|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 3,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 500 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 500 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,327.57
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$5,694.81 |
| Rate for Payer: Aetna American Axle |
$4,112.92
|
| Rate for Payer: Aetna Commercial |
$5,378.43
|
| Rate for Payer: Aetna Medicare |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.33
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS MAPPO |
$2.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.66
|
| Rate for Payer: Cash Price |
$5,062.06
|
| Rate for Payer: Cash Price |
$5,062.06
|
| Rate for Payer: Cofinity Commercial |
$5,441.71
|
| Rate for Payer: Cofinity Commercial |
$4,429.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,429.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,062.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$5,694.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,429.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,745.68
|
| Rate for Payer: Mclaren Medicaid |
$1.43
|
| Rate for Payer: Mclaren Medicare |
$2.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$1.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,378.43
|
| Rate for Payer: PACE Medicare |
$2.53
|
| Rate for Payer: PACE SWMI |
$2.66
|
| Rate for Payer: PHP Commercial |
$5,378.43
|
| Rate for Payer: PHP Medicare Advantage |
$2.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.92
|
| Rate for Payer: Priority Health Medicare |
$2.66
|
| Rate for Payer: Priority Health SBD |
$3,986.37
|
| Rate for Payer: Railroad Medicare Medicare |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.66
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Medicare Advantage |
$2.66
|
| Rate for Payer: UHCCP Medicaid |
$1.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,341.20
|
| Rate for Payer: VA VA |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,745.68
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,327.57
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,784.13 |
| Max. Negotiated Rate |
$5,694.81 |
| Rate for Payer: Aetna American Axle |
$4,112.92
|
| Rate for Payer: Aetna Commercial |
$5,378.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.92
|
| Rate for Payer: Cash Price |
$5,062.06
|
| Rate for Payer: Cofinity Commercial |
$4,429.30
|
| Rate for Payer: Cofinity Commercial |
$5,441.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,429.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,062.06
|
| Rate for Payer: Healthscope Commercial |
$5,694.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,429.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,745.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,378.43
|
| Rate for Payer: PHP Commercial |
$5,378.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.92
|
| Rate for Payer: Priority Health SBD |
$3,986.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,784.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,745.68
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,655.09
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,568.24 |
| Max. Negotiated Rate |
$11,389.58 |
| Rate for Payer: Aetna American Axle |
$8,225.81
|
| Rate for Payer: Aetna Commercial |
$10,756.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,225.81
|
| Rate for Payer: Cash Price |
$10,124.07
|
| Rate for Payer: Cofinity Commercial |
$10,883.38
|
| Rate for Payer: Cofinity Commercial |
$8,858.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,858.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,124.07
|
| Rate for Payer: Healthscope Commercial |
$11,389.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,858.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,491.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,756.83
|
| Rate for Payer: PHP Commercial |
$10,756.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,225.81
|
| Rate for Payer: Priority Health SBD |
$7,972.71
|
| Rate for Payer: UMR Bronson Commercial |
$5,568.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,491.32
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,655.09
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$11,389.58 |
| Rate for Payer: Aetna American Axle |
$8,225.81
|
| Rate for Payer: Aetna Commercial |
$10,756.83
|
| Rate for Payer: Aetna Medicare |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,225.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.33
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS MAPPO |
$2.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.66
|
| Rate for Payer: Cash Price |
$10,124.07
|
| Rate for Payer: Cash Price |
$10,124.07
|
| Rate for Payer: Cofinity Commercial |
$8,858.56
|
| Rate for Payer: Cofinity Commercial |
$10,883.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,858.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,124.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$11,389.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,858.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,491.32
|
| Rate for Payer: Mclaren Medicaid |
$1.43
|
| Rate for Payer: Mclaren Medicare |
$2.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$1.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,756.83
|
| Rate for Payer: PACE Medicare |
$2.53
|
| Rate for Payer: PACE SWMI |
$2.66
|
| Rate for Payer: PHP Commercial |
$10,756.83
|
| Rate for Payer: PHP Medicare Advantage |
$2.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,225.81
|
| Rate for Payer: Priority Health Medicare |
$2.66
|
| Rate for Payer: Priority Health SBD |
