|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,517.76
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$667.81 |
| Max. Negotiated Rate |
$1,365.98 |
| Rate for Payer: Aetna American Axle |
$986.54
|
| Rate for Payer: Aetna American Axle |
$983.78
|
| Rate for Payer: Aetna American Axle |
$1,402.42
|
| Rate for Payer: Aetna American Axle |
$928.51
|
| Rate for Payer: Aetna Commercial |
$1,833.93
|
| Rate for Payer: Aetna Commercial |
$1,290.10
|
| Rate for Payer: Aetna Commercial |
$1,214.21
|
| Rate for Payer: Aetna Commercial |
$1,286.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.51
|
| Rate for Payer: Cash Price |
$1,142.78
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cash Price |
$1,210.81
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cofinity Advantage |
$1,059.46
|
| Rate for Payer: Cofinity Advantage |
$999.94
|
| Rate for Payer: Cofinity Advantage |
$1,062.43
|
| Rate for Payer: Cofinity Advantage |
$1,510.30
|
| Rate for Payer: Cofinity Commercial |
$1,305.27
|
| Rate for Payer: Cofinity Commercial |
$1,228.49
|
| Rate for Payer: Cofinity Commercial |
$1,301.62
|
| Rate for Payer: Cofinity Commercial |
$1,855.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,142.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,726.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.81
|
| Rate for Payer: Healthscope Commercial |
$1,362.16
|
| Rate for Payer: Healthscope Commercial |
$1,941.81
|
| Rate for Payer: Healthscope Commercial |
$1,365.98
|
| Rate for Payer: Healthscope Commercial |
$1,285.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,062.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$999.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,059.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,510.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,135.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,618.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,618.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,135.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,138.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,071.36
|
| Rate for Payer: PHP Commercial |
$1,214.21
|
| Rate for Payer: PHP Commercial |
$1,290.10
|
| Rate for Payer: PHP Commercial |
$1,286.48
|
| Rate for Payer: PHP Commercial |
$1,833.93
|
| Rate for Payer: Priority Health SBD |
$1,359.27
|
| Rate for Payer: Priority Health SBD |
$899.94
|
| Rate for Payer: Priority Health SBD |
$956.19
|
| Rate for Payer: Priority Health SBD |
$953.51
|
| Rate for Payer: UMR Bronson Commercial |
$665.94
|
| Rate for Payer: UMR Bronson Commercial |
$667.81
|
| Rate for Payer: UMR Bronson Commercial |
$628.53
|
| Rate for Payer: UMR Bronson Commercial |
$949.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,135.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,618.18
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Exchange |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$137.09
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna American Axle |
$89.11
|
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.11
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Advantage |
$95.96
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.82
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health SBD |
$86.37
|
| Rate for Payer: UMR Bronson Commercial |
$60.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.82
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna American Axle |
$46.68
|
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Advantage |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health SBD |
$45.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.87
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$71.82
|
|
|
Service Code
|
NDC 69452020713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna American Axle |
$46.68
|
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna Medicare |
$35.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: BCBS Complete |
$28.73
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Advantage |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health SBD |
$45.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.68
|
| Rate for Payer: UHC Core |
$37.42
|
| Rate for Payer: UHC Exchange |
$28.23
|
| Rate for Payer: UMR Bronson Commercial |
$26.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.87
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$228.39
|
|
|
Service Code
|
NDC 30698014323
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.49 |
| Max. Negotiated Rate |
$205.55 |
| Rate for Payer: Aetna American Axle |
$148.45
|
| Rate for Payer: Aetna Commercial |
$194.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.45
|
| Rate for Payer: Cash Price |
$182.71
|
| Rate for Payer: Cofinity Advantage |
$159.87
|
| Rate for Payer: Cofinity Commercial |
$196.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.71
|
| Rate for Payer: Healthscope Commercial |
$205.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.29
|
| Rate for Payer: PHP Commercial |
$194.13
|
| Rate for Payer: Priority Health SBD |
$143.89
|
| Rate for Payer: UMR Bronson Commercial |
$100.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.29
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
NDC 69452020713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna American Axle |
$46.68
|
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Advantage |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health SBD |
$45.25
|
| Rate for Payer: UMR Bronson Commercial |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.87
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$228.39
|
|
|
Service Code
|
NDC 30698014323
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$205.55 |
| Rate for Payer: Aetna American Axle |
$148.45
|
| Rate for Payer: Aetna Commercial |
$194.13
|
| Rate for Payer: Aetna Medicare |
$114.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.45
|
| Rate for Payer: BCBS Complete |
$91.36
|
| Rate for Payer: Cash Price |
$182.71
|
| Rate for Payer: Cofinity Advantage |
$159.87
|
| Rate for Payer: Cofinity Commercial |
$196.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.71
|
| Rate for Payer: Healthscope Commercial |
$205.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.29
|
| Rate for Payer: PHP Commercial |
$194.13
|
| Rate for Payer: Priority Health SBD |
$143.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.45
|
| Rate for Payer: UHC Core |
$118.99
|
| Rate for Payer: UHC Exchange |
$89.76
|
