|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$849.60
|
|
|
Service Code
|
NDC 00904690061
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.35 |
| Max. Negotiated Rate |
$764.64 |
| Rate for Payer: Aetna American Axle |
$552.24
|
| Rate for Payer: Aetna Commercial |
$722.16
|
| Rate for Payer: Aetna Medicare |
$424.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.24
|
| Rate for Payer: BCBS Complete |
$339.84
|
| Rate for Payer: Cash Price |
$679.68
|
| Rate for Payer: Cofinity Advantage |
$594.72
|
| Rate for Payer: Cofinity Commercial |
$730.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.68
|
| Rate for Payer: Healthscope Commercial |
$764.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$594.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$679.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.20
|
| Rate for Payer: PHP Commercial |
$722.16
|
| Rate for Payer: Priority Health SBD |
$535.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.24
|
| Rate for Payer: UHC Core |
$442.64
|
| Rate for Payer: UHC Exchange |
$333.89
|
| Rate for Payer: UMR Bronson Commercial |
$314.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.20
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$936.96
|
|
|
Service Code
|
NDC 51079005820
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.26 |
| Max. Negotiated Rate |
$843.26 |
| Rate for Payer: Aetna American Axle |
$609.02
|
| Rate for Payer: Aetna Commercial |
$796.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.02
|
| Rate for Payer: Cash Price |
$749.57
|
| Rate for Payer: Cofinity Advantage |
$655.87
|
| Rate for Payer: Cofinity Commercial |
$805.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.57
|
| Rate for Payer: Healthscope Commercial |
$843.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$655.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.72
|
| Rate for Payer: PHP Commercial |
$796.42
|
| Rate for Payer: Priority Health SBD |
$590.28
|
| Rate for Payer: UMR Bronson Commercial |
$412.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.72
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$9.37
|
|
|
Service Code
|
NDC 51079005801
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Aetna American Axle |
$6.09
|
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.09
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Advantage |
$6.56
|
| Rate for Payer: Cofinity Commercial |
$8.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.03
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UMR Bronson Commercial |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.03
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$936.96
|
|
|
Service Code
|
NDC 51079005820
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$346.68 |
| Max. Negotiated Rate |
$843.26 |
| Rate for Payer: Aetna American Axle |
$609.02
|
| Rate for Payer: Aetna Commercial |
$796.42
|
| Rate for Payer: Aetna Medicare |
$468.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.02
|
| Rate for Payer: BCBS Complete |
$374.78
|
| Rate for Payer: Cash Price |
$749.57
|
| Rate for Payer: Cofinity Advantage |
$655.87
|
| Rate for Payer: Cofinity Commercial |
$805.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.57
|
| Rate for Payer: Healthscope Commercial |
$843.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$655.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$749.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.72
|
| Rate for Payer: PHP Commercial |
$796.42
|
| Rate for Payer: Priority Health SBD |
$590.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.02
|
| Rate for Payer: UHC Core |
$488.16
|
| Rate for Payer: UHC Exchange |
$368.23
|
| Rate for Payer: UMR Bronson Commercial |
$346.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.72
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$849.60
|
|
|
Service Code
|
NDC 00904690061
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$373.82 |
| Max. Negotiated Rate |
$764.64 |
| Rate for Payer: Aetna American Axle |
$552.24
|
| Rate for Payer: Aetna Commercial |
$722.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.24
|
| Rate for Payer: Cash Price |
$679.68
|
| Rate for Payer: Cofinity Advantage |
$594.72
|
| Rate for Payer: Cofinity Commercial |
$730.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$679.68
|
| Rate for Payer: Healthscope Commercial |
$764.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$594.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$637.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.20
|
| Rate for Payer: PHP Commercial |
$722.16
|
| Rate for Payer: Priority Health SBD |
$535.25
|
| Rate for Payer: UMR Bronson Commercial |
$373.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$637.20
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$9.37
|
|
|
Service Code
|
NDC 51079005801
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Aetna American Axle |
$6.09
|
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.09
|
| Rate for Payer: BCBS Complete |
$3.75
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Advantage |
$6.56
|
| Rate for Payer: Cofinity Commercial |
$8.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.03
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.09
|
| Rate for Payer: UHC Core |
$4.88
|
| Rate for Payer: UHC Exchange |
