|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$7,377.22
|
|
|
Service Code
|
APR-DRG 6612
|
| Min. Negotiated Rate |
$7,025.93 |
| Max. Negotiated Rate |
$7,377.22 |
| Rate for Payer: BCBS Complete |
$7,377.22
|
| Rate for Payer: Mclaren Medicaid |
$7,025.93
|
| Rate for Payer: Meridian Medicaid |
$7,377.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,025.93
|
| Rate for Payer: UHC Medicaid |
$7,025.93
|
| Rate for Payer: UHCCP Medicaid |
$7,025.93
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$29,884.99
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$11,748.52 |
| Max. Negotiated Rate |
$29,884.99 |
| Rate for Payer: Aetna Medicare |
$12,861.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,458.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,458.58
|
| Rate for Payer: BCBS MAPPO |
$12,366.86
|
| Rate for Payer: BCBS Trust/PPO |
$29,884.99
|
| Rate for Payer: BCN Commercial |
$29,884.99
|
| Rate for Payer: BCN Medicare Advantage |
$12,366.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,366.86
|
| Rate for Payer: Mclaren Medicare |
$12,366.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,985.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,221.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,603.55
|
| Rate for Payer: Nomi Health Commercial |
$19,676.37
|
| Rate for Payer: PACE Medicare |
$11,748.52
|
| Rate for Payer: PACE SWMI |
$12,366.86
|
| Rate for Payer: PHP Medicare Advantage |
$12,366.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,591.10
|
| Rate for Payer: Priority Health Medicare |
$12,366.86
|
| Rate for Payer: Priority Health Tiered Network |
$19,672.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,366.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,862.39
|
| Rate for Payer: UHC Core |
$20,800.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,366.86
|
| Rate for Payer: UHC Exchange |
$16,987.27
|
| Rate for Payer: VA VA |
$12,366.86
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 1,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.30
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$4.58
|
| Rate for Payer: BCN Commercial |
$4.58
|
| Rate for Payer: BCN Medicare Advantage |
$1.84
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.84
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Mclaren Medicaid |
$0.96
|
| Rate for Payer: Mclaren Medicare |
$1.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.93
|
| Rate for Payer: Meridian Medicaid |
$1.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$5.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PACE Medicare |
$1.75
|
| Rate for Payer: PACE SWMI |
$1.84
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.82
|
| Rate for Payer: Priority Health Medicare |
$1.84
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: Priority Health Tiered Network |
$4.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$3.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.84
|
| Rate for Payer: UHC Exchange |
$3.02
|
| Rate for Payer: UHC Medicaid |
$0.96
|
| Rate for Payer: UHCCP Medicaid |
$0.96
|
| Rate for Payer: VA VA |
$1.84
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 1,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Advantage |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.14
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,972.03
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,392.38 |
| Max. Negotiated Rate |
$6,274.83 |
| Rate for Payer: Aetna Commercial |
$5,926.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,531.82
|
| Rate for Payer: Cash Price |
$5,577.62
|
| Rate for Payer: Cofinity Advantage |
$4,880.42
|
| Rate for Payer: Cofinity Commercial |
$5,995.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,577.62
|
| Rate for Payer: Healthscope Commercial |
$6,274.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,926.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,229.02
|
| Rate for Payer: PHP Commercial |
$5,926.23
|
| Rate for Payer: Priority Health SBD |
$4,392.38
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,972.03
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$6,274.83 |
| Rate for Payer: Aetna Commercial |
$5,926.23
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,531.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.30
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS MAPPO |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Medicare Advantage |
$2.64
|
| Rate for Payer: Cash Price |
$5,577.62
|
| Rate for Payer: Cash Price |
$5,577.62
|
| Rate for Payer: Cofinity Advantage |
$4,880.42
|
| Rate for Payer: Cofinity Commercial |
$5,995.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,577.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$6,274.83
|
| Rate for Payer: Mclaren Medicaid |
$1.38
|
