|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
OP
|
$3,392.04
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$585.02 |
| Max. Negotiated Rate |
$3,166.25 |
| Rate for Payer: Aetna Commercial |
$2,883.23
|
| Rate for Payer: Aetna Medicare |
$1,112.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,204.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,336.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,336.87
|
| Rate for Payer: BCBS Complete |
$614.32
|
| Rate for Payer: BCBS MAPPO |
$1,069.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,166.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,069.50
|
| Rate for Payer: Cash Price |
$2,713.63
|
| Rate for Payer: Cash Price |
$2,713.63
|
| Rate for Payer: Cofinity Commercial |
$2,917.15
|
| Rate for Payer: Cofinity Commercial |
$2,374.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,069.50
|
| Rate for Payer: Healthscope Commercial |
$3,052.84
|
| Rate for Payer: Mclaren Medicaid |
$585.02
|
| Rate for Payer: Mclaren Medicare |
$1,069.50
|
| Rate for Payer: Meridian Medicaid |
$614.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,122.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,229.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,883.23
|
| Rate for Payer: PACE Medicare |
$1,016.02
|
| Rate for Payer: PACE SWMI |
$1,069.50
|
| Rate for Payer: PHP Commercial |
$2,883.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,069.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,374.43
|
| Rate for Payer: Priority Health Medicare |
$1,069.50
|
| Rate for Payer: Priority Health SBD |
$2,136.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,069.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,069.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,101.58
|
| Rate for Payer: VA VA |
$1,069.50
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
IP
|
$3,124.80
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,968.62 |
| Max. Negotiated Rate |
$2,812.32 |
| Rate for Payer: Aetna Commercial |
$2,656.08
|
| Rate for Payer: Aetna Commercial |
$2,883.23
|
| Rate for Payer: Aetna Commercial |
$4,240.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,204.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,031.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,242.39
|
| Rate for Payer: Cash Price |
$3,990.63
|
| Rate for Payer: Cash Price |
$2,499.84
|
| Rate for Payer: Cash Price |
$2,713.63
|
| Rate for Payer: Cofinity Commercial |
$4,289.93
|
| Rate for Payer: Cofinity Commercial |
$2,917.15
|
| Rate for Payer: Cofinity Commercial |
$2,687.33
|
| Rate for Payer: Cofinity Commercial |
$3,491.80
|
| Rate for Payer: Cofinity Commercial |
$2,187.36
|
| Rate for Payer: Cofinity Commercial |
$2,374.43
|
| Rate for Payer: Healthscope Commercial |
$4,489.46
|
| Rate for Payer: Healthscope Commercial |
$2,812.32
|
| Rate for Payer: Healthscope Commercial |
$3,052.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,883.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,240.05
|
| Rate for Payer: PHP Commercial |
$4,240.05
|
| Rate for Payer: PHP Commercial |
$2,883.23
|
| Rate for Payer: PHP Commercial |
$2,656.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,491.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,374.43
|
| Rate for Payer: Priority Health SBD |
$2,136.99
|
| Rate for Payer: Priority Health SBD |
$1,968.62
|
| Rate for Payer: Priority Health SBD |
$3,142.62
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$137.09
|
|
|
Service Code
|
NDC 0054-0007-13
|
| 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: Healthscope Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.53
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.96
|
| Rate for Payer: Priority Health SBD |
$86.37
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$306.72
|
|
|
Service Code
|
NDC 60687-345-01
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.23 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.37
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Cofinity Commercial |
$214.70
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.71
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.70
|
| Rate for Payer: Priority Health SBD |
$193.23
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$61.28
|
|
|
Service Code
|
NDC 23155-662-03
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$55.15 |
| Rate for Payer: Aetna Commercial |
$52.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.83
|
| Rate for Payer: Cash Price |
$49.02
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Cofinity Commercial |
$52.70
|
| Rate for Payer: Healthscope Commercial |
$55.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.09
|
| Rate for Payer: PHP Commercial |
$52.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health SBD |
$38.61
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$422.40
|
|
|
Service Code
|
NDC 0054-0007-25
|
| 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: Healthscope Commercial |
$380.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.04
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.68
|
| Rate for Payer: Priority Health SBD |
$266.11
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$3.07
|
|
|
Service Code
|
NDC 60687-345-11
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.61
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health SBD |
$1.93
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
IP
|
$215.65
|
|
|
Service Code
|
NDC 69452-208-20
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.86 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: Priority Health SBD |
$135.86
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
IP
|
$682.08
|
|
|
Service Code
|
NDC 0093-7353-01
|
| 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: Healthscope Commercial |
$613.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$579.77
|
| Rate for Payer: PHP Commercial |
$579.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.46
|
| Rate for Payer: Priority Health SBD |
$429.71
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
IP
|
$375.25
|
|
|
Service Code
|
NDC 23155-663-01
|
| 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: Healthscope Commercial |
$337.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.96
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.68
|
| Rate for Payer: Priority Health SBD |
$236.41
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$468.48
|
|
|
Service Code
|
NDC 0904-7119-61
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.14 |
| Max. Negotiated Rate |
$421.63 |
| Rate for Payer: Aetna Commercial |
$398.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.51
|
| Rate for Payer: Cash Price |
$374.78
|
| Rate for Payer: Cofinity Commercial |
$327.94
|
| Rate for Payer: Cofinity Commercial |
$402.89
|
| Rate for Payer: Healthscope Commercial |
$421.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$398.21
|