| Rate for Payer: UMR Bronson Commercial |
$84.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.29
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$286.70
|
|
|
Service Code
|
NDC 23155066201
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$258.03 |
| Rate for Payer: Aetna American Axle |
$186.35
|
| Rate for Payer: Aetna Commercial |
$243.69
|
| Rate for Payer: Aetna Medicare |
$143.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.35
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cofinity Advantage |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.03
|
| Rate for Payer: PHP Commercial |
$243.69
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.35
|
| Rate for Payer: UHC Core |
$149.37
|
| Rate for Payer: UHC Exchange |
$112.67
|
| Rate for Payer: UMR Bronson Commercial |
$106.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.03
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$71.82
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Aetna American Axle |
$46.68
|
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Aetna Medicare |
$35.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.68
|
| Rate for Payer: BCBS Complete |
$28.73
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Advantage |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$61.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$64.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: PHP Commercial |
$61.05
|
| Rate for Payer: Priority Health SBD |
$45.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.68
|
| Rate for Payer: UHC Core |
$37.42
|
| Rate for Payer: UHC Exchange |
$28.23
|
| Rate for Payer: UMR Bronson Commercial |
$26.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.87
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$386.40
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.02 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna American Axle |
$251.16
|
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.16
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Advantage |
$270.48
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.80
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health SBD |
$243.43
|
| Rate for Payer: UMR Bronson Commercial |
$170.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$286.70
|
|
|
Service Code
|
NDC 23155066201
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.15 |
| Max. Negotiated Rate |
$258.03 |
| Rate for Payer: Aetna American Axle |
$186.35
|
| Rate for Payer: Aetna Commercial |
$243.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.35
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cofinity Advantage |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.03
|
| Rate for Payer: PHP Commercial |
$243.69
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: UMR Bronson Commercial |
$126.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.03
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$137.09
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna American Axle |
$89.11
|
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna Medicare |
$68.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.11
|
| Rate for Payer: BCBS Complete |
$54.84
|
| Rate for Payer: Cash Price |
$109.67
|
| Rate for Payer: Cofinity Advantage |
$95.96
|
| Rate for Payer: Cofinity Commercial |
$117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.67
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.82
|
| Rate for Payer: PHP Commercial |
$116.53
|
| Rate for Payer: Priority Health SBD |
$86.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.11
|
| Rate for Payer: UHC Core |
$71.42
|
| Rate for Payer: UHC Exchange |
$53.88
|
| Rate for Payer: UMR Bronson Commercial |
$50.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.82
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
OP
|
$386.40
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.97 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna American Axle |
$251.16
|
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: Aetna Medicare |
$193.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.16
|
| Rate for Payer: BCBS Complete |
$154.56
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Advantage |
$270.48
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.80
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health SBD |
$243.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.16
|
| Rate for Payer: UHC Core |
$201.31
|
| Rate for Payer: UHC Exchange |
$151.86
|
| Rate for Payer: UMR Bronson Commercial |
$142.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$468.15
|
|
|
Service Code
|
NDC 63304024159
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.99 |
| Max. Negotiated Rate |
$421.33 |
| 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 Advantage |
$327.70
|
| Rate for Payer: Cofinity Commercial |
$402.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.52
|
| Rate for Payer: Healthscope Commercial |
$421.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.11
|
| Rate for Payer: PHP Commercial |
$397.93
|
| Rate for Payer: Priority Health SBD |
$294.93
|
| Rate for Payer: UMR Bronson Commercial |
$205.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.11
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
OP
|
$738.60
|
|
|
Service Code
|
NDC 30698091115
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.28 |
| Max. Negotiated Rate |
$664.74 |
| Rate for Payer: Aetna American Axle |
$480.09
|
| Rate for Payer: Aetna Commercial |
$627.81
|
| Rate for Payer: Aetna Medicare |
$369.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.09
|
| Rate for Payer: BCBS Complete |
$295.44
|
| Rate for Payer: Cash Price |
$590.88
|
| Rate for Payer: Cofinity Advantage |
$517.02
|
| Rate for Payer: Cofinity Commercial |
$635.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.88
|
| Rate for Payer: Healthscope Commercial |
$664.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$517.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$590.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$553.95
|
| Rate for Payer: PHP Commercial |
$627.81
|
| Rate for Payer: Priority Health SBD |
$465.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.09
|
| Rate for Payer: UHC Core |
$384.81
|
| Rate for Payer: UHC Exchange |
$290.27
|
| Rate for Payer: UMR Bronson Commercial |
$273.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.95
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1,376.40
|
|
|
Service Code
|
NDC 64980044715
