|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.62 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: BCBS Trust/PPO |
$201.28
|
| Rate for Payer: BCN Commercial |
$201.28
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: Nomi Health Commercial |
$199.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.78
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.46
|
| Rate for Payer: UHC Core |
$203.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,428.48
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.84 |
| Max. Negotiated Rate |
$1,285.63 |
| Rate for Payer: Aetna Commercial |
$1,214.21
|
| Rate for Payer: Aetna Commercial |
$1,290.10
|
| Rate for Payer: Aetna Medicare |
$394.62
|
| Rate for Payer: Aetna Medicare |
$371.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$474.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$474.30
|
| Rate for Payer: BCBS Complete |
$264.41
|
| Rate for Payer: BCBS Complete |
$280.94
|
| Rate for Payer: BCBS MAPPO |
$357.12
|
| Rate for Payer: BCBS MAPPO |
$379.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,174.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,247.75
|
| Rate for Payer: BCN Commercial |
$1,247.75
|
| Rate for Payer: BCN Commercial |
$1,174.35
|
| Rate for Payer: BCN Medicare Advantage |
$379.44
|
| Rate for Payer: BCN Medicare Advantage |
$357.12
|
| Rate for Payer: Cash Price |
$1,142.78
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cofinity Commercial |
$1,228.49
|
| 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: Health Alliance Plan Medicare Advantage |
$379.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.12
|
| Rate for Payer: Healthscope Commercial |
$1,285.63
|
| Rate for Payer: Healthscope Commercial |
$1,365.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.32
|
| Rate for Payer: Mclaren Medicaid |
$267.58
|
| Rate for Payer: Mclaren Medicaid |
$251.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.98
|
| Rate for Payer: Meridian Medicaid |
$264.41
|
| Rate for Payer: Meridian Medicaid |
$280.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$417.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.21
|
| Rate for Payer: Nomi Health Commercial |
$1,244.56
|
| Rate for Payer: Nomi Health Commercial |
$1,171.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.32
|
| Rate for Payer: PACE Senior Care Partners |
$360.47
|
| Rate for Payer: PACE Senior Care Partners |
$339.26
|
| Rate for Payer: PACE SWMI |
$379.44
|
| Rate for Payer: PACE SWMI |
$357.12
|
| Rate for Payer: PHP Commercial |
$1,214.21
|
| Rate for Payer: PHP Commercial |
$1,290.10
|
| Rate for Payer: PHP Medicare Advantage |
$357.12
|
| Rate for Payer: PHP Medicare Advantage |
$379.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,320.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,242.78
|
| Rate for Payer: Priority Health Medicare |
$383.23
|
| Rate for Payer: Priority Health Medicare |
$360.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$994.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,056.36
|
| Rate for Payer: Railroad Medicare Medicare |
$357.12
|
| Rate for Payer: Railroad Medicare Medicare |
$379.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,335.63
|
| Rate for Payer: UHC Core |
$1,267.33
|
| Rate for Payer: UHC Core |
$1,192.78
|
| Rate for Payer: UHC Exchange |
$379.44
|
| Rate for Payer: UHC Exchange |
$357.12
|
| Rate for Payer: UHC Medicaid |
$267.58
|
| Rate for Payer: UHC Medicaid |
$251.84
|
| Rate for Payer: UHC Medicare Advantage |
$357.12
|
| Rate for Payer: UHC Medicare Advantage |
$379.44
|
| Rate for Payer: UHCCP Medicaid |
$251.84
|
| Rate for Payer: UHCCP Medicaid |
$267.58
|
| Rate for Payer: VA VA |
$357.12
|
| Rate for Payer: VA VA |
$379.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.36
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,428.48
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$994.22 |
| Max. Negotiated Rate |
$1,285.63 |
| Rate for Payer: Aetna Commercial |
$1,214.21
|
| Rate for Payer: Aetna Commercial |
$1,290.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.52
|
| Rate for Payer: BCN Commercial |
$1,179.78
|
| Rate for Payer: BCN Commercial |
$1,253.52
|
| Rate for Payer: Cash Price |
$1,142.78
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cofinity Commercial |
$1,305.27
|
| Rate for Payer: Cofinity Commercial |
$1,228.49
|
| 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 |
$1,285.63
|
| Rate for Payer: Healthscope Commercial |
$1,365.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.32
|
| 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: Nomi Health Commercial |
$1,171.35
|
| Rate for Payer: Nomi Health Commercial |
$1,244.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.32
|
| 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 |
$1,320.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,242.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$994.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,056.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,335.63
|
| Rate for Payer: UHC Core |
$1,192.78
|
| Rate for Payer: UHC Core |
$1,267.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.32
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$386.40
