|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 50268016211
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Aetna Commercial |
$5.44
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$4.95
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$5.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: PHP Commercial |
$5.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: Priority Health HMO/PPO |
$5.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC Core |
$5.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.80
|
|
|
CHLORPROMAZINE 10 MG TABLET
|
Facility
|
OP
|
$319.92
|
|
|
Service Code
|
NDC 50268016215
|
| Hospital Charge Code |
1653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.98 |
| Max. Negotiated Rate |
$287.93 |
| Rate for Payer: Aetna Commercial |
$271.93
|
| Rate for Payer: Aetna Medicare |
$83.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.97
|
| Rate for Payer: BCBS Complete |
$127.97
|
| Rate for Payer: BCBS MAPPO |
$79.98
|
| Rate for Payer: BCBS Trust/PPO |
$263.01
|
| Rate for Payer: BCN Commercial |
$248.74
|
| Rate for Payer: BCN Medicare Advantage |
$79.98
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Cofinity Commercial |
$275.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.98
|
| Rate for Payer: Healthscope Commercial |
$287.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.93
|
| Rate for Payer: Nomi Health Commercial |
$262.33
|
| Rate for Payer: PACE Senior Care Partners |
$75.98
|
| Rate for Payer: PACE SWMI |
$79.98
|
| Rate for Payer: PHP Commercial |
$271.93
|
| Rate for Payer: PHP Medicare Advantage |
$79.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.95
|
| Rate for Payer: Priority Health HMO/PPO |
$278.33
|
| Rate for Payer: Priority Health Medicare |
$80.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.35
|
| Rate for Payer: Railroad Medicare Medicare |
$79.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.53
|
| Rate for Payer: UHC Core |
$267.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.98
|
| Rate for Payer: UHC Exchange |
$79.98
|
| Rate for Payer: UHC Medicare Advantage |
$79.98
|
| Rate for Payer: VA VA |
$79.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.94
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$17.65
|
|
|
Service Code
|
NDC 00832030189
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Nomi Health Commercial |
$14.47
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health HMO/PPO |
$15.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.53
|
| Rate for Payer: UHC Core |
$14.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$17.65
|
|
|
Service Code
|
NDC 00832030189
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna Commercial |
$15.00
|
| Rate for Payer: Aetna Medicare |
$4.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.52
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$14.51
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.41
|
| Rate for Payer: Cash Price |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.41
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.00
|
| Rate for Payer: Nomi Health Commercial |
$14.47
|
| Rate for Payer: PACE Senior Care Partners |
$4.19
|
| Rate for Payer: PACE SWMI |
$4.41
|
| Rate for Payer: PHP Commercial |
$15.00
|
| Rate for Payer: PHP Medicare Advantage |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.47
|
| Rate for Payer: Priority Health HMO/PPO |
$15.36
|
| Rate for Payer: Priority Health Medicare |
$4.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.53
|
| Rate for Payer: UHC Core |
$14.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.41
|
| Rate for Payer: UHC Exchange |
$4.41
|
| Rate for Payer: UHC Medicare Advantage |
$4.41
|
| Rate for Payer: VA VA |
$4.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.24
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,177.71
|
|
|
Service Code
|
NDC 00904713061
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.71 |
| Max. Negotiated Rate |
$1,059.94 |
| Rate for Payer: Aetna Commercial |
$1,001.05
|
| Rate for Payer: Aetna Medicare |
$306.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.03
|
| Rate for Payer: BCBS Complete |
$471.08
|
| Rate for Payer: BCBS MAPPO |
$294.43
|
| Rate for Payer: BCBS Trust/PPO |
$968.20
|
| Rate for Payer: BCN Commercial |
$915.67
|
| Rate for Payer: BCN Medicare Advantage |
$294.43
|
| Rate for Payer: Cash Price |
$942.17
|
| Rate for Payer: Cofinity Commercial |
$1,012.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$942.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.43
|
| Rate for Payer: Healthscope Commercial |
$1,059.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$883.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.05
|
| Rate for Payer: Nomi Health Commercial |
$965.72
|
| Rate for Payer: PACE Senior Care Partners |
$279.71
|
| Rate for Payer: PACE SWMI |
$294.43
|
| Rate for Payer: PHP Commercial |
$1,001.05
|
| Rate for Payer: PHP Medicare Advantage |
$294.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,024.61
|
| Rate for Payer: Priority Health Medicare |
