|
COAGULATION FACTOR X 500 (+/-) UNIT RANGE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.01
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
176430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$17.11 |
| Rate for Payer: Aetna American Axle |
$12.36
|
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cofinity Advantage |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.21
|
| Rate for Payer: Healthscope Commercial |
$17.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.26
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.26
|
|
|
COAGULATION FACTOR X 500 (+/-) UNIT RANGE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.01
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
176430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$32.14 |
| Rate for Payer: Aetna American Axle |
$12.36
|
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.44
|
| Rate for Payer: BCBS Complete |
$5.46
|
| Rate for Payer: BCBS MAPPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$32.14
|
| Rate for Payer: BCN Commercial |
$32.14
|
| Rate for Payer: BCN Medicare Advantage |
$9.95
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cofinity Advantage |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.95
|
| Rate for Payer: Healthscope Commercial |
$17.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.26
|
| Rate for Payer: Mclaren Medicaid |
$9.95
|
| Rate for Payer: Mclaren Medicare |
$9.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.45
|
| Rate for Payer: Meridian Medicaid |
$10.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.16
|
| Rate for Payer: Nomi Health Commercial |
$29.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.26
|
| Rate for Payer: PACE Medicare |
$9.45
|
| Rate for Payer: PACE SWMI |
$9.95
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: PHP Medicare Advantage |
$9.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.82
|
| Rate for Payer: Priority Health Medicare |
$9.95
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: Priority Health Tiered Network |
$24.66
|
| Rate for Payer: Railroad Medicare Medicare |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.37
|
| Rate for Payer: UHC Core |
$16.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.95
|
| Rate for Payer: UHC Exchange |
$16.37
|
| Rate for Payer: UHC Medicaid |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$5.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: VA VA |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.26
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$5,214.27
|
|
|
Service Code
|
APR-DRG 7743
|
| Min. Negotiated Rate |
$4,965.97 |
| Max. Negotiated Rate |
$5,214.27 |
| Rate for Payer: BCBS Complete |
$5,214.27
|
| Rate for Payer: Mclaren Medicaid |
$4,965.97
|
| Rate for Payer: Meridian Medicaid |
$5,214.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,965.97
|
| Rate for Payer: UHC Medicaid |
$4,965.97
|
| Rate for Payer: UHCCP Medicaid |
$4,965.97
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,972.75
|
|
|
Service Code
|
APR-DRG 7742
|
| Min. Negotiated Rate |
$3,783.57 |
| Max. Negotiated Rate |
$3,972.75 |
| Rate for Payer: BCBS Complete |
$3,972.75
|
| Rate for Payer: Mclaren Medicaid |
$3,783.57
|
| Rate for Payer: Meridian Medicaid |
$3,972.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,783.57
|
| Rate for Payer: UHC Medicaid |
$3,783.57
|
| Rate for Payer: UHCCP Medicaid |
$3,783.57
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$12,948.51
|
|
|
Service Code
|
APR-DRG 7744
|
| Min. Negotiated Rate |
$12,331.91 |
| Max. Negotiated Rate |
$12,948.51 |
| Rate for Payer: BCBS Complete |
$12,948.51
|
| Rate for Payer: Mclaren Medicaid |
$12,331.91
|
| Rate for Payer: Meridian Medicaid |
$12,948.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,331.91
|
| Rate for Payer: UHC Medicaid |
$12,331.91
|
| Rate for Payer: UHCCP Medicaid |
$12,331.91
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,127.11
|
|
|
Service Code
|
APR-DRG 7741
|
| Min. Negotiated Rate |
$2,978.20 |
| Max. Negotiated Rate |
$3,127.11 |
| Rate for Payer: BCBS Complete |
$3,127.11
|
| Rate for Payer: Mclaren Medicaid |
$2,978.20
|
| Rate for Payer: Meridian Medicaid |
$3,127.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,978.20
|
| Rate for Payer: UHC Medicaid |
$2,978.20
|
| Rate for Payer: UHCCP Medicaid |
$2,978.20
|
|
|
COCCYGECTOMY, PRIMARY
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY
|
Facility
|
OP
|
$106,245.46
|
|
|
Service Code
|
CPT 69930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17,182.41 |
| Max. Negotiated Rate |
$106,245.46 |
| Rate for Payer: Aetna Medicare |
$34,167.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,066.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,066.95
|
| Rate for Payer: BCBS Complete |
$18,043.18
|
| Rate for Payer: BCBS MAPPO |
$32,853.56
|
| Rate for Payer: BCBS Trust/PPO |
$58,767.89
|
| Rate for Payer: BCN Commercial |
$58,767.89
|
| Rate for Payer: BCN Medicare Advantage |
