|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$19.44
|
|
|
Service Code
|
NDC 45802043411
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.08
|
| Rate for Payer: BCBS Complete |
$7.78
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.11
|
| Rate for Payer: BCN Medicare Advantage |
$4.86
|
| Rate for Payer: Cash Price |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$16.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Nomi Health Commercial |
$15.94
|
| Rate for Payer: PACE Senior Care Partners |
$4.62
|
| Rate for Payer: PACE SWMI |
$4.86
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: PHP Medicare Advantage |
$4.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.64
|
| Rate for Payer: Priority Health HMO/PPO |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$4.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: Railroad Medicare Medicare |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.11
|
| Rate for Payer: UHC Core |
$16.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.86
|
| Rate for Payer: UHC Exchange |
$4.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.86
|
| Rate for Payer: VA VA |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.58
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$32.92
|
|
|
Service Code
|
NDC 00472037915
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$29.63 |
| Rate for Payer: Aetna Commercial |
$27.98
|
| Rate for Payer: BCBS Trust/PPO |
$26.87
|
| Rate for Payer: BCN Commercial |
$25.44
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$28.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$29.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.98
|
| Rate for Payer: Nomi Health Commercial |
$26.99
|
| Rate for Payer: PHP Commercial |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health HMO/PPO |
$28.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.97
|
| Rate for Payer: UHC Core |
$27.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.69
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$25.68
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.03
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS MAPPO |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$21.11
|
| Rate for Payer: BCN Commercial |
$19.97
|
| Rate for Payer: BCN Medicare Advantage |
$6.42
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.42
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: Nomi Health Commercial |
$21.06
|
| Rate for Payer: PACE Senior Care Partners |
$6.10
|
| Rate for Payer: PACE SWMI |
$6.42
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: PHP Medicare Advantage |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO |
$22.34
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: Railroad Medicare Medicare |
$6.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.60
|
| Rate for Payer: UHC Core |
$21.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.42
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicare Advantage |
$6.42
|
| Rate for Payer: VA VA |
$6.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.26
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$25.68
|
|
|
Service Code
|
NDC 00168025815
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: Nomi Health Commercial |
$21.06
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health HMO/PPO |
$22.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.60
|
| Rate for Payer: UHC Core |
$21.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.26
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$32.92
|
|
|
Service Code
|
NDC 00472037915
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$29.63 |
| Rate for Payer: Aetna Commercial |
$27.98
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.29
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS MAPPO |
$8.23
|
| Rate for Payer: BCBS Trust/PPO |
$27.06
|
| Rate for Payer: BCN Commercial |
$25.60
|
| Rate for Payer: BCN Medicare Advantage |
$8.23
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$28.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$29.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.98
|
| Rate for Payer: Nomi Health Commercial |
$26.99
|
| Rate for Payer: PACE Senior Care Partners |
$7.82
|
| Rate for Payer: PACE SWMI |
$8.23
|
| Rate for Payer: PHP Commercial |
$27.98
|
| Rate for Payer: PHP Medicare Advantage |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health HMO/PPO |
$28.64
|
| Rate for Payer: Priority Health Medicare |
$8.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.97
|
| Rate for Payer: UHC Core |
$27.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.23
|
| Rate for Payer: UHC Exchange |
$8.23
|
| Rate for Payer: UHC Medicare Advantage |
$8.23
|
| Rate for Payer: VA VA |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.69
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$5.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.04
