|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$61.28
|
|
|
Service Code
|
NDC 23155-662-03
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$55.15 |
| Rate for Payer: Aetna American Axle |
$39.83
|
| Rate for Payer: Aetna Commercial |
$52.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.83
|
| Rate for Payer: Cash Price |
$49.02
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Cofinity Commercial |
$52.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.02
|
| Rate for Payer: Healthscope Commercial |
$55.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.09
|
| Rate for Payer: PHP Commercial |
$52.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health SBD |
$38.61
|
| Rate for Payer: UMR Bronson Commercial |
$26.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.96
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$3.07
|
|
|
Service Code
|
NDC 60687-345-11
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.61
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health SBD |
$1.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$306.72
|
|
|
Service Code
|
NDC 60687-345-01
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna American Axle |
$199.37
|
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.37
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Commercial |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.38
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.71
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.70
|
| Rate for Payer: Priority Health SBD |
$193.23
|
| Rate for Payer: UMR Bronson Commercial |
$134.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.04
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$282.89
|
|
|
Service Code
|
NDC 0054-3120-41
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna American Axle |
$183.88
|
| Rate for Payer: Aetna Commercial |
$240.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.88
|
| Rate for Payer: Cash Price |
$226.31
|
| Rate for Payer: Cofinity Commercial |
$198.02
|
| Rate for Payer: Cofinity Commercial |
$243.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.31
|
| Rate for Payer: Healthscope Commercial |
$254.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.46
|
| Rate for Payer: PHP Commercial |
$240.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.02
|
| Rate for Payer: Priority Health SBD |
$178.22
|
| Rate for Payer: UMR Bronson Commercial |
$124.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.17
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$468.15
|
|
|
Service Code
|
NDC 63304-241-59
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.99 |
| Max. Negotiated Rate |
$421.34 |
| Rate for Payer: Aetna American Axle |
$304.30
|
| Rate for Payer: Aetna Commercial |
$397.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.30
|
| Rate for Payer: Cash Price |
$374.52
|
| Rate for Payer: Cofinity Commercial |
$327.70
|
| Rate for Payer: Cofinity Commercial |
$402.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.52
|
| Rate for Payer: Healthscope Commercial |
$421.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.93
|
| Rate for Payer: PHP Commercial |
$397.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.70
|
| Rate for Payer: Priority Health SBD |
$294.93
|
| Rate for Payer: UMR Bronson Commercial |
$205.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.11
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 23155-531-02
|
| 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: 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 Multiplan/Beech St/PHCS |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.89
|
| 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
|
IP
|
$570.00
|
|
|
Service Code
|
NDC 0781-2081-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna American Axle |
$370.50
|
| Rate for Payer: Aetna Commercial |
$484.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.50
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cofinity Commercial |
$399.00
|
| Rate for Payer: Cofinity Commercial |
$490.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$456.00
|
| Rate for Payer: Healthscope Commercial |
$513.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$399.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.50
|
| Rate for Payer: PHP Commercial |
$484.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.00
|
| Rate for Payer: Priority Health SBD |
$359.10
|
| Rate for Payer: UMR Bronson Commercial |
$250.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.50
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$565.44
|
|
|
Service Code
|
NDC 24689-793-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.79 |
| Max. Negotiated Rate |
$508.90 |
| Rate for Payer: Aetna American Axle |
$367.54
|
| Rate for Payer: Aetna Commercial |
$480.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.54
|
| Rate for Payer: Cash Price |
$452.35
|
| Rate for Payer: Cofinity Commercial |
$395.81
|
| Rate for Payer: Cofinity Commercial |
$486.28
|
| 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 Multiplan/Beech St/PHCS |
$480.62
|
| Rate for Payer: PHP Commercial |
$480.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.81
|
| Rate for Payer: Priority Health SBD |
$356.23
|
| Rate for Payer: UMR Bronson Commercial |
$248.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.08
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$574.56
|
|
|
Service Code
|
NDC 68084-479-01
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.81 |
| Max. Negotiated Rate |
$517.10 |