$32,853.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,853.56
|
| Rate for Payer: Mclaren Medicaid |
$32,853.56
|
| Rate for Payer: Mclaren Medicare |
$32,853.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,496.24
|
| Rate for Payer: Meridian Medicaid |
$34,496.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,781.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,138.92
|
| Rate for Payer: Nomi Health Commercial |
$98,560.68
|
| Rate for Payer: PACE Medicare |
$31,210.88
|
| Rate for Payer: PACE SWMI |
$32,853.56
|
| Rate for Payer: PHP Medicare Advantage |
$32,853.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,182.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$106,245.46
|
| Rate for Payer: Priority Health Medicare |
$32,853.56
|
| Rate for Payer: Priority Health Tiered Network |
$84,996.37
|
| Rate for Payer: Railroad Medicare Medicare |
$32,853.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,853.56
|
| Rate for Payer: UHC Medicaid |
$17,182.41
|
| Rate for Payer: UHCCP Medicaid |
$17,182.41
|
| Rate for Payer: VA VA |
$32,853.56
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$372.41
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.79 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna American Axle |
$242.07
|
| Rate for Payer: Aetna Commercial |
$316.55
|
| Rate for Payer: Aetna Medicare |
$186.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.07
|
| Rate for Payer: BCBS Complete |
$148.96
|
| Rate for Payer: Cash Price |
$297.93
|
| Rate for Payer: Cofinity Advantage |
$260.69
|
| Rate for Payer: Cofinity Commercial |
$320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.93
|
| Rate for Payer: Healthscope Commercial |
$335.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.31
|
| Rate for Payer: PHP Commercial |
$316.55
|
| Rate for Payer: Priority Health SBD |
$234.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.07
|
| Rate for Payer: UHC Core |
$194.03
|
| Rate for Payer: UHC Exchange |
$146.36
|
| Rate for Payer: UMR Bronson Commercial |
$137.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.31
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$742.26
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.64 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: Aetna American Axle |
$482.47
|
| Rate for Payer: Aetna Commercial |
$630.92
|
| Rate for Payer: Aetna Medicare |
$371.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.47
|
| Rate for Payer: BCBS Complete |
$296.90
|
| Rate for Payer: Cash Price |
$593.81
|
| Rate for Payer: Cofinity Advantage |
$519.58
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$519.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$556.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$593.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$556.70
|
| Rate for Payer: PHP Commercial |
$630.92
|
| Rate for Payer: Priority Health SBD |
$467.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.47
|
| Rate for Payer: UHC Core |
$386.72
|
| Rate for Payer: UHC Exchange |
$291.71
|
| Rate for Payer: UMR Bronson Commercial |
$274.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.70
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$25.93
|
|
|
Service Code
|
NDC 60687038911
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna American Axle |
$16.85
|
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.85
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cofinity Advantage |
$18.15
|
| Rate for Payer: Cofinity Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Healthscope Commercial |
$23.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.04
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UMR Bronson Commercial |
$11.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$109.73
|
|
|
Service Code
|
NDC 00591256230
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna American Axle |
$71.32
|
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: Aetna Medicare |
$54.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.32
|
| Rate for Payer: BCBS Complete |
$43.89
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Advantage |
$76.81
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.30
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: Priority Health SBD |
$69.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.32
|
| Rate for Payer: UHC Core |
$57.17
|
| Rate for Payer: UHC Exchange |
$43.12
|
| Rate for Payer: UMR Bronson Commercial |
$40.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$777.89
|
|
|
Service Code
|
NDC 60687038921
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.82 |
| Max. Negotiated Rate |
$700.10 |
| Rate for Payer: Aetna American Axle |
$505.63
|
| Rate for Payer: Aetna Commercial |
$661.21
|
| Rate for Payer: Aetna Medicare |
$388.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.63
|
| Rate for Payer: BCBS Complete |
$311.16
|
| Rate for Payer: Cash Price |
$622.31
|
| Rate for Payer: Cofinity Advantage |
$544.52
|
| Rate for Payer: Cofinity Commercial |
$668.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.31
