|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 00904253321
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna American Axle |
$5.52
|
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.52
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.52
|
| Rate for Payer: Priority Health SBD |
$5.36
|
| Rate for Payer: UMR Bronson Commercial |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
CALASPARGASE PEGOL-MKNL 750 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$130,372.23
|
|
|
Service Code
|
HCPCS J9118
|
| Hospital Charge Code |
191705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$117,335.01 |
| Rate for Payer: Aetna American Axle |
$84,741.95
|
| Rate for Payer: Aetna Commercial |
$110,816.40
|
| Rate for Payer: Aetna Medicare |
$65,186.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84,741.95
|
| Rate for Payer: BCBS Complete |
$52,148.89
|
| Rate for Payer: BCBS Trust/PPO |
$206.34
|
| Rate for Payer: BCN Commercial |
$206.34
|
| Rate for Payer: Cash Price |
$104,297.78
|
| Rate for Payer: Cash Price |
$104,297.78
|
| Rate for Payer: Cofinity Commercial |
$112,120.12
|
| Rate for Payer: Cofinity Commercial |
$91,260.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$91,260.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104,297.78
|
| Rate for Payer: Healthscope Commercial |
$117,335.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91,260.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97,779.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110,816.40
|
| Rate for Payer: PHP Commercial |
$110,816.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84,741.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.53
|
| Rate for Payer: Priority Health Narrow Network |
$61.22
|
| Rate for Payer: Priority Health SBD |
$82,134.50
|
| Rate for Payer: UMR Bronson Commercial |
$48,237.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97,779.17
|
|
|
CALASPARGASE PEGOL-MKNL 750 UNIT/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130,372.23
|
|
|
Service Code
|
HCPCS J9118
|
| Hospital Charge Code |
191705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57,363.78 |
| Max. Negotiated Rate |
$117,335.01 |
| Rate for Payer: Aetna American Axle |
$84,741.95
|
| Rate for Payer: Aetna Commercial |
$110,816.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84,741.95
|
| Rate for Payer: Cash Price |
$104,297.78
|
| Rate for Payer: Cofinity Commercial |
$112,120.12
|
| Rate for Payer: Cofinity Commercial |
$91,260.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$91,260.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104,297.78
|
| Rate for Payer: Healthscope Commercial |
$117,335.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91,260.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97,779.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110,816.40
|
| Rate for Payer: PHP Commercial |
$110,816.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84,741.95
|
| Rate for Payer: Priority Health SBD |
$82,134.50
|
| Rate for Payer: UMR Bronson Commercial |
$57,363.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97,779.17
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$683.76
|
|
|
Service Code
|
NDC 68462050165
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.99 |
| Max. Negotiated Rate |
$615.38 |
| Rate for Payer: Aetna American Axle |
$444.44
|
| Rate for Payer: Aetna Commercial |
$581.20
|
| Rate for Payer: Aetna Medicare |
$341.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.44
|
| Rate for Payer: BCBS Complete |
$273.50
|
| Rate for Payer: Cash Price |
$547.01
|
| Rate for Payer: Cofinity Commercial |
$478.63
|
| Rate for Payer: Cofinity Commercial |
$588.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$478.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.01
|
| Rate for Payer: Healthscope Commercial |
$615.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$478.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$512.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.20
|
| Rate for Payer: PHP Commercial |
$581.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.44
|
| Rate for Payer: Priority Health SBD |
$430.77
|
| Rate for Payer: UMR Bronson Commercial |
$252.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$512.82
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$254.31
|
|
|
Service Code
|
NDC 66993087761
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.90 |
| Max. Negotiated Rate |
$228.88 |
| Rate for Payer: Aetna American Axle |
$165.30
|
| Rate for Payer: Aetna Commercial |
$216.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.30
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cofinity Commercial |
$178.02
|
| Rate for Payer: Cofinity Commercial |
$218.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.45
|
| Rate for Payer: Healthscope Commercial |
$228.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.16
|
| Rate for Payer: PHP Commercial |
$216.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.30
|
| Rate for Payer: Priority Health SBD |
$160.22
|
| Rate for Payer: UMR Bronson Commercial |