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.93 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: BCBS Trust/PPO |
$319.13
|
| Rate for Payer: BCN Commercial |
$319.13
|
| Rate for Payer: Cash Price |
$309.12
|
| 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: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$316.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.80
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$336.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.03
|
| Rate for Payer: UHC Core |
$322.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$422.40
|
|
|
Service Code
|
NDC 00054000725
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.47 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$359.04
|
| Rate for Payer: Aetna Medicare |
$109.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.00
|
| Rate for Payer: BCBS Complete |
$78.19
|
| Rate for Payer: BCBS MAPPO |
$105.60
|
| Rate for Payer: BCBS Trust/PPO |
$347.26
|
| Rate for Payer: BCN Commercial |
$347.26
|
| Rate for Payer: BCN Medicare Advantage |
$105.60
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$380.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.80
|
| Rate for Payer: Mclaren Medicaid |
$74.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.88
|
| Rate for Payer: Meridian Medicaid |
$78.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.04
|
| Rate for Payer: Nomi Health Commercial |
$346.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.80
|
| Rate for Payer: PACE Senior Care Partners |
$100.32
|
| Rate for Payer: PACE SWMI |
$105.60
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: PHP Medicare Advantage |
$105.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.49
|
| Rate for Payer: Priority Health Medicare |
$106.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.99
|
| Rate for Payer: Railroad Medicare Medicare |
$105.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.71
|
| Rate for Payer: UHC Core |
$352.70
|
| Rate for Payer: UHC Exchange |
$105.60
|
| Rate for Payer: UHC Medicaid |
$74.47
|
| Rate for Payer: UHC Medicare Advantage |
$105.60
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: VA VA |
$105.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.80
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$71.82
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna Medicare |
$18.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.44
|
| Rate for Payer: BCBS Complete |
$13.29
|
| Rate for Payer: BCBS MAPPO |
$17.95
|
| Rate for Payer: BCBS Trust/PPO |
$59.04
|
| Rate for Payer: BCN Commercial |
$59.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.95
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.87
|
| Rate for Payer: Mclaren Medicaid |
$12.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.85
|
| Rate for Payer: Meridian Medicaid |
$13.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Nomi Health Commercial |
$58.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: PACE Senior Care Partners |
$17.06
|
| Rate for Payer: PACE SWMI |
$17.95
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: PHP Medicare Advantage |
$17.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.48
|
| Rate for Payer: Priority Health Medicare |
$18.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.99
|
| Rate for Payer: Railroad Medicare Medicare |
$17.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.20
|
| Rate for Payer: UHC Core |
$59.97
|
| Rate for Payer: UHC Exchange |
$17.95
|
| Rate for Payer: UHC Medicaid |
$12.66
|
| Rate for Payer: UHC Medicare Advantage |
$17.95
|
| Rate for Payer: UHCCP Medicaid |
$12.66
|
| Rate for Payer: VA VA |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.87
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: BCBS Trust/PPO |
$59.32
|
| Rate for Payer: BCN Commercial |
$59.32
|
| Rate for Payer: Cash Price |
$57.46
|
| 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: Lakeland Regional Health Systems Commercial |
$53.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Nomi Health Commercial |
$58.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.20
|
| Rate for Payer: UHC Core |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.87
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$3.10
|
| 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: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.21
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Mclaren Medicaid |
$0.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: Meridian Medicaid |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PACE Senior Care Partners |
$0.92
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.37
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.23
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicaid |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.97
|
| Rate for Payer: UHCCP Medicaid |
$0.68
|
| Rate for Payer: VA VA |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$386.40
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: Aetna Medicare |
$100.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.75
|
| Rate for Payer: BCBS Complete |
$71.52
|
| Rate for Payer: BCBS MAPPO |
$96.60
|
| Rate for Payer: BCBS Trust/PPO |