|
| Rate for Payer: Healthscope Commercial |
$700.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.42
|
| Rate for Payer: PHP Commercial |
$661.21
|
| Rate for Payer: Priority Health SBD |
$490.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.63
|
| Rate for Payer: UHC Core |
$405.28
|
| Rate for Payer: UHC Exchange |
$305.71
|
| Rate for Payer: UMR Bronson Commercial |
$287.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.42
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$122.69
|
|
|
Service Code
|
NDC 70710135103
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$110.42 |
| Rate for Payer: Aetna American Axle |
$79.75
|
| Rate for Payer: Aetna Commercial |
$104.29
|
| Rate for Payer: Aetna Medicare |
$61.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.75
|
| Rate for Payer: BCBS Complete |
$49.08
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cofinity Advantage |
$85.88
|
| Rate for Payer: Cofinity Commercial |
$105.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.15
|
| Rate for Payer: Healthscope Commercial |
$110.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.02
|
| Rate for Payer: PHP Commercial |
$104.29
|
| Rate for Payer: Priority Health SBD |
$77.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.75
|
| Rate for Payer: UHC Core |
$63.92
|
| Rate for Payer: UHC Exchange |
$48.22
|
| Rate for Payer: UMR Bronson Commercial |
$45.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.02
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$372.41
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna American Axle |
$242.07
|
| Rate for Payer: Aetna Commercial |
$316.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.07
|
| Rate for Payer: Cash Price |
$297.93
|
| Rate for Payer: Cofinity Advantage |
$260.69
|
| Rate for Payer: Cofinity Commercial |
$320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.93
|
| Rate for Payer: Healthscope Commercial |
$335.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.31
|
| Rate for Payer: PHP Commercial |
$316.55
|
| Rate for Payer: Priority Health SBD |
$234.62
|
| Rate for Payer: UMR Bronson Commercial |
$163.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.31
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$109.73
|
|
|
Service Code
|
NDC 00591256230
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna American Axle |
$71.32
|
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.32
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Advantage |
$76.81
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.30
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: Priority Health SBD |
$69.13
|
| Rate for Payer: UMR Bronson Commercial |
$48.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$742.26
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.59 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: Aetna American Axle |
$482.47
|
| Rate for Payer: Aetna Commercial |
$630.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.47
|
| Rate for Payer: Cash Price |
$593.81
|
| Rate for Payer: Cofinity Advantage |
$519.58
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$519.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$556.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$556.70
|
| Rate for Payer: PHP Commercial |
$630.92
|
| Rate for Payer: Priority Health SBD |
$467.62
|
| Rate for Payer: UMR Bronson Commercial |
$326.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.70
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$777.89
|
|
|
Service Code
|
NDC 60687038921
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$342.27 |
| Max. Negotiated Rate |
$700.10 |
| Rate for Payer: Aetna American Axle |
$505.63
|
| Rate for Payer: Aetna Commercial |
$661.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.63
|
| Rate for Payer: Cash Price |
$622.31
|
| Rate for Payer: Cofinity Advantage |
$544.52
|
| Rate for Payer: Cofinity Commercial |
$668.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.31
|
| Rate for Payer: Healthscope Commercial |
$700.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$583.42
|
| Rate for Payer: PHP Commercial |
$661.21
|
| Rate for Payer: Priority Health SBD |
$490.07
|
| Rate for Payer: UMR Bronson Commercial |
$342.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.42
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$82.37
|
|
|
Service Code
|
NDC 49884017111
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna American Axle |
$53.54
|
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna Medicare |
$41.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: BCBS Complete |
$32.95
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Advantage |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.78
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health SBD |
$51.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.54
|
| Rate for Payer: UHC Core |
$42.91
|
| Rate for Payer: UHC Exchange |
$32.37
|
| Rate for Payer: UMR Bronson Commercial |