$111.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.73
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$1,150.59
|
|
|
Service Code
|
NDC 00781711735
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.26 |
| Max. Negotiated Rate |
$1,035.53 |
| Rate for Payer: Aetna American Axle |
$747.88
|
| Rate for Payer: Aetna Commercial |
$978.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.88
|
| Rate for Payer: Cash Price |
$920.47
|
| Rate for Payer: Cofinity Commercial |
$805.41
|
| Rate for Payer: Cofinity Commercial |
$989.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$805.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.47
|
| Rate for Payer: Healthscope Commercial |
$1,035.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$805.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.00
|
| Rate for Payer: PHP Commercial |
$978.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.88
|
| Rate for Payer: Priority Health SBD |
$724.87
|
| Rate for Payer: UMR Bronson Commercial |
$506.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.94
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
IP
|
$683.76
|
|
|
Service Code
|
NDC 68462050165
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.85 |
| Max. Negotiated Rate |
$615.38 |
| Rate for Payer: Aetna American Axle |
$444.44
|
| Rate for Payer: Aetna Commercial |
$581.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.44
|
| Rate for Payer: Cash Price |
$547.01
|
| Rate for Payer: Cofinity Commercial |
$478.63
|
| Rate for Payer: Cofinity Commercial |
$588.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$478.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.01
|
| Rate for Payer: Healthscope Commercial |
$615.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$478.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$512.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.20
|
| Rate for Payer: PHP Commercial |
$581.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.44
|
| Rate for Payer: Priority Health SBD |
$430.77
|
| Rate for Payer: UMR Bronson Commercial |
$300.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$512.82
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$254.31
|
|
|
Service Code
|
NDC 66993087761
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$228.88 |
| Rate for Payer: Aetna American Axle |
$165.30
|
| Rate for Payer: Aetna Commercial |
$216.16
|
| Rate for Payer: Aetna Medicare |
$127.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.30
|
| Rate for Payer: BCBS Complete |
$101.72
|
| Rate for Payer: Cash Price |
$203.45
|
| Rate for Payer: Cofinity Commercial |
$178.02
|
| Rate for Payer: Cofinity Commercial |
$218.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.45
|
| Rate for Payer: Healthscope Commercial |
$228.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.16
|
| Rate for Payer: PHP Commercial |
$216.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.30
|
| Rate for Payer: Priority Health SBD |
$160.22
|
| Rate for Payer: UMR Bronson Commercial |
$94.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.73
|
|
|
CALCIPOTRIENE 0.005 % TOPICAL CREAM
|
Facility
|
OP
|
$1,150.59
|
|
|
Service Code
|
NDC 00781711735
|
| Hospital Charge Code |
16034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.72 |
| Max. Negotiated Rate |
$1,035.53 |
| Rate for Payer: Aetna American Axle |
$747.88
|
| Rate for Payer: Aetna Commercial |
$978.00
|
| Rate for Payer: Aetna Medicare |
$575.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.88
|
| Rate for Payer: BCBS Complete |
$460.24
|
| Rate for Payer: Cash Price |
$920.47
|
| Rate for Payer: Cofinity Commercial |
$805.41
|
| Rate for Payer: Cofinity Commercial |
$989.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$805.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$920.47
|
| Rate for Payer: Healthscope Commercial |
$1,035.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$805.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.00
|
| Rate for Payer: PHP Commercial |
$978.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.88
|
| Rate for Payer: Priority Health SBD |
$724.87
|
| Rate for Payer: UMR Bronson Commercial |
$425.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.94
|
|
|
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 |
$107.23 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna American Axle |
$158.41
|
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.41
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$170.60
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.41
|
| Rate for Payer: Priority Health SBD |
$153.54
|
| Rate for Payer: UMR Bronson Commercial |
$107.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.78
|
|
|
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 |
$50.78 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Aetna American Axle |
$89.21
|
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: Aetna Medicare |
$68.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.21
|
| Rate for Payer: BCBS Complete |
$54.90
