|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$772.32
|
|
|
Service Code
|
NDC 00904690061
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.82 |
| Max. Negotiated Rate |
$695.09 |
| Rate for Payer: Aetna American Axle |
$502.01
|
| Rate for Payer: Aetna Commercial |
$656.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.01
|
| Rate for Payer: Cash Price |
$617.86
|
| Rate for Payer: Cofinity Commercial |
$540.62
|
| Rate for Payer: Cofinity Commercial |
$664.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$540.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$617.86
|
| Rate for Payer: Healthscope Commercial |
$695.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$540.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.47
|
| Rate for Payer: PHP Commercial |
$656.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.01
|
| Rate for Payer: Priority Health SBD |
$486.56
|
| Rate for Payer: UMR Bronson Commercial |
$339.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.24
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$868.80
|
|
|
Service Code
|
NDC 51079005820
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.46 |
| Max. Negotiated Rate |
$781.92 |
| Rate for Payer: Aetna American Axle |
$564.72
|
| Rate for Payer: Aetna Commercial |
$738.48
|
| Rate for Payer: Aetna Medicare |
$434.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.72
|
| Rate for Payer: BCBS Complete |
$347.52
|
| Rate for Payer: Cash Price |
$695.04
|
| Rate for Payer: Cofinity Commercial |
$608.16
|
| Rate for Payer: Cofinity Commercial |
$747.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$608.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.04
|
| Rate for Payer: Healthscope Commercial |
$781.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.48
|
| Rate for Payer: PHP Commercial |
$738.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.72
|
| Rate for Payer: Priority Health SBD |
$547.34
|
| Rate for Payer: UMR Bronson Commercial |
$321.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.60
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
OP
|
$772.32
|
|
|
Service Code
|
NDC 00904690061
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.76 |
| Max. Negotiated Rate |
$695.09 |
| Rate for Payer: Aetna American Axle |
$502.01
|
| Rate for Payer: Aetna Commercial |
$656.47
|
| Rate for Payer: Aetna Medicare |
$386.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.01
|
| Rate for Payer: BCBS Complete |
$308.93
|
| Rate for Payer: Cash Price |
$617.86
|
| Rate for Payer: Cofinity Commercial |
$540.62
|
| Rate for Payer: Cofinity Commercial |
$664.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$540.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$617.86
|
| Rate for Payer: Healthscope Commercial |
$695.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$540.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.47
|
| Rate for Payer: PHP Commercial |
$656.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.01
|
| Rate for Payer: Priority Health SBD |
$486.56
|
| Rate for Payer: UMR Bronson Commercial |
$285.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.24
|
|
|
CHLORTHALIDONE 25 MG TABLET
|
Facility
|
IP
|
$868.80
|
|
|
Service Code
|
NDC 51079005820
|
| Hospital Charge Code |
1661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.27 |
| Max. Negotiated Rate |
$781.92 |
| Rate for Payer: Aetna American Axle |
$564.72
|
| Rate for Payer: Aetna Commercial |
$738.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.72
|
| Rate for Payer: Cash Price |
$695.04
|
| Rate for Payer: Cofinity Commercial |
$608.16
|
| Rate for Payer: Cofinity Commercial |
$747.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$608.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.04
|
| Rate for Payer: Healthscope Commercial |
$781.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.48
|
| Rate for Payer: PHP Commercial |
$738.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.72
|
| Rate for Payer: Priority Health SBD |
$547.34
|
| Rate for Payer: UMR Bronson Commercial |
$382.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.60
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 77333094825
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 77333094825
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
OP
|
$331.35
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$298.21 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna Medicare |
$165.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: BCBS Complete |
$132.54
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.38
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$122.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
NDC 00904582360
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna American Axle |
$19.86
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.86
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.97
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.86
|
| Rate for Payer: Priority Health SBD |
$19.25
|
| Rate for Payer: UMR Bronson Commercial |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
OP
|
$30.55
|
|
|
Service Code
|
NDC 00904582360
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna American Axle |
$19.86
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.86
|
| Rate for Payer: BCBS Complete |
$12.22
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.97
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.86
|
| Rate for Payer: Priority Health SBD |
$19.25
|
| Rate for Payer: UMR Bronson Commercial |
$11.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET
|
Facility
|
IP
|
$331.35
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
109842
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$298.21 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.38
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$145.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE
|
Facility
|
OP
|
$138.23
|
|
|
Service Code
|
NDC 50268086815
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$124.41 |
| Rate for Payer: Aetna American Axle |
$89.85
|
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: Aetna Medicare |
$69.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.85
|
| Rate for Payer: BCBS Complete |
$55.29
|
| Rate for Payer: Cash Price |
$110.58
|
| Rate for Payer: Cofinity Commercial |
$118.88
|
| Rate for Payer: Cofinity Commercial |
$96.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.58
|
| Rate for Payer: Healthscope Commercial |
$124.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.50
|
| Rate for Payer: PHP Commercial |
$117.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.85
|
| Rate for Payer: Priority Health SBD |
$87.08
|
| Rate for Payer: UMR Bronson Commercial |
$51.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.67
|
|
|
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 Commercial |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.86
|
| 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: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.87
|
| 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
|
$138.23
|
|
|
Service Code
|
NDC 50268086815
|
| Hospital Charge Code |
15636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.82 |
| Max. Negotiated Rate |
$124.41 |
| Rate for Payer: Aetna American Axle |
$89.85
|
| Rate for Payer: Aetna Commercial |
$117.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.85
|
| Rate for Payer: Cash Price |
$110.58
|
| Rate for Payer: Cofinity Commercial |
$118.88
|
| Rate for Payer: Cofinity Commercial |
$96.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.58
|
| Rate for Payer: Healthscope Commercial |
$124.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.50
|
| Rate for Payer: PHP Commercial |
$117.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.85
|
| Rate for Payer: Priority Health SBD |
$87.08
|
| Rate for Payer: UMR Bronson Commercial |
$60.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.67
|
|
|
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 Commercial |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.86
|
| 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: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: Priority Health SBD |
$100.67
|
| 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
|
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 Commercial |
$286.23
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.23
|
| 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: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.79
|
| 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
|
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 Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.06
|
| 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: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| 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
|
$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 Commercial |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.77
|
| 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: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| 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 Commercial |
$241.32
|
| Rate for Payer: Cofinity Commercial |
$296.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.32
|
| 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: PHP Commercial |
$293.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.09
|
| 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
|
|
|
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 Commercial |
$241.32
|
| Rate for Payer: Cofinity Commercial |
$296.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.32
|
| 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: PHP Commercial |
$293.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.09
|
| Rate for Payer: Priority Health SBD |
$217.19
|
| 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
|
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 Commercial |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.77
|
| 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: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health SBD |
$38.49
|
| 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
|
$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 Commercial |
$286.23
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.23
|
| 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: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.79
|
| Rate for Payer: Priority Health SBD |
$257.61
|
| 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
|
$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 Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.06
|
| 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: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| 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) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 00761009840
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna American Axle |
$54.99
|
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$59.22
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.99
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
82639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna American Axle |
$54.99
|
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna Medicare |
$42.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: BCBS Complete |
$33.84
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$59.22
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.99
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$31.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
