Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CLOZAPINE 25 MG TABLET

Facility

$298.30

Service Code	NDC 51079092120
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$119.32
Max. Negotiated Rate	$268.47
Rate for Payer: Aetna Commercial	$253.56
Rate for Payer: Aetna Medicare	$149.15
Rate for Payer: Aetna New Business (MI Preferred)	$193.90
Rate for Payer: BCBS Complete	$119.32
Rate for Payer: Cash Price	$238.64
Rate for Payer: Cofinity Commercial	$208.81
Rate for Payer: Cofinity Commercial	$256.54
Rate for Payer: Cofinity Medicare Advantage	$208.81
Rate for Payer: Encore Health Key Benefits Commercial	$238.64
Rate for Payer: Healthscope Commercial	$268.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.56
Rate for Payer: PHP Commercial	$253.56
Rate for Payer: Priority Health Cigna Priority Health	$193.90
Rate for Payer: Priority Health SBD	$187.93

CLOZAPINE 25 MG TABLET

Facility

$2.99

Service Code	NDC 51079092101
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.69
Rate for Payer: Aetna Commercial	$2.54
Rate for Payer: Aetna New Business (MI Preferred)	$1.94
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Commercial	$2.57
Rate for Payer: Cofinity Medicare Advantage	$2.09
Rate for Payer: Encore Health Key Benefits Commercial	$2.39
Rate for Payer: Healthscope Commercial	$2.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.54
Rate for Payer: PHP Commercial	$2.54
Rate for Payer: Priority Health Cigna Priority Health	$1.94
Rate for Payer: Priority Health SBD	$1.88

CLOZAPINE 25 MG TABLET

Facility

$298.30

Service Code	NDC 51079092120
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$187.93
Max. Negotiated Rate	$268.47
Rate for Payer: Aetna Commercial	$253.56
Rate for Payer: Aetna New Business (MI Preferred)	$193.90
Rate for Payer: Cash Price	$238.64
Rate for Payer: Cofinity Commercial	$208.81
Rate for Payer: Cofinity Commercial	$256.54
Rate for Payer: Cofinity Medicare Advantage	$208.81
Rate for Payer: Encore Health Key Benefits Commercial	$238.64
Rate for Payer: Healthscope Commercial	$268.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.56
Rate for Payer: PHP Commercial	$253.56
Rate for Payer: Priority Health Cigna Priority Health	$193.90
Rate for Payer: Priority Health SBD	$187.93

CLOZAPINE 25 MG TABLET

Facility

$2.92

Service Code	NDC 00093435919
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.63
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna Medicare	$1.46
Rate for Payer: Aetna New Business (MI Preferred)	$1.90
Rate for Payer: BCBS Complete	$1.17
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cofinity Commercial	$2.04
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Cofinity Medicare Advantage	$2.04
Rate for Payer: Encore Health Key Benefits Commercial	$2.34
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.48
Rate for Payer: PHP Commercial	$2.48
Rate for Payer: Priority Health Cigna Priority Health	$1.90
Rate for Payer: Priority Health SBD	$1.84

CLOZAPINE 25 MG TABLET

Facility

$2.92

Service Code	NDC 00093435919
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.63
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna New Business (MI Preferred)	$1.90
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cofinity Commercial	$2.04
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Cofinity Medicare Advantage	$2.04
Rate for Payer: Encore Health Key Benefits Commercial	$2.34
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.48
Rate for Payer: PHP Commercial	$2.48
Rate for Payer: Priority Health Cigna Priority Health	$1.90
Rate for Payer: Priority Health SBD	$1.84

CLOZAPINE 25 MG TABLET

Facility

$2.99

Service Code	NDC 51079092101
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.69
Rate for Payer: Aetna Commercial	$2.54
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: Aetna New Business (MI Preferred)	$1.94
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Commercial	$2.57
Rate for Payer: Cofinity Medicare Advantage	$2.09
Rate for Payer: Encore Health Key Benefits Commercial	$2.39
Rate for Payer: Healthscope Commercial	$2.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.54
Rate for Payer: PHP Commercial	$2.54
Rate for Payer: Priority Health Cigna Priority Health	$1.94
Rate for Payer: Priority Health SBD	$1.88