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$118.03
|
| Rate for Payer: Cofinity Commercial |
$96.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.79
|
| Rate for Payer: Healthscope Commercial |
$123.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: PHP Commercial |
$116.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.21
|
| Rate for Payer: Priority Health SBD |
$86.46
|
| Rate for Payer: UMR Bronson Commercial |
$50.78
|
| 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 |
$90.17 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna American Axle |
$158.41
|
| Rate for Payer: Aetna Commercial |
$207.15
|
| Rate for Payer: Aetna Medicare |
$121.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.41
|
| Rate for Payer: BCBS Complete |
$97.48
|
| Rate for Payer: Cash Price |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$170.60
|
| Rate for Payer: Cofinity Commercial |
$209.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.97
|
| Rate for Payer: Healthscope Commercial |
$219.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.15
|
| Rate for Payer: PHP Commercial |
$207.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.41
|
| Rate for Payer: Priority Health SBD |
$153.54
|
| Rate for Payer: UMR Bronson Commercial |
$90.17
|
| 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 |
$60.39 |
| Max. Negotiated Rate |
$123.52 |
| Rate for Payer: Aetna American Axle |
$89.21
|
| Rate for Payer: Aetna Commercial |
$116.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.21
|
| Rate for Payer: Cash Price |
$109.79
|
| Rate for Payer: Cofinity Commercial |
$118.03
|
| Rate for Payer: Cofinity Commercial |
$96.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.79
|
| Rate for Payer: Healthscope Commercial |
$123.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.65
|
| Rate for Payer: PHP Commercial |
$116.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.21
|
| Rate for Payer: Priority Health SBD |
$86.46
|
| Rate for Payer: UMR Bronson Commercial |
$60.39
|
| 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 |
$612.33 |
| Max. Negotiated Rate |
$3,427.23 |
| Rate for Payer: Aetna American Axle |
$1,479.82
|
| Rate for Payer: Aetna American Axle |
$1,537.85
|
| Rate for Payer: Aetna American Axle |
$1,664.75
|
| Rate for Payer: Aetna Commercial |
$2,176.99
|
| Rate for Payer: Aetna Commercial |
$1,935.14
|
| Rate for Payer: Aetna Commercial |
$2,011.03
|
| Rate for Payer: Aetna Medicare |
$1,188.11
|
| Rate for Payer: Aetna Medicare |
$1,188.11
|
| Rate for Payer: Aetna Medicare |
$1,188.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,664.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,428.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,428.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,428.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,428.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,428.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,428.01
|
| Rate for Payer: BCBS Complete |
$642.95
|
| Rate for Payer: BCBS Complete |
$642.95
|
| Rate for Payer: BCBS Complete |
$642.95
|
| Rate for Payer: BCBS MAPPO |
$1,142.41
|
| Rate for Payer: BCBS MAPPO |
$1,142.41
|
| Rate for Payer: BCBS MAPPO |
$1,142.41
|
| Rate for Payer: BCBS Trust/PPO |
$3,162.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,162.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,162.95
|
| Rate for Payer: BCN Commercial |
$3,162.95
|
| Rate for Payer: BCN Commercial |
$3,162.95
|
| Rate for Payer: BCN Commercial |
$3,162.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.41
|
| Rate for Payer: Cash Price |
$2,048.93
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cash Price |
$2,048.93
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cofinity Commercial |
$2,202.60
|
| Rate for Payer: Cofinity Commercial |
$1,957.91
|
| Rate for Payer: Cofinity Commercial |
$1,593.65
|
| Rate for Payer: Cofinity Commercial |
$2,034.69
|
| Rate for Payer: Cofinity Commercial |
$1,656.14
|
| Rate for Payer: Cofinity Commercial |
$1,792.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,792.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,593.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.41
|
| Rate for Payer: Healthscope Commercial |
$2,048.98
|
| Rate for Payer: Healthscope Commercial |
$2,305.04
|
| Rate for Payer: Healthscope Commercial |
$2,129.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,792.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,656.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,593.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,920.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,774.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.48
|
| Rate for Payer: Mclaren Medicaid |
$612.33
|
| Rate for Payer: Mclaren Medicaid |
$612.33
|
| Rate for Payer: Mclaren Medicaid |
$612.33
|
| Rate for Payer: Mclaren Medicare |
$1,142.41
|
| Rate for Payer: Mclaren Medicare |
$1,142.41
|
| Rate for Payer: Mclaren Medicare |
$1,142.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.53
|
| Rate for Payer: Meridian Medicaid |
$642.95
|