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.62 |
| Max. Negotiated Rate |
$1,238.76 |
| Rate for Payer: Aetna American Axle |
$894.66
|
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.66
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Advantage |
$963.48
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: Priority Health SBD |
$867.13
|
| Rate for Payer: UMR Bronson Commercial |
$605.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.30
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1,376.40
|
|
|
Service Code
|
NDC 64980044715
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$509.27 |
| Max. Negotiated Rate |
$1,238.76 |
| Rate for Payer: Aetna American Axle |
$894.66
|
| Rate for Payer: Aetna Commercial |
$1,169.94
|
| Rate for Payer: Aetna Medicare |
$688.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.66
|
| Rate for Payer: BCBS Complete |
$550.56
|
| Rate for Payer: Cash Price |
$1,101.12
|
| Rate for Payer: Cofinity Advantage |
$963.48
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.12
|
| Rate for Payer: Healthscope Commercial |
$1,238.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$963.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,101.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.30
|
| Rate for Payer: PHP Commercial |
$1,169.94
|
| Rate for Payer: Priority Health SBD |
$867.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$894.66
|
| Rate for Payer: UHC Core |
$717.10
|
| Rate for Payer: UHC Exchange |
$540.93
|
| Rate for Payer: UMR Bronson Commercial |
$509.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.30
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$470.26
|
|
|
Service Code
|
NDC 00054312041
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.91 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Aetna American Axle |
$305.67
|
| Rate for Payer: Aetna Commercial |
$399.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.67
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cofinity Advantage |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.21
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PHP Commercial |
$399.72
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: UMR Bronson Commercial |
$206.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
OP
|
$468.15
|
|
|
Service Code
|
NDC 63304024159
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.22 |
| Max. Negotiated Rate |
$421.33 |
| Rate for Payer: Aetna American Axle |
$304.30
|
| Rate for Payer: Aetna Commercial |
$397.93
|
| Rate for Payer: Aetna Medicare |
$234.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.30
|
| Rate for Payer: BCBS Complete |
$187.26
|
| Rate for Payer: Cash Price |
$374.52
|
| Rate for Payer: Cofinity Advantage |
$327.70
|
| Rate for Payer: Cofinity Commercial |
$402.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.52
|
| Rate for Payer: Healthscope Commercial |
$421.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.11
|
| Rate for Payer: PHP Commercial |
$397.93
|
| Rate for Payer: Priority Health SBD |
$294.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.30
|
| Rate for Payer: UHC Core |
$243.91
|
| Rate for Payer: UHC Exchange |
$183.98
|
| Rate for Payer: UMR Bronson Commercial |
$173.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.11
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
IP
|
$738.60
|
|
|
Service Code
|
NDC 30698091115
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.98 |
| Max. Negotiated Rate |
$664.74 |
| Rate for Payer: Aetna American Axle |
$480.09
|
| Rate for Payer: Aetna Commercial |
$627.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.09
|
| Rate for Payer: Cash Price |
$590.88
|
| Rate for Payer: Cofinity Advantage |
$517.02
|
| Rate for Payer: Cofinity Commercial |
$635.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.88
|
| Rate for Payer: Healthscope Commercial |
$664.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$517.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$553.95
|
| Rate for Payer: PHP Commercial |
$627.81
|
| Rate for Payer: Priority Health SBD |
$465.32
|
| Rate for Payer: UMR Bronson Commercial |
$324.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.95
|
|
|
CALCITRIOL 1 MCG/ML ORAL SOLUTION
|
Facility
|
OP
|
$470.26
|
|
|
Service Code
|
NDC 00054312041
|
| Hospital Charge Code |
16218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Aetna American Axle |
$305.67
|
| Rate for Payer: Aetna Commercial |
$399.72
|
| Rate for Payer: Aetna Medicare |
$235.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.67
|
| Rate for Payer: BCBS Complete |
$188.10
|
| Rate for Payer: Cash Price |
$376.21
|
| Rate for Payer: Cofinity Advantage |
$329.18
|
| Rate for Payer: Cofinity Commercial |
$404.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.21
|
| Rate for Payer: Healthscope Commercial |
$423.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.69
|
| Rate for Payer: PHP Commercial |
$399.72
|
| Rate for Payer: Priority Health SBD |
$296.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.67
|
| Rate for Payer: UHC Core |
$245.01
|
| Rate for Payer: UHC Exchange |
$184.81
|
| Rate for Payer: UMR Bronson Commercial |
$174.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.69
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna American Axle |
$450.45
|
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.45
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Advantage |
$485.10
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Healthscope Commercial |
$623.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$485.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$519.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health SBD |
$436.59
|
| Rate for Payer: UMR Bronson Commercial |
$304.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.75
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$179.55
|
|
|
Service Code
|
NDC 00536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$161.59 |
| Rate for Payer: Aetna American Axle |
$116.71
|
| Rate for Payer: Aetna Commercial |
$152.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.71
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Advantage |
$125.69
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Healthscope Commercial |
$161.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.66
|
| Rate for Payer: PHP Commercial |
$152.62
|
| Rate for Payer: Priority Health SBD |
$113.12
|
| Rate for Payer: UMR Bronson Commercial |
$79.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.66
|
|