CLOZAPINE 25 MG TABLET

Facility

$291.36

Service Code	NDC 00093435993
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$116.54
Max. Negotiated Rate	$262.22
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: Aetna Medicare	$145.68
Rate for Payer: Aetna New Business (MI Preferred)	$189.38
Rate for Payer: BCBS Complete	$116.54
Rate for Payer: Cash Price	$233.09
Rate for Payer: Cofinity Commercial	$203.95
Rate for Payer: Cofinity Commercial	$250.57
Rate for Payer: Cofinity Medicare Advantage	$203.95
Rate for Payer: Encore Health Key Benefits Commercial	$233.09
Rate for Payer: Healthscope Commercial	$262.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.66
Rate for Payer: PHP Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$189.38
Rate for Payer: Priority Health SBD	$183.56

CLOZAPINE 25 MG TABLET

Facility

$291.36

Service Code	NDC 00093435993
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$183.56
Max. Negotiated Rate	$262.22
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: Aetna New Business (MI Preferred)	$189.38
Rate for Payer: Cash Price	$233.09
Rate for Payer: Cofinity Commercial	$203.95
Rate for Payer: Cofinity Commercial	$250.57
Rate for Payer: Cofinity Medicare Advantage	$203.95
Rate for Payer: Encore Health Key Benefits Commercial	$233.09
Rate for Payer: Healthscope Commercial	$262.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.66
Rate for Payer: PHP Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$189.38
Rate for Payer: Priority Health SBD	$183.56

COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION

Facility

$6,327.57

Service Code	HCPCS J7189
Hospital Charge Code	92853
Hospital Revenue Code	636
Min. Negotiated Rate	$3,986.37
Max. Negotiated Rate	$5,694.81
Rate for Payer: Aetna Commercial	$5,378.43
Rate for Payer: Aetna New Business (MI Preferred)	$4,112.92
Rate for Payer: Cash Price	$5,062.06
Rate for Payer: Cofinity Commercial	$4,429.30
Rate for Payer: Cofinity Commercial	$5,441.71
Rate for Payer: Cofinity Medicare Advantage	$4,429.30
Rate for Payer: Encore Health Key Benefits Commercial	$5,062.06
Rate for Payer: Healthscope Commercial	$5,694.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,378.43
Rate for Payer: PHP Commercial	$5,378.43
Rate for Payer: Priority Health Cigna Priority Health	$4,112.92
Rate for Payer: Priority Health SBD	$3,986.37

COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION

Facility

$6,327.57

Service Code	HCPCS J7189
Hospital Charge Code	92853
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$5,694.81
Rate for Payer: Aetna Commercial	$5,378.43
Rate for Payer: Aetna Medicare	$2.65
Rate for Payer: Aetna New Business (MI Preferred)	$4,112.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$3.19
Rate for Payer: Amish Plain Church Group Commercial	$3.19
Rate for Payer: BCBS Complete	$1.44
Rate for Payer: BCBS MAPPO	$2.55
Rate for Payer: BCBS Trust/PPO	$7.18
Rate for Payer: BCN Commercial	$7.18
Rate for Payer: BCN Medicare Advantage	$2.55
Rate for Payer: Cash Price	$5,062.06
Rate for Payer: Cash Price	$5,062.06
Rate for Payer: Cofinity Commercial	$5,441.71
Rate for Payer: Cofinity Commercial	$4,429.30
Rate for Payer: Cofinity Medicare Advantage	$4,429.30
Rate for Payer: Encore Health Key Benefits Commercial	$5,062.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$2.55
Rate for Payer: Healthscope Commercial	$5,694.81
Rate for Payer: Mclaren Medicaid	$1.37
Rate for Payer: Mclaren Medicare	$2.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2.68
Rate for Payer: Meridian Medicaid	$1.44
Rate for Payer: MI Amish Medical Board Commercial	$2.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,378.43
Rate for Payer: Nomi Health Commercial	$7.65
Rate for Payer: PACE Medicare	$2.42
Rate for Payer: PACE SWMI	$2.55
Rate for Payer: PHP Commercial	$5,378.43
Rate for Payer: PHP Medicare Advantage	$2.55
Rate for Payer: Priority Health Choice Medicaid	$1.37
Rate for Payer: Priority Health Cigna Priority Health	$4,112.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.24
Rate for Payer: Priority Health Medicare	$2.55
Rate for Payer: Priority Health Narrow Network	$5.79
Rate for Payer: Priority Health SBD	$3,986.37
Rate for Payer: Railroad Medicare Medicare	$2.55
Rate for Payer: UHC All Payor (Choice/PPO)	$7.18
Rate for Payer: UHC Dual Complete DSNP	$2.55
Rate for Payer: UHC Medicare Advantage	$2.55
Rate for Payer: UHCCP Medicaid	$1.44
Rate for Payer: VA VA	$2.55

COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION

Facility

$30,174.07

Service Code	HCPCS J7189
Hospital Charge Code	92855
Hospital Revenue Code	636
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$27,156.66
Rate for Payer: Aetna Commercial	$25,647.96
Rate for Payer: Aetna Medicare	$2.65
Rate for Payer: Aetna New Business (MI Preferred)	$19,613.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$3.19
Rate for Payer: Amish Plain Church Group Commercial	$3.19
Rate for Payer: BCBS Complete	$1.44
Rate for Payer: BCBS MAPPO	$2.55
Rate for Payer: BCBS Trust/PPO	$7.18
Rate for Payer: BCN Commercial	$7.18
Rate for Payer: BCN Medicare Advantage	$2.55
Rate for Payer: Cash Price	$24,139.26
Rate for Payer: Cash Price	$24,139.26
Rate for Payer: Cofinity Commercial	$25,949.70
Rate for Payer: Cofinity Commercial	$21,121.85
Rate for Payer: Cofinity Medicare Advantage	$21,121.85
Rate for Payer: Encore Health Key Benefits Commercial	$24,139.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$2.55
Rate for Payer: Healthscope Commercial	$27,156.66
Rate for Payer: Mclaren Medicaid	$1.37
Rate for Payer: Mclaren Medicare	$2.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2.68
Rate for Payer: Meridian Medicaid	$1.44
Rate for Payer: MI Amish Medical Board Commercial	$2.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25,647.96
Rate for Payer: Nomi Health Commercial	$7.65
Rate for Payer: PACE Medicare	$2.42
Rate for Payer: PACE SWMI	$2.55
Rate for Payer: PHP Commercial	$25,647.96
Rate for Payer: PHP Medicare Advantage	$2.55
Rate for Payer: Priority Health Choice Medicaid	$1.37
Rate for Payer: Priority Health Cigna Priority Health	$19,613.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.24
Rate for Payer: Priority Health Medicare	$2.55
Rate for Payer: Priority Health Narrow Network	$5.79
Rate for Payer: Priority Health SBD	$19,009.66
Rate for Payer: Railroad Medicare Medicare	$2.55
Rate for Payer: UHC All Payor (Choice/PPO)	$7.18
Rate for Payer: UHC Dual Complete DSNP	$2.55
Rate for Payer: UHC Medicare Advantage	$2.55
Rate for Payer: UHCCP Medicaid	$1.44
Rate for Payer: VA VA	$2.55

COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION

Facility

$30,174.07

Service Code	HCPCS J7189
Hospital Charge Code	92855
Hospital Revenue Code	636
Min. Negotiated Rate	$19,009.66
Max. Negotiated Rate	$27,156.66
Rate for Payer: Aetna Commercial	$25,647.96
Rate for Payer: Aetna New Business (MI Preferred)	$19,613.15
Rate for Payer: Cash Price	$24,139.26
Rate for Payer: Cofinity Commercial	$21,121.85
Rate for Payer: Cofinity Commercial	$25,949.70
Rate for Payer: Cofinity Medicare Advantage	$21,121.85
Rate for Payer: Encore Health Key Benefits Commercial	$24,139.26
Rate for Payer: Healthscope Commercial	$27,156.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25,647.96
Rate for Payer: PHP Commercial	$25,647.96
Rate for Payer: Priority Health Cigna Priority Health	$19,613.15
Rate for Payer: Priority Health SBD	$19,009.66

COCAINE 4 % NASAL SOLUTION

Facility

$690.54

Service Code	HCPCS C9143
Hospital Charge Code	186568
Hospital Revenue Code	636
Min. Negotiated Rate	$435.04
Max. Negotiated Rate	$621.49
Rate for Payer: Aetna Commercial	$586.96
Rate for Payer: Aetna New Business (MI Preferred)	$448.85
Rate for Payer: Cash Price	$552.43
Rate for Payer: Cofinity Commercial	$483.38
Rate for Payer: Cofinity Commercial	$593.86
Rate for Payer: Cofinity Medicare Advantage	$483.38
Rate for Payer: Encore Health Key Benefits Commercial	$552.43
Rate for Payer: Healthscope Commercial	$621.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$586.96
Rate for Payer: PHP Commercial	$586.96
Rate for Payer: Priority Health Cigna Priority Health	$448.85
Rate for Payer: Priority Health SBD	$435.04

