|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$219.03
|
|
|
Service Code
|
NDC 60687080121
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$197.13 |
| Rate for Payer: Aetna Commercial |
$186.18
|
| Rate for Payer: Aetna Medicare |
$56.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.45
|
| Rate for Payer: BCBS Complete |
$87.61
|
| Rate for Payer: BCBS MAPPO |
$54.76
|
| Rate for Payer: BCBS Trust/PPO |
$180.06
|
| Rate for Payer: BCN Commercial |
$170.30
|
| Rate for Payer: BCN Medicare Advantage |
$54.76
|
| Rate for Payer: Cash Price |
$175.22
|
| Rate for Payer: Cofinity Commercial |
$188.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.76
|
| Rate for Payer: Healthscope Commercial |
$197.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.18
|
| Rate for Payer: Nomi Health Commercial |
$179.60
|
| Rate for Payer: PACE Senior Care Partners |
$52.02
|
| Rate for Payer: PACE SWMI |
$54.76
|
| Rate for Payer: PHP Commercial |
$186.18
|
| Rate for Payer: PHP Medicare Advantage |
$54.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.37
|
| Rate for Payer: Priority Health HMO/PPO |
$190.56
|
| Rate for Payer: Priority Health Medicare |
$55.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.75
|
| Rate for Payer: Railroad Medicare Medicare |
$54.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.75
|
| Rate for Payer: UHC Core |
$182.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.76
|
| Rate for Payer: UHC Exchange |
$54.76
|
| Rate for Payer: UHC Medicare Advantage |
$54.76
|
| Rate for Payer: VA VA |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.27
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 72888006301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.82 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: BCBS Trust/PPO |
$301.17
|
| Rate for Payer: BCN Commercial |
$285.12
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Nomi Health Commercial |
$302.54
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.82
|
| Rate for Payer: Priority Health HMO/PPO |
$320.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.68
|
| Rate for Payer: UHC Core |
$308.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 16729020101
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.35 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: BCBS Trust/PPO |
$183.79
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 16729020101
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$58.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.36
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: BCBS MAPPO |
$56.29
|
| Rate for Payer: BCBS Trust/PPO |
$185.10
|
| Rate for Payer: BCN Commercial |
$175.05
|
| Rate for Payer: BCN Medicare Advantage |
$56.29
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.29
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Nomi Health Commercial |
$184.62
|
| Rate for Payer: PACE Senior Care Partners |
$53.47
|
| Rate for Payer: PACE SWMI |
$56.29
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: PHP Medicare Advantage |
$56.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health HMO/PPO |
$195.88
|
| Rate for Payer: Priority Health Medicare |
$56.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.85
|
| Rate for Payer: Railroad Medicare Medicare |
$56.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.29
|
| Rate for Payer: UHC Exchange |
$56.29
|
| Rate for Payer: UHC Medicare Advantage |
$56.29
|
| Rate for Payer: VA VA |
$56.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$478.20 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna Commercial |
$625.35
|
| Rate for Payer: BCBS Trust/PPO |
$600.55
|
| Rate for Payer: BCN Commercial |
$568.55
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.35
|
| Rate for Payer: Nomi Health Commercial |
$603.27
|
| Rate for Payer: PHP Commercial |
$625.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.20
|
| Rate for Payer: Priority Health HMO/PPO |
$640.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.42
|
| Rate for Payer: UHC Core |
$614.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.77
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$371.35
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$334.21 |
| Rate for Payer: Aetna Commercial |
$315.65
|
| Rate for Payer: Aetna Medicare |
$96.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.05
|
| Rate for Payer: BCBS Complete |
$148.54
|
| Rate for Payer: BCBS MAPPO |
$92.84
|
| Rate for Payer: BCBS Trust/PPO |
$305.29
|
| Rate for Payer: BCN Commercial |
$288.72
|
| Rate for Payer: BCN Medicare Advantage |
$92.84
|
| Rate for Payer: Cash Price |
$297.08
|
| Rate for Payer: Cofinity Commercial |
$319.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.84
|
| Rate for Payer: Healthscope Commercial |
$334.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.65
|
| Rate for Payer: Nomi Health Commercial |
$304.51
|
| Rate for Payer: PACE Senior Care Partners |
$88.20
|
| Rate for Payer: PACE SWMI |
$92.84
|
| Rate for Payer: PHP Commercial |
$315.65
|
| Rate for Payer: PHP Medicare Advantage |
$92.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.38
|
| Rate for Payer: Priority Health HMO/PPO |
$323.07
|
| Rate for Payer: Priority Health Medicare |
$93.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.80