| Rate for Payer: Meridian Medicaid |
$642.95
|
| Rate for Payer: Meridian Medicaid |
$642.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.99
|
| 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 |
$3,427.23
|
| Rate for Payer: Nomi Health Commercial |
$3,427.23
|
| Rate for Payer: Nomi Health Commercial |
$3,427.23
|
| Rate for Payer: PACE Medicare |
$1,085.29
|
| Rate for Payer: PACE Medicare |
$1,085.29
|
| Rate for Payer: PACE Medicare |
$1,085.29
|
| Rate for Payer: PACE SWMI |
$1,142.41
|
| Rate for Payer: PACE SWMI |
$1,142.41
|
| Rate for Payer: PACE SWMI |
$1,142.41
|
| Rate for Payer: PHP Commercial |
$2,011.03
|
| Rate for Payer: PHP Commercial |
$1,935.14
|
| Rate for Payer: PHP Commercial |
$2,176.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.75
|
| 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/Tiered Network |
$3,376.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,376.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,376.10
|
| Rate for Payer: Priority Health Medicare |
$1,142.41
|
| Rate for Payer: Priority Health Medicare |
$1,142.41
|
| Rate for Payer: Priority Health Medicare |
$1,142.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,700.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,700.88
|
| Rate for Payer: Priority Health Narrow Network |
$2,700.88
|
| Rate for Payer: Priority Health SBD |
$1,434.28
|
| Rate for Payer: Priority Health SBD |
$1,490.53
|
| Rate for Payer: Priority Health SBD |
$1,613.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,215.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,215.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,215.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.41
|
| Rate for Payer: UHC Exchange |
$2,183.26
|
| Rate for Payer: UHC Exchange |
$2,183.26
|
| Rate for Payer: UHC Exchange |
$2,183.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.41
|
| Rate for Payer: UHCCP Medicaid |
$612.33
|
| Rate for Payer: UHCCP Medicaid |
$612.33
|
| Rate for Payer: UHCCP Medicaid |
$612.33
|
| Rate for Payer: UMR Bronson Commercial |
$875.39
|
| Rate for Payer: UMR Bronson Commercial |
$842.36
|
| Rate for Payer: UMR Bronson Commercial |
$947.63
|
| Rate for Payer: VA VA |
$1,142.41
|
| Rate for Payer: VA VA |
$1,142.41
|
| Rate for Payer: VA VA |
$1,142.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,707.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,920.87
|
| 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 |
$1,001.72 |
| Max. Negotiated Rate |
$2,048.98 |
| Rate for Payer: Aetna American Axle |
$1,479.82
|
| Rate for Payer: Aetna American Axle |
$1,537.85
|
| Rate for Payer: Aetna American Axle |
$1,664.75
|
| Rate for Payer: Aetna Commercial |
$2,011.03
|
| Rate for Payer: Aetna Commercial |
$1,935.14
|
| Rate for Payer: Aetna Commercial |
$2,176.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,664.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.85
|
| Rate for Payer: Cash Price |
$2,048.93
|
| Rate for Payer: Cash Price |
$1,892.74
|
| Rate for Payer: Cash Price |
$1,821.31
|
| Rate for Payer: Cofinity Commercial |
$1,957.91
|
| Rate for Payer: Cofinity Commercial |
$2,034.69
|
| Rate for Payer: Cofinity Commercial |
$1,656.14
|
| Rate for Payer: Cofinity Commercial |
$2,202.60
|
| Rate for Payer: Cofinity Commercial |
$1,792.81
|
| Rate for Payer: Cofinity Commercial |
$1,593.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,656.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,593.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,792.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,048.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,821.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,892.74
|
| Rate for Payer: Healthscope Commercial |
$2,129.33
|
| Rate for Payer: Healthscope Commercial |
$2,048.98
|
| Rate for Payer: Healthscope Commercial |
$2,305.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,593.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,656.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,792.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,774.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,707.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,920.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,176.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,011.03
|
| Rate for Payer: PHP Commercial |
$2,176.99
|
| Rate for Payer: PHP Commercial |
$2,011.03
|
| Rate for Payer: PHP Commercial |
$1,935.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,479.82
|
| Rate for Payer: Priority Health SBD |
$1,613.53
|
| Rate for Payer: Priority Health SBD |
$1,490.53
|
| Rate for Payer: Priority Health SBD |
$1,434.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,001.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,041.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,920.87
|
| 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
|
$228.39
|
|
|
Service Code
|
NDC 30698014323
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.49 |
| Max. Negotiated Rate |
$205.55 |
| Rate for Payer: Aetna American Axle |