COCAINE 4 % NASAL SOLUTION

Facility

$690.54

Service Code	HCPCS C9143
Hospital Charge Code	186568
Hospital Revenue Code	636
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$621.49
Rate for Payer: Aetna Commercial	$586.96
Rate for Payer: Aetna Medicare	$345.27
Rate for Payer: Aetna New Business (MI Preferred)	$448.85
Rate for Payer: BCBS Complete	$276.22
Rate for Payer: BCBS Trust/PPO	$4.38
Rate for Payer: BCN Commercial	$4.38
Rate for Payer: Cash Price	$552.43
Rate for Payer: Cash Price	$552.43
Rate for Payer: Cofinity Commercial	$483.38
Rate for Payer: Cofinity Commercial	$593.86
Rate for Payer: Cofinity Medicare Advantage	$483.38
Rate for Payer: Encore Health Key Benefits Commercial	$552.43
Rate for Payer: Healthscope Commercial	$621.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$586.96
Rate for Payer: PHP Commercial	$586.96
Rate for Payer: Priority Health Cigna Priority Health	$448.85
Rate for Payer: Priority Health SBD	$435.04

COLCHICINE 0.6 MG TABLET

Facility

$11.91

Service Code	NDC 50268018711
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$10.72
Rate for Payer: Aetna Commercial	$10.12
Rate for Payer: Aetna Medicare	$5.96
Rate for Payer: Aetna New Business (MI Preferred)	$7.74
Rate for Payer: BCBS Complete	$4.76
Rate for Payer: Cash Price	$9.53
Rate for Payer: Cofinity Commercial	$10.24
Rate for Payer: Cofinity Commercial	$8.34
Rate for Payer: Cofinity Medicare Advantage	$8.34
Rate for Payer: Encore Health Key Benefits Commercial	$9.53
Rate for Payer: Healthscope Commercial	$10.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.12
Rate for Payer: PHP Commercial	$10.12
Rate for Payer: Priority Health Cigna Priority Health	$7.74
Rate for Payer: Priority Health SBD	$7.50

COLCHICINE 0.6 MG TABLET

Facility

$2,474.19

Service Code	NDC 64764011901
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$989.68
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 Commercial	$1,731.93
Rate for Payer: Cofinity Commercial	$2,127.80
Rate for Payer: Cofinity Medicare Advantage	$1,731.93
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: PHP Commercial	$2,103.06
Rate for Payer: Priority Health Cigna Priority Health	$1,608.22
Rate for Payer: Priority Health SBD	$1,558.74

COLCHICINE 0.6 MG TABLET

Facility

$595.33

Service Code	NDC 50268018715
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$375.06
Max. Negotiated Rate	$535.80
Rate for Payer: Aetna Commercial	$506.03
Rate for Payer: Aetna New Business (MI Preferred)	$386.96
Rate for Payer: Cash Price	$476.26
Rate for Payer: Cofinity Commercial	$416.73
Rate for Payer: Cofinity Commercial	$511.98
Rate for Payer: Cofinity Medicare Advantage	$416.73
Rate for Payer: Encore Health Key Benefits Commercial	$476.26
Rate for Payer: Healthscope Commercial	$535.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$506.03
Rate for Payer: PHP Commercial	$506.03
Rate for Payer: Priority Health Cigna Priority Health	$386.96
Rate for Payer: Priority Health SBD	$375.06

COLCHICINE 0.6 MG TABLET

Facility

$420.65

Service Code	NDC 67877058901
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$168.26
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 Commercial	$294.46
Rate for Payer: Cofinity Commercial	$361.76
Rate for Payer: Cofinity Medicare Advantage	$294.46
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: PHP Commercial	$357.55
Rate for Payer: Priority Health Cigna Priority Health	$273.42
Rate for Payer: Priority Health SBD	$265.01

