Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$565.44

Service Code	NDC 00781208102
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$226.18
Max. Negotiated Rate	$508.90
Rate for Payer: Aetna Commercial	$480.62
Rate for Payer: Aetna Medicare	$282.72
Rate for Payer: Aetna New Business (MI Preferred)	$367.54
Rate for Payer: BCBS Complete	$226.18
Rate for Payer: Cash Price	$452.35
Rate for Payer: Cofinity Commercial	$395.81
Rate for Payer: Cofinity Commercial	$486.28
Rate for Payer: Cofinity Medicare Advantage	$395.81
Rate for Payer: Encore Health Key Benefits Commercial	$452.35
Rate for Payer: Healthscope Commercial	$508.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$480.62
Rate for Payer: PHP Commercial	$480.62
Rate for Payer: Priority Health Cigna Priority Health	$367.54
Rate for Payer: Priority Health SBD	$356.23

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$507.84

Service Code	NDC 00054008826
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$319.94
Max. Negotiated Rate	$457.06
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: Cofinity Medicare Advantage	$355.49
Rate for Payer: Encore Health Key Benefits Commercial	$406.27
Rate for Payer: Healthscope Commercial	$457.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.66
Rate for Payer: PHP Commercial	$431.66
Rate for Payer: Priority Health Cigna Priority Health	$330.10
Rate for Payer: Priority Health SBD	$319.94

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$507.84

Service Code	NDC 00054008826
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$203.14
Max. Negotiated Rate	$457.06
Rate for Payer: Aetna Commercial	$431.66
Rate for Payer: Aetna Medicare	$253.92
Rate for Payer: Aetna New Business (MI Preferred)	$330.10
Rate for Payer: BCBS Complete	$203.14
Rate for Payer: Cash Price	$406.27
Rate for Payer: Cofinity Commercial	$355.49
Rate for Payer: Cofinity Commercial	$436.74
Rate for Payer: Cofinity Medicare Advantage	$355.49
Rate for Payer: Encore Health Key Benefits Commercial	$406.27
Rate for Payer: Healthscope Commercial	$457.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.66
Rate for Payer: PHP Commercial	$431.66
Rate for Payer: Priority Health Cigna Priority Health	$330.10
Rate for Payer: Priority Health SBD	$319.94

CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE

Facility

$626.88

Service Code	NDC 62135019122
Hospital Charge Code	30961
Hospital Revenue Code	637
Min. Negotiated Rate	$250.75
Max. Negotiated Rate	$564.19
Rate for Payer: Aetna Commercial	$532.85
Rate for Payer: Aetna Medicare	$313.44
Rate for Payer: Aetna New Business (MI Preferred)	$407.47
Rate for Payer: BCBS Complete	$250.75
Rate for Payer: Cash Price	$501.50
Rate for Payer: Cofinity Commercial	$438.82
Rate for Payer: Cofinity Commercial	$539.12
Rate for Payer: Cofinity Medicare Advantage	$438.82
Rate for Payer: Encore Health Key Benefits Commercial	$501.50
Rate for Payer: Healthscope Commercial	$564.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$532.85
Rate for Payer: PHP Commercial	$532.85
Rate for Payer: Priority Health Cigna Priority Health	$407.47
Rate for Payer: Priority Health SBD	$394.93

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION

Facility

$33.65

Service Code	NDC 00517671010
Hospital Charge Code	108968
Hospital Revenue Code	250
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$30.29
Rate for Payer: Aetna Commercial	$28.60
Rate for Payer: Aetna Medicare	$16.82
Rate for Payer: Aetna New Business (MI Preferred)	$21.87
Rate for Payer: BCBS Complete	$13.46
Rate for Payer: Cash Price	$26.92
Rate for Payer: Cofinity Commercial	$23.55
Rate for Payer: Cofinity Commercial	$28.94
Rate for Payer: Cofinity Medicare Advantage	$23.55
Rate for Payer: Encore Health Key Benefits Commercial	$26.92
Rate for Payer: Healthscope Commercial	$30.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.60
Rate for Payer: PHP Commercial	$28.60
Rate for Payer: Priority Health Cigna Priority Health	$21.87
Rate for Payer: Priority Health SBD	$21.20