|
| Rate for Payer: BCN Commercial |
$15.17
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.63
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Medicare |
$4.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.07
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.17
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 68462029817
|
| Hospital Charge Code |
29424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.93
|
| Rate for Payer: BCN Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.17
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$358.08
|
|
|
Service Code
|
NDC 60687041501
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$322.27 |
| Rate for Payer: Aetna Commercial |
$304.37
|
| Rate for Payer: BCBS Trust/PPO |
$292.30
|
| Rate for Payer: BCN Commercial |
$276.72
|
| Rate for Payer: Cash Price |
$286.46
|
| Rate for Payer: Cofinity Commercial |
$307.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.46
|
| Rate for Payer: Healthscope Commercial |
$322.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.37
|
| Rate for Payer: Nomi Health Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$304.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.75
|
| Rate for Payer: Priority Health HMO/PPO |
$311.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.11
|
| Rate for Payer: UHC Core |
$299.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.56
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$358.08
|
|
|
Service Code
|
NDC 60687041501
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$322.27 |
| Rate for Payer: Aetna Commercial |
$304.37
|
| Rate for Payer: Aetna Medicare |
$93.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.90
|
| Rate for Payer: BCBS Complete |
$143.23
|
| Rate for Payer: BCBS MAPPO |
$89.52
|
| Rate for Payer: BCBS Trust/PPO |
$294.38
|
| Rate for Payer: BCN Commercial |
$278.41
|
| Rate for Payer: BCN Medicare Advantage |
$89.52
|
| Rate for Payer: Cash Price |
$286.46
|
| Rate for Payer: Cofinity Commercial |
$307.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.52
|
| Rate for Payer: Healthscope Commercial |
$322.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.37
|
| Rate for Payer: Nomi Health Commercial |
$293.63
|
| Rate for Payer: PACE Senior Care Partners |
$85.04
|
| Rate for Payer: PACE SWMI |
$89.52
|
| Rate for Payer: PHP Commercial |
$304.37
|
| Rate for Payer: PHP Medicare Advantage |
$89.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.75
|
| Rate for Payer: Priority Health HMO/PPO |
$311.53
|
| Rate for Payer: Priority Health Medicare |
$90.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.91
|
| Rate for Payer: Railroad Medicare Medicare |
$89.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.11
|
| Rate for Payer: UHC Core |
$299.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.52
|
| Rate for Payer: UHC Exchange |
$89.52
|
| Rate for Payer: UHC Medicare Advantage |
$89.52
|
| Rate for Payer: VA VA |
$89.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.56
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$794.76
|
|
|
Service Code
|
NDC 00093777201
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$715.28 |
| Rate for Payer: Aetna Commercial |
$675.55
|
| Rate for Payer: Aetna Medicare |
$206.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.36
|
| Rate for Payer: BCBS Complete |
$317.90
|
| Rate for Payer: BCBS MAPPO |
$198.69
|
| Rate for Payer: BCBS Trust/PPO |
$653.37
|
| Rate for Payer: BCN Commercial |
$617.93
|
| Rate for Payer: BCN Medicare Advantage |
$198.69
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cofinity Commercial |
$683.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.69
|
| Rate for Payer: Healthscope Commercial |
$715.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.55
|
| Rate for Payer: Nomi Health Commercial |
$651.70
|
| Rate for Payer: PACE Senior Care Partners |
$188.76
|
| Rate for Payer: PACE SWMI |
$198.69
|
| Rate for Payer: PHP Commercial |
$675.55
|
| Rate for Payer: PHP Medicare Advantage |
$198.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.59
|
| Rate for Payer: Priority Health HMO/PPO |
$691.44
|
| Rate for Payer: Priority Health Medicare |
$200.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.49
|
| Rate for Payer: Railroad Medicare Medicare |
$198.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.39
|
| Rate for Payer: UHC Core |
$663.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.69
|
| Rate for Payer: UHC Exchange |
$198.69
|
| Rate for Payer: UHC Medicare Advantage |
$198.69
|
| Rate for Payer: VA VA |
$198.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.07
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$794.76
|
|
|
Service Code
|
NDC 00093777201
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$516.59 |
| Max. Negotiated Rate |
$715.28 |
| Rate for Payer: Aetna Commercial |
$675.55
|
| Rate for Payer: BCBS Trust/PPO |