$297.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$789.07
|
| Rate for Payer: Railroad Medicare Medicare |
$294.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,036.38
|
| Rate for Payer: UHC Core |
$983.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.43
|
| Rate for Payer: UHC Exchange |
$294.43
|
| Rate for Payer: UHC Medicare Advantage |
$294.43
|
| Rate for Payer: VA VA |
$294.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$883.28
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,307.95
|
|
|
Service Code
|
NDC 00832030100
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$850.17 |
| Max. Negotiated Rate |
$1,177.15 |
| Rate for Payer: Aetna Commercial |
$1,111.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,067.68
|
| Rate for Payer: BCN Commercial |
$1,010.78
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Commercial |
$1,124.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Healthscope Commercial |
$1,177.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.76
|
| Rate for Payer: Nomi Health Commercial |
$1,072.52
|
| Rate for Payer: PHP Commercial |
$1,111.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,137.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$876.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,151.00
|
| Rate for Payer: UHC Core |
$1,092.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.96
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,307.95
|
|
|
Service Code
|
NDC 00832030100
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.64 |
| Max. Negotiated Rate |
$1,177.15 |
| Rate for Payer: Aetna Commercial |
$1,111.76
|
| Rate for Payer: Aetna Medicare |
$340.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$408.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$408.73
|
| Rate for Payer: BCBS Complete |
$523.18
|
| Rate for Payer: BCBS MAPPO |
$326.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.27
|
| Rate for Payer: BCN Commercial |
$1,016.93
|
| Rate for Payer: BCN Medicare Advantage |
$326.99
|
| Rate for Payer: Cash Price |
$1,046.36
|
| Rate for Payer: Cofinity Commercial |
$1,124.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.99
|
| Rate for Payer: Healthscope Commercial |
$1,177.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.76
|
| Rate for Payer: Nomi Health Commercial |
$1,072.52
|
| Rate for Payer: PACE Senior Care Partners |
$310.64
|
| Rate for Payer: PACE SWMI |
$326.99
|
| Rate for Payer: PHP Commercial |
$1,111.76
|
| Rate for Payer: PHP Medicare Advantage |
$326.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,137.92
|
| Rate for Payer: Priority Health Medicare |
$330.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$876.33
|
| Rate for Payer: Railroad Medicare Medicare |
$326.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,151.00
|
| Rate for Payer: UHC Core |
$1,092.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.99
|
| Rate for Payer: UHC Exchange |
$326.99
|
| Rate for Payer: UHC Medicare Advantage |
$326.99
|
| Rate for Payer: VA VA |
$326.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.96
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 50268016311
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.38
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$6.25
|
| Rate for Payer: BCN Commercial |
$5.91
|
| Rate for Payer: BCN Medicare Advantage |
$1.90
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: PACE Senior Care Partners |
$1.80
|
| Rate for Payer: PACE SWMI |
$1.90
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.69
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.90
|
| Rate for Payer: UHC Exchange |
$1.90
|
| Rate for Payer: UHC Medicare Advantage |
$1.90
|
| Rate for Payer: VA VA |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$1,764.16
|
|
|
Service Code
|
NDC 00832030101
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.99 |
| Max. Negotiated Rate |
$1,587.74 |
| Rate for Payer: Aetna Commercial |
$1,499.54
|
| Rate for Payer: Aetna Medicare |
$458.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.30
|
| Rate for Payer: BCBS Complete |
$705.66
|
| Rate for Payer: BCBS MAPPO |
$441.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,450.32
|
| Rate for Payer: BCN Commercial |
$1,371.63
|
| Rate for Payer: BCN Medicare Advantage |
$441.04
|
| Rate for Payer: Cash Price |
$1,411.33
|
| Rate for Payer: Cofinity Commercial |
$1,517.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,411.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.04
|
| Rate for Payer: Healthscope Commercial |
$1,587.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,323.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,499.54
|
| Rate for Payer: Nomi Health Commercial |
$1,446.61
|
| Rate for Payer: PACE Senior Care Partners |
$418.99
|
| Rate for Payer: PACE SWMI |
$441.04
|
| Rate for Payer: PHP Commercial |
$1,499.54
|
| Rate for Payer: PHP Medicare Advantage |
$441.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,534.82
|
| Rate for Payer: Priority Health Medicare |
