|
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
|
$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
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
OP
|
$2,299.70
|
|
|
Service Code
|
NDC 65597070118
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$850.89 |
| Max. Negotiated Rate |
$2,069.73 |
| Rate for Payer: Aetna American Axle |
$1,494.81
|
| Rate for Payer: Aetna Commercial |
$1,954.74
|
| Rate for Payer: Aetna Medicare |
$1,149.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,494.81
|
| Rate for Payer: BCBS Complete |
$919.88
|
| Rate for Payer: Cash Price |
$1,839.76
|
| Rate for Payer: Cofinity Commercial |
$1,609.79
|
| Rate for Payer: Cofinity Commercial |
$1,977.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,609.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,839.76
|
| Rate for Payer: Healthscope Commercial |
$2,069.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,609.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,724.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,954.74
|
| Rate for Payer: PHP Commercial |
$1,954.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,494.81
|
| Rate for Payer: Priority Health SBD |
$1,448.81
|
| Rate for Payer: UMR Bronson Commercial |
$850.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,724.78
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
IP
|
$343.66
|
|
|
Service Code
|
NDC 60687038525
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.21 |
| Max. Negotiated Rate |
$309.29 |
| Rate for Payer: Aetna American Axle |
$223.38
|
| Rate for Payer: Aetna Commercial |
$292.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.38
|
| Rate for Payer: Cash Price |
$274.93
|
| Rate for Payer: Cofinity Commercial |
$240.56
|
| Rate for Payer: Cofinity Commercial |
$295.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.93
|
| Rate for Payer: Healthscope Commercial |
$309.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.11
|
| Rate for Payer: PHP Commercial |
$292.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.38
|
| Rate for Payer: Priority Health SBD |
$216.51
|
| Rate for Payer: UMR Bronson Commercial |
$151.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.75
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
OP
|
$11.46
|
|
|
Service Code
|
NDC 60687038595
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna Medicare |
$5.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: BCBS Complete |
$4.58
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.45
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
OP
|
$531.81
|
|
|
Service Code
|
NDC 68462043318
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$478.63 |
| Rate for Payer: Aetna American Axle |
$345.68
|
| Rate for Payer: Aetna Commercial |
$452.04
|
| Rate for Payer: Aetna Medicare |
$265.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.68
|
| Rate for Payer: BCBS Complete |
$212.72
|
| Rate for Payer: Cash Price |
$425.45
|
| Rate for Payer: Cofinity Commercial |
$372.27
|
| Rate for Payer: Cofinity Commercial |
$457.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.45
|
| Rate for Payer: Healthscope Commercial |
$478.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.04
|
| Rate for Payer: PHP Commercial |
$452.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.68
|
| Rate for Payer: Priority Health SBD |
$335.04
|
| Rate for Payer: UMR Bronson Commercial |
$196.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.86
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
OP
|
$343.66
|
|
|
Service Code
|
NDC 60687038525
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.15 |
| Max. Negotiated Rate |
$309.29 |
| Rate for Payer: Aetna American Axle |
$223.38
|
| Rate for Payer: Aetna Commercial |
$292.11
|
| Rate for Payer: Aetna Medicare |
$171.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.38
|
| Rate for Payer: BCBS Complete |
$137.46
|
| Rate for Payer: Cash Price |
$274.93
|
| Rate for Payer: Cofinity Commercial |
$240.56
|
| Rate for Payer: Cofinity Commercial |
$295.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.93
|
| Rate for Payer: Healthscope Commercial |
$309.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.11
|
| Rate for Payer: PHP Commercial |
$292.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.38
|
| Rate for Payer: Priority Health SBD |
$216.51
|
| Rate for Payer: UMR Bronson Commercial |
$127.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.75
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
IP
|
$2,299.70
|
|
|
Service Code
|
NDC 65597070118
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,011.87 |
| Max. Negotiated Rate |
$2,069.73 |
| Rate for Payer: Aetna American Axle |
$1,494.81
|
| Rate for Payer: Aetna Commercial |
$1,954.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,494.81
|
| Rate for Payer: Cash Price |
$1,839.76
|
| Rate for Payer: Cofinity Commercial |
$1,609.79
|
| Rate for Payer: Cofinity Commercial |
$1,977.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,609.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,839.76
|
| Rate for Payer: Healthscope Commercial |
$2,069.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,609.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,724.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,954.74
|
| Rate for Payer: PHP Commercial |
$1,954.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,494.81
|
| Rate for Payer: Priority Health SBD |
$1,448.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,011.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,724.78
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
IP
|
$11.46
|
|
|
Service Code
|
NDC 60687038595
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.45
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
IP
|
$531.81
|
|
|
Service Code
|
NDC 68462043318
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$478.63 |
| Rate for Payer: Aetna American Axle |
$345.68
|
| Rate for Payer: Aetna Commercial |
$452.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.68
|
| Rate for Payer: Cash Price |
$425.45
|
| Rate for Payer: Cofinity Commercial |
$372.27
|
| Rate for Payer: Cofinity Commercial |
$457.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.45
|
| Rate for Payer: Healthscope Commercial |
$478.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.04
|
| Rate for Payer: PHP Commercial |
$452.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.68
|
| Rate for Payer: Priority Health SBD |
$335.04
|
| Rate for Payer: UMR Bronson Commercial |
$234.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.86
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$407.24
|
|
|
Service Code
|
NDC 00115521116
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.19 |
| Max. Negotiated Rate |
$366.52 |
| Rate for Payer: Aetna American Axle |
$264.71
|
| Rate for Payer: Aetna Commercial |
$346.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.71
|
| Rate for Payer: Cash Price |
$325.79
|
| Rate for Payer: Cofinity Commercial |
$285.07
|
| Rate for Payer: Cofinity Commercial |
$350.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.79
|
| Rate for Payer: Healthscope Commercial |
$366.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.15
|
| Rate for Payer: PHP Commercial |
$346.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.71
