: BCBS MAPPO |
$176.45
|
| Rate for Payer: BCN Medicare Advantage |
$176.45
|
| Rate for Payer: BCN Medicare Advantage |
$176.45
|
| Rate for Payer: Cash Price |
$323.76
|
| Rate for Payer: Cash Price |
$323.76
|
| Rate for Payer: Cash Price |
$332.28
|
| Rate for Payer: Cash Price |
$332.28
|
| Rate for Payer: Cofinity Commercial |
$283.29
|
| Rate for Payer: Cofinity Commercial |
$348.04
|
| Rate for Payer: Cofinity Commercial |
$290.75
|
| Rate for Payer: Cofinity Commercial |
$357.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$373.81
|
| Rate for Payer: Healthscope Commercial |
$364.23
|
| 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 |
$94.58
|
| Rate for Payer: Mclaren Medicaid |
$94.58
|
| Rate for Payer: Mclaren Medicare |
$176.45
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.27
|
| Rate for Payer: Meridian Medicaid |
$99.31
|
| Rate for Payer: Meridian Medicaid |
$99.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.00
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$353.05
|
| Rate for Payer: PHP Commercial |
$344.00
|
| Rate for Payer: PHP Medicare Advantage |
$176.45
|
| Rate for Payer: PHP Medicare Advantage |
$176.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.06
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health SBD |
$261.67
|
| Rate for Payer: Priority Health SBD |
$254.96
|
| Rate for Payer: Railroad Medicare Medicare |
$176.45
|
| Rate for Payer: Railroad Medicare Medicare |
$176.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.45
|
| Rate for Payer: UHC Exchange |
$337.21
|
| Rate for Payer: UHC Exchange |
$337.21
|
| Rate for Payer: UHC Medicare Advantage |
$176.45
|
| Rate for Payer: UHC Medicare Advantage |
$176.45
|
| Rate for Payer: UHCCP Medicaid |
$94.58
|
| Rate for Payer: UHCCP Medicaid |
$94.58
|
| Rate for Payer: UMR Bronson Commercial |
$149.74
|
| Rate for Payer: UMR Bronson Commercial |
$153.68
|
| Rate for Payer: VA VA |
$176.45
|
| Rate for Payer: VA VA |
$176.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.52
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
IP
|
$612.88
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.67 |
| Max. Negotiated Rate |
$551.59 |
| Rate for Payer: Aetna American Axle |
$398.37
|
| Rate for Payer: Aetna Commercial |
$520.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.37
|
| Rate for Payer: Cash Price |
$490.30
|
| Rate for Payer: Cofinity Commercial |
$429.02
|
| Rate for Payer: Cofinity Commercial |
$527.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$429.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.30
|
| Rate for Payer: Healthscope Commercial |
$551.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$429.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.95
|
| Rate for Payer: PHP Commercial |
$520.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.37
|
| Rate for Payer: Priority Health SBD |
$386.11
|
| Rate for Payer: UMR Bronson Commercial |
$269.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.66
|
|
|
LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$612.88
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.58 |
| Max. Negotiated Rate |
$551.59 |
| Rate for Payer: Aetna American Axle |
$398.37
|
| Rate for Payer: Aetna Commercial |
$520.95
|
| Rate for Payer: Aetna Medicare |
$183.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.37
|
| 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 |
$490.30
|
| Rate for Payer: Cash Price |
$490.30
|
| Rate for Payer: Cofinity Commercial |
$527.08
|
| Rate for Payer: Cofinity Commercial |
$429.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$429.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$551.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$429.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.66
|
| 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 |
$520.95
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$520.95
|
| 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 |
$398.37
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health SBD |
$386.11
|
| 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 |
$226.77
|
| Rate for Payer: VA VA |
$176.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.66
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT
|
Facility
|
IP
|
$5,492.71
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
27123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,416.79 |
| Max. Negotiated Rate |
$4,943.44 |
| Rate for Payer: Aetna American Axle |
$3,570.26
|
| Rate for Payer: Aetna Commercial |
$4,668.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,570.26
|
| Rate for Payer: Cash Price |
$4,394.17
|
| Rate for Payer: Cofinity Commercial |
$3,844.90
|
| Rate for Payer: Cofinity Commercial |
$4,723.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,844.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,394.17
|
| Rate for Payer: Healthscope Commercial |
$4,943.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,844.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,119.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,668.80
|
| Rate for Payer: PHP Commercial |
$4,668.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,570.26
|
| Rate for Payer: Priority Health SBD |
$3,460.41
|
| Rate for Payer: UMR Bronson Commercial |
