|
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 |
$1.37 |
| 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 |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,613.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: BCBS MAPPO |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$6.85
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: BCN Medicare Advantage |
$2.55
|
| 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 |
$2.55
|
| 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 |
$1.37
|
| Rate for Payer: Mclaren Medicare |
$2.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.68
|
| Rate for Payer: Meridian Medicaid |
$1.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,647.96
|
| Rate for Payer: Nomi Health Commercial |
$7.65
|
| Rate for Payer: PACE Medicare |
$2.42
|
| Rate for Payer: PACE SWMI |
$2.55
|
| Rate for Payer: PHP Commercial |
$25,647.96
|
| Rate for Payer: PHP Medicare Advantage |
$2.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,613.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.24
|
| Rate for Payer: Priority Health Medicare |
$2.55
|
| Rate for Payer: Priority Health Narrow Network |
$5.79
|
| Rate for Payer: Priority Health SBD |
$19,009.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.55
|
| Rate for Payer: UHC Exchange |
$4.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.55
|
| Rate for Payer: UHCCP Medicaid |
$1.37
|
| Rate for Payer: UMR Bronson Commercial |
$11,164.41
|
| Rate for Payer: VA VA |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,630.55
|
|
|
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 |
$5.11 |
| Max. Negotiated Rate |
$28.59 |
| Rate for Payer: Aetna American Axle |
$12.36
|
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.91
|
| Rate for Payer: BCBS Complete |
$5.36
|
| Rate for Payer: BCBS MAPPO |
$9.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.70
|
| Rate for Payer: BCN Commercial |
$25.70
|
| Rate for Payer: BCN Medicare Advantage |
$9.53
|
| 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 |
$9.53
|
| 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 |
$5.11
|
| Rate for Payer: Mclaren Medicare |
$9.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.01
|
| Rate for Payer: Meridian Medicaid |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.16
|
| Rate for Payer: Nomi Health Commercial |
$28.59
|
| Rate for Payer: PACE Medicare |
$9.05
|
| Rate for Payer: PACE SWMI |
$9.53
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: PHP Medicare Advantage |
$9.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.23
|
| Rate for Payer: Priority Health Medicare |
$9.53
|
| Rate for Payer: Priority Health Narrow Network |
$20.98
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.53
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicare Advantage |
$9.53
|
| Rate for Payer: UHCCP Medicaid |
$5.11
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: VA VA |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.26
|
|
|
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
|
|
|
COCAINE 4 % NASAL SOLUTION
|
Facility
|
OP
|
$853.69
|
|
|
Service Code
|
HCPCS C9143
|
| Hospital Charge Code |
186568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$768.32 |
| Rate for Payer: Aetna American Axle |
$554.90
|
| Rate for Payer: Aetna American Axle |
$448.85
|
| Rate for Payer: Aetna American Axle |
$695.07
|
| Rate for Payer: Aetna Commercial |
$725.64
|
| Rate for Payer: Aetna Commercial |
$908.94
|
| Rate for Payer: Aetna Commercial |
$586.96
|
| Rate for Payer: Aetna Medicare |
$345.27
|
| Rate for Payer: Aetna Medicare |
$534.67
|
| Rate for Payer: Aetna Medicare |
$426.84
|
| 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: BCBS Complete |
$276.22
|
| Rate for Payer: BCBS Complete |
$341.48
|
| Rate for Payer: BCBS Complete |
$427.74
|
| Rate for Payer: BCBS Trust/PPO |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.18
|
| Rate for Payer: BCN Commercial |
$4.18
|
| Rate for Payer: BCN Commercial |
$4.18
|
| Rate for Payer: BCN Commercial |
$4.18
|
| Rate for Payer: Cash Price |
$552.43
|
| Rate for Payer: Cash Price |
$682.95
|
| Rate for Payer: Cash Price |
$855.47
|
| Rate for Payer: Cash Price |
$552.43
|
| Rate for Payer: Cash Price |
$855.47
|
| Rate for Payer: Cash Price |
$682.95
|
| 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 |
$483.38
|
| Rate for Payer: Cofinity Commercial |
$597.58
|
| Rate for Payer: Cofinity Commercial |
$734.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$748.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.95
|
| Rate for Payer: Healthscope Commercial |
$768.32
|
| Rate for Payer: Healthscope Commercial |
$621.49
|
