|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Medicare |
$4.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.52
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.52
|
| Rate for Payer: Priority Health SBD |
$5.36
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,276.64
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,434.28 |
| Max. Negotiated Rate |
$2,048.98 |
| Rate for Payer: Aetna Commercial |
$1,935.14
|
| Rate for Payer: Aetna Commercial |
$2,011.03
|
| Rate for Payer: Aetna Commercial |
$2,176.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,664.75
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$2,048.93
|
| Rate for Payer: Cofinity Commercial |
$1,593.65
|
| Rate for Payer: Cofinity Commercial |
$1,957.91
|
| Rate for Payer: Cofinity Commercial |
$1,656.14
|
| Rate for Payer: Cofinity Commercial |
$2,034.69
|
| Rate for Payer: Cofinity Commercial |
$1,792.81
|
| Rate for Payer: Cofinity Commercial |
$2,202.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,792.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,593.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.31
|
| Rate for Payer: Healthscope Commercial |
$2,129.33
|
| Rate for Payer: Healthscope Commercial |
$2,048.98
|
| Rate for Payer: Healthscope Commercial |
$2,305.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.99
|
| Rate for Payer: PHP Commercial |
$2,011.03
|
| Rate for Payer: PHP Commercial |
$2,176.99
|
| Rate for Payer: PHP Commercial |
$1,935.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.82
|
| Rate for Payer: Priority Health SBD |
$1,490.53
|
| Rate for Payer: Priority Health SBD |
$1,613.53
|
| Rate for Payer: Priority Health SBD |
$1,434.28
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,276.64
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$612.33 |
| Max. Negotiated Rate |
$3,427.23 |
| Rate for Payer: Aetna Commercial |
$1,935.14
|
| Rate for Payer: Aetna Commercial |
$2,176.99
|
| Rate for Payer: Aetna Commercial |
$2,011.03
|
| Rate for Payer: Aetna Medicare |
$1,188.11
|
| Rate for Payer: Aetna Medicare |
$1,188.11
|
| Rate for Payer: Aetna Medicare |
$1,188.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,664.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,428.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,428.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,428.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,428.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,428.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,428.01
|
| Rate for Payer: BCBS Complete |
$642.95
|
| Rate for Payer: BCBS Complete |
$642.95
|
| Rate for Payer: BCBS Complete |
$642.95
|
| Rate for Payer: BCBS MAPPO |
$1,142.41
|
| Rate for Payer: BCBS MAPPO |
$1,142.41
|
| Rate for Payer: BCBS MAPPO |
$1,142.41
|
| Rate for Payer: BCBS Trust/PPO |
$3,313.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,313.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,313.66
|
| Rate for Payer: BCN Commercial |
$3,313.66
|
| Rate for Payer: BCN Commercial |
$3,313.66
|
| Rate for Payer: BCN Commercial |
$3,313.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.41
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cash Price |
$2,048.93
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cash Price |
$2,048.93
|
| Rate for Payer: Cofinity Commercial |
$1,656.14
|
| Rate for Payer: Cofinity Commercial |
$1,593.65
|
| Rate for Payer: Cofinity Commercial |
$1,957.91
|
| Rate for Payer: Cofinity Commercial |
$2,202.60
|
| Rate for Payer: Cofinity Commercial |
$1,792.81
|
| Rate for Payer: Cofinity Commercial |
$2,034.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,792.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,593.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.41
|
| Rate for Payer: Healthscope Commercial |
$2,048.98
|
| Rate for Payer: Healthscope Commercial |
$2,129.33
|
| Rate for Payer: Healthscope Commercial |
$2,305.04
|
| Rate for Payer: Mclaren Medicaid |
$612.33
|
| Rate for Payer: Mclaren Medicaid |
$612.33
|
| Rate for Payer: Mclaren Medicaid |
$612.33
|
| Rate for Payer: Mclaren Medicare |
$1,142.41
|
| Rate for Payer: Mclaren Medicare |
$1,142.41
|
| Rate for Payer: Mclaren Medicare |
$1,142.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.53
|
| Rate for Payer: Meridian Medicaid |
$642.95
|
| Rate for Payer: Meridian Medicaid |
$642.95
|
| Rate for Payer: Meridian Medicaid |
$642.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.99
|
| Rate for Payer: Nomi Health Commercial |
$3,427.23
|
| Rate for Payer: Nomi Health Commercial |
$3,427.23
|
| Rate for Payer: Nomi Health Commercial |
$3,427.23
|
| Rate for Payer: PACE Medicare |
$1,085.29
|
| Rate for Payer: PACE Medicare |
$1,085.29
|
| Rate for Payer: PACE Medicare |
$1,085.29
|
| Rate for Payer: PACE SWMI |
$1,142.41
|
| Rate for Payer: PACE SWMI |
$1,142.41
|
| Rate for Payer: PACE SWMI |
$1,142.41
|
| Rate for Payer: PHP Commercial |
$2,011.03
|
| Rate for Payer: PHP Commercial |
$1,935.14
|
| Rate for Payer: PHP Commercial |
$2,176.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,376.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,376.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,376.10
