|
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
|
$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
|
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
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$71.82
|
|
|
Service Code
|
NDC 69452020713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna American Axle |
$46.68
|
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna Medicare |
$35.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: BCBS Complete |
$28.73
|
| 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 |
$26.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.86
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,376.40
|
|
|
Service Code
|
NDC 64980044715
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.62 |
| Max. Negotiated Rate |
$1,238.76 |
| Rate for Payer: Aetna American Axle |
$894.66
|
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.66
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Cofinity Commercial |
$963.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$963.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.66
|
| Rate for Payer: Priority Health SBD |
$867.13
|
| Rate for Payer: UMR Bronson Commercial |
$605.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.30
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,376.40
|
|
|
Service Code
|
NDC 64980044715
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$509.27 |
| Max. Negotiated Rate |
$1,238.76 |
| Rate for Payer: Aetna American Axle |
$894.66
|
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna Medicare |
$688.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.66
|
| Rate for Payer: BCBS Complete |
$550.56
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Cofinity Commercial |
$963.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$963.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.66
|
| Rate for Payer: Priority Health SBD |
$867.13
|
| Rate for Payer: UMR Bronson Commercial |
$509.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.30
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$468.15
|
|
|
Service Code
|
NDC 63304024159
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.99 |
| Max. Negotiated Rate |
$421.34 |
| Rate for Payer: Aetna American Axle |
$304.30
|
| Rate for Payer: Aetna Commercial |
$397.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.30
|
| Rate for Payer: Cash Price |
$374.52
|
| Rate for Payer: Cofinity Commercial |
$327.70
|
| Rate for Payer: Cofinity Commercial |
$402.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.52
|
| Rate for Payer: Healthscope Commercial |
$421.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.93
|
| Rate for Payer: PHP Commercial |
$397.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.30
|
| Rate for Payer: Priority Health SBD |
$294.93
|
| Rate for Payer: UMR Bronson Commercial |
$205.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.11
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
OP
|
$468.15
|
|
|
Service Code
|
NDC 63304024159
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.22 |
| Max. Negotiated Rate |
$421.34 |
| Rate for Payer: Aetna American Axle |
$304.30
|
| Rate for Payer: Aetna Commercial |
$397.93
|
| Rate for Payer: Aetna Medicare |
$234.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.30
|
| Rate for Payer: BCBS Complete |
$187.26
|
| Rate for Payer: Cash Price |
$374.52
|
| Rate for Payer: Cofinity Commercial |
$327.70
|
| Rate for Payer: Cofinity Commercial |
$402.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.52
|
| Rate for Payer: Healthscope Commercial |
$421.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.93
|
| Rate for Payer: PHP Commercial |
$397.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.30
|
| Rate for Payer: Priority Health SBD |
$294.93
|
| Rate for Payer: UMR Bronson Commercial |
$173.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.11
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
OP
|
$738.60
|
|
|
Service Code
|
NDC 30698091115
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.28 |
| Max. Negotiated Rate |
$664.74 |
| Rate for Payer: Aetna American Axle |
$480.09
|
| Rate for Payer: Aetna Commercial |
$627.81
|
| Rate for Payer: Aetna Medicare |
$369.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.09
|
| Rate for Payer: BCBS Complete |
$295.44
|
| Rate for Payer: Cash Price |
$590.88
|
| Rate for Payer: Cofinity Commercial |
$517.02
|
| Rate for Payer: Cofinity Commercial |
$635.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$517.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.88
|
| Rate for Payer: Healthscope Commercial |
$664.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$517.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.81
|
| Rate for Payer: PHP Commercial |
$627.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.09
|
| Rate for Payer: Priority Health SBD |
$465.32
|
| Rate for Payer: UMR Bronson Commercial |
$273.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.95
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
OP
|
$406.32
|
|
|
Service Code
|
NDC 00054312041
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.34 |
| Max. Negotiated Rate |
$365.69 |
| Rate for Payer: Aetna American Axle |
$264.11
|
| Rate for Payer: Aetna Commercial |
$345.37
|
| Rate for Payer: Aetna Medicare |
$203.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.11
|
| Rate for Payer: BCBS Complete |
$162.53
|
| Rate for Payer: Cash Price |
$325.06
|
| Rate for Payer: Cofinity Commercial |
$284.42
|
| Rate for Payer: Cofinity Commercial |
$349.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$284.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.06
|
| Rate for Payer: Healthscope Commercial |
$365.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.37
|
| Rate for Payer: PHP Commercial |
$345.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.11
|
| Rate for Payer: Priority Health SBD |
$255.98
|
| Rate for Payer: UMR Bronson Commercial |
$150.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.74
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$406.32
|
|
|
Service Code
|
NDC 00054312041
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$365.69 |
| Rate for Payer: Aetna American Axle |
$264.11
|
| Rate for Payer: Aetna Commercial |
$345.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.11
|
| Rate for Payer: Cash Price |
$325.06
|
| Rate for Payer: Cofinity Commercial |
$284.42
|
| Rate for Payer: Cofinity Commercial |
$349.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$284.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.06
|
| Rate for Payer: Healthscope Commercial |
$365.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.37
|
| Rate for Payer: PHP Commercial |
$345.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.11
|
| Rate for Payer: Priority Health SBD |
$255.98
|
| Rate for Payer: UMR Bronson Commercial |
$178.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.74
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$738.60
|
|
|
Service Code
|
NDC 30698091115
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.98 |
| Max. Negotiated Rate |
$664.74 |
| Rate for Payer: Aetna American Axle |
$480.09
|
| Rate for Payer: Aetna Commercial |
$627.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.09
|
| Rate for Payer: Cash Price |
$590.88
|
| Rate for Payer: Cofinity Commercial |
$517.02
|
| Rate for Payer: Cofinity Commercial |
$635.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$517.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.88
|
| Rate for Payer: Healthscope Commercial |
$664.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$517.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.81
|
| Rate for Payer: PHP Commercial |
$627.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.09
|
| Rate for Payer: Priority Health SBD |
$465.32
|
| Rate for Payer: UMR Bronson Commercial |
$324.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.95
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 09629513811
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.21 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna American Axle |
$86.00
|
| Rate for Payer: Aetna Commercial |
$112.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| 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 |
$112.46
|
| Rate for Payer: PHP Commercial |
$112.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.00
|
| Rate for Payer: Priority Health SBD |
$83.35
|
| Rate for Payer: UMR Bronson Commercial |
$58.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
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 |
$121.90
|
| 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
|
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 |
$91.46
|
| Rate for Payer: Aetna Commercial |
$119.60
|
| Rate for Payer: Aetna Medicare |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.46
|
| 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 |
$105.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.60
|
| Rate for Payer: PHP Commercial |
$119.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.46
|
| 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 |
$105.52
|
|
|
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 |
$121.90
|
| 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
|
$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 |
$112.46
|
| 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 |
$112.46
|
| Rate for Payer: PHP Commercial |
$112.46
|
| 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
|
$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 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
|
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 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 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 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
|
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 |
$198.58
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.58
|
| 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 |
$198.58
|
| Rate for Payer: Priority Health SBD |
$192.46
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