| Rate for Payer: Aetna American Axle |
$373.46
|
| Rate for Payer: Aetna Commercial |
$488.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.46
|
| Rate for Payer: Cash Price |
$459.65
|
| Rate for Payer: Cofinity Commercial |
$402.19
|
| Rate for Payer: Cofinity Commercial |
$494.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.65
|
| Rate for Payer: Healthscope Commercial |
$517.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$402.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$488.38
|
| Rate for Payer: PHP Commercial |
$488.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$402.19
|
| Rate for Payer: Priority Health SBD |
$361.97
|
| Rate for Payer: UMR Bronson Commercial |
$252.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.92
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$507.84
|
|
|
Service Code
|
NDC 0054-0088-26
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.45 |
| Max. Negotiated Rate |
$457.06 |
| Rate for Payer: Aetna American Axle |
$330.10
|
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.10
|
| Rate for Payer: Cash Price |
$406.27
|
| Rate for Payer: Cofinity Commercial |
$355.49
|
| Rate for Payer: Cofinity Commercial |
$436.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.27
|
| Rate for Payer: Healthscope Commercial |
$457.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.66
|
| Rate for Payer: PHP Commercial |
$431.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.49
|
| Rate for Payer: Priority Health SBD |
$319.94
|
| Rate for Payer: UMR Bronson Commercial |
$223.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.88
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$5.75
|
|
|
Service Code
|
NDC 68084-479-11
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna American Axle |
$3.74
|
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.74
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.89
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.02
|
| Rate for Payer: Priority Health SBD |
$3.62
|
| Rate for Payer: UMR Bronson Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.31
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$626.88
|
|
|
Service Code
|
NDC 29033-026-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.83 |
| Max. Negotiated Rate |
$564.19 |
| Rate for Payer: Aetna American Axle |
$407.47
|
| Rate for Payer: Aetna Commercial |
$532.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.47
|
| Rate for Payer: Cash Price |
$501.50
|
| Rate for Payer: Cofinity Commercial |
$438.82
|
| Rate for Payer: Cofinity Commercial |
$539.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.50
|
| Rate for Payer: Healthscope Commercial |
$564.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$438.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$470.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$532.85
|
| Rate for Payer: PHP Commercial |
$532.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.82
|
| Rate for Payer: Priority Health SBD |
$394.93
|
| Rate for Payer: UMR Bronson Commercial |
$275.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.16
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$140.70
|
|
|
Service Code
|
NDC 48433-106-01
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.06 |
| Max. Negotiated Rate |
$126.63 |
| Rate for Payer: Aetna American Axle |
$91.46
|
| Rate for Payer: Aetna Commercial |
$119.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.46
|
| Rate for Payer: BCBS Complete |
$56.28
|
| Rate for Payer: Cash Price |
$112.56
|
| Rate for Payer: Cofinity Commercial |
$121.00
|
| Rate for Payer: Cofinity Commercial |
$98.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.56
|
| Rate for Payer: Healthscope Commercial |
$126.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.60
|
| Rate for Payer: PHP Commercial |
$119.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.49
|
| Rate for Payer: Priority Health SBD |
$88.64
|
| Rate for Payer: UMR Bronson Commercial |
$52.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.52
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$132.30
|
|
|
Service Code
|
NDC 96295-13811
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.21 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Aetna American Axle |
$86.00
|
| Rate for Payer: Aetna Commercial |
$112.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.00
|
| Rate for Payer: Cash Price |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$113.78
|
| Rate for Payer: Cofinity Commercial |
$92.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.84
|
| Rate for Payer: Healthscope Commercial |
$119.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.46
|
| Rate for Payer: PHP Commercial |
$112.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.61
|
| Rate for Payer: Priority Health SBD |
$83.35
|
| Rate for Payer: UMR Bronson Commercial |
$58.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.22
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$141.75
|
|
|
Service Code
|
NDC 70000-0034-1
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Aetna American Axle |
$92.14
|
| Rate for Payer: Aetna Commercial |
$120.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.14
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$121.90
|
| Rate for Payer: Cofinity Commercial |
$99.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.40
|
| Rate for Payer: Healthscope Commercial |
$127.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.49
|
| Rate for Payer: PHP Commercial |
$120.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.22