|
| Rate for Payer: Priority Health Medicare |
$1,142.41
|
| Rate for Payer: Priority Health Medicare |
$1,142.41
|
| Rate for Payer: Priority Health Medicare |
$1,142.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,700.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,700.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,700.88
|
| Rate for Payer: Priority Health SBD |
$1,490.53
|
| Rate for Payer: Priority Health SBD |
$1,613.53
|
| Rate for Payer: Priority Health SBD |
$1,434.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,215.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,215.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,215.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.41
|
| Rate for Payer: UHCCP Medicaid |
$643.18
|
| Rate for Payer: UHCCP Medicaid |
$643.18
|
| Rate for Payer: UHCCP Medicaid |
$643.18
|
| Rate for Payer: VA VA |
$1,142.41
|
| Rate for Payer: VA VA |
$1,142.41
|
| Rate for Payer: VA VA |
$1,142.41
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health SBD |
$2.03
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$422.40
|
|
|
Service Code
|
NDC 00054000725
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.96 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$359.04
|
| Rate for Payer: Aetna Medicare |
$211.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.56
|
| Rate for Payer: BCBS Complete |
$168.96
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Cofinity Commercial |
$295.68
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.92
|
| Rate for Payer: Healthscope Commercial |
$380.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.04
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.56
|
| Rate for Payer: Priority Health SBD |
$266.11
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$322.56
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.21 |
| Max. Negotiated Rate |
$290.30 |
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.66
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cofinity Commercial |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$277.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.05
|
| Rate for Payer: Healthscope Commercial |
$290.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.18
|
| Rate for Payer: PHP Commercial |
$274.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.66
|
| Rate for Payer: Priority Health SBD |
$203.21
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$322.56
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.02 |
| Max. Negotiated Rate |
$290.30 |
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: Aetna Medicare |
$161.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.66
|
| Rate for Payer: BCBS Complete |
$129.02
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cofinity Commercial |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$277.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.05
|
| Rate for Payer: Healthscope Commercial |
$290.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.18
|
| Rate for Payer: PHP Commercial |
$274.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.66
|
| Rate for Payer: Priority Health SBD |
$203.21
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$422.40
|
|
|
Service Code
|
NDC 00054000725
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.11 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$359.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.56
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Cofinity Commercial |
$295.68
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.92
|
| Rate for Payer: Healthscope Commercial |
$380.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.04
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.56
|
| Rate for Payer: Priority Health SBD |
$266.11
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$137.09
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna Medicare |
$68.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.11
|
| Rate for Payer: BCBS Complete |
$54.84
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| Rate for Payer: Cofinity Commercial |
$95.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.11
|
| Rate for Payer: Priority Health SBD |
$86.37
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$3.23
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: BCBS Complete |
$1.29
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health SBD |
$2.03
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$63.84
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna Medicare |
$31.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.50
|
| Rate for Payer: BCBS Complete |
$25.54
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$44.69
|
| Rate for Payer: Cofinity Commercial |
$54.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$57.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: Priority Health SBD |
$40.22
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$137.09
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.11
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| Rate for Payer: Cofinity Commercial |
$95.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.11
|
| Rate for Payer: Priority Health SBD |
$86.37
