|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
OP
|
$30,072.00
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$30,072.00 |
| Rate for Payer: Aetna Commercial |
$27,064.80
|
| Rate for Payer: Aetna Medicare |
$24.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.23
|
| Rate for Payer: ASR ASR |
$29,169.84
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$24,794.36
|
| Rate for Payer: BCN Commercial |
$24,794.36
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$24,057.60
|
| Rate for Payer: Cash Price |
$24,057.60
|
| Rate for Payer: Cofinity Commercial |
$28,267.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,057.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$29,169.84
|
| Rate for Payer: Healthscope Whirlpool |
$30,072.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.18
|
| Rate for Payer: Mclaren Commercial |
$27,064.80
|
| Rate for Payer: Mclaren Medicaid |
$24.18
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: Meridian Medicaid |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,561.20
|
| Rate for Payer: Nomi Health Commercial |
$24,659.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,554.00
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: PHP Medicaid |
$12.96
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25.08
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health Narrow Network |
$20.06
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,463.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.18
|
| Rate for Payer: UHC Exchange |
$37.48
|
| Rate for Payer: UHC Medicaid |
$12.65
|
| Rate for Payer: UHCCP DNSP |
$24.18
|
| Rate for Payer: UHCCP Medicaid |
$12.65
|
| Rate for Payer: VA VA |
$24.18
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
IP
|
$30,072.00
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,554.00 |
| Max. Negotiated Rate |
$30,072.00 |
| Rate for Payer: Aetna Commercial |
$27,064.80
|
| Rate for Payer: ASR ASR |
$29,169.84
|
| Rate for Payer: BCBS Trust/PPO |
$24,695.13
|
| Rate for Payer: BCN Commercial |
$24,695.13
|
| Rate for Payer: Cash Price |
$24,057.60
|
| Rate for Payer: Cofinity Commercial |
$28,267.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,057.60
|
| Rate for Payer: Healthscope Commercial |
$29,169.84
|
| Rate for Payer: Healthscope Whirlpool |
$30,072.00
|
| Rate for Payer: Mclaren Commercial |
$27,064.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,561.20
|
| Rate for Payer: Nomi Health Commercial |
$24,659.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,554.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26,463.36
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$159.92
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.17 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Aetna Commercial |
$143.93
|
| Rate for Payer: Aetna Medicare |
$59.17
|
| Rate for Payer: ASR ASR |
$155.12
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS Trust/PPO |
$131.85
|
| Rate for Payer: BCN Commercial |
$131.85
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.94
|
| Rate for Payer: Healthscope Commercial |
$155.12
|
| Rate for Payer: Healthscope Whirlpool |
$159.92
|
| Rate for Payer: Mclaren Commercial |
$143.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.93
|
| Rate for Payer: Nomi Health Commercial |
$131.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$140.12
|
| Rate for Payer: Priority Health Narrow Network |
$112.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.73
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$159.92
|
|
|
Service Code
|
NDC 49884016111
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: Aetna Commercial |
$143.93
|
| Rate for Payer: ASR ASR |
$155.12
|
| Rate for Payer: BCBS Trust/PPO |
$131.33
|
| Rate for Payer: BCN Commercial |
$131.33
|
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.94
|
| Rate for Payer: Healthscope Commercial |
$155.12
|
| Rate for Payer: Healthscope Whirlpool |
$159.92
|
| Rate for Payer: Mclaren Commercial |
$143.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.93
|
| Rate for Payer: Nomi Health Commercial |
$131.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.73
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,521.12
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,140.84 |
| Max. Negotiated Rate |
$1,521.12 |
| Rate for Payer: Aetna Commercial |
$1,369.01
|
| Rate for Payer: ASR ASR |
$1,475.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.14
|
| Rate for Payer: BCN Commercial |
$1,249.14
|
| Rate for Payer: Cash Price |
$1,216.90
|
| Rate for Payer: Cofinity Commercial |
$1,429.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,216.90
|
| Rate for Payer: Healthscope Commercial |
$1,475.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.12
|
| Rate for Payer: Mclaren Commercial |
$1,369.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,292.95
|
| Rate for Payer: Nomi Health Commercial |
$1,247.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,140.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.59
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,521.12
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$562.81 |
| Max. Negotiated Rate |
$1,521.12 |
| Rate for Payer: Aetna Commercial |
$1,369.01
|
| Rate for Payer: Aetna Medicare |
$562.81
|
| Rate for Payer: ASR ASR |
$1,475.49
|
| Rate for Payer: BCBS Complete |
$608.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.16
|
| Rate for Payer: BCN Commercial |
$1,254.16
|
| Rate for Payer: Cash Price |
$1,216.90
|
| Rate for Payer: Cash Price |
$1,216.90
|
| Rate for Payer: Cofinity Commercial |
$1,429.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,216.90
|
| Rate for Payer: Healthscope Commercial |
$1,475.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.12
|
| Rate for Payer: Mclaren Commercial |
$1,369.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,216.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,292.95
|
| Rate for Payer: Nomi Health Commercial |
$1,247.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,140.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$816.00
|
| Rate for Payer: Priority Health Narrow Network |