$30.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$25.93
|
|
|
Service Code
|
NDC 60687038911
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$23.34 |
| Rate for Payer: Aetna American Axle |
$16.85
|
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Aetna Medicare |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.85
|
| Rate for Payer: BCBS Complete |
$10.37
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cofinity Advantage |
$18.15
|
| Rate for Payer: Cofinity Commercial |
$22.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Healthscope Commercial |
$23.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.04
|
| Rate for Payer: Priority Health SBD |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.85
|
| Rate for Payer: UHC Core |
$13.51
|
| Rate for Payer: UHC Exchange |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$122.69
|
|
|
Service Code
|
NDC 70710135103
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$110.42 |
| Rate for Payer: Aetna American Axle |
$79.75
|
| Rate for Payer: Aetna Commercial |
$104.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.75
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cofinity Advantage |
$85.88
|
| Rate for Payer: Cofinity Commercial |
$105.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.15
|
| Rate for Payer: Healthscope Commercial |
$110.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.02
|
| Rate for Payer: PHP Commercial |
$104.29
|
| Rate for Payer: Priority Health SBD |
$77.29
|
| Rate for Payer: UMR Bronson Commercial |
$53.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.02
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$82.37
|
|
|
Service Code
|
NDC 49884017111
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$74.13 |
| Rate for Payer: Aetna American Axle |
$53.54
|
| Rate for Payer: Aetna Commercial |
$70.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.54
|
| Rate for Payer: Cash Price |
$65.90
|
| Rate for Payer: Cofinity Advantage |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.90
|
| Rate for Payer: Healthscope Commercial |
$74.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.78
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health SBD |
$51.89
|
| Rate for Payer: UMR Bronson Commercial |
$36.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
OP
|
$528.39
|
|
|
Service Code
|
NDC 68462043318
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$475.55 |
| Rate for Payer: Aetna American Axle |
$343.45
|
| Rate for Payer: Aetna Commercial |
$449.13
|
| Rate for Payer: Aetna Medicare |
$264.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.45
|
| Rate for Payer: BCBS Complete |
$211.36
|
| Rate for Payer: Cash Price |
$422.71
|
| Rate for Payer: Cofinity Advantage |
$369.87
|
| Rate for Payer: Cofinity Commercial |
$454.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.71
|
| Rate for Payer: Healthscope Commercial |
$475.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.29
|
| Rate for Payer: PHP Commercial |
$449.13
|
| Rate for Payer: Priority Health SBD |
$332.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.45
|
| Rate for Payer: UHC Core |
$275.29
|
| Rate for Payer: UHC Exchange |
$207.66
|
| Rate for Payer: UMR Bronson Commercial |
$195.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.29
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
OP
|
$12.57
|
|
|
Service Code
|
NDC 60687038595
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$11.31 |
| Rate for Payer: Aetna American Axle |
$8.17
|
| Rate for Payer: Aetna Commercial |
$10.68
|
| Rate for Payer: Aetna Medicare |
$6.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.17
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cofinity Advantage |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$10.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.06
|
| Rate for Payer: Healthscope Commercial |
$11.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.43
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: Priority Health SBD |
$7.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.17
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Exchange |
$4.94
|
| Rate for Payer: UMR Bronson Commercial |
$4.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.43
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
IP
|
$376.85
|
|
|
Service Code
|
NDC 60687038525
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: Aetna American Axle |
$244.95
|
| Rate for Payer: Aetna Commercial |
$320.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.95
|
| Rate for Payer: Cash Price |
$301.48
|
| Rate for Payer: Cofinity Advantage |
$263.80
|
| Rate for Payer: Cofinity Commercial |
$324.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.48
|
| Rate for Payer: Healthscope Commercial |
$339.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.64
|
| Rate for Payer: PHP Commercial |
$320.32
|
| Rate for Payer: Priority Health SBD |
$237.42
|
| Rate for Payer: UMR Bronson Commercial |
$165.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.64
|
|