$317.66
|
| Rate for Payer: BCN Commercial |
$317.66
|
| Rate for Payer: BCN Medicare Advantage |
$96.60
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.60
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: Mclaren Medicaid |
$68.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.43
|
| Rate for Payer: Meridian Medicaid |
$71.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$106.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$316.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.80
|
| Rate for Payer: PACE Senior Care Partners |
$91.77
|
| Rate for Payer: PACE SWMI |
$96.60
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: PHP Medicare Advantage |
$96.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$336.17
|
| Rate for Payer: Priority Health Medicare |
$97.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.93
|
| Rate for Payer: Railroad Medicare Medicare |
$96.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.03
|
| Rate for Payer: UHC Core |
$322.64
|
| Rate for Payer: UHC Exchange |
$96.60
|
| Rate for Payer: UHC Medicaid |
$68.12
|
| Rate for Payer: UHC Medicare Advantage |
$96.60
|
| Rate for Payer: UHCCP Medicaid |
$68.12
|
| Rate for Payer: VA VA |
$96.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$422.40
|
|
|
Service Code
|
NDC 00054000725
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.99 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$359.04
|
| Rate for Payer: BCBS Trust/PPO |
$348.86
|
| Rate for Payer: BCN Commercial |
$348.86
|
| Rate for Payer: Cash Price |
$337.92
|
| 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: Lakeland Regional Health Systems Commercial |
$316.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.04
|
| Rate for Payer: Nomi Health Commercial |
$346.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.80
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$367.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.71
|
| Rate for Payer: UHC Core |
$352.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.80
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$245.70
|
|
|
Service Code
|
NDC 00766074152
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: Aetna Medicare |
$63.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.78
|
| Rate for Payer: BCBS Complete |
$45.48
|
| Rate for Payer: BCBS MAPPO |
$61.42
|
| Rate for Payer: BCBS Trust/PPO |
$201.99
|
| Rate for Payer: BCN Commercial |
$201.99
|
| Rate for Payer: BCN Medicare Advantage |
$61.42
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$211.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.42
|
| Rate for Payer: Healthscope Commercial |
$221.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.28
|
| Rate for Payer: Mclaren Medicaid |
$43.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.50
|
| Rate for Payer: Meridian Medicaid |
$45.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Nomi Health Commercial |
$201.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.28
|
| Rate for Payer: PACE Senior Care Partners |
$58.35
|
| Rate for Payer: PACE SWMI |
$61.42
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: PHP Medicare Advantage |
$61.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.76
|
| Rate for Payer: Priority Health Medicare |
$62.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.01
|
| Rate for Payer: Railroad Medicare Medicare |
$61.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.22
|
| Rate for Payer: UHC Core |
$205.16
|
| Rate for Payer: UHC Exchange |
$61.42
|
| Rate for Payer: UHC Medicaid |
$43.32
|
| Rate for Payer: UHC Medicare Advantage |
$61.42
|
| Rate for Payer: UHCCP Medicaid |
$43.32
|
| Rate for Payer: VA VA |
$61.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.28
|
|
|
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 |
$124.97 |
| Max. Negotiated Rate |
$161.59 |
| Rate for Payer: Aetna Commercial |
$152.62
|
| Rate for Payer: BCBS Trust/PPO |
$148.29
|
| Rate for Payer: BCN Commercial |
$148.29
|
| Rate for Payer: Cash Price |
$143.64
|
| 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: Lakeland Regional Health Systems Commercial |
$134.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: Nomi Health Commercial |
$147.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.66
|
| Rate for Payer: PHP Commercial |
$152.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.00
|
| Rate for Payer: UHC Core |
$149.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.66
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$245.70
|
|
|
Service Code
|
NDC 00766074152
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: BCBS Trust/PPO |
$202.92
|
| Rate for Payer: BCN Commercial |
$202.92
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$211.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Healthscope Commercial |
$221.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Nomi Health Commercial |
$201.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.28
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.22
|
| Rate for Payer: UHC Core |
$205.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.28
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$179.55
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$161.59 |