|
| Rate for Payer: Railroad Medicare Medicare |
$92.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.79
|
| Rate for Payer: UHC Core |
$310.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.84
|
| Rate for Payer: UHC Exchange |
$92.84
|
| Rate for Payer: UHC Medicare Advantage |
$92.84
|
| Rate for Payer: VA VA |
$92.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.51
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.90 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna Medicare |
$78.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.61
|
| Rate for Payer: BCBS Complete |
$121.10
|
| Rate for Payer: BCBS MAPPO |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$248.89
|
| Rate for Payer: BCN Commercial |
$235.39
|
| Rate for Payer: BCN Medicare Advantage |
$75.69
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$260.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.69
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: Nomi Health Commercial |
$248.25
|
| Rate for Payer: PACE Senior Care Partners |
$71.90
|
| Rate for Payer: PACE SWMI |
$75.69
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: PHP Medicare Advantage |
$75.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.79
|
| Rate for Payer: Priority Health HMO/PPO |
$263.39
|
| Rate for Payer: Priority Health Medicare |
$76.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.84
|
| Rate for Payer: Railroad Medicare Medicare |
$75.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.42
|
| Rate for Payer: UHC Core |
$252.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.69
|
| Rate for Payer: UHC Exchange |
$75.69
|
| Rate for Payer: UHC Medicare Advantage |
$75.69
|
| Rate for Payer: VA VA |
$75.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.79 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: BCBS Trust/PPO |
$247.13
|
| Rate for Payer: BCN Commercial |
$233.97
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$260.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: Nomi Health Commercial |
$248.25
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.79
|
| Rate for Payer: Priority Health HMO/PPO |
$263.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.42
|
| Rate for Payer: UHC Core |
$252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.73 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna Commercial |
$625.35
|
| Rate for Payer: Aetna Medicare |
$191.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.91
|
| Rate for Payer: BCBS Complete |
$294.28
|
| Rate for Payer: BCBS MAPPO |
$183.93
|
| Rate for Payer: BCBS Trust/PPO |
$604.82
|
| Rate for Payer: BCN Commercial |
$572.01
|
| Rate for Payer: BCN Medicare Advantage |
$183.93
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.93
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.35
|
| Rate for Payer: Nomi Health Commercial |
$603.27
|
| Rate for Payer: PACE Senior Care Partners |
$174.73
|
| Rate for Payer: PACE SWMI |
$183.93
|
| Rate for Payer: PHP Commercial |
$625.35
|
| Rate for Payer: PHP Medicare Advantage |
$183.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.20
|
| Rate for Payer: Priority Health HMO/PPO |
$640.06
|
| Rate for Payer: Priority Health Medicare |
$185.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.92
|
| Rate for Payer: Railroad Medicare Medicare |
$183.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.42
|
| Rate for Payer: UHC Core |
$614.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.93
|
| Rate for Payer: UHC Exchange |
$183.93
|
| Rate for Payer: UHC Medicare Advantage |
$183.93
|
| Rate for Payer: VA VA |
$183.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.77
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$371.35
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.38 |
| Max. Negotiated Rate |
$334.21 |
| Rate for Payer: Aetna Commercial |
$315.65
|
| Rate for Payer: BCBS Trust/PPO |
$303.13
|
| Rate for Payer: BCN Commercial |
$286.98
|
| Rate for Payer: Cash Price |
$297.08
|
| Rate for Payer: Cofinity Commercial |
$319.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.08
|
| Rate for Payer: Healthscope Commercial |
$334.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.65
|
| Rate for Payer: Nomi Health Commercial |
$304.51
|
| Rate for Payer: PHP Commercial |
$315.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.38
|
| Rate for Payer: Priority Health HMO/PPO |
$323.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.79
|
| Rate for Payer: UHC Core |
$310.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.51
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCN Commercial |
$11.08
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$11.76
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.32
|
| Rate for Payer: Priority Health HMO/PPO |
$12.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.62
|
| Rate for Payer: UHC Core |
$11.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 00395041396
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$3.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.48
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.79
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: Nomi Health Commercial |
$11.76
|
| Rate for Payer: PACE Senior Care Partners |
$3.41
