|
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 |
$2.14
|
| 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 |
$2.14
|
|
|
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 |
$2.14
|
| 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 |
$2.14
|
|
|
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
|
|
|
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 |
$172.64
|
| 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 |
$172.64
|
| 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 |
$172.64
|
| 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 |
$172.64
|
| 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 |
$172.64
|
| 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 |
$172.64
|
| 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 |
$172.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.50
|
| Rate for Payer: UHC Exchange |
$160.50
|
| Rate for Payer: UHC Exchange |
$172.64
|
| Rate for Payer: UHC Medicare Advantage |
$160.50
|
| Rate for Payer: UHC Medicare Advantage |
$172.64
|
| Rate for Payer: VA VA |
$160.50
|
| Rate for Payer: VA VA |
$172.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.49
|
|
|
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
|
|
|
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
|
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
|
IP
|
$100.80
|
|
|
Service Code
|
NDC 70710135103
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: BCBS Trust/PPO |
$82.28
|
| Rate for Payer: BCN Commercial |
$77.90
|
| 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: Healthscope Commercial |
$90.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.70
|
| Rate for Payer: UHC Core |
$84.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
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
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$742.26
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.29 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: Aetna Commercial |
$630.92
|
| Rate for Payer: Aetna Medicare |
$192.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.96
|
| Rate for Payer: BCBS Complete |
$296.90
|
| Rate for Payer: BCBS MAPPO |
$185.56
|
| Rate for Payer: BCBS Trust/PPO |
$610.21
|
| Rate for Payer: BCN Commercial |
$577.11
|
| Rate for Payer: BCN Medicare Advantage |
$185.56
|
| 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: Health Alliance Plan Medicare Advantage |
$185.56
|
| Rate for Payer: Healthscope Commercial |
$668.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$556.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.92
|
| Rate for Payer: Nomi Health Commercial |
$608.65
|
| Rate for Payer: PACE Senior Care Partners |
$176.29
|
| Rate for Payer: PACE SWMI |
$185.56
|
| Rate for Payer: PHP Commercial |
$630.92
|
| Rate for Payer: PHP Medicare Advantage |
$185.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.47
|
| Rate for Payer: Priority Health HMO/PPO |
$645.77
|
| Rate for Payer: Priority Health Medicare |
$187.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.31
|
| Rate for Payer: Railroad Medicare Medicare |
$185.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.19
|
| Rate for Payer: UHC Core |
$619.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.56
|
| Rate for Payer: UHC Exchange |
$185.56
|
| Rate for Payer: UHC Medicare Advantage |
$185.56
|
| Rate for Payer: VA VA |
$185.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.70
|
|
|
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
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
NDC 59762045001
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$374.40 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: BCBS Trust/PPO |
$470.19
|
| Rate for Payer: BCN Commercial |
$445.13
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$495.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Healthscope Commercial |
$518.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.60
|
| Rate for Payer: Nomi Health Commercial |
$472.32
|
| Rate for Payer: PHP Commercial |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health HMO/PPO |
$501.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.88
|
| Rate for Payer: UHC Core |
$480.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.00
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
NDC 59762045001
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna Medicare |
$149.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.00
|
| Rate for Payer: BCBS Complete |
$230.40
|
| Rate for Payer: BCBS MAPPO |
$144.00
|
| Rate for Payer: BCBS Trust/PPO |
$473.53
|
| Rate for Payer: BCN Commercial |
$447.84
|
| Rate for Payer: BCN Medicare Advantage |
$144.00
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$495.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$518.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.60
|
| Rate for Payer: Nomi Health Commercial |
$472.32
|
| Rate for Payer: PACE Senior Care Partners |
$136.80
|
| Rate for Payer: PACE SWMI |
$144.00
|
| Rate for Payer: PHP Commercial |