COLCHICINE 0.6 MG TABLET

Facility

$14.37

Service Code	NDC 42292005401
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$12.93
Rate for Payer: Aetna Commercial	$12.21
Rate for Payer: Aetna Medicare	$7.18
Rate for Payer: Aetna New Business (MI Preferred)	$9.34
Rate for Payer: BCBS Complete	$5.75
Rate for Payer: Cash Price	$11.50
Rate for Payer: Cofinity Commercial	$10.06
Rate for Payer: Cofinity Commercial	$12.36
Rate for Payer: Cofinity Medicare Advantage	$10.06
Rate for Payer: Encore Health Key Benefits Commercial	$11.50
Rate for Payer: Healthscope Commercial	$12.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.21
Rate for Payer: PHP Commercial	$12.21
Rate for Payer: Priority Health Cigna Priority Health	$9.34
Rate for Payer: Priority Health SBD	$9.05

COLCHICINE 0.6 MG TABLET

Facility

$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 Commercial	$18.15
Rate for Payer: Cofinity Commercial	$22.30
Rate for Payer: Cofinity Medicare Advantage	$18.15
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: PHP Commercial	$22.04
Rate for Payer: Priority Health Cigna Priority Health	$16.85
Rate for Payer: Priority Health SBD	$16.34

COLCHICINE 0.6 MG TABLET

Facility

$1,931.77

Service Code	NDC 00254200801
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$1,217.02
Max. Negotiated Rate	$1,738.59
Rate for Payer: Aetna Commercial	$1,642.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,255.65
Rate for Payer: Cash Price	$1,545.42
Rate for Payer: Cofinity Commercial	$1,352.24
Rate for Payer: Cofinity Commercial	$1,661.32
Rate for Payer: Cofinity Medicare Advantage	$1,352.24
Rate for Payer: Encore Health Key Benefits Commercial	$1,545.42
Rate for Payer: Healthscope Commercial	$1,738.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,642.00
Rate for Payer: PHP Commercial	$1,642.00
Rate for Payer: Priority Health Cigna Priority Health	$1,255.65
Rate for Payer: Priority Health SBD	$1,217.02

COLCHICINE 0.6 MG TABLET

Facility

$14.37

Service Code	NDC 42292005401
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$12.93
Rate for Payer: Aetna Commercial	$12.21
Rate for Payer: Aetna New Business (MI Preferred)	$9.34
Rate for Payer: Cash Price	$11.50
Rate for Payer: Cofinity Commercial	$10.06
Rate for Payer: Cofinity Commercial	$12.36
Rate for Payer: Cofinity Medicare Advantage	$10.06
Rate for Payer: Encore Health Key Benefits Commercial	$11.50
Rate for Payer: Healthscope Commercial	$12.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.21
Rate for Payer: PHP Commercial	$12.21
Rate for Payer: Priority Health Cigna Priority Health	$9.34
Rate for Payer: Priority Health SBD	$9.05

COLCHICINE 0.6 MG TABLET

Facility

$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 Commercial	$294.46
Rate for Payer: Cofinity Commercial	$361.76
Rate for Payer: Cofinity Medicare Advantage	$294.46
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: PHP Commercial	$357.55
Rate for Payer: Priority Health Cigna Priority Health	$273.42
Rate for Payer: Priority Health SBD	$265.01

COLCHICINE 0.6 MG TABLET

Facility

$595.33

Service Code	NDC 50268018715
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$238.13
Max. Negotiated Rate	$535.80
Rate for Payer: Aetna Commercial	$506.03
Rate for Payer: Aetna Medicare	$297.66
Rate for Payer: Aetna New Business (MI Preferred)	$386.96
Rate for Payer: BCBS Complete	$238.13
Rate for Payer: Cash Price	$476.26
Rate for Payer: Cofinity Commercial	$416.73
Rate for Payer: Cofinity Commercial	$511.98
Rate for Payer: Cofinity Medicare Advantage	$416.73
Rate for Payer: Encore Health Key Benefits Commercial	$476.26
Rate for Payer: Healthscope Commercial	$535.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$506.03
Rate for Payer: PHP Commercial	$506.03
Rate for Payer: Priority Health Cigna Priority Health	$386.96
Rate for Payer: Priority Health SBD	$375.06

COLCHICINE 0.6 MG TABLET

Facility

$777.89

Service Code	NDC 60687038921
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$311.16
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 Commercial	$544.52
Rate for Payer: Cofinity Commercial	$668.99
Rate for Payer: Cofinity Medicare Advantage	$544.52
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: PHP Commercial	$661.21
Rate for Payer: Priority Health Cigna Priority Health	$505.63
Rate for Payer: Priority Health SBD	$490.07

Know your out-of-pocket cost for care.

All Charges