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.32
|
| Rate for Payer: Priority Health HMO/PPO |
$12.48
|
| Rate for Payer: Priority Health Medicare |
$3.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.61
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.62
|
| Rate for Payer: UHC Core |
$11.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: VA VA |
$3.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$137.24
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: Aetna Medicare |
$35.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.89
|
| Rate for Payer: BCBS Complete |
$54.90
|
| Rate for Payer: BCBS MAPPO |
$34.31
|
| Rate for Payer: BCBS Trust/PPO |
$112.83
|
| Rate for Payer: BCN Commercial |
$106.70
|
| Rate for Payer: BCN Medicare Advantage |
$34.31
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$118.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.31
|
| Rate for Payer: Healthscope Commercial |
$123.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: Nomi Health Commercial |
$112.54
|
| Rate for Payer: PACE Senior Care Partners |
$32.59
|
| Rate for Payer: PACE SWMI |
$34.31
|
| Rate for Payer: PHP Commercial |
$116.65
|
| Rate for Payer: PHP Medicare Advantage |
$34.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.21
|
| Rate for Payer: Priority Health HMO/PPO |
$119.40
|
| Rate for Payer: Priority Health Medicare |
$34.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.95
|
| Rate for Payer: Railroad Medicare Medicare |
$34.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.77
|
| Rate for Payer: UHC Core |
$114.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.31
|
| Rate for Payer: UHC Exchange |
$34.31
|
| Rate for Payer: UHC Medicare Advantage |
$34.31
|
| Rate for Payer: VA VA |
$34.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.93
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$243.71
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna Medicare |
$63.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.16
|
| Rate for Payer: BCBS Complete |
$97.48
|
| Rate for Payer: BCBS MAPPO |
$60.93
|
| Rate for Payer: BCBS Trust/PPO |
$200.35
|
| Rate for Payer: BCN Commercial |
$189.48
|
| Rate for Payer: BCN Medicare Advantage |
$60.93
|
| 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: Health Alliance Plan Medicare Advantage |
$60.93
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: Nomi Health Commercial |
$199.84
|
| Rate for Payer: PACE Senior Care Partners |
$57.88
|
| Rate for Payer: PACE SWMI |
$60.93
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: PHP Medicare Advantage |
$60.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.41
|
| Rate for Payer: Priority Health HMO/PPO |
$212.03
|
| Rate for Payer: Priority Health Medicare |
$61.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.29
|
| Rate for Payer: Railroad Medicare Medicare |
$60.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.46
|
| Rate for Payer: UHC Core |
$203.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.93
|
| Rate for Payer: UHC Exchange |
$60.93
|
| Rate for Payer: UHC Medicare Advantage |
$60.93
|
| Rate for Payer: VA VA |
$60.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
|
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 |
$158.41 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: BCBS Trust/PPO |
$198.94
|
| Rate for Payer: BCN Commercial |
$188.34
|
| 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: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.41
|
| Rate for Payer: Priority Health HMO/PPO |
$212.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.29
|
| 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/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$137.24
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.21 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: BCBS Trust/PPO |
$112.03
|
| Rate for Payer: BCN Commercial |
$106.06
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$118.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.79
|
| Rate for Payer: Healthscope Commercial |
$123.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: Nomi Health Commercial |
$112.54
|
| Rate for Payer: PHP Commercial |
$116.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.21
|
| Rate for Payer: Priority Health HMO/PPO |
$119.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.77
|
| Rate for Payer: UHC Core |
$114.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.93
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$2,276.64
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$350.63 |
| Max. Negotiated Rate |
$2,048.98 |
| Rate for Payer: Aetna Commercial |
$1,935.14
|
| Rate for Payer: Aetna Commercial |
$2,011.03
|
| Rate for Payer: Aetna Medicare |
$591.93
|
| Rate for Payer: Aetna Medicare |
$615.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$711.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$739.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$711.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$739.35
|
| Rate for Payer: BCBS Complete |
$368.19
|
| Rate for Payer: BCBS Complete |
$368.19
|
| Rate for Payer: BCBS MAPPO |
$591.48
|
| Rate for Payer: BCBS MAPPO |
$569.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,871.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,945.02