$648.76
|
| Rate for Payer: BCN Commercial |
$614.19
|
| Rate for Payer: Cash Price |
$635.81
|
| Rate for Payer: Cofinity Commercial |
$683.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.81
|
| Rate for Payer: Healthscope Commercial |
$715.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.55
|
| Rate for Payer: Nomi Health Commercial |
$651.70
|
| Rate for Payer: PHP Commercial |
$675.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.59
|
| Rate for Payer: Priority Health HMO/PPO |
$691.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$532.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.39
|
| Rate for Payer: UHC Core |
$663.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.07
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
NDC 60687041511
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.12
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS MAPPO |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.95
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: BCN Medicare Advantage |
$0.90
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.90
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.05
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.90
|
| Rate for Payer: PHP Commercial |
$3.05
|
| Rate for Payer: PHP Medicare Advantage |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.33
|
| Rate for Payer: Priority Health HMO/PPO |
$3.12
|
| Rate for Payer: Priority Health Medicare |
$0.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.41
|
| Rate for Payer: Railroad Medicare Medicare |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.16
|
| Rate for Payer: UHC Core |
$3.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.90
|
| Rate for Payer: UHC Exchange |
$0.90
|
| Rate for Payer: UHC Medicare Advantage |
$0.90
|
| Rate for Payer: VA VA |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$751.10
|
|
|
Service Code
|
NDC 00378086001
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.39 |
| Max. Negotiated Rate |
$675.99 |
| Rate for Payer: Aetna Commercial |
$638.43
|
| Rate for Payer: Aetna Medicare |
$195.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.72
|
| Rate for Payer: BCBS Complete |
$300.44
|
| Rate for Payer: BCBS MAPPO |
$187.78
|
| Rate for Payer: BCBS Trust/PPO |
$617.48
|
| Rate for Payer: BCN Commercial |
$583.98
|
| Rate for Payer: BCN Medicare Advantage |
$187.78
|
| Rate for Payer: Cash Price |
$600.88
|
| Rate for Payer: Cofinity Commercial |
$645.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.78
|
| Rate for Payer: Healthscope Commercial |
$675.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.43
|
| Rate for Payer: Nomi Health Commercial |
$615.90
|
| Rate for Payer: PACE Senior Care Partners |
$178.39
|
| Rate for Payer: PACE SWMI |
$187.78
|
| Rate for Payer: PHP Commercial |
$638.43
|
| Rate for Payer: PHP Medicare Advantage |
$187.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.21
|
| Rate for Payer: Priority Health HMO/PPO |
$653.46
|
| Rate for Payer: Priority Health Medicare |
$189.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.24
|
| Rate for Payer: Railroad Medicare Medicare |
$187.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.97
|
| Rate for Payer: UHC Core |
$627.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.78
|
| Rate for Payer: UHC Exchange |
$187.78
|
| Rate for Payer: UHC Medicare Advantage |
$187.78
|
| Rate for Payer: VA VA |
$187.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.33
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$751.10
|
|
|
Service Code
|
NDC 00378086001
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$488.21 |
| Max. Negotiated Rate |
$675.99 |
| Rate for Payer: Aetna Commercial |
$638.43
|
| Rate for Payer: BCBS Trust/PPO |
$613.12
|
| Rate for Payer: BCN Commercial |
$580.45
|
| Rate for Payer: Cash Price |
$600.88
|
| Rate for Payer: Cofinity Commercial |
$645.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.88
|
| Rate for Payer: Healthscope Commercial |
$675.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.43
|
| Rate for Payer: Nomi Health Commercial |
$615.90
|
| Rate for Payer: PHP Commercial |
$638.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$488.21
|
| Rate for Payer: Priority Health HMO/PPO |
$653.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.97
|
| Rate for Payer: UHC Core |
$627.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.33
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
NDC 60687041511
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.87
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.05
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PHP Commercial |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.33
|
| Rate for Payer: Priority Health HMO/PPO |
$3.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.16
|
| Rate for Payer: UHC Core |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60687040411