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$63.84
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.50
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$44.69
|
| Rate for Payer: Cofinity Commercial |
$54.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$57.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: Priority Health SBD |
$40.22
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
OP
|
$219.45
|
|
|
Service Code
|
NDC 69452020820
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$109.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: BCBS Complete |
$87.78
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.64
|
| Rate for Payer: Priority Health SBD |
$138.25
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
OP
|
$375.25
|
|
|
Service Code
|
NDC 23155066301
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.10 |
| Max. Negotiated Rate |
$337.72 |
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna Medicare |
$187.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: BCBS Complete |
$150.10
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.91
|
| Rate for Payer: Priority Health SBD |
$236.41
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
OP
|
$682.08
|
|
|
Service Code
|
NDC 00093735301
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.83 |
| Max. Negotiated Rate |
$613.87 |
| Rate for Payer: Aetna Commercial |
$579.77
|
| Rate for Payer: Aetna Medicare |
$341.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.35
|
| Rate for Payer: BCBS Complete |
$272.83
|
| Rate for Payer: Cash Price |
$545.66
|
| Rate for Payer: Cofinity Commercial |
$477.46
|
| Rate for Payer: Cofinity Commercial |
$586.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$477.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$545.66
|
| Rate for Payer: Healthscope Commercial |
$613.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.77
|
| Rate for Payer: PHP Commercial |
$579.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.35
|
| Rate for Payer: Priority Health SBD |
$429.71
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
IP
|
$375.25
|
|
|
Service Code
|
NDC 23155066301
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.41 |
| Max. Negotiated Rate |
$337.72 |
| Rate for Payer: Aetna Commercial |
$318.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.91
|
| Rate for Payer: Cash Price |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$262.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.91
|
| Rate for Payer: Priority Health SBD |
$236.41
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
IP
|
$682.08
|
|
|
Service Code
|
NDC 00093735301
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.71 |
| Max. Negotiated Rate |
$613.87 |
| Rate for Payer: Aetna Commercial |
$579.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.35
|
| Rate for Payer: Cash Price |
$545.66
|
| Rate for Payer: Cofinity Commercial |
$477.46
|
| Rate for Payer: Cofinity Commercial |
$586.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$477.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$545.66
|
| Rate for Payer: Healthscope Commercial |
$613.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.77
|
| Rate for Payer: PHP Commercial |
$579.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.35
|
| Rate for Payer: Priority Health SBD |
$429.71
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
IP
|
$219.45
|
|
|
Service Code
|
NDC 69452020820
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.64
|
| Rate for Payer: Cash Price |
$175.56
|
| Rate for Payer: Cofinity Commercial |
$153.62
|
| Rate for Payer: Cofinity Commercial |
$188.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.56
|
| Rate for Payer: Healthscope Commercial |
$197.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.53
|
| Rate for Payer: PHP Commercial |
$186.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.64
|
| Rate for Payer: Priority Health SBD |
$138.25
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$577.50
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: Aetna Medicare |
$288.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.38
|
| Rate for Payer: BCBS Complete |
$231.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$404.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.38
|
| Rate for Payer: Priority Health SBD |
$363.82
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$151.20
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$75.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: BCBS Complete |
$60.48
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health SBD |
$95.26
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 57896076315
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.26 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health SBD |
$95.26
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 57896076315
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$577.50
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$363.82 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.38
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$404.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.38
|
| Rate for Payer: Priority Health SBD |
$363.82
|
|
