|
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
|
|
|
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 |
$540.70 |
| 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 |
$867.32
|
| Rate for Payer: BCBS Complete |
$867.32
|
| 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 |
$825.96
|
| Rate for Payer: Mclaren Medicaid |
$825.96
|
| 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 |
$867.32
|
| Rate for Payer: Meridian Medicaid |
$867.32
|
| 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 |
$825.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$825.96
|
| 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 |
$825.96
|
| Rate for Payer: UHCCP Medicaid |
$825.96
|
| 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
|
|
|
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
|
|
|
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
|
$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
|
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
|
$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
|
$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
|
IP
|
$422.40
|
|
|
Service Code
|
NDC 00054000725
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.56 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$359.04
|
| Rate for Payer: BCBS Trust/PPO |
$344.81
|
| Rate for Payer: BCN Commercial |
$326.43
|
| 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: PHP Commercial |
$359.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.56
|
| Rate for Payer: Priority Health HMO/PPO |
$367.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.01
|
| 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 |
$58.35 |
| 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 |
$98.28
|
| Rate for Payer: BCBS MAPPO |
$61.42
|
| Rate for Payer: BCBS Trust/PPO |
$201.99
|
| Rate for Payer: BCN Commercial |
$191.03
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.84
|
| Rate for Payer: Nomi Health Commercial |
$201.47
|
| 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 Cigna Priority Health |
$159.70
|
| Rate for Payer: Priority Health HMO/PPO |
$213.76
|
| Rate for Payer: Priority Health Medicare |
$62.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.62
|
| 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 Dual Complete DSNP |
$61.42
|
| Rate for Payer: UHC Exchange |
$61.42
|
| Rate for Payer: UHC Medicare Advantage |
$61.42
|
| 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
|
OP
|
$151.20
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$39.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.25
|
| Rate for Payer: BCBS Complete |
$60.48
|
| Rate for Payer: BCBS MAPPO |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$124.30
|
| Rate for Payer: BCN Commercial |
$117.56
|
| Rate for Payer: BCN Medicare Advantage |
$37.80
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.80
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Nomi Health Commercial |
$123.98
|
| Rate for Payer: PACE Senior Care Partners |
$35.91
|
| Rate for Payer: PACE SWMI |
$37.80
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: PHP Medicare Advantage |
$37.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health HMO/PPO |
$131.54
|
| Rate for Payer: Priority Health Medicare |
$38.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.30
|
| Rate for Payer: Railroad Medicare Medicare |
$37.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.06
|
| Rate for Payer: UHC Core |
$126.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.80
|
| Rate for Payer: UHC Exchange |
$37.80
|
| Rate for Payer: UHC Medicare Advantage |
$37.80
|
| Rate for Payer: VA VA |
$37.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: BCBS Trust/PPO |
$123.42
|
| Rate for Payer: BCN Commercial |
$116.85
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Nomi Health Commercial |
$123.98
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health HMO/PPO |
$131.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.06
|
| Rate for Payer: UHC Core |
$126.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
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 |
$159.70 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: BCBS Trust/PPO |
$200.56
|
| Rate for Payer: BCN Commercial |
$189.88
|
| 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: PHP Commercial |
$208.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.70
|
| Rate for Payer: Priority Health HMO/PPO |
$213.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.62
|
| 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 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna Commercial |
$146.20
|
| Rate for Payer: BCBS Trust/PPO |
$140.40
|
| Rate for Payer: BCN Commercial |
$132.92
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.60
|
| Rate for Payer: Healthscope Commercial |
$154.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.20
|
| Rate for Payer: Nomi Health Commercial |
$141.04
|
| Rate for Payer: PHP Commercial |
$146.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health HMO/PPO |
$149.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.36
|
| Rate for Payer: UHC Core |
$143.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.00
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$86.94
|
|
|
Service Code
|
NDC 00536781708