$3.68
|
| Rate for Payer: UMR Bronson Commercial |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.03
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
IP
|
$35.25
|
|
|
Service Code
|
NDC 00904582360
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Advantage |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.44
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Advantage |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| 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: Opus (Opus Packaging Group) HMA |
$264.38
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health SBD |
$222.07
|
| Rate for Payer: UMR Bronson Commercial |
$155.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
OP
|
$35.25
|
|
|
Service Code
|
NDC 00904582360
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna American Axle |
$22.91
|
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.91
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Advantage |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.44
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health SBD |
$22.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.91
|
| Rate for Payer: UHC Core |
$18.37
|
| Rate for Payer: UHC Exchange |
$13.85
|
| Rate for Payer: UMR Bronson Commercial |
$13.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
IP
|
$3.53
|
|
|
Service Code
|
NDC 77333094825
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Advantage |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
OP
|
$352.50
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.43 |
| 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 Advantage |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| 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: MI Amish Medical Board Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.38
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health SBD |
$222.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.12
|
| Rate for Payer: UHC Core |
$183.65
|
| Rate for Payer: UHC Exchange |
$138.53
|
| Rate for Payer: UMR Bronson Commercial |
$130.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
OP
|
$3.53
|
|
|
Service Code
|
NDC 77333094825
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Advantage |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.65
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: UHC Exchange |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
OP
|
$159.80
|
|
|
Service Code
|
NDC 79854009098
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna American Axle |
$103.87
|
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Medicare |
$79.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.87
|
| Rate for Payer: BCBS Complete |
$63.92
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Advantage |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.85
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health SBD |
$100.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.87
|
| Rate for Payer: UHC Core |
$83.26
|
| Rate for Payer: UHC Exchange |
$62.80
|
| Rate for Payer: UMR Bronson Commercial |
$59.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
OP
|
$408.90
|
|
|
Service Code
|
NDC 30768029173
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.29 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna American Axle |
$265.79
|
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: Aetna Medicare |
$204.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.79
|
| Rate for Payer: BCBS Complete |
$163.56
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Advantage |
$286.23
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.68
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health SBD |
$257.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.79
|
| Rate for Payer: UHC Core |
$213.04
|
| Rate for Payer: UHC Exchange |
$160.70
|
| Rate for Payer: UMR Bronson Commercial |
$151.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$127.78
|
|
|
Service Code
|
NDC 50268086815
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.22 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna American Axle |
$83.06
|
| Rate for Payer: Aetna Commercial |
$108.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.06
|
| Rate for Payer: Cash Price |
$102.22
|
| Rate for Payer: Cofinity Advantage |
$89.45
|
| Rate for Payer: Cofinity Commercial |
$109.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.22
|
| Rate for Payer: Healthscope Commercial |
$115.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.83
|
| Rate for Payer: PHP Commercial |
$108.61
|
| Rate for Payer: Priority Health SBD |
$80.50
|
| Rate for Payer: UMR Bronson Commercial |
$56.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.83
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$408.90
|
|
|
Service Code
|
NDC 30768029173
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.92 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna American Axle |
$265.79
|
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.79
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Advantage |
$286.23
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.68
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health SBD |
$257.61
|
| Rate for Payer: UMR Bronson Commercial |
$179.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 79854009098
