Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CLOZAPINE 100 MG TABLET

Facility

$325.44

Service Code	NDC 00904708761
Hospital Charge Code	9647
Hospital Revenue Code	637
Min. Negotiated Rate	$205.03
Max. Negotiated Rate	$292.90
Rate for Payer: Aetna Commercial	$276.62
Rate for Payer: Aetna New Business (MI Preferred)	$211.54
Rate for Payer: Cash Price	$260.35
Rate for Payer: Cofinity Commercial	$227.81
Rate for Payer: Cofinity Commercial	$279.88
Rate for Payer: Cofinity Medicare Advantage	$227.81
Rate for Payer: Encore Health Key Benefits Commercial	$260.35
Rate for Payer: Healthscope Commercial	$292.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$276.62
Rate for Payer: PHP Commercial	$276.62
Rate for Payer: Priority Health Cigna Priority Health	$211.54
Rate for Payer: Priority Health SBD	$205.03

CLOZAPINE 100 MG TABLET

Facility

$303.84

Service Code	NDC 65862084601
Hospital Charge Code	9647
Hospital Revenue Code	637
Min. Negotiated Rate	$121.54
Max. Negotiated Rate	$273.46
Rate for Payer: Aetna Commercial	$258.26
Rate for Payer: Aetna Medicare	$151.92
Rate for Payer: Aetna New Business (MI Preferred)	$197.50
Rate for Payer: BCBS Complete	$121.54
Rate for Payer: Cash Price	$243.07
Rate for Payer: Cofinity Commercial	$212.69
Rate for Payer: Cofinity Commercial	$261.30
Rate for Payer: Cofinity Medicare Advantage	$212.69
Rate for Payer: Encore Health Key Benefits Commercial	$243.07
Rate for Payer: Healthscope Commercial	$273.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.26
Rate for Payer: PHP Commercial	$258.26
Rate for Payer: Priority Health Cigna Priority Health	$197.50
Rate for Payer: Priority Health SBD	$191.42

CLOZAPINE 100 MG TABLET

Facility

$381.60

Service Code	NDC 51079092220
Hospital Charge Code	9647
Hospital Revenue Code	637
Min. Negotiated Rate	$152.64
Max. Negotiated Rate	$343.44
Rate for Payer: Aetna Commercial	$324.36
Rate for Payer: Aetna Medicare	$190.80
Rate for Payer: Aetna New Business (MI Preferred)	$248.04
Rate for Payer: BCBS Complete	$152.64
Rate for Payer: Cash Price	$305.28
Rate for Payer: Cofinity Commercial	$267.12
Rate for Payer: Cofinity Commercial	$328.18
Rate for Payer: Cofinity Medicare Advantage	$267.12
Rate for Payer: Encore Health Key Benefits Commercial	$305.28
Rate for Payer: Healthscope Commercial	$343.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$324.36
Rate for Payer: PHP Commercial	$324.36
Rate for Payer: Priority Health Cigna Priority Health	$248.04
Rate for Payer: Priority Health SBD	$240.41

CLOZAPINE 100 MG TABLET

Facility

$794.76

Service Code	NDC 00093777201
Hospital Charge Code	9647
Hospital Revenue Code	637
Min. Negotiated Rate	$500.70
Max. Negotiated Rate	$715.28
Rate for Payer: Aetna Commercial	$675.55
Rate for Payer: Aetna New Business (MI Preferred)	$516.59
Rate for Payer: Cash Price	$635.81
Rate for Payer: Cofinity Commercial	$556.33
Rate for Payer: Cofinity Commercial	$683.49
Rate for Payer: Cofinity Medicare Advantage	$556.33
Rate for Payer: Encore Health Key Benefits Commercial	$635.81
Rate for Payer: Healthscope Commercial	$715.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.55
Rate for Payer: PHP Commercial	$675.55
Rate for Payer: Priority Health Cigna Priority Health	$516.59
Rate for Payer: Priority Health SBD	$500.70

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	$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	$1.20
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

