|
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 |
$55.94 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$75.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: BCBS Complete |
$60.48
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$55.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$140.70
|
|
|
Service Code
|
NDC 48433010601
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.06 |
| Max. Negotiated Rate |
$126.63 |
| Rate for Payer: Aetna American Axle |
$91.45
|
| Rate for Payer: Aetna Commercial |
$119.59
|
| Rate for Payer: Aetna Medicare |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.45
|
| Rate for Payer: BCBS Complete |
$56.28
|
| Rate for Payer: Cash Price |
$112.56
|
| Rate for Payer: Cofinity Commercial |
$121.00
|
| Rate for Payer: Cofinity Commercial |
$98.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.56
|
| Rate for Payer: Healthscope Commercial |
$126.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.59
|
| Rate for Payer: PHP Commercial |
$119.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.45
|
| Rate for Payer: Priority Health SBD |
$88.64
|
| Rate for Payer: UMR Bronson Commercial |
$52.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.53
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$141.75
|
|
|
Service Code
|
NDC 70000003401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Aetna American Axle |
$92.14
|
| Rate for Payer: Aetna Commercial |
$120.49
|
| Rate for Payer: Aetna Medicare |
$70.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.14
|
| Rate for Payer: BCBS Complete |
$56.70
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$121.91
|
| Rate for Payer: Cofinity Commercial |
$99.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.40
|
| Rate for Payer: Healthscope Commercial |
$127.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.49
|
| Rate for Payer: PHP Commercial |
$120.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.14
|
| Rate for Payer: Priority Health SBD |
$89.30
|
| Rate for Payer: UMR Bronson Commercial |
$52.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.31
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$141.75
|
|
|
Service Code
|
NDC 70000003401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Aetna American Axle |
$92.14
|
| Rate for Payer: Aetna Commercial |
$120.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.14
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$121.91
|
| Rate for Payer: Cofinity Commercial |
$99.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.40
|
| Rate for Payer: Healthscope Commercial |
$127.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.49
|
| Rate for Payer: PHP Commercial |
$120.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.14
|
| Rate for Payer: Priority Health SBD |
$89.30
|
| Rate for Payer: UMR Bronson Commercial |
$62.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.31
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$577.50
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.68 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna American Axle |
$375.38
|
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: Aetna Medicare |
$288.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.38
|
| Rate for Payer: BCBS Complete |
$231.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$404.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.38
|
| Rate for Payer: Priority Health SBD |
$363.82
|
| Rate for Payer: UMR Bronson Commercial |
$213.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.12
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$132.30
|
|
|
Service Code
|
NDC 09629513811
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna American Axle |
$86.00
|
| Rate for Payer: Aetna Commercial |
$112.45
|
| Rate for Payer: Aetna Medicare |
$66.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: BCBS Complete |
$52.92
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: PHP Commercial |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.00
|
| Rate for Payer: Priority Health SBD |
$83.35
|
| Rate for Payer: UMR Bronson Commercial |
$48.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$577.50
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna American Axle |
$375.38
|
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.38
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$404.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.88
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.38
|
| Rate for Payer: Priority Health SBD |
$363.82
|
| Rate for Payer: UMR Bronson Commercial |
$254.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.12
|
|
|
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 |
$66.53 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$66.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
CALCIUM 200 MG (AS CALCIUM CITRATE 950 MG) TABLET
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
NDC 80681014000
|
| Hospital Charge Code |
1308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna American Axle |
$85.80
|
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$92.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health SBD |
$83.16
|
| Rate for Payer: UMR Bronson Commercial |
$48.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
CALCIUM 200 MG (AS CALCIUM CITRATE 950 MG) TABLET
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 80681014000
|
| Hospital Charge Code |
1308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna American Axle |
$85.80
|
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$92.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health SBD |
$83.16
|
| Rate for Payer: UMR Bronson Commercial |
$58.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$20.71
|
|
|
Service Code
|
NDC 00121476605
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Cash Price |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$18.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 09900001946
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 00054311763
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 00054311763
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 09900001946
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$211.20
|
|
|
Service Code
|
NDC 00121076616
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna American Axle |