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION

Facility

$33.65

Service Code	NDC 00517671001
Hospital Charge Code	108968
Hospital Revenue Code	250
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$30.29
Rate for Payer: Aetna Commercial	$28.60
Rate for Payer: Aetna Medicare	$16.82
Rate for Payer: Aetna New Business (MI Preferred)	$21.87
Rate for Payer: BCBS Complete	$13.46
Rate for Payer: Cash Price	$26.92
Rate for Payer: Cofinity Commercial	$23.55
Rate for Payer: Cofinity Commercial	$28.94
Rate for Payer: Cofinity Medicare Advantage	$23.55
Rate for Payer: Encore Health Key Benefits Commercial	$26.92
Rate for Payer: Healthscope Commercial	$30.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.60
Rate for Payer: PHP Commercial	$28.60
Rate for Payer: Priority Health Cigna Priority Health	$21.87
Rate for Payer: Priority Health SBD	$21.20

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION

Facility

$33.65

Service Code	NDC 00517671010
Hospital Charge Code	108968
Hospital Revenue Code	250
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$30.29
Rate for Payer: Aetna Commercial	$28.60
Rate for Payer: Aetna New Business (MI Preferred)	$21.87
Rate for Payer: Cash Price	$26.92
Rate for Payer: Cofinity Commercial	$23.55
Rate for Payer: Cofinity Commercial	$28.94
Rate for Payer: Cofinity Medicare Advantage	$23.55
Rate for Payer: Encore Health Key Benefits Commercial	$26.92
Rate for Payer: Healthscope Commercial	$30.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.60
Rate for Payer: PHP Commercial	$28.60
Rate for Payer: Priority Health Cigna Priority Health	$21.87
Rate for Payer: Priority Health SBD	$21.20

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION

Facility

$33.65

Service Code	NDC 00517671001
Hospital Charge Code	108968
Hospital Revenue Code	250
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$30.29
Rate for Payer: Aetna Commercial	$28.60
Rate for Payer: Aetna New Business (MI Preferred)	$21.87
Rate for Payer: Cash Price	$26.92
Rate for Payer: Cofinity Commercial	$23.55
Rate for Payer: Cofinity Commercial	$28.94
Rate for Payer: Cofinity Medicare Advantage	$23.55
Rate for Payer: Encore Health Key Benefits Commercial	$26.92
Rate for Payer: Healthscope Commercial	$30.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.60
Rate for Payer: PHP Commercial	$28.60
Rate for Payer: Priority Health Cigna Priority Health	$21.87
Rate for Payer: Priority Health SBD	$21.20

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE

Facility

$36.23

Service Code	NDC 64253090091
Hospital Charge Code	1306
Hospital Revenue Code	250
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$32.61
Rate for Payer: Aetna Commercial	$30.80
Rate for Payer: Aetna Medicare	$18.11
Rate for Payer: Aetna New Business (MI Preferred)	$23.55
Rate for Payer: BCBS Complete	$14.49
Rate for Payer: Cash Price	$28.98
Rate for Payer: Cofinity Commercial	$25.36
Rate for Payer: Cofinity Commercial	$31.16
Rate for Payer: Cofinity Medicare Advantage	$25.36
Rate for Payer: Encore Health Key Benefits Commercial	$28.98
Rate for Payer: Healthscope Commercial	$32.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.80
Rate for Payer: PHP Commercial	$30.80
Rate for Payer: Priority Health Cigna Priority Health	$23.55
Rate for Payer: Priority Health SBD	$22.82

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE

Facility

$70.54

Service Code	NDC 00409492834
Hospital Charge Code	1306
Hospital Revenue Code	250
Min. Negotiated Rate	$28.22
Max. Negotiated Rate	$63.49
Rate for Payer: Aetna Commercial	$59.96
Rate for Payer: Aetna Medicare	$35.27
Rate for Payer: Aetna New Business (MI Preferred)	$45.85
Rate for Payer: BCBS Complete	$28.22
Rate for Payer: Cash Price	$56.43
Rate for Payer: Cofinity Commercial	$49.38
Rate for Payer: Cofinity Commercial	$60.66
Rate for Payer: Cofinity Medicare Advantage	$49.38
Rate for Payer: Encore Health Key Benefits Commercial	$56.43
Rate for Payer: Healthscope Commercial	$63.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.96
Rate for Payer: PHP Commercial	$59.96
Rate for Payer: Priority Health Cigna Priority Health	$45.85
Rate for Payer: Priority Health SBD	$44.44