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

$2.92

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

$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

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	$1.43
Max. Negotiated Rate	$5,694.81
Rate for Payer: Aetna Commercial	$5,378.43
Rate for Payer: Aetna Medicare	$2.77
Rate for Payer: Aetna New Business (MI Preferred)	$4,112.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$3.33
Rate for Payer: Amish Plain Church Group Commercial	$3.33
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: BCBS MAPPO	$2.66
Rate for Payer: BCN Medicare Advantage	$2.66
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	$2.66
Rate for Payer: Healthscope Commercial	$5,694.81
Rate for Payer: Mclaren Medicaid	$1.43
Rate for Payer: Mclaren Medicare	$2.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2.79
Rate for Payer: Meridian Medicaid	$1.50
Rate for Payer: MI Amish Medical Board Commercial	$3.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,378.43
Rate for Payer: PACE Medicare	$2.53
Rate for Payer: PACE SWMI	$2.66
Rate for Payer: PHP Commercial	$5,378.43
Rate for Payer: PHP Medicare Advantage	$2.66
Rate for Payer: Priority Health Choice Medicaid	$1.43
Rate for Payer: Priority Health Cigna Priority Health	$4,112.92
Rate for Payer: Priority Health Medicare	$2.66
Rate for Payer: Priority Health SBD	$3,986.37
Rate for Payer: Railroad Medicare Medicare	$2.66
Rate for Payer: UHC All Payor (Choice/PPO)	$7.49
Rate for Payer: UHC Dual Complete DSNP	$2.66
Rate for Payer: UHC Medicare Advantage	$2.66
Rate for Payer: UHCCP Medicaid	$1.50
Rate for Payer: VA VA	$2.66

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 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	$1.43
Max. Negotiated Rate	$27,156.66
Rate for Payer: Aetna Commercial	$25,647.96
Rate for Payer: Aetna Medicare	$2.77
Rate for Payer: Aetna New Business (MI Preferred)	$19,613.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$3.33
Rate for Payer: Amish Plain Church Group Commercial	$3.33
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: BCBS MAPPO	$2.66
Rate for Payer: BCN Medicare Advantage	$2.66
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	$2.66
Rate for Payer: Healthscope Commercial	$27,156.66
Rate for Payer: Mclaren Medicaid	$1.43
Rate for Payer: Mclaren Medicare	$2.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2.79
Rate for Payer: Meridian Medicaid	$1.50
Rate for Payer: MI Amish Medical Board Commercial	$3.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25,647.96
Rate for Payer: PACE Medicare	$2.53
Rate for Payer: PACE SWMI	$2.66
Rate for Payer: PHP Commercial	$25,647.96
Rate for Payer: PHP Medicare Advantage	$2.66
Rate for Payer: Priority Health Choice Medicaid	$1.43
Rate for Payer: Priority Health Cigna Priority Health	$19,613.15
Rate for Payer: Priority Health Medicare	$2.66
Rate for Payer: Priority Health SBD	$19,009.66
Rate for Payer: Railroad Medicare Medicare	$2.66
Rate for Payer: UHC All Payor (Choice/PPO)	$7.49
Rate for Payer: UHC Dual Complete DSNP	$2.66
Rate for Payer: UHC Medicare Advantage	$2.66
Rate for Payer: UHCCP Medicaid	$1.50
Rate for Payer: VA VA	$2.66

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	$276.22
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: 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	$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

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

$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

$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

$11.91

Service Code	NDC 50268018711
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$10.72
Rate for Payer: Aetna Commercial	$10.12
Rate for Payer: Aetna New Business (MI Preferred)	$7.74
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

$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

COLCHICINE 0.6 MG TABLET

Facility

$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 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

COLCHICINE 0.6 MG TABLET

Facility

$1,931.77

Service Code	NDC 00254200801
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$772.71
Max. Negotiated Rate	$1,738.59
Rate for Payer: Aetna Commercial	$1,642.00
Rate for Payer: Aetna Medicare	$965.88
Rate for Payer: Aetna New Business (MI Preferred)	$1,255.65
Rate for Payer: BCBS Complete	$772.71
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

Know your out-of-pocket cost for care.

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