|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$17.53
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$12.27
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$15.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PHP Commercial |
$14.90
|
| Rate for Payer: Priority Health SBD |
$11.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.39
|
| Rate for Payer: UHC Core |
$9.13
|
| Rate for Payer: UHC Exchange |
$6.89
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$17.53
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$12.27
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PHP Commercial |
$14.90
|
| Rate for Payer: Priority Health SBD |
$11.04
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$159.92
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna Commercial |
$135.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.95
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cofinity Advantage |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.94
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.94
|
| Rate for Payer: PHP Commercial |
$135.93
|
| Rate for Payer: Priority Health SBD |
$100.75
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$159.92
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$143.93 |
| Rate for Payer: Aetna Commercial |
$135.93
|
| Rate for Payer: Aetna Medicare |
$79.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.95
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cofinity Advantage |
$111.94
|
| Rate for Payer: Cofinity Commercial |
$137.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.94
|
| Rate for Payer: Healthscope Commercial |
$143.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.94
|
| Rate for Payer: PHP Commercial |
$135.93
|
| Rate for Payer: Priority Health SBD |
$100.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.95
|
| Rate for Payer: UHC Core |
$83.32
|
| Rate for Payer: UHC Exchange |
$62.85
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,517.76
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$607.10 |
| Max. Negotiated Rate |
$2,364.78 |
| Rate for Payer: Aetna Commercial |
$1,290.10
|
| Rate for Payer: Aetna Commercial |
$1,286.48
|
| Rate for Payer: Aetna Commercial |
$1,214.21
|
| Rate for Payer: Aetna Medicare |
$714.24
|
| Rate for Payer: Aetna Medicare |
$758.88
|
| Rate for Payer: Aetna Medicare |
$756.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.51
|
| Rate for Payer: BCBS Complete |
$605.40
|
| Rate for Payer: BCBS Complete |
$571.39
|
| Rate for Payer: BCBS Complete |
$607.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,155.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,155.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,155.11
|
| Rate for Payer: BCN Commercial |
$1,155.11
|
| Rate for Payer: BCN Commercial |
$1,155.11
|
| Rate for Payer: BCN Commercial |
$1,155.11
|
| Rate for Payer: Cash Price |
$1,210.81
|
| Rate for Payer: Cash Price |
$1,142.78
|
| Rate for Payer: Cash Price |
$1,142.78
|
| Rate for Payer: Cash Price |
$1,210.81
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cofinity Advantage |
$999.94
|
| Rate for Payer: Cofinity Advantage |
$1,059.46
|
| Rate for Payer: Cofinity Advantage |
$1,062.43
|
| Rate for Payer: Cofinity Commercial |
$1,228.49
|
| Rate for Payer: Cofinity Commercial |
$1,301.62
|
| Rate for Payer: Cofinity Commercial |
$1,305.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.78
|
| Rate for Payer: Healthscope Commercial |
$1,362.16
|
| Rate for Payer: Healthscope Commercial |
$1,365.98
|
| Rate for Payer: Healthscope Commercial |
$1,285.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,142.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,210.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,214.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,135.13
|
| Rate for Payer: PHP Commercial |
$1,286.48
|
| Rate for Payer: PHP Commercial |
$1,290.10
|
| Rate for Payer: PHP Commercial |
$1,214.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$848.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$848.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$848.00
|
| Rate for Payer: Priority Health SBD |
$956.19
|
| Rate for Payer: Priority Health SBD |
$953.51
|
| Rate for Payer: Priority Health SBD |
$899.94
|
| Rate for Payer: Priority Health Tiered Network |
$678.40
|
| Rate for Payer: Priority Health Tiered Network |
$678.40
|
| Rate for Payer: Priority Health Tiered Network |
$678.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,364.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,364.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,364.78
|
| Rate for Payer: UHC Core |
$2,364.78
|
| Rate for Payer: UHC Core |
$2,364.78
|
| Rate for Payer: UHC Core |
$2,364.78
|
| Rate for Payer: UHC Exchange |
$2,364.78
|
| Rate for Payer: UHC Exchange |
$2,364.78
|
| Rate for Payer: UHC Exchange |
$2,364.78
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,517.76
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$956.19 |
| Max. Negotiated Rate |
$1,365.98 |
| Rate for Payer: Aetna Commercial |
$1,290.10
|
| Rate for Payer: Aetna Commercial |
$1,214.21
|
| Rate for Payer: Aetna Commercial |
$1,286.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.54
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cash Price |
$1,142.78
|
| Rate for Payer: Cash Price |
$1,210.81
|
| Rate for Payer: Cofinity Advantage |
$1,062.43
|
| Rate for Payer: Cofinity Advantage |
$999.94
|
| Rate for Payer: Cofinity Advantage |
$1,059.46
|
| Rate for Payer: Cofinity Commercial |
$1,228.49
|
| Rate for Payer: Cofinity Commercial |
$1,301.62
|
| Rate for Payer: Cofinity Commercial |
$1,305.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.81
|
| Rate for Payer: Healthscope Commercial |
$1,285.63
|
| Rate for Payer: Healthscope Commercial |
$1,362.16
|
| Rate for Payer: Healthscope Commercial |
$1,365.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,135.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.32
|
| Rate for Payer: PHP Commercial |
$1,286.48
|
| Rate for Payer: PHP Commercial |
$1,290.10
|
| Rate for Payer: PHP Commercial |
$1,214.21
|
| Rate for Payer: Priority Health SBD |
$899.94
|
| Rate for Payer: Priority Health SBD |
$956.19
|
| Rate for Payer: Priority Health SBD |
$953.51
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$137.09
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna Medicare |
$68.55
|
| 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 Advantage |
$95.96
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.82
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health SBD |
$86.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.11
|
| Rate for Payer: UHC Core |
$71.42
|
| Rate for Payer: UHC Exchange |
$53.88
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Exchange |
$1.52
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$71.82
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.23 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna Medicare |
$35.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: BCBS Complete |
$28.73
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Advantage |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health SBD |
