|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$527.25
|
|
|
Service Code
|
NDC 00955173730
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.08 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna American Axle |
$342.71
|
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna Medicare |
$263.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: BCBS Complete |
$210.90
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Commercial |
$369.08
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.80
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.16
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.71
|
| Rate for Payer: Priority Health SBD |
$332.17
|
| Rate for Payer: UMR Bronson Commercial |
$195.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.44
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$7.11
|
|
|
Service Code
|
NDC 50268047811
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna American Axle |
$4.62
|
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna Medicare |
$3.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.62
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cofinity Commercial |
$4.98
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.62
|
| Rate for Payer: Priority Health SBD |
$4.48
|
| Rate for Payer: UMR Bronson Commercial |
$2.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.33
|
|
|
LENGTHENING OF HAMSTRING TENDON; SINGLE TENDON
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27393
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$487.48 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$536.23
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$487.48
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
LENGTHENING OF PALATE, AND PHARYNGEAL FLAP
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 42226
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$856.67 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,703.90
|
| Rate for Payer: BCN Commercial |
$3,703.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.34
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$856.67
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
LENGTHENING OF TENDON, FLEXOR, HAND OR FINGER, EACH TENDON
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$624.59 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.05
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$624.59
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; MULTIPLE TENDONS (THROUGH SAME INCISION), EACH
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 27686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$514.93 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.42
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$514.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 27685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$450.17 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,652.81
|
| Rate for Payer: BCN Commercial |
$4,652.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.19
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$450.17
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$2,867.02
|
|
|
Service Code
|
NDC 00078024915
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$2,580.32 |
| Rate for Payer: Aetna American Axle |
$1,863.56
|
| Rate for Payer: Aetna Commercial |
$2,436.97
|
| Rate for Payer: Aetna Medicare |
$1,433.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,863.56
|
| Rate for Payer: BCBS Complete |
$1,146.81
|
| Rate for Payer: Cash Price |
$2,293.62
|
| Rate for Payer: Cofinity Commercial |
$2,006.91
|
| Rate for Payer: Cofinity Commercial |
$2,465.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,006.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,293.62
|
| Rate for Payer: Healthscope Commercial |
$2,580.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,006.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,150.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.97
|
| Rate for Payer: PHP Commercial |
$2,436.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.56
|
| Rate for Payer: Priority Health SBD |
$1,806.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,060.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,150.26
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$2,867.02
|
|
|
Service Code
|
NDC 00078024915
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,261.49 |
| Max. Negotiated Rate |
$2,580.32 |
| Rate for Payer: Aetna American Axle |
$1,863.56
|
| Rate for Payer: Aetna Commercial |
$2,436.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,863.56
|
| Rate for Payer: Cash Price |
$2,293.62
|
| Rate for Payer: Cofinity Commercial |
$2,006.91
|
| Rate for Payer: Cofinity Commercial |
$2,465.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,006.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,293.62
|
| Rate for Payer: Healthscope Commercial |
$2,580.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,006.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,150.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,436.97
|
| Rate for Payer: PHP Commercial |
$2,436.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.56
|
| Rate for Payer: Priority Health SBD |
$1,806.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,261.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,150.26
|
|
|
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 |
$83.90
|
| 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 |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.90
|
| Rate for Payer: PHP Commercial |
$83.90
|
| 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 |
$74.02
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 50268047611
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| 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 |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
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 Medicare |
$1.86
|
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| 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
|
$65.55
|
|
|
Service Code
|
NDC 62756051183
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Aetna American Axle |
$42.61
|
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| 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 |
$59.00
|
| 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 |
$28.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$185.73
|
|
|
Service Code
|
NDC 50268047615
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$167.16 |
| Rate for Payer: Aetna American Axle |
$120.72
|
| Rate for Payer: Aetna Commercial |
$157.87
|
| Rate for Payer: Aetna Medicare |
$92.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.72
|
| Rate for Payer: BCBS Complete |
$74.29
|
| 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 |
$68.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.30
|
|
|
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 |
$59.00 |
| Rate for Payer: Aetna American Axle |
$42.61
|
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna Medicare |
$32.78
|
| 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 |
$59.00
|
| 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
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
NDC 00093762056
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna American Axle |
$51.69
|
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| Rate for Payer: Cash Price |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$55.66