|
| Rate for Payer: Priority Health SBD |
$89.30
|
| Rate for Payer: UMR Bronson Commercial |
$62.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.31
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$577.50
|
|
|
Service Code
|
NDC 66553-004-01
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna American Axle |
$375.38
|
| Rate for Payer: Aetna Commercial |
$490.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.38
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$404.25
|
| Rate for Payer: Cofinity Commercial |
$496.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.00
|
| Rate for Payer: Healthscope Commercial |
$519.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.88
|
| Rate for Payer: PHP Commercial |
$490.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.25
|
| Rate for Payer: Priority Health SBD |
$363.82
|
| Rate for Payer: UMR Bronson Commercial |
$254.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.12
|
|
|
CALCIUM CARBONATE 500 MG/5 ML CALCIUM (1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$20.33
|
|
|
Service Code
|
NDC 0121-4766-05
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$18.30 |
| Rate for Payer: Aetna American Axle |
$13.21
|
| Rate for Payer: Aetna Commercial |
$17.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.21
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.28
|
| Rate for Payer: PHP Commercial |
$17.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.23
|
| Rate for Payer: Priority Health SBD |
$12.81
|
| Rate for Payer: UMR Bronson Commercial |
$8.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.25
|
|
|
CALCIUM CARBONATE 500 MG/5 ML CALCIUM (1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 54311763
|
| 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: 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 Multiplan/Beech St/PHCS |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| 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 CARBONATE 500 MG/5 ML CALCIUM (1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 9900-0019-46
|
| 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: 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 Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| 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 CARBONATE 500 MG/5 ML CALCIUM (1,250 MG/5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$200.08
|
|
|
Service Code
|
NDC 0121-0766-16
|
| Hospital Charge Code |
1299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.04 |
| Max. Negotiated Rate |
$180.07 |
| Rate for Payer: Aetna American Axle |
$130.05
|
| Rate for Payer: Aetna Commercial |
$170.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.05
|
| Rate for Payer: Cash Price |
$160.06
|
| Rate for Payer: Cofinity Commercial |
$140.06
|
| Rate for Payer: Cofinity Commercial |
$172.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.06
|
| Rate for Payer: Healthscope Commercial |
$180.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.07
|
| Rate for Payer: PHP Commercial |
$170.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.06
|
| Rate for Payer: Priority Health SBD |
$126.05
|
| Rate for Payer: UMR Bronson Commercial |
$88.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.06
|
|
|
CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) TABLET
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 904188361
|
| 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 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: 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 Multiplan/Beech St/PHCS |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| 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 CARBONATE 500 MG CALCIUM (1,250 MG) TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 904188361
|
| 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: 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 Multiplan/Beech St/PHCS |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| 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 CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$106.70
|
|
|
Service Code
|
NDC 3786408289
|
| 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: 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 Multiplan/Beech St/PHCS |
$90.70
|
| Rate for Payer: PHP Commercial |
$90.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.69
|
| 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 CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
NDC 1000670038
|
| 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: 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 Multiplan/Beech St/PHCS |
$146.20
|
| Rate for Payer: PHP Commercial |
$146.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.40
|
| 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 CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
NDC 6373929101
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna American Axle |
$780.00
|
| Rate for Payer: Aetna Commercial |
$1,020.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$1,032.00
|
| Rate for Payer: Cofinity Commercial |
$840.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.00
|
| Rate for Payer: Healthscope Commercial |
$1,080.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.00
|
| Rate for Payer: PHP Commercial |
$1,020.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
| Rate for Payer: Priority Health SBD |
$756.00
|
| Rate for Payer: UMR Bronson Commercial |
$528.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.00
|
|