$7,972.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.66
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Medicare Advantage |
$2.66
|
| Rate for Payer: UHCCP Medicaid |
$1.43
|
| Rate for Payer: UMR Bronson Commercial |
$4,682.38
|
| Rate for Payer: VA VA |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,491.32
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,174.07
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,276.59 |
| Max. Negotiated Rate |
$27,156.66 |
| Rate for Payer: Aetna American Axle |
$19,613.15
|
| Rate for Payer: Aetna Commercial |
$25,647.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,613.15
|
| Rate for Payer: Cash Price |
$24,139.26
|
| Rate for Payer: Cofinity Commercial |
$21,121.85
|
| Rate for Payer: Cofinity Commercial |
$25,949.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,121.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,139.26
|
| Rate for Payer: Healthscope Commercial |
$27,156.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,121.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,630.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,647.96
|
| Rate for Payer: PHP Commercial |
$25,647.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,613.15
|
| Rate for Payer: Priority Health SBD |
$19,009.66
|
| Rate for Payer: UMR Bronson Commercial |
$13,276.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,630.55
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,174.07
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$27,156.66 |
| Rate for Payer: Aetna American Axle |
$19,613.15
|
| Rate for Payer: Aetna Commercial |
$25,647.96
|
| Rate for Payer: Aetna Medicare |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,613.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.33
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS MAPPO |
$2.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.66
|
| Rate for Payer: Cash Price |
$24,139.26
|
| Rate for Payer: Cash Price |
$24,139.26
|
| Rate for Payer: Cofinity Commercial |
$25,949.70
|
| Rate for Payer: Cofinity Commercial |
$21,121.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,121.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,139.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$27,156.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,121.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,630.55
|
| Rate for Payer: Mclaren Medicaid |
$1.43
|
| Rate for Payer: Mclaren Medicare |
$2.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$1.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,647.96
|
| Rate for Payer: PACE Medicare |
$2.53
|
| Rate for Payer: PACE SWMI |
$2.66
|
| Rate for Payer: PHP Commercial |
$25,647.96
|
| Rate for Payer: PHP Medicare Advantage |
$2.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,613.15
|
| Rate for Payer: Priority Health Medicare |
$2.66
|
| Rate for Payer: Priority Health SBD |
$19,009.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.66
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Medicare Advantage |
$2.66
|
| Rate for Payer: UHCCP Medicaid |
$1.43
|
| Rate for Payer: UMR Bronson Commercial |
$11,164.41
|
| Rate for Payer: VA VA |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,630.55
|
|
|
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 Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.31
|
| 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: PHP Commercial |
$16.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| 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 |
$5.24 |
| Max. Negotiated Rate |
$27.53 |
| Rate for Payer: Aetna American Axle |
$12.36
|
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna Medicare |
$10.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.22
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS MAPPO |
$9.78
|
| Rate for Payer: BCN Medicare Advantage |
$9.78
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.78
|
| 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 |
$5.24
|
| Rate for Payer: Mclaren Medicare |
$9.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.27
|
| Rate for Payer: Meridian Medicaid |
$5.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.16
|
| Rate for Payer: PACE Medicare |
$9.29
|
| Rate for Payer: PACE SWMI |
$9.78
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: PHP Medicare Advantage |
$9.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health Medicare |
$9.78
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.78
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UHC Medicare Advantage |
$9.78
|
| Rate for Payer: UHCCP Medicaid |
$5.24
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: VA VA |
$9.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.26
|
|
|
COCAINE 4 % NASAL SOLUTION
|
Facility
|
OP
|
$853.69
|
|
|
Service Code
|
HCPCS C9143
|
| Hospital Charge Code |
186568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$315.87 |
| Max. Negotiated Rate |
$768.32 |
| Rate for Payer: Aetna American Axle |
$554.90
|
| Rate for Payer: Aetna American Axle |
$695.07
|
| Rate for Payer: Aetna American Axle |
$448.85
|
| Rate for Payer: Aetna Commercial |
$725.64
|
| Rate for Payer: Aetna Commercial |
$586.96
|
| Rate for Payer: Aetna Commercial |
$908.94
|
| Rate for Payer: Aetna Medicare |
$426.85
|
| Rate for Payer: Aetna Medicare |
$345.27
|
| Rate for Payer: Aetna Medicare |
$534.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.07
|
| Rate for Payer: BCBS Complete |
$427.74
|
| Rate for Payer: BCBS Complete |
$276.22
|
| Rate for Payer: BCBS Complete |
$341.48
|
| Rate for Payer: Cash Price |
$682.95
|
| Rate for Payer: Cash Price |
$552.43