|
| Rate for Payer: Priority Health SBD |
$256.56
|
| Rate for Payer: UMR Bronson Commercial |
$179.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.43
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$407.24
|
|
|
Service Code
|
NDC 00115521116
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.68 |
| Max. Negotiated Rate |
$366.52 |
| Rate for Payer: Aetna American Axle |
$264.71
|
| Rate for Payer: Aetna Commercial |
$346.15
|
| Rate for Payer: Aetna Medicare |
$203.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.71
|
| Rate for Payer: BCBS Complete |
$162.90
|
| Rate for Payer: Cash Price |
$325.79
|
| Rate for Payer: Cofinity Commercial |
$285.07
|
| Rate for Payer: Cofinity Commercial |
$350.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.79
|
| Rate for Payer: Healthscope Commercial |
$366.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.15
|
| Rate for Payer: PHP Commercial |
$346.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.71
|
| Rate for Payer: Priority Health SBD |
$256.56
|
| Rate for Payer: UMR Bronson Commercial |
$150.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.43
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
NDC 59762045001
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna American Axle |
$374.40
|
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna Medicare |
$288.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.40
|
| Rate for Payer: BCBS Complete |
$230.40
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$495.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Healthscope Commercial |
$518.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.60
|
| Rate for Payer: PHP Commercial |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health SBD |
$362.88
|
| Rate for Payer: UMR Bronson Commercial |
$213.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.00
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
NDC 59762045001
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna American Axle |
$374.40
|
| Rate for Payer: Aetna Commercial |
$489.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.40
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$495.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.80
|
| Rate for Payer: Healthscope Commercial |
$518.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.60
|
| Rate for Payer: PHP Commercial |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health SBD |
$362.88
|
| Rate for Payer: UMR Bronson Commercial |
$253.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.00
|
|
|
COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$116.64
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
9681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.32 |
| Max. Negotiated Rate |
$104.98 |
| Rate for Payer: Aetna American Axle |
$75.82
|
| Rate for Payer: Aetna American Axle |
$28.26
|
| Rate for Payer: Aetna Commercial |
$99.14
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: Cash Price |
$93.31
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$100.31
|
| Rate for Payer: Cofinity Commercial |
$81.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Healthscope Commercial |
$104.98
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.14
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.26
|
| Rate for Payer: Priority Health SBD |
$73.48
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: UMR Bronson Commercial |
$51.32
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.61
|
|
|
COLISTIN (COLISTIMETHATE SODIUM) 150 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$116.64
|
|
|
Service Code
|
HCPCS J0770
|
| Hospital Charge Code |
9681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$104.98 |
| Rate for Payer: Aetna American Axle |
$75.82
|
| Rate for Payer: Aetna American Axle |
$28.26
|
| Rate for Payer: Aetna Commercial |
$99.14
|
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna Medicare |
$58.32
|
| Rate for Payer: Aetna Medicare |
$21.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: BCBS Complete |
$17.39
|
| Rate for Payer: BCBS Complete |
$46.66
|
| Rate for Payer: Cash Price |
$93.31
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$81.65
|
| Rate for Payer: Cofinity Commercial |
$100.31
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.78
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Healthscope Commercial |
$104.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: PHP Commercial |
$99.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.26
|
| Rate for Payer: Priority Health SBD |
$27.39
|
| Rate for Payer: Priority Health SBD |
$73.48
|
| Rate for Payer: UMR Bronson Commercial |
$43.16
|
| Rate for Payer: UMR Bronson Commercial |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.48
|
|
|
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 |
$424.16 |
| Max. Negotiated Rate |
$867.61 |
| Rate for Payer: Aetna American Axle |
$626.61
|
| Rate for Payer: Aetna Commercial |
$819.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.61
|
| Rate for Payer: Cash Price |
$771.21
|
| Rate for Payer: Cofinity Commercial |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$829.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$674.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.21
|
| Rate for Payer: Healthscope Commercial |
$867.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$674.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.41
|
| Rate for Payer: PHP Commercial |
$819.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.61
|
| Rate for Payer: Priority Health SBD |
$607.33
|
| Rate for Payer: UMR Bronson Commercial |
$424.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.01
|
|
|
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 |
$356.68 |
| Max. Negotiated Rate |
$867.61 |
| Rate for Payer: Aetna American Axle |
$626.61
|
| Rate for Payer: Aetna Commercial |
$819.41
|
| Rate for Payer: Aetna Medicare |
$482.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.61
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: Cash Price |
$771.21
|
| Rate for Payer: Cofinity Commercial |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$829.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$674.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.21
|
| Rate for Payer: Healthscope Commercial |
$867.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$674.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.41
|
| Rate for Payer: PHP Commercial |
$819.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.61
|
| Rate for Payer: Priority Health SBD |
$607.33
|
| Rate for Payer: UMR Bronson Commercial |
$356.68
|
| 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
|
$2,502.92
|
|
|
Service Code
|
CPT 45378
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$2,502.92 |
| Rate for Payer: Aetna Medicare |
$924.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,502.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
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
|
$3,236.94
|
|
|
Service Code
|
CPT 45388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45398
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
COLONOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45382
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45381
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