| Rate for Payer: Mclaren Medicare |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.77
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,926.23
|
| Rate for Payer: Nomi Health Commercial |
$7.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,229.02
|
| Rate for Payer: PACE Medicare |
$2.51
|
| Rate for Payer: PACE SWMI |
$2.64
|
| Rate for Payer: PHP Commercial |
$5,926.23
|
| Rate for Payer: PHP Medicare Advantage |
$2.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.36
|
| Rate for Payer: Priority Health Medicare |
$2.64
|
| Rate for Payer: Priority Health SBD |
$4,392.38
|
| Rate for Payer: Priority Health Tiered Network |
$6.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.32
|
| Rate for Payer: UHC Core |
$4.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.64
|
| Rate for Payer: UHC Exchange |
$4.32
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: VA VA |
$2.64
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$34,860.15
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,961.89 |
| Max. Negotiated Rate |
$31,374.13 |
| Rate for Payer: Aetna Commercial |
$29,631.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,659.10
|
| Rate for Payer: Cash Price |
$27,888.12
|
| Rate for Payer: Cofinity Advantage |
$24,402.10
|
| Rate for Payer: Cofinity Commercial |
$29,979.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,888.12
|
| Rate for Payer: Healthscope Commercial |
$31,374.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,631.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26,145.11
|
| Rate for Payer: PHP Commercial |
$29,631.13
|
| Rate for Payer: Priority Health SBD |
$21,961.89
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$34,860.15
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$31,374.13 |
| Rate for Payer: Aetna Commercial |
$29,631.13
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,659.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.30
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: BCBS MAPPO |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: BCN Medicare Advantage |
$2.64
|
| Rate for Payer: Cash Price |
$27,888.12
|
| Rate for Payer: Cash Price |
$27,888.12
|
| Rate for Payer: Cofinity Advantage |
$24,402.10
|
| Rate for Payer: Cofinity Commercial |
$29,979.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,888.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$31,374.13
|
| Rate for Payer: Mclaren Medicaid |
$1.38
|
| Rate for Payer: Mclaren Medicare |
$2.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.77
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,631.13
|
| Rate for Payer: Nomi Health Commercial |
$7.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26,145.11
|
| Rate for Payer: PACE Medicare |
$2.51
|
| Rate for Payer: PACE SWMI |
$2.64
|
| Rate for Payer: PHP Commercial |
$29,631.13
|
| Rate for Payer: PHP Medicare Advantage |
$2.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.36
|
| Rate for Payer: Priority Health Medicare |
$2.64
|
| Rate for Payer: Priority Health SBD |
$21,961.89
|
| Rate for Payer: Priority Health Tiered Network |
$6.69
|
| Rate for Payer: Railroad Medicare Medicare |
$2.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.32
|
| Rate for Payer: UHC Core |
$4.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.64
|
| Rate for Payer: UHC Exchange |
$4.32
|
| Rate for Payer: UHC Medicaid |
$1.38
|
| Rate for Payer: UHCCP Medicaid |
$1.38
|
| Rate for Payer: VA VA |
$2.64
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,938.41
|
|
|
Service Code
|
APR-DRG 7743
|
| Min. Negotiated Rate |
$4,703.24 |
| Max. Negotiated Rate |
$4,938.41 |
| Rate for Payer: BCBS Complete |
$4,938.41
|
| Rate for Payer: Mclaren Medicaid |
$4,703.24
|
| Rate for Payer: Meridian Medicaid |
$4,938.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,703.24
|
| Rate for Payer: UHC Medicaid |
$4,703.24
|
| Rate for Payer: UHCCP Medicaid |
$4,703.24
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$2,961.67
|
|
|
Service Code
|
APR-DRG 7741
|
| Min. Negotiated Rate |
$2,820.64 |
| Max. Negotiated Rate |
$2,961.67 |
| Rate for Payer: BCBS Complete |
$2,961.67
|
| Rate for Payer: Mclaren Medicaid |
$2,820.64
|
| Rate for Payer: Meridian Medicaid |
$2,961.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,820.64
|
| Rate for Payer: UHC Medicaid |
$2,820.64
|
| Rate for Payer: UHCCP Medicaid |
$2,820.64
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,762.57
|
|
|
Service Code
|
APR-DRG 7742
|
| Min. Negotiated Rate |
$3,583.40 |
| Max. Negotiated Rate |
$3,762.57 |
| Rate for Payer: BCBS Complete |
$3,762.57
|
| Rate for Payer: Mclaren Medicaid |
$3,583.40
|
| Rate for Payer: Meridian Medicaid |
$3,762.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,583.40
|
| Rate for Payer: UHC Medicaid |
$3,583.40
|