| Rate for Payer: Aetna Commercial |
$152.62
|
| Rate for Payer: Aetna Medicare |
$46.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.11
|
| Rate for Payer: BCBS Complete |
$33.23
|
| Rate for Payer: BCBS MAPPO |
$44.89
|
| Rate for Payer: BCBS Trust/PPO |
$147.61
|
| Rate for Payer: BCN Commercial |
$147.61
|
| Rate for Payer: BCN Medicare Advantage |
$44.89
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.89
|
| Rate for Payer: Healthscope Commercial |
$161.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.66
|
| Rate for Payer: Mclaren Medicaid |
$31.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.13
|
| Rate for Payer: Meridian Medicaid |
$33.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: Nomi Health Commercial |
$147.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.66
|
| Rate for Payer: PACE Senior Care Partners |
$42.64
|
| Rate for Payer: PACE SWMI |
$44.89
|
| Rate for Payer: PHP Commercial |
$152.62
|
| Rate for Payer: PHP Medicare Advantage |
$44.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.21
|
| Rate for Payer: Priority Health Medicare |
$45.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.97
|
| Rate for Payer: Railroad Medicare Medicare |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.00
|
| Rate for Payer: UHC Core |
$149.92
|
| Rate for Payer: UHC Exchange |
$44.89
|
| Rate for Payer: UHC Medicaid |
$31.65
|
| Rate for Payer: UHC Medicare Advantage |
$44.89
|
| Rate for Payer: UHCCP Medicaid |
$31.65
|
| Rate for Payer: VA VA |
$44.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.66
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 77333011025
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$1.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.44
|
| Rate for Payer: Nomi Health Commercial |
$1.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.49
|
| Rate for Payer: UHC Core |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.27
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$90.72
|
|
|
Service Code
|
NDC 00536781708
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: BCBS Trust/PPO |
$74.93
|
| Rate for Payer: BCN Commercial |
$74.93
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: Nomi Health Commercial |
$74.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.04
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.83
|
| Rate for Payer: UHC Core |
$75.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$90.72
|
|
|
Service Code
|
NDC 00536781708
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna Medicare |
$23.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.35
|
| Rate for Payer: BCBS Complete |
$16.79
|
| Rate for Payer: BCBS MAPPO |
$22.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.58
|
| Rate for Payer: BCN Commercial |
$74.58
|
| Rate for Payer: BCN Medicare Advantage |
$22.68
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.68
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: Mclaren Medicaid |
$15.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.81
|
| Rate for Payer: Meridian Medicaid |
$16.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: Nomi Health Commercial |
$74.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.04
|
| Rate for Payer: PACE Senior Care Partners |
$21.55
|
| Rate for Payer: PACE SWMI |
$22.68
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: PHP Medicare Advantage |
$22.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.93
|
| Rate for Payer: Priority Health Medicare |
$22.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.14
|
| Rate for Payer: Railroad Medicare Medicare |
$22.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.83
|
| Rate for Payer: UHC Core |
$75.75
|
| Rate for Payer: UHC Exchange |
$22.68
|
| Rate for Payer: UHC Medicaid |
$15.99
|
| Rate for Payer: UHC Medicare Advantage |
$22.68
|
| Rate for Payer: UHCCP Medicaid |
$15.99
|
| Rate for Payer: VA VA |
$22.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$48.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.75
|
| Rate for Payer: BCBS Complete |
$34.80
|
| Rate for Payer: BCBS MAPPO |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.55
|
| Rate for Payer: BCN Commercial |
$154.55
|
| Rate for Payer: BCN Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Mclaren Medicaid |
$33.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.35
|
| Rate for Payer: Meridian Medicaid |
$34.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE Senior Care Partners |
$44.65
|
| Rate for Payer: PACE SWMI |
$47.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Medicare |
$47.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: Railroad Medicare Medicare |
$47.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: UHC Exchange |
$47.00
|
| Rate for Payer: UHC Medicaid |
$33.14
|
| Rate for Payer: UHC Medicare Advantage |
$47.00
|
| Rate for Payer: UHCCP Medicaid |
$33.14
|
| Rate for Payer: VA VA |
$47.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
NDC 77333011010
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$151.47 |
| Rate for Payer: Aetna Commercial |
$143.06
|
| Rate for Payer: Aetna Medicare |
$43.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.59
|
| Rate for Payer: BCBS Complete |
$31.15
|