|
| Rate for Payer: Cash Price |
$855.47
|
| Rate for Payer: Cofinity Commercial |
$593.86
|
| Rate for Payer: Cofinity Commercial |
$748.54
|
| Rate for Payer: Cofinity Commercial |
$919.63
|
| Rate for Payer: Cofinity Commercial |
$734.17
|
| Rate for Payer: Cofinity Commercial |
$597.58
|
| Rate for Payer: Cofinity Commercial |
$483.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$748.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.95
|
| Rate for Payer: Healthscope Commercial |
$962.41
|
| Rate for Payer: Healthscope Commercial |
$621.49
|
| Rate for Payer: Healthscope Commercial |
$768.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$748.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$802.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.64
|
| Rate for Payer: PHP Commercial |
$908.94
|
| Rate for Payer: PHP Commercial |
$586.96
|
| Rate for Payer: PHP Commercial |
$725.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.07
|
| Rate for Payer: Priority Health SBD |
$435.04
|
| Rate for Payer: Priority Health SBD |
$673.68
|
| Rate for Payer: Priority Health SBD |
$537.82
|
| Rate for Payer: UMR Bronson Commercial |
$315.87
|
| Rate for Payer: UMR Bronson Commercial |
$395.66
|
| Rate for Payer: UMR Bronson Commercial |
$255.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$802.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.27
|
|
|
COCAINE 4 % NASAL SOLUTION
|
Facility
|
IP
|
$1,069.34
|
|
|
Service Code
|
HCPCS C9143
|
| Hospital Charge Code |
186568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$470.51 |
| Max. Negotiated Rate |
$962.41 |
| Rate for Payer: Aetna American Axle |
$695.07
|
| Rate for Payer: Aetna American Axle |
$448.85
|
| Rate for Payer: Aetna American Axle |
$554.90
|
| Rate for Payer: Aetna Commercial |
$586.96
|
| Rate for Payer: Aetna Commercial |
$908.94
|
| Rate for Payer: Aetna Commercial |
$725.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.85
|
| Rate for Payer: Cash Price |
$682.95
|
| Rate for Payer: Cash Price |
$552.43
|
| Rate for Payer: Cash Price |
$855.47
|
| Rate for Payer: Cofinity Commercial |
$919.63
|
| Rate for Payer: Cofinity Commercial |
$593.86
|
| Rate for Payer: Cofinity Commercial |
$483.38
|
| Rate for Payer: Cofinity Commercial |
$734.17
|
| Rate for Payer: Cofinity Commercial |
$597.58
|
| Rate for Payer: Cofinity Commercial |
$748.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$748.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.43
|
| Rate for Payer: Healthscope Commercial |
$621.49
|
| Rate for Payer: Healthscope Commercial |
$962.41
|
| Rate for Payer: Healthscope Commercial |
$768.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$748.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$802.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.96
|
| Rate for Payer: PHP Commercial |
$725.64
|
| Rate for Payer: PHP Commercial |
$586.96
|
| Rate for Payer: PHP Commercial |
$908.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.07
|
| Rate for Payer: Priority Health SBD |
$537.82
|
| Rate for Payer: Priority Health SBD |
$435.04
|
| Rate for Payer: Priority Health SBD |
$673.68
|
| Rate for Payer: UMR Bronson Commercial |
$470.51
|
| Rate for Payer: UMR Bronson Commercial |
$375.62
|
| Rate for Payer: UMR Bronson Commercial |
$303.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$802.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.90
|
|
|
COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY
|
Facility
|
OP
|
$87,322.50
|
|
|
Service Code
|
CPT 69930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,627.54 |
| Max. Negotiated Rate |
$87,322.50 |
| Rate for Payer: Aetna Medicare |
$32,262.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,776.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,776.91
|
| Rate for Payer: BCBS Complete |
$17,458.92
|
| Rate for Payer: BCBS MAPPO |
$31,021.53
|
| Rate for Payer: BCN Medicare Advantage |
$31,021.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,021.53
|
| Rate for Payer: Mclaren Medicaid |
$16,627.54
|
| Rate for Payer: Mclaren Medicare |
$31,021.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,572.61
|
| Rate for Payer: Meridian Medicaid |
$17,458.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,674.76
|
| Rate for Payer: PACE Medicare |
$29,470.45
|
| Rate for Payer: PACE SWMI |
$31,021.53
|
| Rate for Payer: PHP Medicare Advantage |
$31,021.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,627.54
|
| Rate for Payer: Priority Health Medicare |
$31,021.53
|
| Rate for Payer: Railroad Medicare Medicare |
$31,021.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87,322.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$31,021.53
|
| Rate for Payer: UHC Exchange |
$59,285.25
|
| Rate for Payer: UHC Medicare Advantage |
$31,021.53
|
| Rate for Payer: UHCCP Medicaid |
$16,627.54
|
| Rate for Payer: VA VA |
$31,021.53
|
|
|
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 Commercial |
$18.15
|
| Rate for Payer: Cofinity Commercial |
$22.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Healthscope Commercial |
$23.34
|
| Rate for Payer: 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: PHP Commercial |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.85
|
| 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
|
$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 Commercial |
$519.58
|
| Rate for Payer: Cofinity Commercial |
$638.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$519.58
|
| 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: PHP Commercial |
$630.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.47
|
| Rate for Payer: Priority Health SBD |