$445.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,181.99
|
| Rate for Payer: Railroad Medicare Medicare |
$441.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,552.46
|
| Rate for Payer: UHC Core |
$1,473.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.04
|
| Rate for Payer: UHC Exchange |
$441.04
|
| Rate for Payer: UHC Medicare Advantage |
$441.04
|
| Rate for Payer: VA VA |
$441.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,323.12
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
OP
|
$379.62
|
|
|
Service Code
|
NDC 50268016315
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$341.66 |
| Rate for Payer: Aetna Commercial |
$322.68
|
| Rate for Payer: Aetna Medicare |
$98.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.63
|
| Rate for Payer: BCBS Complete |
$151.85
|
| Rate for Payer: BCBS MAPPO |
$94.91
|
| Rate for Payer: BCBS Trust/PPO |
$312.09
|
| Rate for Payer: BCN Commercial |
$295.15
|
| Rate for Payer: BCN Medicare Advantage |
$94.91
|
| Rate for Payer: Cash Price |
$303.70
|
| Rate for Payer: Cofinity Commercial |
$326.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.91
|
| Rate for Payer: Healthscope Commercial |
$341.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.68
|
| Rate for Payer: Nomi Health Commercial |
$311.29
|
| Rate for Payer: PACE Senior Care Partners |
$90.16
|
| Rate for Payer: PACE SWMI |
$94.91
|
| Rate for Payer: PHP Commercial |
$322.68
|
| Rate for Payer: PHP Medicare Advantage |
$94.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health HMO/PPO |
$330.27
|
| Rate for Payer: Priority Health Medicare |
$95.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.35
|
| Rate for Payer: Railroad Medicare Medicare |
$94.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.07
|
| Rate for Payer: UHC Core |
$316.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.91
|
| Rate for Payer: UHC Exchange |
$94.91
|
| Rate for Payer: UHC Medicare Advantage |
$94.91
|
| Rate for Payer: VA VA |
$94.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.71
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,177.71
|
|
|
Service Code
|
NDC 00904713061
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$765.51 |
| Max. Negotiated Rate |
$1,059.94 |
| Rate for Payer: Aetna Commercial |
$1,001.05
|
| Rate for Payer: BCBS Trust/PPO |
$961.36
|
| Rate for Payer: BCN Commercial |
$910.13
|
| Rate for Payer: Cash Price |
$942.17
|
| Rate for Payer: Cofinity Commercial |
$1,012.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$942.17
|
| Rate for Payer: Healthscope Commercial |
$1,059.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$883.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.05
|
| Rate for Payer: Nomi Health Commercial |
$965.72
|
| Rate for Payer: PHP Commercial |
$1,001.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$765.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,024.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$789.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,036.38
|
| Rate for Payer: UHC Core |
$983.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$883.28
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$1,764.16
|
|
|
Service Code
|
NDC 00832030101
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,146.70 |
| Max. Negotiated Rate |
$1,587.74 |
| Rate for Payer: Aetna Commercial |
$1,499.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,440.08
|
| Rate for Payer: BCN Commercial |
$1,363.34
|
| Rate for Payer: Cash Price |
$1,411.33
|
| Rate for Payer: Cofinity Commercial |
$1,517.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,411.33
|
| Rate for Payer: Healthscope Commercial |
$1,587.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,323.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,499.54
|
| Rate for Payer: Nomi Health Commercial |
$1,446.61
|
| Rate for Payer: PHP Commercial |
$1,499.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,534.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,181.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,552.46
|
| Rate for Payer: UHC Core |
$1,473.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,323.12
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$379.62
|
|
|
Service Code
|
NDC 50268016315
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$341.66 |
| Rate for Payer: Aetna Commercial |
$322.68
|
| Rate for Payer: BCBS Trust/PPO |
$309.88
|
| Rate for Payer: BCN Commercial |
$293.37
|
| Rate for Payer: Cash Price |
$303.70
|
| Rate for Payer: Cofinity Commercial |
$326.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$341.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.68
|
| Rate for Payer: Nomi Health Commercial |
$311.29
|
| Rate for Payer: PHP Commercial |
$322.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health HMO/PPO |
$330.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.07
|
| Rate for Payer: UHC Core |
$316.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.71
|
|
|
CHLORPROMAZINE 25 MG TABLET
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 50268016311
