|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 1,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
168017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 2,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (BENEFIX) 3,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
168019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
COAGULATION FACTOR IX (RECOMB) (RIXUBIS) 1000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300428
|
|
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: 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 Multiplan/Beech St/PHCS |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| 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) 2,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300429
|
|
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: 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 Multiplan/Beech St/PHCS |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| 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) 250 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300426
|
|
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: 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 Multiplan/Beech St/PHCS |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| 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) 3,000 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
HCPCS J7200
|
| Hospital Charge Code |
300430
|
|
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: 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 Multiplan/Beech St/PHCS |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| 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
|
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: 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 Multiplan/Beech St/PHCS |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| 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 VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,034.81
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,655.32 |
| Max. Negotiated Rate |
$5,431.33 |
| Rate for Payer: Aetna American Axle |
$3,922.63
|
| Rate for Payer: Aetna Commercial |
$5,129.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,922.63
|
| Rate for Payer: Cash Price |
$4,827.85
|
| Rate for Payer: Cofinity Commercial |
$4,224.37
|
| Rate for Payer: Cofinity Commercial |
$5,189.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,827.85
|
| Rate for Payer: Healthscope Commercial |
$5,431.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,224.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,526.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,129.59
|
| Rate for Payer: PHP Commercial |
$5,129.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,224.37
|
| Rate for Payer: Priority Health SBD |
$3,801.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,655.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,526.11
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,069.62
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
92854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,310.63 |
| Max. Negotiated Rate |
$10,862.66 |
| Rate for Payer: Aetna American Axle |
$7,845.25
|
| Rate for Payer: Aetna Commercial |
$10,259.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,845.25
|
| Rate for Payer: Cash Price |
$9,655.70
|
| Rate for Payer: Cofinity Commercial |
$10,379.87
|
| Rate for Payer: Cofinity Commercial |
$8,448.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,655.70
|
| Rate for Payer: Healthscope Commercial |
$10,862.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,448.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,052.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,259.18
|
| Rate for Payer: PHP Commercial |
$10,259.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,448.73
|
| Rate for Payer: Priority Health SBD |
$7,603.86
|
| Rate for Payer: UMR Bronson Commercial |
$5,310.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,052.22
|
|
|
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: 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 Multiplan/Beech St/PHCS |
$25,647.96
|
| Rate for Payer: PHP Commercial |
$25,647.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,121.85
|
| 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 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 |
$16.35
|
| Rate for Payer: Cofinity Commercial |
$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 Multiplan/Beech St/PHCS |
$16.16
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.31
|
| 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
|
IP
|
$690.54
|
|
|
Service Code
|
HCPCS C9143
|
| Hospital Charge Code |
186568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.84 |
| Max. Negotiated Rate |
$621.49 |
| Rate for Payer: Aetna American Axle |
$448.85
|
| Rate for Payer: Aetna Commercial |
$586.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.85
|
| Rate for Payer: Cash Price |
$552.43
|
| Rate for Payer: Cofinity Commercial |
$483.38
|
| Rate for Payer: Cofinity Commercial |
$593.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.43
|
| Rate for Payer: Healthscope Commercial |
$621.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$586.96
|
| Rate for Payer: PHP Commercial |
$586.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.38
|
| Rate for Payer: Priority Health SBD |
$435.04
|
| Rate for Payer: UMR Bronson Commercial |
$303.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.90
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$25.93
|
|
|
Service Code
|
NDC 60687-389-11
|
| 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: 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 Multiplan/Beech St/PHCS |
$22.04
|