$137.28
|
| Rate for Payer: Aetna Commercial |
$179.52
|
| Rate for Payer: Aetna Medicare |
$105.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.28
|
| Rate for Payer: BCBS Complete |
$84.48
|
| Rate for Payer: Cash Price |
$168.96
|
| Rate for Payer: Cofinity Commercial |
$147.84
|
| Rate for Payer: Cofinity Commercial |
$181.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.96
|
| Rate for Payer: Healthscope Commercial |
$190.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.52
|
| Rate for Payer: PHP Commercial |
$179.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.28
|
| Rate for Payer: Priority Health SBD |
$133.06
|
| Rate for Payer: UMR Bronson Commercial |
$78.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.40
|
|
|
CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$20.71
|
|
|
Service Code
|
NDC 00121476605
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: Cash Price |
$16.57
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$18.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
CALCIUM 500 MG/5 ML (AS CALCIUM CARB 1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$211.20
|
|
|
Service Code
|
NDC 00121076616
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.93 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna American Axle |
$137.28
|
| Rate for Payer: Aetna Commercial |
$179.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.28
|
| Rate for Payer: Cash Price |
$168.96
|
| Rate for Payer: Cofinity Commercial |
$147.84
|
| Rate for Payer: Cofinity Commercial |
$181.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.96
|
| Rate for Payer: Healthscope Commercial |
$190.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.52
|
| Rate for Payer: PHP Commercial |
$179.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.28
|
| Rate for Payer: Priority Health SBD |
$133.06
|
| Rate for Payer: UMR Bronson Commercial |
$92.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.40
|
|
|
CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 00904188361
|
| Hospital Charge Code |
1300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UMR Bronson Commercial |
$69.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 00904188361
|
| Hospital Charge Code |
1300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UMR Bronson Commercial |
$83.16
|
| 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
|
$106.70
|
|
|
Service Code
|
NDC 37864008289
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Aetna American Axle |
$69.36
|
| Rate for Payer: Aetna Commercial |
$90.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cofinity Commercial |
$74.69
|
| Rate for Payer: Cofinity Commercial |
$91.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.36
|
| Rate for Payer: Healthscope Commercial |
$96.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.69
|
| Rate for Payer: PHP Commercial |
$90.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.36
|
| Rate for Payer: Priority Health SBD |
$67.22
|
| Rate for Payer: UMR Bronson Commercial |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.03
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$321.30
|
|
|
Service Code
|
NDC 00904546072
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.88 |
| Max. Negotiated Rate |
$289.17 |
| Rate for Payer: Aetna American Axle |
$208.84
|
| Rate for Payer: Aetna Commercial |
$273.11
|
| Rate for Payer: Aetna Medicare |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.84
|
| Rate for Payer: BCBS Complete |
$128.52
|
| Rate for Payer: Cash Price |
$257.04
|
| Rate for Payer: Cofinity Commercial |
$224.91
|
| Rate for Payer: Cofinity Commercial |
$276.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.04
|
| Rate for Payer: Healthscope Commercial |
$289.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.11
|
| Rate for Payer: PHP Commercial |
$273.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.84
|
| Rate for Payer: Priority Health SBD |
$202.42
|
| Rate for Payer: UMR Bronson Commercial |
$118.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.97
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 77333011025
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna American Axle |
$1.17
|
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna Medicare |
$0.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.17
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.44
|
| Rate for Payer: Healthscope Commercial |
$1.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.53
|
| Rate for Payer: PHP Commercial |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.17
|
| Rate for Payer: Priority Health SBD |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.35
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$111.10
|
|
|
Service Code
|
NDC 51645082899
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: Aetna American Axle |
$72.22
|
| Rate for Payer: Aetna Commercial |
$94.44
|
| Rate for Payer: Aetna Medicare |
$55.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.22
|
| Rate for Payer: BCBS Complete |
$44.44
|
| Rate for Payer: Cash Price |
$88.88
|
| Rate for Payer: Cofinity Commercial |
$77.77
|
| Rate for Payer: Cofinity Commercial |
$95.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.88
|
| Rate for Payer: Healthscope Commercial |
$99.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.44
|
| Rate for Payer: PHP Commercial |
$94.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.22
|
| Rate for Payer: Priority Health SBD |
$69.99
|
| Rate for Payer: UMR Bronson Commercial |
$41.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.33
|
|
|
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 |
$63.64 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna American Axle |
$111.80
|
| Rate for Payer: Aetna Commercial |
$146.20
|
| Rate for Payer: Aetna Medicare |
$86.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.80
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$120.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.60
|
| Rate for Payer: Healthscope Commercial |
$154.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.20
|
| Rate for Payer: PHP Commercial |
$146.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health SBD |
$108.36
|
| Rate for Payer: UMR Bronson Commercial |
$63.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.00
|
|