$652.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,338.59
|
|
|
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 |
$71.82 |
| Rate for Payer: Aetna Commercial |
$64.64
|
| Rate for Payer: Aetna Medicare |
$26.57
|
| Rate for Payer: ASR ASR |
$69.67
|
| Rate for Payer: BCBS Complete |
$28.73
|
| Rate for Payer: BCBS Trust/PPO |
$59.22
|
| Rate for Payer: BCN Commercial |
$59.22
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$67.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$69.67
|
| Rate for Payer: Healthscope Whirlpool |
$71.82
|
| Rate for Payer: Mclaren Commercial |
$64.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Nomi Health Commercial |
$58.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62.93
|
| Rate for Payer: Priority Health Narrow Network |
$50.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.20
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
NDC 23155066203
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.87 |
| Max. Negotiated Rate |
$71.82 |
| Rate for Payer: Aetna Commercial |
$64.64
|
| Rate for Payer: ASR ASR |
$69.67
|
| Rate for Payer: BCBS Trust/PPO |
$58.98
|
| Rate for Payer: BCN Commercial |
$58.98
|
| Rate for Payer: Cash Price |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$67.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.46
|
| Rate for Payer: Healthscope Commercial |
$69.67
|
| Rate for Payer: Healthscope Whirlpool |
$71.82
|
| Rate for Payer: Mclaren Commercial |
$64.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.05
|
| Rate for Payer: Nomi Health Commercial |
$58.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.20
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
NDC 68084098833
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: ASR ASR |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$1.57
|
| Rate for Payer: BCN Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$1.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.63
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.69
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 57896076315
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: ASR ASR |
$183.33
|
| Rate for Payer: BCBS Trust/PPO |
$155.21
|
| Rate for Payer: BCN Commercial |
$155.21
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$183.33
|
| Rate for Payer: Healthscope Whirlpool |
$189.00
|
| Rate for Payer: Mclaren Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.32
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$38.30
|
|
|
Service Code
|
NDC 68084098832
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Aetna Commercial |
$34.47
|
| Rate for Payer: Aetna Medicare |
$14.17
|
| Rate for Payer: ASR ASR |
$37.15
|
| Rate for Payer: BCBS Complete |
$15.32
|
| Rate for Payer: BCBS Trust/PPO |
$31.58
|
| Rate for Payer: BCN Commercial |
$31.58
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cofinity Commercial |
$36.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.64
|
| Rate for Payer: Healthscope Commercial |
$37.15
|
| Rate for Payer: Healthscope Whirlpool |
$38.30
|
| Rate for Payer: Mclaren Commercial |
$34.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.56
|
| Rate for Payer: Nomi Health Commercial |
$31.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.56
|
| Rate for Payer: Priority Health Narrow Network |
$26.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.71
|
|
|
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 |
$519.75 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: ASR ASR |
$672.21
|
| Rate for Payer: BCBS Trust/PPO |
$569.09
|
| Rate for Payer: BCN Commercial |
$569.09
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$651.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Healthscope Commercial |
$672.21
|
| Rate for Payer: Healthscope Whirlpool |
$693.00
|
| Rate for Payer: Mclaren Commercial |
$623.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Nomi Health Commercial |
$568.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$609.84
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 57896076315
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Medicare |
$69.93
|
| Rate for Payer: ASR ASR |
$183.33
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: BCBS Trust/PPO |
$155.83
|
| Rate for Payer: BCN Commercial |
$155.83
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$183.33
|
| Rate for Payer: Healthscope Whirlpool |
$189.00
|
| Rate for Payer: Mclaren Commercial |
$170.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$165.60
|
| Rate for Payer: Priority Health Narrow Network |
$132.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.32
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$179.55
|
|
|
Service Code
|
NDC 536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: ASR ASR |
$174.16
|
| Rate for Payer: BCBS Trust/PPO |
$147.45
|
| Rate for Payer: BCN Commercial |
$147.45
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$168.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Healthscope Commercial |
$174.16
|
| Rate for Payer: Healthscope Whirlpool |
$179.55
|
| Rate for Payer: Mclaren Commercial |
$161.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: Nomi Health Commercial |
$147.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.00
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$38.30
|
|
|
Service Code
|
NDC 68084098832
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Aetna Commercial |
$34.47
|
| Rate for Payer: ASR ASR |
$37.15
|
| Rate for Payer: BCBS Trust/PPO |
$31.46
|
| Rate for Payer: BCN Commercial |
$31.46
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cofinity Commercial |
$36.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.64
|
| Rate for Payer: Healthscope Commercial |
$37.15
|
| Rate for Payer: Healthscope Whirlpool |
$38.30
|
| Rate for Payer: Mclaren Commercial |
$34.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.56
|
| Rate for Payer: Nomi Health Commercial |
$31.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.71
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
NDC 68084098833
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: ASR ASR |
$1.86