|
| Rate for Payer: BCN Commercial |
$1,770.09
|
| Rate for Payer: BCN Commercial |
$1,839.50
|
| Rate for Payer: BCN Medicare Advantage |
$569.16
|
| Rate for Payer: BCN Medicare Advantage |
$591.48
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cofinity Commercial |
$1,957.91
|
| Rate for Payer: Cofinity Commercial |
$2,034.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.48
|
| Rate for Payer: Healthscope Commercial |
$2,129.33
|
| Rate for Payer: Healthscope Commercial |
$2,048.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,774.44
|
| Rate for Payer: Mclaren Medicaid |
$350.63
|
| Rate for Payer: Mclaren Medicaid |
$350.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$597.62
|
| Rate for Payer: Meridian Medicaid |
$368.19
|
| Rate for Payer: Meridian Medicaid |
$368.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$654.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$680.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.03
|
| Rate for Payer: Nomi Health Commercial |
$1,866.84
|
| Rate for Payer: Nomi Health Commercial |
$1,940.05
|
| Rate for Payer: PACE Senior Care Partners |
$540.70
|
| Rate for Payer: PACE Senior Care Partners |
$561.91
|
| Rate for Payer: PACE SWMI |
$569.16
|
| Rate for Payer: PACE SWMI |
$591.48
|
| Rate for Payer: PHP Commercial |
$2,011.03
|
| Rate for Payer: PHP Commercial |
$1,935.14
|
| Rate for Payer: PHP Medicare Advantage |
$569.16
|
| Rate for Payer: PHP Medicare Advantage |
$591.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2,058.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,980.68
|
| Rate for Payer: Priority Health Medicare |
$574.85
|
| Rate for Payer: Priority Health Medicare |
$597.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,525.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,585.17
|
| Rate for Payer: Railroad Medicare Medicare |
$591.48
|
| Rate for Payer: Railroad Medicare Medicare |
$569.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,082.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,003.44
|
| Rate for Payer: UHC Core |
$1,975.54
|
| Rate for Payer: UHC Core |
$1,900.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$569.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.48
|
| Rate for Payer: UHC Exchange |
$591.48
|
| Rate for Payer: UHC Exchange |
$569.16
|
| Rate for Payer: UHC Medicare Advantage |
$591.48
|
| Rate for Payer: UHC Medicare Advantage |
$569.16
|
| Rate for Payer: UHCCP Medicaid |
$350.63
|
| Rate for Payer: UHCCP Medicaid |
$350.63
|
| Rate for Payer: VA VA |
$569.16
|
| Rate for Payer: VA VA |
$591.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,774.44
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,276.64
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,479.82 |
| Max. Negotiated Rate |
$2,048.98 |
| Rate for Payer: Aetna Commercial |
$1,935.14
|
| Rate for Payer: Aetna Commercial |
$2,011.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,931.30
|
| Rate for Payer: BCN Commercial |
$1,759.39
|
| Rate for Payer: BCN Commercial |
$1,828.38
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cofinity Commercial |
$2,034.69
|
| Rate for Payer: Cofinity Commercial |
$1,957.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.31
|
| Rate for Payer: Healthscope Commercial |
$2,048.98
|
| Rate for Payer: Healthscope Commercial |
$2,129.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,774.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.03
|
| Rate for Payer: Nomi Health Commercial |
$1,866.84
|
| Rate for Payer: Nomi Health Commercial |
$1,940.05
|
| Rate for Payer: PHP Commercial |
$1,935.14
|
| Rate for Payer: PHP Commercial |
$2,011.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.82
|
| Rate for Payer: Priority Health HMO/PPO |
$2,058.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,980.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,525.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,585.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,003.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,082.01
|
| Rate for Payer: UHC Core |
$1,900.99
|
| Rate for Payer: UHC Core |
$1,975.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,774.44
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$322.56
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.66 |
| Max. Negotiated Rate |
$290.30 |
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: BCBS Trust/PPO |
$263.31
|
| Rate for Payer: BCN Commercial |
$249.27
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cofinity Commercial |
$277.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.05
|
| Rate for Payer: Healthscope Commercial |
$290.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.18
|
| Rate for Payer: Nomi Health Commercial |
$264.50
|
| Rate for Payer: PHP Commercial |
$274.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.66
|
| Rate for Payer: Priority Health HMO/PPO |
$280.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.85
|
| Rate for Payer: UHC Core |
$269.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.92
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$3.23
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.01
|
| Rate for Payer: BCBS Complete |
$1.29
|
| Rate for Payer: BCBS MAPPO |