| Rate for Payer: PHP Commercial |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| 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 64764-119-07
|
| 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: 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 Multiplan/Beech St/PHCS |
$630.92
|
| Rate for Payer: PHP Commercial |
$630.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.58
|
| Rate for Payer: Priority Health SBD |
$467.62
|
| Rate for Payer: UMR Bronson Commercial |
$326.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.70
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$82.37
|
|
|
Service Code
|
NDC 49884-171-11
|
| 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: 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 Multiplan/Beech St/PHCS |
$70.01
|
| Rate for Payer: PHP Commercial |
$70.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.66
|
| 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
|
IP
|
$1,931.77
|
|
|
Service Code
|
NDC 0254-2008-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$1,642.00
|
| Rate for Payer: PHP Commercial |
$1,642.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,352.24
|
| 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
|
$356.20
|
|
|
Service Code
|
NDC 0904-7120-04
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.73 |
| Max. Negotiated Rate |
$320.58 |
| Rate for Payer: Aetna American Axle |
$231.53
|
| Rate for Payer: Aetna Commercial |
$302.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.53
|
| Rate for Payer: Cash Price |
$284.96
|
| Rate for Payer: Cofinity Commercial |
$249.34
|
| Rate for Payer: Cofinity Commercial |
$306.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.96
|
| Rate for Payer: Healthscope Commercial |
$320.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.77
|
| Rate for Payer: PHP Commercial |
$302.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.34
|
| Rate for Payer: Priority Health SBD |
$224.41
|
| Rate for Payer: UMR Bronson Commercial |
$156.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.15
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$777.89
|
|
|
Service Code
|
NDC 60687-389-21
|
| 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: 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 Multiplan/Beech St/PHCS |
$661.21
|
| Rate for Payer: PHP Commercial |
$661.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.52
|
| 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
|
IP
|
$98.50
|
|
|
Service Code
|
NDC 70710-1351-3
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Aetna American Axle |
$64.02
|
| Rate for Payer: Aetna Commercial |
$83.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.02
|
| Rate for Payer: Cash Price |
$78.80
|
| Rate for Payer: Cofinity Commercial |
$68.95
|
| Rate for Payer: Cofinity Commercial |
$84.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.80
|
| Rate for Payer: Healthscope Commercial |
$88.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.72
|
| Rate for Payer: PHP Commercial |
$83.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health SBD |
$62.06
|
| Rate for Payer: UMR Bronson Commercial |
$43.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.88
|
|
|
COLECTOMY, PARTIAL; WITH ANASTOMOSIS
|
Facility
|
OP
|
$4,683.77
|
|
|
Service Code
|
CPT 44140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,315.66 |
| Max. Negotiated Rate |
$4,683.77 |
| Rate for Payer: BCBS Trust/PPO |
$4,683.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,447.23
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,315.66
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
IP
|
$343.66
|
|
|
Service Code
|
NDC 60687-385-25
|
| 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: 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 |
$257.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.11
|
| Rate for Payer: PHP Commercial |
$292.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.56
|
| 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 |
$257.74
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
IP
|
$2,299.70
|
|
|
Service Code
|
NDC 65597-701-18
|
| 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 |
$1,494.80
|
| Rate for Payer: Aetna Commercial |
$1,954.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,494.80
|
| 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: 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 Multiplan/Beech St/PHCS |
$1,954.74
|
| Rate for Payer: PHP Commercial |
$1,954.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.79
|
| 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
|
$459.99
|
|
|
Service Code
|
NDC 68462-433-18
|
| Hospital Charge Code |
28372
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$413.99 |
| Rate for Payer: Aetna American Axle |
$298.99
|
| Rate for Payer: Aetna Commercial |
$390.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.99
|
| Rate for Payer: Cash Price |
$367.99
|
| Rate for Payer: Cofinity Commercial |
$321.99
|
| Rate for Payer: Cofinity Commercial |
$395.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.99
|
| Rate for Payer: Healthscope Commercial |
$413.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$390.99
|
| Rate for Payer: PHP Commercial |
$390.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.99
|
| Rate for Payer: Priority Health SBD |
$289.79
|
| Rate for Payer: UMR Bronson Commercial |
$202.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.99
|
|
|
COLESEVELAM 625 MG TABLET
|
Facility
|
IP
|
$11.46
|
|
|
Service Code
|
NDC 60687-385-95
|
| 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 |
$9.86
|
| Rate for Payer: Cofinity Commercial |
$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 Multiplan/Beech St/PHCS |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| 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
|
|