$148.45
|
| Rate for Payer: Aetna Commercial |
$194.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.45
|
| Rate for Payer: Cash Price |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$159.87
|
| Rate for Payer: Cofinity Commercial |
$196.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.71
|
| Rate for Payer: Healthscope Commercial |
$205.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.13
|
| Rate for Payer: PHP Commercial |
$194.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.45
|
| Rate for Payer: Priority Health SBD |
$143.89
|
| Rate for Payer: UMR Bronson Commercial |
$100.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.29
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$63.84
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.09 |
| Max. Negotiated Rate |
$57.46 |
| Rate for Payer: Aetna American Axle |
$41.50
|
| Rate for Payer: Aetna Commercial |
$54.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.50
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cofinity Commercial |
$44.69
|
| Rate for Payer: Cofinity Commercial |
$54.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$57.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.26
|
| Rate for Payer: PHP Commercial |
$54.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.50
|
| Rate for Payer: Priority Health SBD |
$40.22
|
| Rate for Payer: UMR Bronson Commercial |
$28.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.88
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$137.09
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna American Axle |
$89.11
|
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna Medicare |
$68.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.11
|
| Rate for Payer: BCBS Complete |
$54.84
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| Rate for Payer: Cofinity Commercial |
$95.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.11
|
| Rate for Payer: Priority Health SBD |
$86.37
|
| Rate for Payer: UMR Bronson Commercial |
$50.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.82
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna American Axle |
$2.10
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$352.50
|
|
|
Service Code
|
NDC 23155066201
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna Medicare |
$176.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: BCBS Complete |
$141.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.12
|
| Rate for Payer: Priority Health SBD |
$222.08
|
| Rate for Payer: UMR Bronson Commercial |
$130.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$228.39
|
|
|
Service Code
|
NDC 30698014323
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$205.55 |
| Rate for Payer: Aetna American Axle |
$148.45
|
| Rate for Payer: Aetna Commercial |
$194.13
|
| Rate for Payer: Aetna Medicare |
$114.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.45
|
| Rate for Payer: BCBS Complete |
$91.36
|
| Rate for Payer: Cash Price |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$159.87
|
| Rate for Payer: Cofinity Commercial |
$196.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.71
|
| Rate for Payer: Healthscope Commercial |
$205.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.13
|
| Rate for Payer: PHP Commercial |
$194.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.45
|
| Rate for Payer: Priority Health SBD |
$143.89
|
| Rate for Payer: UMR Bronson Commercial |
$84.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.29
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
NDC 69452020713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna American Axle |
$46.68
|
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.68
|
| Rate for Payer: Priority Health SBD |
$45.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.86
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$3.23
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna American Axle |
$2.10
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: BCBS Complete |
$1.29
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 23155066201
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.12
|
| Rate for Payer: Priority Health SBD |
$222.08
|
| Rate for Payer: UMR Bronson Commercial |
$155.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$322.56
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.93 |
| Max. Negotiated Rate |
$290.30 |
| Rate for Payer: Aetna American Axle |
$209.66
|
| Rate for Payer: Aetna Commercial |
$274.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.66
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cofinity Commercial |
$225.79
|
| Rate for Payer: Cofinity Commercial |
$277.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.05
|
| Rate for Payer: Healthscope Commercial |
$290.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.18
|
| Rate for Payer: PHP Commercial |
$274.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.66
|
| Rate for Payer: Priority Health SBD |
$203.21
|
| Rate for Payer: UMR Bronson Commercial |
$141.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.92
|
|