| Rate for Payer: Healthscope Commercial |
$962.41
|
| 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 |
$802.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.90
|
| 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 |
$725.64
|
| Rate for Payer: PHP Commercial |
$908.94
|
| Rate for Payer: PHP Commercial |
$586.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.07
|
| 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 SBD |
$435.04
|
| Rate for Payer: Priority Health SBD |
$537.82
|
| Rate for Payer: Priority Health SBD |
$673.68
|
| 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
|
$97,950.07
|
|
|
Service Code
|
CPT 69930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,164.56 |
| Max. Negotiated Rate |
$97,950.07 |
| Rate for Payer: Aetna Medicare |
$32,411.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,955.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,955.84
|
| Rate for Payer: BCBS Complete |
$17,539.48
|
| Rate for Payer: BCBS MAPPO |
$31,164.67
|
| Rate for Payer: BCBS Trust/PPO |
$48,645.07
|
| Rate for Payer: BCN Commercial |
$48,645.07
|
| Rate for Payer: BCN Medicare Advantage |
$31,164.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,164.67
|
| Rate for Payer: Mclaren Medicaid |
$16,704.26
|
| Rate for Payer: Mclaren Medicare |
$31,164.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,722.90
|
| Rate for Payer: Meridian Medicaid |
$17,539.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,839.37
|
| Rate for Payer: Nomi Health Commercial |
$65,445.81
|
| Rate for Payer: PACE Medicare |
$29,606.44
|
| Rate for Payer: PACE SWMI |
$31,164.67
|
| Rate for Payer: PHP Medicare Advantage |
$31,164.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,704.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97,950.07
|
| Rate for Payer: Priority Health Medicare |
$31,164.67
|
| Rate for Payer: Priority Health Narrow Network |
$78,360.06
|
| Rate for Payer: Railroad Medicare Medicare |
$31,164.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,281.02
|
| Rate for Payer: UHC Core |
$52,490.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$31,164.67
|
| Rate for Payer: UHC Exchange |
$1,164.56
|
| Rate for Payer: UHC Medicare Advantage |
$31,164.67
|
| Rate for Payer: UHCCP Medicaid |
$16,704.26
|
| Rate for Payer: VA VA |
$31,164.67
|
|
|
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
|
|
|
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
|
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 |
$41.18
|
| 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 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 |
$30.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.78
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$364.53
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.39 |
| Max. Negotiated Rate |
$328.08 |
| Rate for Payer: Aetna American Axle |
$236.94
|
| Rate for Payer: Aetna Commercial |
$309.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.94
|
| 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 |
$160.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.40
|
|
|
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
|
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
|
$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
|
$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
|
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
|
$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 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 |
$9.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
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
|
$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
|
$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
|
$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
|
|
|
COLECTOMY, PARTIAL; WITH ANASTOMOSIS
|
Facility
|
OP
|
$4,912.39
|
|
|
Service Code
|
CPT 44140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,310.30 |
| Max. Negotiated Rate |
$4,912.39 |
| Rate for Payer: BCBS Trust/PPO |
$4,912.39
|
| Rate for Payer: BCN Commercial |
$4,912.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,441.33
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,310.30
|
|
|
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
|
$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 |
$1,494.80
|
| Rate for Payer: Aetna Commercial |
$1,954.74
|
| Rate for Payer: Aetna Medicare |
$1,149.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,494.80
|
| 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 |
$1,494.80
|
| 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
|
$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
|
|
|
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
|
|