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE

Facility

$33.11

Service Code	NDC 64253090030
Hospital Charge Code	1306
Hospital Revenue Code	250
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$29.80
Rate for Payer: Aetna Commercial	$28.14
Rate for Payer: Aetna New Business (MI Preferred)	$21.52
Rate for Payer: Cash Price	$26.49
Rate for Payer: Cofinity Commercial	$23.18
Rate for Payer: Cofinity Commercial	$28.47
Rate for Payer: Cofinity Medicare Advantage	$23.18
Rate for Payer: Encore Health Key Benefits Commercial	$26.49
Rate for Payer: Healthscope Commercial	$29.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.14
Rate for Payer: PHP Commercial	$28.14
Rate for Payer: Priority Health Cigna Priority Health	$21.52
Rate for Payer: Priority Health SBD	$20.86

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE

Facility

$70.54

Service Code	NDC 00409492834
Hospital Charge Code	1306
Hospital Revenue Code	250
Min. Negotiated Rate	$44.44
Max. Negotiated Rate	$63.49
Rate for Payer: Aetna Commercial	$59.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.85
Rate for Payer: Cash Price	$56.43
Rate for Payer: Cofinity Commercial	$49.38
Rate for Payer: Cofinity Commercial	$60.66
Rate for Payer: Cofinity Medicare Advantage	$49.38
Rate for Payer: Encore Health Key Benefits Commercial	$56.43
Rate for Payer: Healthscope Commercial	$63.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.96
Rate for Payer: PHP Commercial	$59.96
Rate for Payer: Priority Health Cigna Priority Health	$45.85
Rate for Payer: Priority Health SBD	$44.44

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE

Facility

$39.34

Service Code	NDC 76329330401
Hospital Charge Code	1306
Hospital Revenue Code	250
Min. Negotiated Rate	$24.78
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna New Business (MI Preferred)	$25.57
Rate for Payer: Cash Price	$31.47
Rate for Payer: Cofinity Commercial	$27.54
Rate for Payer: Cofinity Commercial	$33.83
Rate for Payer: Cofinity Medicare Advantage	$27.54
Rate for Payer: Encore Health Key Benefits Commercial	$31.47
Rate for Payer: Healthscope Commercial	$35.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.44
Rate for Payer: PHP Commercial	$33.44
Rate for Payer: Priority Health Cigna Priority Health	$25.57
Rate for Payer: Priority Health SBD	$24.78

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE

Facility

$33.11

Service Code	NDC 64253090030
Hospital Charge Code	1306
Hospital Revenue Code	250
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$29.80
Rate for Payer: Aetna Commercial	$28.14
Rate for Payer: Aetna Medicare	$16.55
Rate for Payer: Aetna New Business (MI Preferred)	$21.52
Rate for Payer: BCBS Complete	$13.24
Rate for Payer: Cash Price	$26.49
Rate for Payer: Cofinity Commercial	$23.18
Rate for Payer: Cofinity Commercial	$28.47
Rate for Payer: Cofinity Medicare Advantage	$23.18
Rate for Payer: Encore Health Key Benefits Commercial	$26.49
Rate for Payer: Healthscope Commercial	$29.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.14
Rate for Payer: PHP Commercial	$28.14
Rate for Payer: Priority Health Cigna Priority Health	$21.52
Rate for Payer: Priority Health SBD	$20.86

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE

Facility

$39.34

Service Code	NDC 76329330401
Hospital Charge Code	1306
Hospital Revenue Code	250
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare	$19.67
Rate for Payer: Aetna New Business (MI Preferred)	$25.57
Rate for Payer: BCBS Complete	$15.74
Rate for Payer: Cash Price	$31.47
Rate for Payer: Cofinity Commercial	$27.54
Rate for Payer: Cofinity Commercial	$33.83
Rate for Payer: Cofinity Medicare Advantage	$27.54
Rate for Payer: Encore Health Key Benefits Commercial	$31.47
Rate for Payer: Healthscope Commercial	$35.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.44
Rate for Payer: PHP Commercial	$33.44
Rate for Payer: Priority Health Cigna Priority Health	$25.57
Rate for Payer: Priority Health SBD	$24.78