| Rate for Payer: UHCCP Medicaid |
$3,583.40
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$12,263.46
|
|
|
Service Code
|
APR-DRG 7744
|
| Min. Negotiated Rate |
$11,679.49 |
| Max. Negotiated Rate |
$12,263.46 |
| Rate for Payer: BCBS Complete |
$12,263.46
|
| Rate for Payer: Mclaren Medicaid |
$11,679.49
|
| Rate for Payer: Meridian Medicaid |
$12,263.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,679.49
|
| Rate for Payer: UHC Medicaid |
$11,679.49
|
| Rate for Payer: UHCCP Medicaid |
$11,679.49
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 67877058901
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.01 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Advantage |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health SBD |
$265.01
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$372.41
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.36 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna Commercial |
$316.55
|
| Rate for Payer: Aetna Medicare |
$186.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.07
|
| Rate for Payer: BCBS Complete |
$148.96
|
| Rate for Payer: Cash Price |
$297.93
|
| Rate for Payer: Cofinity Advantage |
$260.69
|
| Rate for Payer: Cofinity Commercial |
$320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.93
|
| Rate for Payer: Healthscope Commercial |
$335.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.31
|
| Rate for Payer: PHP Commercial |
$316.55
|
| Rate for Payer: Priority Health SBD |
$234.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.07
|
| Rate for Payer: UHC Core |
$194.03
|
| Rate for Payer: UHC Exchange |
$146.36
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$777.89
|
|
|
Service Code
|
NDC 60687038921
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$490.07 |
| Max. Negotiated Rate |
$700.10 |
| Rate for Payer: Aetna Commercial |
$661.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.63
|
| Rate for Payer: Cash Price |
$622.31
|
| Rate for Payer: Cofinity Advantage |
$544.52
|
| Rate for Payer: Cofinity Commercial |
$668.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.31
|
| Rate for Payer: Healthscope Commercial |
$700.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.42
|
| Rate for Payer: PHP Commercial |
$661.21
|
| Rate for Payer: Priority Health SBD |
$490.07
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$595.52
|
|
|
Service Code
|
NDC 50268018715
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.18 |
| Max. Negotiated Rate |
$535.97 |
| Rate for Payer: Aetna Commercial |
$506.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.09
|
| Rate for Payer: Cash Price |
$476.42
|
| Rate for Payer: Cofinity Advantage |
$416.86
|
| Rate for Payer: Cofinity Commercial |
$512.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$535.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.64
|
| Rate for Payer: PHP Commercial |
$506.19
|
| Rate for Payer: Priority Health SBD |
$375.18
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$777.89
|
|
|
Service Code
|
NDC 60687038921
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.71 |
| Max. Negotiated Rate |
$700.10 |
| Rate for Payer: Aetna Commercial |
$661.21
|
| Rate for Payer: Aetna Medicare |
$388.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.63
|
| Rate for Payer: BCBS Complete |
$311.16
|
| Rate for Payer: Cash Price |
$622.31
|
| Rate for Payer: Cofinity Advantage |
$544.52
|
| Rate for Payer: Cofinity Commercial |
$668.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.31
|
| Rate for Payer: Healthscope Commercial |
$700.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.42
|
| Rate for Payer: PHP Commercial |
$661.21
|
| Rate for Payer: Priority Health SBD |
$490.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.63
|
| Rate for Payer: UHC Core |
$405.28
|
| Rate for Payer: UHC Exchange |
$305.71
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$2,474.19
|
|
|
Service Code
|
NDC 64764011901
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,558.74 |
| Max. Negotiated Rate |
$2,226.77 |
| Rate for Payer: Aetna Commercial |
$2,103.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,608.22
|
| Rate for Payer: Cash Price |
$1,979.35
|
| Rate for Payer: Cofinity Advantage |
$1,731.93
|
| Rate for Payer: Cofinity Commercial |
$2,127.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,979.35
|
| Rate for Payer: Healthscope Commercial |
$2,226.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,103.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,855.64
|
| Rate for Payer: PHP Commercial |
$2,103.06
|
| Rate for Payer: Priority Health SBD |
$1,558.74
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$2,474.19
|
|
|
Service Code
|
NDC 64764011901
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$972.36 |
| Max. Negotiated Rate |
$2,226.77 |