| Rate for Payer: BCBS MAPPO |
$42.08
|
| Rate for Payer: BCBS Trust/PPO |
$138.36
|
| Rate for Payer: BCN Commercial |
$138.36
|
| Rate for Payer: BCN Medicare Advantage |
$42.08
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.08
|
| Rate for Payer: Healthscope Commercial |
$151.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.22
|
| Rate for Payer: Mclaren Medicaid |
$29.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.18
|
| Rate for Payer: Meridian Medicaid |
$31.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.22
|
| Rate for Payer: PACE Senior Care Partners |
$39.97
|
| Rate for Payer: PACE SWMI |
$42.08
|
| Rate for Payer: PHP Commercial |
$143.06
|
| Rate for Payer: PHP Medicare Advantage |
$42.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.42
|
| Rate for Payer: Priority Health Medicare |
$42.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.14
|
| Rate for Payer: Railroad Medicare Medicare |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.10
|
| Rate for Payer: UHC Core |
$140.53
|
| Rate for Payer: UHC Exchange |
$42.08
|
| Rate for Payer: UHC Medicaid |
$29.67
|
| Rate for Payer: UHC Medicare Advantage |
$42.08
|
| Rate for Payer: UHCCP Medicaid |
$29.67
|
| Rate for Payer: VA VA |
$42.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.22
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 77333011025
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.44
|
| Rate for Payer: Aetna Medicare |
$0.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.53
|
| Rate for Payer: BCBS Complete |
$0.31
|
| Rate for Payer: BCBS MAPPO |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.39
|
| Rate for Payer: BCN Commercial |
$1.39
|
| Rate for Payer: BCN Medicare Advantage |
$0.42
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$1.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.27
|
| Rate for Payer: Mclaren Medicaid |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.44
|
| Rate for Payer: Meridian Medicaid |
$0.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.44
|
| Rate for Payer: Nomi Health Commercial |
$1.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.27
|
| Rate for Payer: PACE Senior Care Partners |
$0.40
|
| Rate for Payer: PACE SWMI |
$0.42
|
| Rate for Payer: PHP Commercial |
$1.44
|
| Rate for Payer: PHP Medicare Advantage |
$0.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.47
|
| Rate for Payer: Priority Health Medicare |
$0.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.18
|
| Rate for Payer: Railroad Medicare Medicare |
$0.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.49
|
| Rate for Payer: UHC Core |
$1.41
|
| Rate for Payer: UHC Exchange |
$0.42
|
| Rate for Payer: UHC Medicaid |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.42
|
| Rate for Payer: UHCCP Medicaid |
$0.30
|
| Rate for Payer: VA VA |
$0.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.27
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
NDC 77333011010
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$151.47 |
| Rate for Payer: Aetna Commercial |
$143.06
|
| Rate for Payer: BCBS Trust/PPO |
$139.00
|
| Rate for Payer: BCN Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$151.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.22
|
| Rate for Payer: PHP Commercial |
$143.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.10
|
| Rate for Payer: UHC Core |
$140.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.22
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 00904546092
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$49.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.06
|
| Rate for Payer: BCBS Complete |
$34.98
|
| Rate for Payer: BCBS MAPPO |
$47.25
|
| Rate for Payer: BCBS Trust/PPO |
$155.38
|
| Rate for Payer: BCN Commercial |
$155.38
|
| Rate for Payer: BCN Medicare Advantage |
$47.25
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.25
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Mclaren Medicaid |
$33.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.61
|
| Rate for Payer: Meridian Medicaid |
$34.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PACE Senior Care Partners |
$44.89
|
| Rate for Payer: PACE SWMI |
$47.25
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: PHP Medicare Advantage |
$47.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Medicare |
$47.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.54
|
| Rate for Payer: Railroad Medicare Medicare |
$47.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.81
|
| Rate for Payer: UHC Exchange |
$47.25
|
| Rate for Payer: UHC Medicaid |
$33.32
|
| Rate for Payer: UHC Medicare Advantage |
$47.25
|
| Rate for Payer: UHCCP Medicaid |
$33.32
|
| Rate for Payer: VA VA |
$47.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.85 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$155.27
|
| Rate for Payer: BCN Commercial |
$155.27
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 00904546092
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: BCBS Trust/PPO |
$156.10
|
| Rate for Payer: BCN Commercial |
$156.10
|
| Rate for Payer: Cash Price |
$151.20
|
| 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: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