$0.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: BCN Medicare Advantage |
$0.81
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.65
|
| Rate for Payer: PACE Senior Care Partners |
$0.77
|
| Rate for Payer: PACE SWMI |
$0.81
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: PHP Medicare Advantage |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health HMO/PPO |
$2.81
|
| Rate for Payer: Priority Health Medicare |
$0.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.16
|
| Rate for Payer: Railroad Medicare Medicare |
$0.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.84
|
| Rate for Payer: UHC Core |
$2.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.81
|
| Rate for Payer: UHC Exchange |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$0.81
|
| Rate for Payer: VA VA |
$0.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health HMO/PPO |
$2.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.84
|
| Rate for Payer: UHC Core |
$2.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$322.56
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.61 |
| Max. Negotiated Rate |
$290.30 |
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: Aetna Medicare |
$83.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.80
|
| Rate for Payer: BCBS Complete |
$129.02
|
| Rate for Payer: BCBS MAPPO |
$80.64
|
| Rate for Payer: BCBS Trust/PPO |
$265.18
|
| Rate for Payer: BCN Commercial |
$250.79
|
| Rate for Payer: BCN Medicare Advantage |
$80.64
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cofinity Commercial |
$277.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$290.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.18
|
| Rate for Payer: Nomi Health Commercial |
$264.50
|
| Rate for Payer: PACE Senior Care Partners |
$76.61
|
| Rate for Payer: PACE SWMI |
$80.64
|
| Rate for Payer: PHP Commercial |
$274.18
|
| Rate for Payer: PHP Medicare Advantage |
$80.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.66
|
| Rate for Payer: Priority Health HMO/PPO |
$280.63
|
| Rate for Payer: Priority Health Medicare |
$81.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.12
|
| Rate for Payer: Railroad Medicare Medicare |
$80.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.85
|
| Rate for Payer: UHC Core |
$269.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.64
|
| Rate for Payer: UHC Exchange |
$80.64
|
| Rate for Payer: UHC Medicare Advantage |
$80.64
|
| Rate for Payer: VA VA |
$80.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.92
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$422.40
|
|
|
Service Code
|
NDC 00054000725
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.32 |
| 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 |
$168.96
|
| Rate for Payer: BCBS MAPPO |
$105.60
|
| Rate for Payer: BCBS Trust/PPO |
$347.26
|
| Rate for Payer: BCN Commercial |
$328.42
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.04
|
| Rate for Payer: Nomi Health Commercial |
$346.37
|
| 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 Cigna Priority Health |
$274.56
|
| Rate for Payer: Priority Health HMO/PPO |
$367.49
|
| Rate for Payer: Priority Health Medicare |
$106.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.01
|
| 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 Dual Complete DSNP |
$105.60
|
| Rate for Payer: UHC Exchange |
$105.60
|
| Rate for Payer: UHC Medicare Advantage |
$105.60
|
| Rate for Payer: VA VA |
$105.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.80
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$63.84
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: BCBS Trust/PPO |
$52.11
|
| Rate for Payer: BCN Commercial |
$49.34
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$54.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: Nomi Health Commercial |
$52.35
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: Priority Health HMO/PPO |
$55.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.18
|
| Rate for Payer: UHC Core |
$53.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.88
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$63.84
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.95
|
| Rate for Payer: BCBS Complete |
$25.54
|
| Rate for Payer: BCBS MAPPO |
$15.96
|
| Rate for Payer: BCBS Trust/PPO |
$52.48
|
| Rate for Payer: BCN Commercial |
$49.64
|
| Rate for Payer: BCN Medicare Advantage |
$15.96
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$54.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.96
|
| Rate for Payer: Healthscope Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: Nomi Health Commercial |
$52.35
|
| Rate for Payer: PACE Senior Care Partners |
$15.16
|
| Rate for Payer: PACE SWMI |
$15.96
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: PHP Medicare Advantage |
$15.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: Priority Health HMO/PPO |
$55.54
|
| Rate for Payer: Priority Health Medicare |
$16.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.77
|
| Rate for Payer: Railroad Medicare Medicare |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.18
|
| Rate for Payer: UHC Core |
$53.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.96
|
| Rate for Payer: UHC Exchange |
$15.96
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.88
|
|