|
| Hospital Charge Code |
1656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$6.84 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$6.20
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.08
|
| Rate for Payer: Healthscope Commercial |
$6.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$6.23
|
| Rate for Payer: PHP Commercial |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.94
|
| Rate for Payer: Priority Health HMO/PPO |
$6.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.69
|
| Rate for Payer: UHC Core |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.70
|
|
|
CHLORPROMAZINE (BULK) 100 % POWDER
|
Facility
|
IP
|
$194.40
|
|
|
Service Code
|
NDC 38779042304
|
| Hospital Charge Code |
12309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.36 |
| Max. Negotiated Rate |
$174.96 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: BCBS Trust/PPO |
$158.69
|
| Rate for Payer: BCN Commercial |
$150.23
|
| Rate for Payer: Cash Price |
$155.52
|
| Rate for Payer: Cofinity Commercial |
$167.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.52
|
| Rate for Payer: Healthscope Commercial |
$174.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.24
|
| Rate for Payer: Nomi Health Commercial |
$159.41
|
| Rate for Payer: PHP Commercial |
$165.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health HMO/PPO |
$169.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.07
|
| Rate for Payer: UHC Core |
$162.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.80
|
|
|
CHLORPROMAZINE (BULK) 100 % POWDER
|
Facility
|
OP
|
$194.40
|
|
|
Service Code
|
NDC 38779042304
|
| Hospital Charge Code |
12309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$174.96 |
| Rate for Payer: Aetna Commercial |
$165.24
|
| Rate for Payer: Aetna Medicare |
$50.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.75
|
| Rate for Payer: BCBS Complete |
$77.76
|
| Rate for Payer: BCBS MAPPO |
$48.60
|
| Rate for Payer: BCBS Trust/PPO |
$159.82
|
| Rate for Payer: BCN Commercial |
$151.15
|
| Rate for Payer: BCN Medicare Advantage |
$48.60
|
| Rate for Payer: Cash Price |
$155.52
|
| Rate for Payer: Cofinity Commercial |
$167.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.60
|
| Rate for Payer: Healthscope Commercial |
$174.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.24
|
| Rate for Payer: Nomi Health Commercial |
$159.41
|
| Rate for Payer: PACE Senior Care Partners |
$46.17
|
| Rate for Payer: PACE SWMI |
$48.60
|
| Rate for Payer: PHP Commercial |
$165.24
|
| Rate for Payer: PHP Medicare Advantage |
$48.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.36
|
| Rate for Payer: Priority Health HMO/PPO |
$169.13
|
| Rate for Payer: Priority Health Medicare |
$49.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.25
|
| Rate for Payer: Railroad Medicare Medicare |
$48.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.07
|
| Rate for Payer: UHC Core |
$162.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.60
|
| Rate for Payer: UHC Exchange |
$48.60
|
| Rate for Payer: UHC Medicare Advantage |
$48.60
|
| Rate for Payer: VA VA |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.80
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 43598071901
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.57 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: BCBS Trust/PPO |
$249.38
|
| Rate for Payer: BCN Commercial |
$236.09
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$431.04
|
|
|
Service Code
|
NDC 00378022201
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna Medicare |
$112.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.70
|
| Rate for Payer: BCBS Complete |
$172.42
|
| Rate for Payer: BCBS MAPPO |
$107.76
|
| Rate for Payer: BCBS Trust/PPO |
$354.36
|
| Rate for Payer: BCN Commercial |
$335.13
|
| Rate for Payer: BCN Medicare Advantage |
$107.76
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.76
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Nomi Health Commercial |
$353.45
|
| Rate for Payer: PACE Senior Care Partners |
$102.37
|
| Rate for Payer: PACE SWMI |
$107.76
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: PHP Medicare Advantage |
$107.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: Priority Health HMO/PPO |
$375.00
|
| Rate for Payer: Priority Health Medicare |
$108.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.80
|
| Rate for Payer: Railroad Medicare Medicare |
$107.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.32
|
| Rate for Payer: UHC Core |
$359.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.76
|
| Rate for Payer: UHC Exchange |
$107.76
|
| Rate for Payer: UHC Medicare Advantage |
$107.76
|
| Rate for Payer: VA VA |
$107.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 00378022201
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.18 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: BCBS Trust/PPO |
$351.86
|
| Rate for Payer: BCN Commercial |
$333.11
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Nomi Health Commercial |
$353.45