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna Commercial |
$73.90
|
| Rate for Payer: Aetna Medicare |
$22.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.17
|
| Rate for Payer: BCBS Complete |
$34.78
|
| Rate for Payer: BCBS MAPPO |
$21.74
|
| Rate for Payer: BCBS Trust/PPO |
$71.47
|
| Rate for Payer: BCN Commercial |
$67.60
|
| Rate for Payer: BCN Medicare Advantage |
$21.74
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Cofinity Commercial |
$74.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.74
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.90
|
| Rate for Payer: Nomi Health Commercial |
$71.29
|
| Rate for Payer: PACE Senior Care Partners |
$20.65
|
| Rate for Payer: PACE SWMI |
$21.74
|
| Rate for Payer: PHP Commercial |
$73.90
|
| Rate for Payer: PHP Medicare Advantage |
$21.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.51
|
| Rate for Payer: Priority Health HMO/PPO |
$75.64
|
| Rate for Payer: Priority Health Medicare |
$21.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.25
|
| Rate for Payer: Railroad Medicare Medicare |
$21.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.51
|
| Rate for Payer: UHC Core |
$72.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.74
|
| Rate for Payer: UHC Exchange |
$21.74
|
| Rate for Payer: UHC Medicare Advantage |
$21.74
|
| Rate for Payer: VA VA |
$21.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.20
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$170.10
|
|
|
Service Code
|
NDC 57896074201
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$144.58
|
| Rate for Payer: Aetna Medicare |
$44.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.16
|
| Rate for Payer: BCBS Complete |
$68.04
|
| Rate for Payer: BCBS MAPPO |
$42.52
|
| Rate for Payer: BCBS Trust/PPO |
$139.84
|
| Rate for Payer: BCN Commercial |
$132.25
|
| Rate for Payer: BCN Medicare Advantage |
$42.52
|
| Rate for Payer: Cash Price |
$136.08
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.52
|
| Rate for Payer: Healthscope Commercial |
$153.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.58
|
| Rate for Payer: Nomi Health Commercial |
$139.48
|
| Rate for Payer: PACE Senior Care Partners |
$40.40
|
| Rate for Payer: PACE SWMI |
$42.52
|
| Rate for Payer: PHP Commercial |
$144.58
|
| Rate for Payer: PHP Medicare Advantage |
$42.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.56
|
| Rate for Payer: Priority Health HMO/PPO |
$147.99
|
| Rate for Payer: Priority Health Medicare |
$42.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.97
|
| Rate for Payer: Railroad Medicare Medicare |
$42.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.69
|
| Rate for Payer: UHC Core |
$142.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.52
|
| Rate for Payer: UHC Exchange |
$42.52
|
| Rate for Payer: UHC Medicare Advantage |
$42.52
|
| Rate for Payer: VA VA |
$42.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.58
|
|
|
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 |
$122.85 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: BCBS Trust/PPO |
$154.28
|
| Rate for Payer: BCN Commercial |
$146.06
|
| 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: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.85 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna Commercial |
$146.20
|
| Rate for Payer: Aetna Medicare |
$44.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.75
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$43.00
|
| Rate for Payer: BCBS Trust/PPO |
$141.40
|
| Rate for Payer: BCN Commercial |
$133.73
|
| Rate for Payer: BCN Medicare Advantage |
$43.00
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$154.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.20
|
| Rate for Payer: Nomi Health Commercial |
$141.04
|
| Rate for Payer: PACE Senior Care Partners |
$40.85
|
| Rate for Payer: PACE SWMI |
$43.00
|
| Rate for Payer: PHP Commercial |
$146.20
|
| Rate for Payer: PHP Medicare Advantage |
$43.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health HMO/PPO |
$149.64
|
| Rate for Payer: Priority Health Medicare |
$43.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.24
|
| Rate for Payer: Railroad Medicare Medicare |
$43.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.36
|
| Rate for Payer: UHC Core |
$143.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.00
|
| Rate for Payer: UHC Exchange |
$43.00
|
| Rate for Payer: UHC Medicare Advantage |
$43.00
|
| Rate for Payer: VA VA |
$43.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.00
|
|
|
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 |
$44.89 |
| 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 |
$75.60
|
| Rate for Payer: BCBS MAPPO |
$47.25
|
| Rate for Payer: BCBS Trust/PPO |
$155.38
|
| Rate for Payer: BCN Commercial |
$146.95
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| 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 Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Medicare |
$47.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.63
|
| Rate for Payer: Railroad Medicare Medicare |
$47.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.25
|
| Rate for Payer: UHC Exchange |
$47.25
|
| Rate for Payer: UHC Medicare Advantage |
$47.25
|
| 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
|
$170.10
|
|
|