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna American Axle |
$103.87
|
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.87
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Advantage |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.85
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health SBD |
$100.67
|
| Rate for Payer: UMR Bronson Commercial |
$70.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 53191024401
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 53191024401
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.12
|
| Rate for Payer: UHC Core |
$72.24
|
| Rate for Payer: UHC Exchange |
$54.49
|
| Rate for Payer: UMR Bronson Commercial |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$284.82
|
|
|
Service Code
|
NDC 88395014110
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.32 |
| Max. Negotiated Rate |
$256.34 |
| Rate for Payer: Aetna American Axle |
$185.13
|
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.13
|
| Rate for Payer: Cash Price |
$227.86
|
| Rate for Payer: Cofinity Advantage |
$199.37
|
| Rate for Payer: Cofinity Commercial |
$244.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.86
|
| Rate for Payer: Healthscope Commercial |
$256.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.62
|
| Rate for Payer: PHP Commercial |
$242.10
|
| Rate for Payer: Priority Health SBD |
$179.44
|
| Rate for Payer: UMR Bronson Commercial |
$125.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.62
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
OP
|
$284.82
|
|
|
Service Code
|
NDC 88395014110
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$256.34 |
| Rate for Payer: Aetna American Axle |
$185.13
|
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Medicare |
$142.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.13
|
| Rate for Payer: BCBS Complete |
$113.93
|
| Rate for Payer: Cash Price |
$227.86
|
| Rate for Payer: Cofinity Advantage |
$199.37
|
| Rate for Payer: Cofinity Commercial |
$244.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.86
|
| Rate for Payer: Healthscope Commercial |
$256.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.62
|
| Rate for Payer: PHP Commercial |
$242.10
|
| Rate for Payer: Priority Health SBD |
$179.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.13
|
| Rate for Payer: UHC Core |
$148.39
|
| Rate for Payer: UHC Exchange |
$111.93
|
| Rate for Payer: UMR Bronson Commercial |
$105.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.62
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 80681013100
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna American Axle |
$39.72
|
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$30.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Advantage |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.72
|
| Rate for Payer: UHC Core |
$31.83
|
| Rate for Payer: UHC Exchange |
$24.01
|
| Rate for Payer: UMR Bronson Commercial |
$22.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
OP
|
$344.75
|
|
|
Service Code
|
NDC 31604002621
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.56 |
| Max. Negotiated Rate |
$310.27 |
| Rate for Payer: Aetna American Axle |
$224.09
|
| Rate for Payer: Aetna Commercial |
$293.04
|
| Rate for Payer: Aetna Medicare |
$172.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.09
|
| Rate for Payer: BCBS Complete |
$137.90
|
| Rate for Payer: Cash Price |
$275.80
|
| Rate for Payer: Cofinity Advantage |
$241.32
|
| Rate for Payer: Cofinity Commercial |
$296.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.80
|
| Rate for Payer: Healthscope Commercial |
$310.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.56
|
| Rate for Payer: PHP Commercial |
$293.04
|
| Rate for Payer: Priority Health SBD |
$217.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.09
|
| Rate for Payer: UHC Core |
$179.61
|
| Rate for Payer: UHC Exchange |
$135.49
|
| Rate for Payer: UMR Bronson Commercial |
$127.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.56
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 80681013100
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna American Axle |
$39.72
|
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Advantage |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.83
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| Rate for Payer: UMR Bronson Commercial |
$26.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
IP
|
$344.75
|
|
|
Service Code
|
NDC 31604002621
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.69 |
| Max. Negotiated Rate |
$310.27 |
| Rate for Payer: Aetna American Axle |
$224.09
|
| Rate for Payer: Aetna Commercial |
$293.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.09
|
| Rate for Payer: Cash Price |
$275.80
|
| Rate for Payer: Cofinity Advantage |
$241.32
|
| Rate for Payer: Cofinity Commercial |
$296.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.80
|
| Rate for Payer: Healthscope Commercial |
$310.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$241.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.56
|
| Rate for Payer: PHP Commercial |
$293.04
|
| Rate for Payer: Priority Health SBD |
$217.19
|
| Rate for Payer: UMR Bronson Commercial |
$151.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.56
|
|