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: Priority Health HMO/PPO |
$375.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.32
|
| Rate for Payer: UHC Core |
$359.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 43598071901
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.56 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$79.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.47
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: BCBS MAPPO |
$76.38
|
| Rate for Payer: BCBS Trust/PPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$237.53
|
| Rate for Payer: BCN Medicare Advantage |
$76.38
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.38
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: PACE Senior Care Partners |
$72.56
|
| Rate for Payer: PACE SWMI |
$76.38
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: PHP Medicare Advantage |
$76.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.69
|
| Rate for Payer: Railroad Medicare Medicare |
$76.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.38
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Medicare Advantage |
$76.38
|
| Rate for Payer: VA VA |
$76.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: BCBS Trust/PPO |
$69.06
|
| Rate for Payer: BCN Commercial |
$65.38
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.99
|
| Rate for Payer: Priority Health HMO/PPO |
$73.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.45
|
| Rate for Payer: UHC Core |
$70.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 07610009840
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.06
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$35.25
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$109.63
|
| Rate for Payer: BCN Medicare Advantage |
$35.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.25
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: PACE Senior Care Partners |
$33.49
|
| Rate for Payer: PACE SWMI |
$35.25
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.25
|
| Rate for Payer: UHC Exchange |
$35.25
|
| Rate for Payer: UHC Medicare Advantage |
$35.25
|
| Rate for Payer: VA VA |
$35.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.44
|
| Rate for Payer: BCBS Complete |
$33.84
|
| Rate for Payer: BCBS MAPPO |
$21.15
|
| Rate for Payer: BCBS Trust/PPO |
$69.55
|
| Rate for Payer: BCN Commercial |
$65.78
|
| Rate for Payer: BCN Medicare Advantage |
$21.15
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: PACE Senior Care Partners |
$20.09
|
| Rate for Payer: PACE SWMI |
$21.15
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: PHP Medicare Advantage |
$21.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.99
|
| Rate for Payer: Priority Health HMO/PPO |
$73.60
|
| Rate for Payer: Priority Health Medicare |
$21.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.68
|
| Rate for Payer: Railroad Medicare Medicare |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.45
|
| Rate for Payer: UHC Core |
$70.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.15
|
| Rate for Payer: UHC Exchange |
$21.15
|
| Rate for Payer: UHC Medicare Advantage |
$21.15
|
| Rate for Payer: VA VA |
$21.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 31604001870
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.07 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: BCBS Trust/PPO |
$109.34
|
| Rate for Payer: BCN Commercial |
$103.52
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Nomi Health Commercial |
$109.84
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.07
|
| Rate for Payer: Priority Health HMO/PPO |
$116.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.88
|
| Rate for Payer: UHC Core |
$111.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$133.95
|
|
|
Service Code
|
NDC 31604001870
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna Medicare |
$34.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.86
|
| Rate for Payer: BCBS Complete |
$53.58
|
| Rate for Payer: BCBS MAPPO |
$33.49
|
| Rate for Payer: BCBS Trust/PPO |
$110.12
|
| Rate for Payer: BCN Commercial |
$104.15
|
| Rate for Payer: BCN Medicare Advantage |
$33.49
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.49
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Nomi Health Commercial |
$109.84
|
| Rate for Payer: PACE Senior Care Partners |
$31.81
|
| Rate for Payer: PACE SWMI |
$33.49
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: PHP Medicare Advantage |
$33.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.07
|
| Rate for Payer: Priority Health HMO/PPO |
$116.54
|
| Rate for Payer: Priority Health Medicare |
$33.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.75
|
| Rate for Payer: Railroad Medicare Medicare |
$33.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.88
|
| Rate for Payer: UHC Core |
$111.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.49
|
| Rate for Payer: UHC Exchange |
$33.49
|
| Rate for Payer: UHC Medicare Advantage |
$33.49
|
| Rate for Payer: VA VA |
$33.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