Service Code
|
NDC 57896074201
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.56 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$144.58
|
| Rate for Payer: BCBS Trust/PPO |
$138.85
|
| Rate for Payer: BCN Commercial |
$131.45
|
| Rate for Payer: Cash Price |
$136.08
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.08
|
| Rate for Payer: Healthscope Commercial |
$153.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.58
|
| Rate for Payer: Nomi Health Commercial |
$139.48
|
| Rate for Payer: PHP Commercial |
$144.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.56
|
| Rate for Payer: Priority Health HMO/PPO |
$147.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.69
|
| Rate for Payer: UHC Core |
$142.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.58
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$86.94
|
|
|
Service Code
|
NDC 00536781708
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna Commercial |
$73.90
|
| Rate for Payer: BCBS Trust/PPO |
$70.97
|
| Rate for Payer: BCN Commercial |
$67.19
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Cofinity Commercial |
$74.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.55
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.90
|
| Rate for Payer: Nomi Health Commercial |
$71.29
|
| Rate for Payer: PHP Commercial |
$73.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.51
|
| Rate for Payer: Priority Health HMO/PPO |
$75.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.51
|
| Rate for Payer: UHC Core |
$72.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.20
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
NDC 00536133632
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$336.05 |
| Max. Negotiated Rate |
$465.30 |
| Rate for Payer: Aetna Commercial |
$439.45
|
| Rate for Payer: BCBS Trust/PPO |
$422.03
|
| Rate for Payer: BCN Commercial |
$399.54
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$444.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Healthscope Commercial |
$465.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: Nomi Health Commercial |
$423.94
|
| Rate for Payer: PHP Commercial |
$439.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.05
|
| Rate for Payer: Priority Health HMO/PPO |
$449.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.96
|
| Rate for Payer: UHC Core |
$431.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.75
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
IP
|
$559.30
|
|
|
Service Code
|
NDC 71321080320
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$363.54 |
| Max. Negotiated Rate |
$503.37 |
| Rate for Payer: Aetna Commercial |
$475.40
|
| Rate for Payer: BCBS Trust/PPO |
$456.56
|
| Rate for Payer: BCN Commercial |
$432.23
|
| Rate for Payer: Cash Price |
$447.44
|
| Rate for Payer: Cofinity Commercial |
$481.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$447.44
|
| Rate for Payer: Healthscope Commercial |
$503.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$419.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.40
|
| Rate for Payer: Nomi Health Commercial |
$458.63
|
| Rate for Payer: PHP Commercial |
$475.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.54
|
| Rate for Payer: Priority Health HMO/PPO |
$486.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$374.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.18
|
| Rate for Payer: UHC Core |
$467.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$419.48
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
OP
|
$559.30
|
|
|
Service Code
|
NDC 71321080320
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.83 |
| Max. Negotiated Rate |
$503.37 |
| Rate for Payer: Aetna Commercial |
$475.40
|
| Rate for Payer: Aetna Medicare |
$145.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$174.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$174.78
|
| Rate for Payer: BCBS Complete |
$223.72
|
| Rate for Payer: BCBS MAPPO |
$139.82
|
| Rate for Payer: BCBS Trust/PPO |
$459.80
|
| Rate for Payer: BCN Commercial |
$434.86
|
| Rate for Payer: BCN Medicare Advantage |
$139.82
|
| Rate for Payer: Cash Price |
$447.44
|
| Rate for Payer: Cofinity Commercial |
$481.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$447.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.82
|
| Rate for Payer: Healthscope Commercial |
$503.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$419.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.40
|
| Rate for Payer: Nomi Health Commercial |
$458.63
|
| Rate for Payer: PACE Senior Care Partners |
$132.83
|
| Rate for Payer: PACE SWMI |
$139.82
|
| Rate for Payer: PHP Commercial |
$475.40
|
| Rate for Payer: PHP Medicare Advantage |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.54
|
| Rate for Payer: Priority Health HMO/PPO |
$486.59
|
| Rate for Payer: Priority Health Medicare |
$141.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$374.73
|
| Rate for Payer: Railroad Medicare Medicare |
$139.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.18
|
| Rate for Payer: UHC Core |
$467.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.82
|
| Rate for Payer: UHC Exchange |
$139.82
|
| Rate for Payer: UHC Medicare Advantage |
$139.82
|
| Rate for Payer: VA VA |
$139.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$419.48
|
|