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health HMO/PPO |
$2.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$285.95
|
|
|
Service Code
|
NDC 60687040401
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: BCBS Trust/PPO |
$233.42
|
| Rate for Payer: BCN Commercial |
$220.98
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
OP
|
$285.95
|
|
|
Service Code
|
NDC 60687040401
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.91 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: Aetna Medicare |
$74.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.36
|
| Rate for Payer: BCBS Complete |
$114.38
|
| Rate for Payer: BCBS MAPPO |
$71.49
|
| Rate for Payer: BCBS Trust/PPO |
$235.08
|
| Rate for Payer: BCN Commercial |
$222.33
|
| Rate for Payer: BCN Medicare Advantage |
$71.49
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.49
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: PACE Senior Care Partners |
$67.91
|
| Rate for Payer: PACE SWMI |
$71.49
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: PHP Medicare Advantage |
$71.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.87
|
| Rate for Payer: Priority Health HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$72.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.59
|
| Rate for Payer: Railroad Medicare Medicare |
$71.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.49
|
| Rate for Payer: UHC Exchange |
$71.49
|
| Rate for Payer: UHC Medicare Advantage |
$71.49
|
| Rate for Payer: VA VA |
$71.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 60687040411
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.89
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$0.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Medicare Advantage |
$0.72
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.72
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: PACE Senior Care Partners |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.72
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: PHP Medicare Advantage |
$0.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health HMO/PPO |
$2.49
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.92
|
| Rate for Payer: Railroad Medicare Medicare |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.72
|
| Rate for Payer: UHC Exchange |
$0.72
|
| Rate for Payer: UHC Medicare Advantage |
$0.72
|
| Rate for Payer: VA VA |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
COCAINE 4 % NASAL SOLUTION
|
Facility
|
IP
|
$641.99
|
|
|
Service Code
|
HCPCS C9143
|
| Hospital Charge Code |
186568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$417.29 |
| Max. Negotiated Rate |
$577.79 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Commercial |
$586.96
|
| Rate for Payer: BCBS Trust/PPO |
$524.06
|
| Rate for Payer: BCBS Trust/PPO |
$563.69
|
| Rate for Payer: BCN Commercial |
$496.13
|
| Rate for Payer: BCN Commercial |
$533.65
|
| Rate for Payer: Cash Price |
$513.59
|
| Rate for Payer: Cash Price |
$552.43
|
| Rate for Payer: Cofinity Commercial |
$593.86
|
| Rate for Payer: Cofinity Commercial |
$552.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.59
|
| Rate for Payer: Healthscope Commercial |
$577.79
|
| Rate for Payer: Healthscope Commercial |
$621.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.96
|
| Rate for Payer: Nomi Health Commercial |
$526.43
|
| Rate for Payer: Nomi Health Commercial |
$566.24
|
| Rate for Payer: PHP Commercial |
$545.69
|
| Rate for Payer: PHP Commercial |
$586.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.29
|
| Rate for Payer: Priority Health HMO/PPO |
$600.77
|
| Rate for Payer: Priority Health HMO/PPO |
$558.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$430.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.68
|
| Rate for Payer: UHC Core |
$536.06
|
| Rate for Payer: UHC Core |
$576.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.90
|
|
|
COCAINE 4 % NASAL SOLUTION
|
Facility
|
OP
|
$690.54
|
|
|
Service Code
|
HCPCS C9143
|
| Hospital Charge Code |
186568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$621.49 |
| Rate for Payer: Aetna Commercial |
$586.96
|
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Medicare |
$179.54
|
| Rate for Payer: Aetna Medicare |
$166.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.62
|
| Rate for Payer: BCBS Complete |
$256.80
|
| Rate for Payer: BCBS Complete |
$276.22
|
| Rate for Payer: BCBS MAPPO |
$160.50
|
| Rate for Payer: BCBS MAPPO |
$172.63
|
| Rate for Payer: BCBS Trust/PPO |
$567.69
|
| Rate for Payer: BCBS Trust/PPO |
$527.78
|
| Rate for Payer: BCN Commercial |
$536.89
|
| Rate for Payer: BCN Commercial |
$499.15
|
| Rate for Payer: BCN Medicare Advantage |
$172.63
|
| Rate for Payer: BCN Medicare Advantage |
$160.50
|
| Rate for Payer: Cash Price |
$552.43
|
| Rate for Payer: Cash Price |
$513.59
|
| Rate for Payer: Cofinity Commercial |