$45.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.68
|
| Rate for Payer: UHC Core |
$37.42
|
| Rate for Payer: UHC Exchange |
$28.23
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$386.40
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: Aetna Medicare |
$193.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.16
|
| Rate for Payer: BCBS Complete |
$154.56
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Advantage |
$270.48
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.80
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health SBD |
$243.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.16
|
| Rate for Payer: UHC Core |
$201.31
|
| Rate for Payer: UHC Exchange |
$151.86
|
|
|
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: Priority Health SBD |
$86.37
|
| 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 Advantage |
$95.96
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| 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: Opus (Opus Packaging Group) HMA |
$102.82
|
| Rate for Payer: PHP Commercial |
$116.53
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$386.40
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.43 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.16
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Advantage |
$270.48
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.80
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health SBD |
$243.43
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$422.40
|
|
|
Service Code
|
NDC 00054000725
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.00 |
| 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 Advantage |
$295.68
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.92
|
| Rate for Payer: Healthscope Commercial |
$380.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.80
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: Priority Health SBD |
$266.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.56
|
| Rate for Payer: UHC Core |
$220.07
|
| Rate for Payer: UHC Exchange |
$166.00
|
|
|
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 Advantage |
$295.68
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| 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: Opus (Opus Packaging Group) HMA |
$316.80
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: Priority Health SBD |
$266.11
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Advantage |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health SBD |
$45.25
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
OP
|
$682.08
|
|
|
Service Code
|
NDC 00093735301
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.06 |
| 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 Advantage |
$477.46
|
| Rate for Payer: Cofinity Commercial |
$586.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$545.66
|
| Rate for Payer: Healthscope Commercial |
$613.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$545.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$511.56
|
| Rate for Payer: PHP Commercial |
$579.77
|
| Rate for Payer: Priority Health SBD |
$429.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.35
|
| Rate for Payer: UHC Core |
$355.36
|
| Rate for Payer: UHC Exchange |
$268.06
|
|
|
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 |
$337.73 |
| 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 Advantage |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.44
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health SBD |
$236.41
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
OP
|
$375.25
|
|
|
Service Code
|
NDC 23155066301
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.47 |
| Max. Negotiated Rate |
$337.73 |
| 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 Advantage |
$262.68
|
| Rate for Payer: Cofinity Commercial |
$322.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.20
|
| Rate for Payer: Healthscope Commercial |
$337.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.44
|
| Rate for Payer: PHP Commercial |
$318.96
|
| Rate for Payer: Priority Health SBD |
$236.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.91
|
| Rate for Payer: UHC Core |
$195.51
|
| Rate for Payer: UHC Exchange |
$147.47
|
|
|
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 Advantage |
$477.46
|
| Rate for Payer: Cofinity Commercial |
$586.59
|
| 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: Opus (Opus Packaging Group) HMA |
$511.56
|
| Rate for Payer: PHP Commercial |
$579.77
|
| Rate for Payer: Priority Health SBD |
$429.71
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
OP
|
$226.10
|
|
|
Service Code
|
NDC 69452020820
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.86 |
| Max. Negotiated Rate |
$203.49 |
| Rate for Payer: Aetna Commercial |
$192.19
|
| Rate for Payer: Aetna Medicare |
$113.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.97
|
| Rate for Payer: BCBS Complete |
$90.44
|
| Rate for Payer: Cash Price |
$180.88
|
| Rate for Payer: Cofinity Advantage |
$158.27
|
| Rate for Payer: Cofinity Commercial |
$194.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.88
|
| Rate for Payer: Healthscope Commercial |
$203.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.57
|
| Rate for Payer: PHP Commercial |
$192.19
|
| Rate for Payer: Priority Health SBD |
$142.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.97
|
| Rate for Payer: UHC Core |
$117.80
|
| Rate for Payer: UHC Exchange |
$88.86
|
|
|
CALCITRIOL 0.5 MCG CAPSULE
|
Facility
|
IP
|
$226.10
|
|
|
Service Code
|
NDC 69452020820
|
| Hospital Charge Code |
9351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.44 |
| Max. Negotiated Rate |
$203.49 |
| Rate for Payer: Aetna Commercial |
$192.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.97
|
| Rate for Payer: Cash Price |
$180.88
|
| Rate for Payer: Cofinity Advantage |
$158.27
|
| Rate for Payer: Cofinity Commercial |
$194.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.88
|
| Rate for Payer: Healthscope Commercial |
$203.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.57
|
| Rate for Payer: PHP Commercial |
$192.19
|
| Rate for Payer: Priority Health SBD |
$142.44
|
|
|
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 |
$74.28 |
| 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 Advantage |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.85
|
| Rate for Payer: UHC Core |
$98.47
|
| Rate for Payer: UHC Exchange |
$74.28
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$179.55
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$161.59 |
| Rate for Payer: Aetna Commercial |
$152.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.71
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Advantage |
$125.69
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Healthscope Commercial |
$161.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.66
|
| Rate for Payer: PHP Commercial |
$152.62
|
| Rate for Payer: Priority Health SBD |
$113.12
|
|
|
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 Advantage |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| 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: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