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.62
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.59
|
| Rate for Payer: PHP Commercial |
$67.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.69
|
| Rate for Payer: Priority Health SBD |
$50.10
|
| Rate for Payer: UMR Bronson Commercial |
$34.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.64
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
IP
|
$109.28
|
|
|
Service Code
|
NDC 51991075933
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.08 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity 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 |
$48.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
NDC 00093762056
|
| Hospital Charge Code |
21509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$71.57 |
| Rate for Payer: Aetna American Axle |
$51.69
|
| Rate for Payer: Aetna Commercial |
$67.59
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.69
|
| Rate for Payer: BCBS Complete |
$31.81
|
| Rate for Payer: Cash Price |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$55.66
|
| Rate for Payer: Cofinity Commercial |
$68.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.62
|
| Rate for Payer: Healthscope Commercial |
$71.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.59
|
| Rate for Payer: PHP Commercial |
$67.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.69
|
| Rate for Payer: Priority Health SBD |
$50.10
|
| Rate for Payer: UMR Bronson Commercial |
$29.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.64
|
|
|
LETROZOLE 2.5 MG TABLET
|
Facility
|
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 |
$83.90
|
| 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 |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.90
|
| Rate for Payer: PHP Commercial |
$83.90
|
| 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 |
$74.02
|
|
|
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 |
$18.57
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna American Axle |
$53.77
|
| 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 Commercial |
$42.41
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna Medicare |
$24.94
|
| Rate for Payer: Aetna Medicare |
$14.26
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna Medicare |
$41.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.43
|
| 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) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: BCBS Complete |
$11.41
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS Complete |
$19.96
|
| Rate for Payer: BCBS Complete |
$33.09
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$66.18
|
| Rate for Payer: Cash Price |
$39.91
|
| Rate for Payer: Cash Price |
$39.91
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| 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 |
$57.91
|
| Rate for Payer: Cofinity Commercial |
$42.91
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| 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 |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.91
|
| Rate for Payer: Healthscope Commercial |
$44.90
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| 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 |
$34.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| 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 |
$42.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$70.32
|
| Rate for Payer: PHP Commercial |
$42.41
|
| Rate for Payer: PHP Commercial |
$24.25
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$24.28
|
| 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 |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.54
|
| Rate for Payer: Priority Health SBD |
$17.97
|
| Rate for Payer: Priority Health SBD |
$52.12
|
| Rate for Payer: Priority Health SBD |
$31.43
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| Rate for Payer: UMR Bronson Commercial |
$10.56
|
| Rate for Payer: UMR Bronson Commercial |
$18.46
|
| Rate for Payer: UMR Bronson Commercial |
$30.61
|
| 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 |
$62.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
|
|
LEUCOVORIN CALCIUM 200 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$38.99
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
15426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$35.09 |
| Rate for Payer: Aetna American Axle |
$25.34
|
| Rate for Payer: Aetna American Axle |
$107.58
|
| Rate for Payer: Aetna American Axle |
$36.34
|
| Rate for Payer: Aetna American Axle |
$43.56
|
| Rate for Payer: Aetna American Axle |
$72.63
|
| Rate for Payer: Aetna Commercial |
$56.97
|
| Rate for Payer: Aetna Commercial |
$94.98
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Aetna Medicare |
$55.87
|
| Rate for Payer: Aetna Medicare |
$82.75
|
| Rate for Payer: Aetna Medicare |
$33.51
|
| Rate for Payer: Aetna Medicare |
$27.95
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.63
|
| Rate for Payer: BCBS Complete |
$44.70
|
| Rate for Payer: BCBS Complete |
$26.81
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS Complete |
$22.36
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: Cash Price |
$89.39
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$44.72
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cash Price |
$89.39
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$44.72
|
| Rate for Payer: Cofinity Commercial |
$46.91
|
| Rate for Payer: Cofinity Commercial |
$96.10
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$39.13
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Cofinity Commercial |
$27.29
|
| Rate for Payer: Cofinity Commercial |
$78.22
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| 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 |
$39.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Healthscope Commercial |
$100.57
|
| Rate for Payer: Healthscope Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$50.31
|
| Rate for Payer: Healthscope Commercial |
$60.32
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.22
|
| 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 |
$115.85
|
| 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 |
$83.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.97
|
| 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 |
$94.98
|
| Rate for Payer: PHP Commercial |
$56.97
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$33.14
|
| Rate for Payer: PHP Commercial |
$47.52
|
| Rate for Payer: PHP Commercial |
$94.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.34
|
| 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 SBD |
$70.40
|
| Rate for Payer: Priority Health SBD |
$35.22
|
| Rate for Payer: Priority Health SBD |
$42.22
|
| Rate for Payer: Priority Health SBD |
$104.26
|
| Rate for Payer: Priority Health SBD |
$24.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.43
|
| Rate for Payer: UMR Bronson Commercial |
$20.68
|
| Rate for Payer: UMR Bronson Commercial |
$61.24
|
| Rate for Payer: UMR Bronson Commercial |
$41.34
|
| Rate for Payer: UMR Bronson Commercial |
$24.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.26
|
| 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 |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.80
|
|
|
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 |
$50.26
|
| 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 |
$50.26
|
|