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.58
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.92
|
| Rate for Payer: Mclaren Commercial |
$1.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.63
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.68
|
| Rate for Payer: Priority Health Narrow Network |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.69
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$179.55
|
|
|
Service Code
|
NDC 536100715
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: Aetna Medicare |
$66.43
|
| Rate for Payer: ASR ASR |
$174.16
|
| Rate for Payer: BCBS Complete |
$71.82
|
| Rate for Payer: BCBS Trust/PPO |
$148.04
|
| Rate for Payer: BCN Commercial |
$148.04
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$168.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Healthscope Commercial |
$174.16
|
| Rate for Payer: Healthscope Whirlpool |
$179.55
|
| Rate for Payer: Mclaren Commercial |
$161.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: Nomi Health Commercial |
$147.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$157.32
|
| Rate for Payer: Priority Health Narrow Network |
$125.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.00
|
|
|
CALCIUM 200 MG (AS CALCIUM CARBONATE 500 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
NDC 66553000401
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.41 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Aetna Medicare |
$256.41
|
| Rate for Payer: ASR ASR |
$672.21
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: BCBS Trust/PPO |
$571.38
|
| Rate for Payer: BCN Commercial |
$571.38
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$651.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Healthscope Commercial |
$672.21
|
| Rate for Payer: Healthscope Whirlpool |
$693.00
|
| Rate for Payer: Mclaren Commercial |
$623.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$554.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Nomi Health Commercial |
$568.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$607.21
|
| Rate for Payer: Priority Health Narrow Network |
$485.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$609.84
|
|
|
CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$44.52
|
|
|
Service Code
|
NDC 50268014913
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.39 |
| Max. Negotiated Rate |
$44.52 |
| Rate for Payer: Aetna Commercial |
$40.07
|
| Rate for Payer: ASR ASR |
$43.18
|
| Rate for Payer: BCBS Trust/PPO |
$36.56
|
| Rate for Payer: BCN Commercial |
$36.56
|
| Rate for Payer: Cash Price |
$35.62
|
| Rate for Payer: Cofinity Commercial |
$41.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.62
|
| Rate for Payer: Healthscope Commercial |
$43.18
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$40.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.84
|
| Rate for Payer: Nomi Health Commercial |
$36.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.18
|
|
|
CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 50268014911
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.34
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Healthscope Whirlpool |
$1.48
|
| Rate for Payer: Mclaren Commercial |
$1.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.31
|
|
|
CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 50268014911
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.34
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Healthscope Whirlpool |
$1.48
|
| Rate for Payer: Mclaren Commercial |
$1.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.31
|
|
|
CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$44.52
|
|
|
Service Code
|
NDC 50268014913
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$44.52 |
| Rate for Payer: Aetna Commercial |
$40.07
|
| Rate for Payer: Aetna Medicare |
$16.47
|
| Rate for Payer: ASR ASR |
$43.18
|
| Rate for Payer: BCBS Complete |
$17.81
|
| Rate for Payer: BCBS Trust/PPO |
$36.71
|
| Rate for Payer: BCN Commercial |
$36.71
|
| Rate for Payer: Cash Price |
$35.62
|
| Rate for Payer: Cofinity Commercial |
$41.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.62
|
| Rate for Payer: Healthscope Commercial |
$43.18
|
| Rate for Payer: Healthscope Whirlpool |
$44.52
|
| Rate for Payer: Mclaren Commercial |
$40.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.84
|
| Rate for Payer: Nomi Health Commercial |
$36.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.01
|
| Rate for Payer: Priority Health Narrow Network |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.18
|
|
|
CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) CHEWABLE TABLET
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
NDC 79854010892
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Medicare |
$121.36
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS Trust/PPO |
$270.44
|
| Rate for Payer: BCN Commercial |
$270.44
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$318.16
|
| Rate for Payer: Healthscope Whirlpool |
$328.00
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$262.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$287.39
|
| Rate for Payer: Priority Health Narrow Network |
$229.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
|
|
CALCIUM 500 MG (AS CALCIUM CARBONATE 1,250 MG) CHEWABLE TABLET
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
NDC 79854010892
|
| Hospital Charge Code |
1298
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: BCBS Trust/PPO |
$269.35
|
| Rate for Payer: BCN Commercial |
$269.35
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$318.16
|
| Rate for Payer: Healthscope Whirlpool |
$328.00
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
NDC 77333011010
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: BCBS Complete |
$67.32
|
| Rate for Payer: BCBS Trust/PPO |
$138.76
|
| Rate for Payer: BCN Commercial |
$138.76
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$163.25
|
| Rate for Payer: Healthscope Whirlpool |
$168.30
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.46
|
| Rate for Payer: Priority Health Narrow Network |
$117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
|