$552.11
|
| Rate for Payer: Cofinity Commercial |
$593.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.63
|
| Rate for Payer: Healthscope Commercial |
$577.79
|
| Rate for Payer: Healthscope Commercial |
$621.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.69
|
| Rate for Payer: Nomi Health Commercial |
$566.24
|
| Rate for Payer: Nomi Health Commercial |
$526.43
|
| Rate for Payer: PACE Senior Care Partners |
$164.00
|
| Rate for Payer: PACE Senior Care Partners |
$152.47
|
| Rate for Payer: PACE SWMI |
$172.63
|
| Rate for Payer: PACE SWMI |
$160.50
|
| Rate for Payer: PHP Commercial |
$586.96
|
| Rate for Payer: PHP Commercial |
$545.69
|
| Rate for Payer: PHP Medicare Advantage |
$160.50
|
| Rate for Payer: PHP Medicare Advantage |
$172.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.29
|
| Rate for Payer: Priority Health HMO/PPO |
$558.53
|
| Rate for Payer: Priority Health HMO/PPO |
$600.77
|
| Rate for Payer: Priority Health Medicare |
$174.36
|
| Rate for Payer: Priority Health Medicare |
$162.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$430.13
|
| Rate for Payer: Railroad Medicare Medicare |
$160.50
|
| Rate for Payer: Railroad Medicare Medicare |
$172.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.68
|
| Rate for Payer: UHC Core |
$576.60
|
| Rate for Payer: UHC Core |
$536.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.50
|
| Rate for Payer: UHC Exchange |
$160.50
|
| Rate for Payer: UHC Exchange |
$172.63
|
| Rate for Payer: UHC Medicare Advantage |
$160.50
|
| Rate for Payer: UHC Medicare Advantage |
$172.63
|
| Rate for Payer: VA VA |
$160.50
|
| Rate for Payer: VA VA |
$172.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.49
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
NDC 70710135103
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.50
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$82.87
|
| Rate for Payer: BCN Commercial |
$78.37
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: PACE Senior Care Partners |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.54
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.70
|
| Rate for Payer: UHC Core |
$84.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.20
|
| Rate for Payer: UHC Exchange |
$25.20
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
| Rate for Payer: VA VA |
$25.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$364.53
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$94.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.92
|
| Rate for Payer: BCBS Complete |
$145.81
|
| Rate for Payer: BCBS MAPPO |
$91.13
|
| Rate for Payer: BCBS Trust/PPO |
$299.68
|
| Rate for Payer: BCN Commercial |
$283.42
|
| Rate for Payer: BCN Medicare Advantage |
$91.13
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.13
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: PACE Senior Care Partners |
$86.58
|
| Rate for Payer: PACE SWMI |
$91.13
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: PHP Medicare Advantage |
$91.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.94
|
| Rate for Payer: Priority Health HMO/PPO |
$317.14
|
| Rate for Payer: Priority Health Medicare |
$92.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.24
|
| Rate for Payer: Railroad Medicare Medicare |
$91.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.13
|
| Rate for Payer: UHC Exchange |
$91.13
|
| Rate for Payer: UHC Medicare Advantage |
$91.13
|
| Rate for Payer: VA VA |
$91.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$742.26
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$482.47 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: Aetna Commercial |
$630.92
|
| Rate for Payer: BCBS Trust/PPO |
$605.91
|
| Rate for Payer: BCN Commercial |
$573.62
|
| Rate for Payer: Cash Price |
$593.81
|
| Rate for Payer: Cofinity Commercial |
$638.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$593.81
|
| Rate for Payer: Healthscope Commercial |
$668.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$556.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.92
|
| Rate for Payer: Nomi Health Commercial |
$608.65
|
| Rate for Payer: PHP Commercial |
$630.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.47
|
| Rate for Payer: Priority Health HMO/PPO |
$645.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.19
|
| Rate for Payer: UHC Core |
$619.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.70
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.94 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: BCBS Trust/PPO |
$297.57
|
| Rate for Payer: BCN Commercial |
$281.71
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: Nomi Health Commercial |
$298.91
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.94
|
| Rate for Payer: Priority Health HMO/PPO |
$317.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Core |
$304.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