| Rate for Payer: PHP Commercial |
$398.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.94
|
| Rate for Payer: Priority Health SBD |
$295.14
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$626.88
|
|
|
Service Code
|
NDC 29033-026-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.93 |
| Max. Negotiated Rate |
$564.19 |
| Rate for Payer: Aetna Commercial |
$532.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.47
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cofinity Commercial |
$438.82
|
| Rate for Payer: Cofinity Commercial |
$539.12
|
| Rate for Payer: Healthscope Commercial |
$564.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$532.85
|
| Rate for Payer: PHP Commercial |
$532.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.82
|
| Rate for Payer: Priority Health SBD |
$394.93
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$507.84
|
|
|
Service Code
|
NDC 0054-0088-26
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.94 |
| Max. Negotiated Rate |
$457.06 |
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.10
|
| Rate for Payer: Cash Price |
$406.27
|
| Rate for Payer: Cofinity Commercial |
$355.49
|
| Rate for Payer: Cofinity Commercial |
$436.74
|
| Rate for Payer: Healthscope Commercial |
$457.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.66
|
| Rate for Payer: PHP Commercial |
$431.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.49
|
| Rate for Payer: Priority Health SBD |
$319.94
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$570.00
|
|
|
Service Code
|
NDC 0781-2081-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$484.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.50
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cofinity Commercial |
$399.00
|
| Rate for Payer: Cofinity Commercial |
$490.20
|
| Rate for Payer: Healthscope Commercial |
$513.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.50
|
| Rate for Payer: PHP Commercial |
$484.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.00
|
| Rate for Payer: Priority Health SBD |
$359.10
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$5.75
|
|
|
Service Code
|
NDC 68084-479-11
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.74
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.89
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.02
|
| Rate for Payer: Priority Health SBD |
$3.62
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$574.56
|
|
|
Service Code
|
NDC 68084-479-01
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.97 |
| Max. Negotiated Rate |
$517.10 |
| Rate for Payer: Aetna Commercial |
$488.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.46
|
| Rate for Payer: Cash Price |
$459.65
|
| Rate for Payer: Cofinity Commercial |
$402.19
|
| Rate for Payer: Cofinity Commercial |
$494.12
|
| Rate for Payer: Healthscope Commercial |
$517.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$488.38
|
| Rate for Payer: PHP Commercial |
$488.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.19
|
| Rate for Payer: Priority Health SBD |
$361.97
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$442.70
|
|
|
Service Code
|
NDC 23155-531-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.90 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.89
|
| Rate for Payer: Priority Health SBD |
$278.90
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$626.88
|
|
|
Service Code
|
NDC 62135-191-22
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.93 |
| Max. Negotiated Rate |
$564.19 |
| Rate for Payer: Aetna Commercial |
$532.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.47
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cofinity Commercial |
$438.82
|
| Rate for Payer: Cofinity Commercial |
$539.12
|
| Rate for Payer: Healthscope Commercial |
$564.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$532.85
|
| Rate for Payer: PHP Commercial |
$532.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.82
|
| Rate for Payer: Priority Health SBD |
$394.93
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
IP
|
$577.50
|
|
|
Service Code
|
NDC 66553-004-01
|
| 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: Healthscope Commercial |
$519.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.88
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.25
|
| Rate for Payer: Priority Health SBD |
$363.82
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
NDC 57896-763-15
|
| 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: Healthscope Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
IP
|
$141.75
|
|
|
Service Code
|
NDC 0536-1007-15
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Aetna Commercial |
$120.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.14
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$121.90
|
| Rate for Payer: Cofinity Commercial |
$99.22
|
| Rate for Payer: Healthscope Commercial |
$127.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.49
|
| Rate for Payer: PHP Commercial |
$120.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.22
|
| Rate for Payer: Priority Health SBD |
$89.30
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
NDC 6373929101
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$756.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$1,020.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$1,032.00
|
| Rate for Payer: Cofinity Commercial |
$840.00
|
| Rate for Payer: Healthscope Commercial |
$1,080.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.00
|
| Rate for Payer: PHP Commercial |
$1,020.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
| Rate for Payer: Priority Health SBD |
$756.00
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
NDC 904546092
|
| Hospital Charge Code |
19483
|
|
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: Healthscope Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
NDC 1000670038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna Commercial |
$146.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.80
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Healthscope Commercial |
$154.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.20
|
| Rate for Payer: PHP Commercial |
$146.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.40
|
| Rate for Payer: Priority Health SBD |
$108.36
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$321.30
|
|
|
Service Code
|
NDC 904546072
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$289.17 |
| Rate for Payer: Aetna Commercial |
$273.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.84
|
| Rate for Payer: Cash Price |
$257.04
|
| Rate for Payer: Cofinity Commercial |
$224.91
|
| Rate for Payer: Cofinity Commercial |
$276.32
|
| Rate for Payer: Healthscope Commercial |
$289.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.10
|
| Rate for Payer: PHP Commercial |
$273.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.91
|
| Rate for Payer: Priority Health SBD |
$202.42
|
|