$2,416.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,119.53
|
|
|
LEUPROLIDE 7.5 MG (PED) INTRAMUSCULAR KIT
|
Facility
|
OP
|
$5,492.71
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
27123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$927.45 |
| Max. Negotiated Rate |
$4,943.44 |
| Rate for Payer: Aetna American Axle |
$3,570.26
|
| Rate for Payer: Aetna Commercial |
$4,668.80
|
| Rate for Payer: Aetna Medicare |
$1,799.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,570.26
|
| 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 |
$4,394.17
|
| Rate for Payer: Cash Price |
$4,394.17
|
| Rate for Payer: Cofinity Commercial |
$3,844.90
|
| Rate for Payer: Cofinity Commercial |
$4,723.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,844.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,394.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,730.32
|
| Rate for Payer: Healthscope Commercial |
$4,943.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,844.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,119.53
|
| 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 |
$4,668.80
|
| Rate for Payer: PACE Medicare |
$1,643.80
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$4,668.80
|
| 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 |
$3,570.26
|
| Rate for Payer: Priority Health Medicare |
$1,730.32
|
| Rate for Payer: Priority Health SBD |
$3,460.41
|
| 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 |
$2,032.30
|
| Rate for Payer: VA VA |
$1,730.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,119.53
|
|
|
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 |
$94.58 |
| 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 |
$183.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.72
|
| 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 |
$1,751.04
|
| Rate for Payer: Cash Price |
$1,751.04
|
| Rate for Payer: Cofinity Commercial |
$1,882.37
|
| Rate for Payer: Cofinity Commercial |
$1,532.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,532.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,751.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| 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 |
$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 |
$1,860.48
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$1,860.48
|
| 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 |
$1,422.72
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health SBD |
$1,378.94
|
| 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 |
$809.86
|
| Rate for Payer: VA VA |
$176.45
|
| 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 Commercial |
$1,532.16
|
| Rate for Payer: Cofinity Commercial |
$1,882.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,532.16
|
| 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: PHP Commercial |
$1,860.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,422.72
|
| 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
|
IP
|
$3,314.79
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,458.51 |
| Max. Negotiated Rate |
$2,983.31 |
| Rate for Payer: Aetna American Axle |
$2,154.61
|
| Rate for Payer: Aetna Commercial |
$2,817.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,154.61
|
| Rate for Payer: Cash Price |
$2,651.83
|
| Rate for Payer: Cofinity Commercial |
$2,320.35
|
| Rate for Payer: Cofinity Commercial |
$2,850.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,651.83
|
| Rate for Payer: Healthscope Commercial |
$2,983.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,320.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,486.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,817.57
|
| Rate for Payer: PHP Commercial |
$2,817.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,154.61
|
| Rate for Payer: Priority Health SBD |
$2,088.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,458.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,486.09
|
|
|
LEUPROLIDE ACETATE (6 MONTH) 45 MG INTRAMUSCULAR SYRINGE KIT
|
Facility
|
OP
|
$3,314.79
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
152942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.58 |
| Max. Negotiated Rate |
$2,983.31 |
| Rate for Payer: Aetna American Axle |
$2,154.61
|
| Rate for Payer: Aetna Commercial |
$2,817.57
|
| Rate for Payer: Aetna Medicare |
$183.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,154.61
|
| 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 |
$2,651.83
|
| Rate for Payer: Cash Price |
$2,651.83
|
| Rate for Payer: Cofinity Commercial |
$2,850.72
|
| Rate for Payer: Cofinity Commercial |
$2,320.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,651.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$2,983.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,320.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,486.09
|
| 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 |
$2,817.57
|
| Rate for Payer: PACE Medicare |
$167.63
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$2,817.57
|
| 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 |
$2,154.61
|
| Rate for Payer: Priority Health Medicare |
$176.45
|
| Rate for Payer: Priority Health SBD |
$2,088.32
|
| 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 |
$1,226.47
|
| Rate for Payer: VA VA |
$176.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,486.09