$489.60
|
| Rate for Payer: PHP Medicare Advantage |
$144.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health HMO/PPO |
$501.12
|
| Rate for Payer: Priority Health Medicare |
$145.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.92
|
| Rate for Payer: Railroad Medicare Medicare |
$144.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.88
|
| Rate for Payer: UHC Core |
$480.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.00
|
| Rate for Payer: UHC Exchange |
$144.00
|
| Rate for Payer: UHC Medicare Advantage |
$144.00
|
| Rate for Payer: VA VA |
$144.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.00
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
OP
|
$964.01
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$867.61 |
| Rate for Payer: Aetna Commercial |
$819.41
|
| Rate for Payer: Aetna Medicare |
$250.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.25
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: BCBS MAPPO |
$241.00
|
| Rate for Payer: BCBS Trust/PPO |
$792.51
|
| Rate for Payer: BCN Commercial |
$749.52
|
| Rate for Payer: BCN Medicare Advantage |
$241.00
|
| Rate for Payer: Cash Price |
$771.21
|
| Rate for Payer: Cofinity Commercial |
$829.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.00
|
| Rate for Payer: Healthscope Commercial |
$867.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.41
|
| Rate for Payer: Nomi Health Commercial |
$790.49
|
| Rate for Payer: PACE Senior Care Partners |
$228.95
|
| Rate for Payer: PACE SWMI |
$241.00
|
| Rate for Payer: PHP Commercial |
$819.41
|
| Rate for Payer: PHP Medicare Advantage |
$241.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.61
|
| Rate for Payer: Priority Health HMO/PPO |
$838.69
|
| Rate for Payer: Priority Health Medicare |
$243.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$645.89
|
| Rate for Payer: Railroad Medicare Medicare |
$241.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.33
|
| Rate for Payer: UHC Core |
$804.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.00
|
| Rate for Payer: UHC Exchange |
$241.00
|
| Rate for Payer: UHC Medicare Advantage |
$241.00
|
| Rate for Payer: VA VA |
$241.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.01
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$964.01
|
|
|
Service Code
|
NDC 50484001030
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$626.61 |
| Max. Negotiated Rate |
$867.61 |
| Rate for Payer: Aetna Commercial |
$819.41
|
| Rate for Payer: BCBS Trust/PPO |
$786.92
|
| Rate for Payer: BCN Commercial |
$744.99
|
| Rate for Payer: Cash Price |
$771.21
|
| Rate for Payer: Cofinity Commercial |
$829.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.21
|
| Rate for Payer: Healthscope Commercial |
$867.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.41
|
| Rate for Payer: Nomi Health Commercial |
$790.49
|
| Rate for Payer: PHP Commercial |
$819.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.61
|
| Rate for Payer: Priority Health HMO/PPO |
$838.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$645.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.33
|
| Rate for Payer: UHC Core |
$804.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.01
|
|
|
COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$678.18
|
|
|
Service Code
|
CPT 45378
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.84 |
| Max. Negotiated Rate |
$678.18 |
| Rate for Payer: BCBS Complete |
$678.18
|
| Rate for Payer: Mclaren Medicaid |
$645.84
|
| Rate for Payer: Meridian Medicaid |
$678.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.84
|
| Rate for Payer: UHCCP Medicaid |
$645.84
|
|
|
COLONOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 45388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 45398
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 45380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 45381
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 45384
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 45385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
|
COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$678.18
|
|
|
Service Code
|
CPT 44388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.84 |
| Max. Negotiated Rate |
$678.18 |
| Rate for Payer: BCBS Complete |
$678.18
|
| Rate for Payer: Mclaren Medicaid |
$645.84
|
| Rate for Payer: Meridian Medicaid |
$678.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.84
|
| Rate for Payer: UHCCP Medicaid |
$645.84
|
|
|
COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 44389
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
|
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$877.06
|
|
|
Service Code
|
CPT 44394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.24 |
| Max. Negotiated Rate |
$877.06 |
| Rate for Payer: BCBS Complete |
$877.06
|
| Rate for Payer: Mclaren Medicaid |
$835.24
|
| Rate for Payer: Meridian Medicaid |
$877.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.24
|
| Rate for Payer: UHCCP Medicaid |
$835.24
|
|