$467.62
|
| 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
|
$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 Commercial |
$57.66
|
| Rate for Payer: Cofinity Commercial |
$70.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.66
|
| 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: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.54
|
| 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
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
NDC 70710135103
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.30 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna American Axle |
$65.52
|
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$50.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.52
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health SBD |
$63.50
|
| Rate for Payer: UMR Bronson Commercial |
$37.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$1,931.77
|
|
|
Service Code
|
NDC 00254200801
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$849.98 |
| Max. Negotiated Rate |
$1,738.59 |
| Rate for Payer: Aetna American Axle |
$1,255.65
|
| Rate for Payer: Aetna Commercial |
$1,642.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,255.65
|
| Rate for Payer: Cash Price |
$1,545.42
|
| Rate for Payer: Cofinity Commercial |
$1,352.24
|
| Rate for Payer: Cofinity Commercial |
$1,661.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,352.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,545.42
|
| Rate for Payer: Healthscope Commercial |
$1,738.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,352.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,448.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,642.00
|
| Rate for Payer: PHP Commercial |
$1,642.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,255.65
|
| Rate for Payer: Priority Health SBD |
$1,217.02
|
| Rate for Payer: UMR Bronson Commercial |
$849.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,448.83
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$100.80
|
|
|
Service Code
|
NDC 70710135103
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna American Axle |
$65.52
|
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.52
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health SBD |
$63.50
|
| Rate for Payer: UMR Bronson Commercial |
$44.35
|
| 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 |
$134.88 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna American Axle |
$236.94
|
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna Medicare |
$182.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| Rate for Payer: BCBS Complete |
$145.81
|
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Cofinity Commercial |
$255.17
|
| Rate for Payer: Cofinity Commercial |
$313.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.62
|
| Rate for Payer: Healthscope Commercial |
$328.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.85
|
| Rate for Payer: PHP Commercial |
$309.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.94
|
| Rate for Payer: Priority Health SBD |
$229.65
|
| Rate for Payer: UMR Bronson Commercial |
$134.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$1,931.77
|
|
|
Service Code
|
NDC 00254200801
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$714.75 |
| Max. Negotiated Rate |
$1,738.59 |
| Rate for Payer: Aetna American Axle |
$1,255.65
|
| Rate for Payer: Aetna Commercial |
$1,642.00
|
| Rate for Payer: Aetna Medicare |
$965.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,255.65
|
| Rate for Payer: BCBS Complete |
$772.71
|
| Rate for Payer: Cash Price |
$1,545.42
|
| Rate for Payer: Cofinity Commercial |
$1,352.24
|
| Rate for Payer: Cofinity Commercial |
$1,661.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,352.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,545.42
|
| Rate for Payer: Healthscope Commercial |
$1,738.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,352.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,448.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,642.00
|
| Rate for Payer: PHP Commercial |
$1,642.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,255.65
|
| Rate for Payer: Priority Health SBD |
$1,217.02
|
| Rate for Payer: UMR Bronson Commercial |
$714.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,448.83
|
|
|
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 Commercial |
$519.58
|
| Rate for Payer: Cofinity Commercial |
$638.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$519.58
|
| 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: PHP Commercial |
$630.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.47
|
| 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
|
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 Commercial |
$544.52
|
| Rate for Payer: Cofinity Commercial |
$668.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.31
|
| Rate for Payer: Healthscope Commercial |
$700.10
|
| Rate for Payer: 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: PHP Commercial |
$661.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.63
|
| Rate for Payer: Priority Health SBD |
$490.07
|
| 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
|
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 Commercial |
$544.52
|
| Rate for Payer: Cofinity Commercial |
$668.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.31
|
| Rate for Payer: Healthscope Commercial |
$700.10
|
| Rate for Payer: 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: PHP Commercial |
$661.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.63
|
| 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
|
|