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE

Facility

$36.23

Service Code	NDC 64253090091
Hospital Charge Code	1306
Hospital Revenue Code	250
Min. Negotiated Rate	$22.82
Max. Negotiated Rate	$32.61
Rate for Payer: Aetna Commercial	$30.80
Rate for Payer: Aetna New Business (MI Preferred)	$23.55
Rate for Payer: Cash Price	$28.98
Rate for Payer: Cofinity Commercial	$25.36
Rate for Payer: Cofinity Commercial	$31.16
Rate for Payer: Cofinity Medicare Advantage	$25.36
Rate for Payer: Encore Health Key Benefits Commercial	$28.98
Rate for Payer: Healthscope Commercial	$32.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.80
Rate for Payer: PHP Commercial	$30.80
Rate for Payer: Priority Health Cigna Priority Health	$23.55
Rate for Payer: Priority Health SBD	$22.82

CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)

Facility

$70.54

Service Code	NDC 00409492834
Hospital Charge Code	163711
Hospital Revenue Code	250
Min. Negotiated Rate	$28.22
Max. Negotiated Rate	$63.49
Rate for Payer: Aetna Commercial	$59.96
Rate for Payer: Aetna Medicare	$35.27
Rate for Payer: Aetna New Business (MI Preferred)	$45.85
Rate for Payer: BCBS Complete	$28.22
Rate for Payer: Cash Price	$56.43
Rate for Payer: Cofinity Commercial	$49.38
Rate for Payer: Cofinity Commercial	$60.66
Rate for Payer: Cofinity Medicare Advantage	$49.38
Rate for Payer: Encore Health Key Benefits Commercial	$56.43
Rate for Payer: Healthscope Commercial	$63.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.96
Rate for Payer: PHP Commercial	$59.96
Rate for Payer: Priority Health Cigna Priority Health	$45.85
Rate for Payer: Priority Health SBD	$44.44

CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)

Facility

$70.54

Service Code	NDC 00409492834
Hospital Charge Code	163711
Hospital Revenue Code	250
Min. Negotiated Rate	$44.44
Max. Negotiated Rate	$63.49
Rate for Payer: Aetna Commercial	$59.96
Rate for Payer: Aetna New Business (MI Preferred)	$45.85
Rate for Payer: Cash Price	$56.43
Rate for Payer: Cofinity Commercial	$49.38
Rate for Payer: Cofinity Commercial	$60.66
Rate for Payer: Cofinity Medicare Advantage	$49.38
Rate for Payer: Encore Health Key Benefits Commercial	$56.43
Rate for Payer: Healthscope Commercial	$63.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.96
Rate for Payer: PHP Commercial	$59.96
Rate for Payer: Priority Health Cigna Priority Health	$45.85
Rate for Payer: Priority Health SBD	$44.44

CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)

Facility

$39.34

Service Code	NDC 76329330401
Hospital Charge Code	163711
Hospital Revenue Code	250
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare	$19.67
Rate for Payer: Aetna New Business (MI Preferred)	$25.57
Rate for Payer: BCBS Complete	$15.74
Rate for Payer: Cash Price	$31.47
Rate for Payer: Cofinity Commercial	$27.54
Rate for Payer: Cofinity Commercial	$33.83
Rate for Payer: Cofinity Medicare Advantage	$27.54
Rate for Payer: Encore Health Key Benefits Commercial	$31.47
Rate for Payer: Healthscope Commercial	$35.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.44
Rate for Payer: PHP Commercial	$33.44
Rate for Payer: Priority Health Cigna Priority Health	$25.57
Rate for Payer: Priority Health SBD	$24.78

CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)

Facility

$39.34

Service Code	NDC 76329330401
Hospital Charge Code	163711
Hospital Revenue Code	250
Min. Negotiated Rate	$24.78
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna New Business (MI Preferred)	$25.57
Rate for Payer: Cash Price	$31.47
Rate for Payer: Cofinity Commercial	$27.54
Rate for Payer: Cofinity Commercial	$33.83
Rate for Payer: Cofinity Medicare Advantage	$27.54
Rate for Payer: Encore Health Key Benefits Commercial	$31.47
Rate for Payer: Healthscope Commercial	$35.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.44
Rate for Payer: PHP Commercial	$33.44
Rate for Payer: Priority Health Cigna Priority Health	$25.57
Rate for Payer: Priority Health SBD	$24.78

CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION

Facility

$33.11

Service Code	HCPCS J0612
Hospital Charge Code	1312
Hospital Revenue Code	636
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$29.80
Rate for Payer: Aetna Commercial	$28.14
Rate for Payer: Aetna New Business (MI Preferred)	$21.52
Rate for Payer: Cash Price	$26.49
Rate for Payer: Cofinity Commercial	$23.18
Rate for Payer: Cofinity Commercial	$28.47
Rate for Payer: Cofinity Medicare Advantage	$23.18
Rate for Payer: Encore Health Key Benefits Commercial	$26.49
Rate for Payer: Healthscope Commercial	$29.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.14
Rate for Payer: PHP Commercial	$28.14
Rate for Payer: Priority Health Cigna Priority Health	$21.52
Rate for Payer: Priority Health SBD	$20.86

CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION

Facility

$33.11

Service Code	HCPCS J0612
Hospital Charge Code	1312
Hospital Revenue Code	636
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$29.80
Rate for Payer: Aetna Commercial	$28.14
Rate for Payer: Aetna Medicare	$16.55
Rate for Payer: Aetna New Business (MI Preferred)	$21.52
Rate for Payer: BCBS Complete	$13.24
Rate for Payer: Cash Price	$26.49
Rate for Payer: Cofinity Commercial	$23.18
Rate for Payer: Cofinity Commercial	$28.47
Rate for Payer: Cofinity Medicare Advantage	$23.18
Rate for Payer: Encore Health Key Benefits Commercial	$26.49
Rate for Payer: Healthscope Commercial	$29.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.14
Rate for Payer: PHP Commercial	$28.14
Rate for Payer: Priority Health Cigna Priority Health	$21.52
Rate for Payer: Priority Health SBD	$20.86

CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS (TPN COMPONENT)

Facility

$167.77

Service Code	HCPCS J0612
Hospital Charge Code	180903
Hospital Revenue Code	636
Min. Negotiated Rate	$67.11
Max. Negotiated Rate	$150.99
Rate for Payer: Aetna Commercial	$142.60
Rate for Payer: Aetna Medicare	$83.89
Rate for Payer: Aetna New Business (MI Preferred)	$109.05
Rate for Payer: BCBS Complete	$67.11
Rate for Payer: Cash Price	$134.22
Rate for Payer: Cofinity Commercial	$117.44
Rate for Payer: Cofinity Commercial	$144.28
Rate for Payer: Cofinity Medicare Advantage	$117.44
Rate for Payer: Encore Health Key Benefits Commercial	$134.22
Rate for Payer: Healthscope Commercial	$150.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.60
Rate for Payer: PHP Commercial	$142.60
Rate for Payer: Priority Health Cigna Priority Health	$109.05
Rate for Payer: Priority Health SBD	$105.70

CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS (TPN COMPONENT)

Facility

$167.77

Service Code	HCPCS J0612
Hospital Charge Code	180903
Hospital Revenue Code	636
Min. Negotiated Rate	$105.70
Max. Negotiated Rate	$150.99
Rate for Payer: Aetna Commercial	$142.60
Rate for Payer: Aetna New Business (MI Preferred)	$109.05
Rate for Payer: Cash Price	$134.22
Rate for Payer: Cofinity Commercial	$117.44
Rate for Payer: Cofinity Commercial	$144.28
Rate for Payer: Cofinity Medicare Advantage	$117.44
Rate for Payer: Encore Health Key Benefits Commercial	$134.22
Rate for Payer: Healthscope Commercial	$150.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.60
Rate for Payer: PHP Commercial	$142.60
Rate for Payer: Priority Health Cigna Priority Health	$109.05
Rate for Payer: Priority Health SBD	$105.70

CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION

Facility

$35.38

Service Code	HCPCS J0612
Hospital Charge Code	189461
Hospital Revenue Code	636
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$31.84
Rate for Payer: Aetna Commercial	$30.07
Rate for Payer: Aetna Medicare	$17.69
Rate for Payer: Aetna New Business (MI Preferred)	$23.00
Rate for Payer: BCBS Complete	$14.15
Rate for Payer: Cash Price	$28.30
Rate for Payer: Cofinity Commercial	$24.77
Rate for Payer: Cofinity Commercial	$30.43
Rate for Payer: Cofinity Medicare Advantage	$24.77
Rate for Payer: Encore Health Key Benefits Commercial	$28.30
Rate for Payer: Healthscope Commercial	$31.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.07
Rate for Payer: PHP Commercial	$30.07
Rate for Payer: Priority Health Cigna Priority Health	$23.00
Rate for Payer: Priority Health SBD	$22.29

Know your out-of-pocket cost for care.

All Charges