| Rate for Payer: Aetna Commercial |
$2,103.06
|
| Rate for Payer: Aetna Medicare |
$1,237.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,608.22
|
| Rate for Payer: BCBS Complete |
$989.68
|
| Rate for Payer: Cash Price |
$1,979.35
|
| Rate for Payer: Cofinity Advantage |
$1,731.93
|
| Rate for Payer: Cofinity Commercial |
$2,127.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,979.35
|
| Rate for Payer: Healthscope Commercial |
$2,226.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,979.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,103.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,855.64
|
| Rate for Payer: PHP Commercial |
$2,103.06
|
| Rate for Payer: Priority Health SBD |
$1,558.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,608.22
|
| Rate for Payer: UHC Core |
$1,289.05
|
| Rate for Payer: UHC Exchange |
$972.36
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$11.92
|
|
|
Service Code
|
NDC 50268018711
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$10.73 |
| Rate for Payer: Aetna Commercial |
$10.13
|
| Rate for Payer: Aetna Medicare |
$5.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.75
|
| Rate for Payer: BCBS Complete |
$4.77
|
| Rate for Payer: Cash Price |
$9.54
|
| Rate for Payer: Cofinity Advantage |
$8.34
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.54
|
| Rate for Payer: Healthscope Commercial |
$10.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.94
|
| Rate for Payer: PHP Commercial |
$10.13
|
| Rate for Payer: Priority Health SBD |
$7.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.75
|
| Rate for Payer: UHC Core |
$6.21
|
| Rate for Payer: UHC Exchange |
$4.68
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$431.02
|
|
|
Service Code
|
NDC 42292005403
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.39 |
| Max. Negotiated Rate |
$387.92 |
| Rate for Payer: Aetna Commercial |
$366.37
|
| Rate for Payer: Aetna Medicare |
$215.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.16
|
| Rate for Payer: BCBS Complete |
$172.41
|
| Rate for Payer: Cash Price |
$344.82
|
| Rate for Payer: Cofinity Advantage |
$301.71
|
| Rate for Payer: Cofinity Commercial |
$370.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.82
|
| Rate for Payer: Healthscope Commercial |
$387.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.26
|
| Rate for Payer: PHP Commercial |
$366.37
|
| Rate for Payer: Priority Health SBD |
$271.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.16
|
| Rate for Payer: UHC Core |
$224.56
|
| Rate for Payer: UHC Exchange |
$169.39
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$372.41
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.62 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna Commercial |
$316.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.07
|
| Rate for Payer: Cash Price |
$297.93
|
| Rate for Payer: Cofinity Advantage |
$260.69
|
| Rate for Payer: Cofinity Commercial |
$320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.93
|
| Rate for Payer: Healthscope Commercial |
$335.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.31
|
| Rate for Payer: PHP Commercial |
$316.55
|
| Rate for Payer: Priority Health SBD |
$234.62
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$25.93
|
|
|
Service Code
|
NDC 60687038911
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.85
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cofinity Advantage |
$18.15
|
| Rate for Payer: Cofinity Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Healthscope Commercial |
$23.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.04
|
| Rate for Payer: Priority Health SBD |
$16.34
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$431.02
|
|
|
Service Code
|
NDC 42292005403
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.54 |
| Max. Negotiated Rate |
$387.92 |
| Rate for Payer: Aetna Commercial |
$366.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.16
|
| Rate for Payer: Cash Price |
$344.82
|
| Rate for Payer: Cofinity Advantage |
$301.71
|
| Rate for Payer: Cofinity Commercial |
$370.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.82
|
| Rate for Payer: Healthscope Commercial |
$387.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.26
|
| Rate for Payer: PHP Commercial |
$366.37
|
| Rate for Payer: Priority Health SBD |
$271.54
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 67877058901
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.32 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$210.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: BCBS Complete |
$168.26
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Advantage |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.42
|
| Rate for Payer: UHC Core |
$219.16
|
| Rate for Payer: UHC Exchange |
$165.32
|
|