|
|
|
LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$7.15
|
|
|
Service Code
|
HCPCS J7614
|
| Hospital Charge Code |
24915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: Aetna American Axle |
$4.65
|
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna American Axle |
$3.48
|
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Aetna Medicare |
$2.68
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS Complete |
$2.86
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$4.27
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.72
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| 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 |
$3.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.08
|
| Rate for Payer: PHP Commercial |
$4.22
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: PHP Commercial |
$6.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$3.38
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: Priority Health SBD |
$4.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.36
|
|
|
LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$4.96
|
|
|
Service Code
|
HCPCS J7614
|
| Hospital Charge Code |
24915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| 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 |
$4.22
|
| Rate for Payer: Aetna Commercial |
$6.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.48
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cash Price |
$3.97
|
| Rate for Payer: Cofinity Commercial |
$4.27
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$6.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: PHP Commercial |
$6.08
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: PHP Commercial |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$4.50
|
| Rate for Payer: Priority Health SBD |
$3.38
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.18
|
| 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 |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
|
|
LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$17.09
|
|
|
Service Code
|
HCPCS J7612
|
| Hospital Charge Code |
39278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna American Axle |
$11.11
|
| Rate for Payer: Aetna American Axle |
$6.06
|
| Rate for Payer: Aetna Commercial |
$14.53
|
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Aetna Medicare |
$8.54
|
| Rate for Payer: Aetna Medicare |
$4.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: BCBS Complete |
$6.84
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$11.96
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$8.39
|
| Rate for Payer: Healthscope Commercial |
$15.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: PHP Commercial |
$7.92
|
| Rate for Payer: PHP Commercial |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.06
|
| Rate for Payer: Priority Health SBD |
$5.87
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: UMR Bronson Commercial |
$6.32
|
| Rate for Payer: UMR Bronson Commercial |
$3.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
|
|
LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$17.09
|
|
|
Service Code
|
HCPCS J7612
|
| Hospital Charge Code |
39278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna American Axle |
$11.11
|
| Rate for Payer: Aetna American Axle |
$6.06
|
| Rate for Payer: Aetna Commercial |
$14.53
|
| Rate for Payer: Aetna Commercial |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.06
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Cofinity Commercial |
$11.96
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$8.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.53
|
| Rate for Payer: PHP Commercial |
$7.92
|
| Rate for Payer: PHP Commercial |
$14.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.06
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: Priority Health SBD |
$5.87
|
| Rate for Payer: UMR Bronson Commercial |
$7.52
|
| Rate for Payer: UMR Bronson Commercial |
$4.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.99
|
|
|
LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$202.86
|
|
|
Service Code
|
NDC 00591292754
|
| Hospital Charge Code |
43472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.26 |
| Max. Negotiated Rate |
$182.57 |
| Rate for Payer: Aetna American Axle |
$131.86
|
| Rate for Payer: Aetna Commercial |
$172.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.86
|
| Rate for Payer: Cash Price |
$162.29
|
| Rate for Payer: Cofinity Commercial |
$142.00
|
| Rate for Payer: Cofinity Commercial |
$174.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.29
|
| Rate for Payer: Healthscope Commercial |
$182.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.43
|
| Rate for Payer: PHP Commercial |
$172.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.86
|
| Rate for Payer: Priority Health SBD |
$127.80
|
| Rate for Payer: UMR Bronson Commercial |
$89.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.15
|
|
|
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 Commercial |
$108.75
|
| Rate for Payer: Cofinity Commercial |
$133.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.75
|
| 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: PHP Commercial |
$132.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.98
|
| 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
|
|
