|
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
|
$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
|
$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
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 00054311763
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.58
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.58
|
| 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 |
$198.58
|
| Rate for Payer: Priority Health SBD |
$192.46
|
| Rate for Payer: UMR Bronson Commercial |
$113.04
|
| 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 |
$198.58
|
| 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
|
|
|
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 (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
|
$111.10
|
|
|
Service Code
|
NDC 51645082899
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.88 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: Aetna American Axle |
$72.22
|
| Rate for Payer: Aetna Commercial |
$94.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.22
|
| 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 |
$83.32
|
| 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 |
$48.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.32
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$179.30
|
|
|
Service Code
|
NDC 77333011010
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$161.37 |
| Rate for Payer: Aetna American Axle |
$116.54
|
| Rate for Payer: Aetna Commercial |
$152.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.54
|
| Rate for Payer: Cash Price |
$143.44
|
| Rate for Payer: Cofinity Commercial |
$125.51
|
| Rate for Payer: Cofinity Commercial |
$154.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.44
|
| Rate for Payer: Healthscope Commercial |
$161.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.40
|
| Rate for Payer: PHP Commercial |
$152.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.54
|
| Rate for Payer: Priority Health SBD |
$112.96
|
| Rate for Payer: UMR Bronson Commercial |
$78.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.48
|
|
|
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 |
$83.32
|
| 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 |
$83.32
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$321.30
|
|
|
Service Code
|
NDC 00904546072
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.37 |
| Max. Negotiated Rate |
$289.17 |
| Rate for Payer: Aetna American Axle |
$208.84
|
| Rate for Payer: Aetna Commercial |
$273.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.84
|
| 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 |
$240.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.10
|
| Rate for Payer: PHP Commercial |
$273.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.84
|
| Rate for Payer: Priority Health SBD |
$202.42
|
| Rate for Payer: UMR Bronson Commercial |
$141.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.98
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$179.30
|
|
|
Service Code
|
NDC 77333011010
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$161.37 |
| Rate for Payer: Aetna American Axle |
$116.54
|
| Rate for Payer: Aetna Commercial |
$152.40
|
| Rate for Payer: Aetna Medicare |
$89.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.54
|
| Rate for Payer: BCBS Complete |
$71.72
|
| Rate for Payer: Cash Price |
$143.44
|
| Rate for Payer: Cofinity Commercial |
$125.51
|
| Rate for Payer: Cofinity Commercial |
$154.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.44
|
| Rate for Payer: Healthscope Commercial |
$161.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.40
|
| Rate for Payer: PHP Commercial |
$152.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.54
|
| Rate for Payer: Priority Health SBD |
$112.96
|
| Rate for Payer: UMR Bronson Commercial |
$66.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.48
|
|
|
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 |
$273.10
|
| 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 |
$240.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.10
|
| Rate for Payer: PHP Commercial |
$273.10
|
| 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 |
$240.98
|
|
|
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 |
$90.70
|
| 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 |
$80.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.70
|
| Rate for Payer: PHP Commercial |
$90.70
|
| 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 |
$80.02
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$106.70
|
|
|
Service Code
|
NDC 37864008289
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Aetna American Axle |
$69.36
|
| Rate for Payer: Aetna Commercial |
$90.70
|
| Rate for Payer: Aetna Medicare |
$53.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.36
|
| Rate for Payer: BCBS Complete |
$42.68
|
| 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 |
$80.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.70
|
| Rate for Payer: PHP Commercial |
$90.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.36
|
| Rate for Payer: Priority Health SBD |
$67.22
|
| Rate for Payer: UMR Bronson Commercial |
$39.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.02
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.68 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna American Axle |
$111.80
|
| Rate for Payer: Aetna Commercial |
$146.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.80
|
| 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 |
$75.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.00
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$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
|
$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
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 77333011025
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna American Axle |
$1.17
|
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.17
|
| 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 |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.35
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 23155053102
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.79 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.76
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.76
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$194.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$565.44
|
|
|
Service Code
|
NDC 00781208102
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.21 |
| Max. Negotiated Rate |
$508.90 |
| Rate for Payer: Aetna American Axle |
$367.54
|
| Rate for Payer: Aetna Commercial |
$480.62
|
| Rate for Payer: Aetna Medicare |
$282.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.54
|
| Rate for Payer: BCBS Complete |
$226.18
|
| Rate for Payer: Cash Price |
$452.35
|
| Rate for Payer: Cofinity Commercial |
$395.81
|
| Rate for Payer: Cofinity Commercial |
$486.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.35
|
| Rate for Payer: Healthscope Commercial |
$508.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.62
|
| Rate for Payer: PHP Commercial |
$480.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.54
|
| Rate for Payer: Priority Health SBD |
$356.23
|
| Rate for Payer: UMR Bronson Commercial |
$209.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.08
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 68084047911
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$503.52
|
|
|
Service Code
|
NDC 68084047901
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.55 |
| Max. Negotiated Rate |
$453.17 |
| Rate for Payer: Aetna American Axle |
$327.29
|
| Rate for Payer: Aetna Commercial |
$427.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.29
|
| Rate for Payer: Cash Price |
$402.82
|
| Rate for Payer: Cofinity Commercial |
$352.46
|
| Rate for Payer: Cofinity Commercial |
$433.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.82
|
| Rate for Payer: Healthscope Commercial |
$453.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.99
|
| Rate for Payer: PHP Commercial |
$427.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.29
|
| Rate for Payer: Priority Health SBD |
$317.22
|
| Rate for Payer: UMR Bronson Commercial |
$221.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.64
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$440.80
|
|
|
Service Code
|
NDC 16571081320
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.95 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Aetna American Axle |
$286.52
|
| Rate for Payer: Aetna Commercial |
$374.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.52
|
| Rate for Payer: Cash Price |
$352.64
|
| Rate for Payer: Cofinity Commercial |
$308.56
|
| Rate for Payer: Cofinity Commercial |
$379.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.64
|
| Rate for Payer: Healthscope Commercial |
$396.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.68
|
| Rate for Payer: PHP Commercial |
$374.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.52
|
| Rate for Payer: Priority Health SBD |
$277.70
|
| Rate for Payer: UMR Bronson Commercial |
$193.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.60
|
|
