|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 23155053102
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.90 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.75
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Advantage |
$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: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.02
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health SBD |
$278.90
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$456.48
|
|
|
Service Code
|
NDC 00904711961
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.58 |
| Max. Negotiated Rate |
$410.83 |
| Rate for Payer: Aetna Commercial |
$388.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.71
|
| Rate for Payer: Cash Price |
$365.18
|
| Rate for Payer: Cofinity Advantage |
$319.54
|
| Rate for Payer: Cofinity Commercial |
$392.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$365.18
|
| Rate for Payer: Healthscope Commercial |
$410.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.36
|
| Rate for Payer: PHP Commercial |
$388.01
|
| Rate for Payer: Priority Health SBD |
$287.58
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$626.88
|
|
|
Service Code
|
NDC 62135019122
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.36 |
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$501.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$532.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.16
|
| Rate for Payer: PHP Commercial |
$532.85
|
| Rate for Payer: Priority Health SBD |
$394.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.47
|
| Rate for Payer: UHC Core |
$326.60
|
| Rate for Payer: UHC Exchange |
$246.36
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$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 Advantage |
$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: Multiplan/Beech St/PHCS Commercial |
$431.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.88
|
| Rate for Payer: PHP Commercial |
$431.66
|
| Rate for Payer: Priority Health SBD |
$319.94
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.65
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
108968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| 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: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cofinity Advantage |
$23.55
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.92
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.24
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health SBD |
$21.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.65
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
108968
|
|
Hospital Revenue Code
|
636
|
| 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 Advantage |
$23.55
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| 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: Opus (Opus Packaging Group) HMA |
$25.24
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health SBD |
$21.20
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Advantage |
$27.54
|
| Rate for Payer: Cofinity Advantage |
$23.18
|
| Rate for Payer: Cofinity Advantage |
$49.38
|
| Rate for Payer: Cofinity Advantage |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.17
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: Priority Health SBD |
$44.44
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: Priority Health SBD |
$20.86
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$36.23
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$32.61 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$18.11
|
| Rate for Payer: Aetna Medicare |
$35.27
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.55
|
| Rate for Payer: BCBS Complete |
$28.22
|
| Rate for Payer: BCBS Complete |
$14.49
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cofinity Advantage |
$49.38
|
| Rate for Payer: Cofinity Advantage |
$23.18
|
| Rate for Payer: Cofinity Advantage |
$27.54
|
| Rate for Payer: Cofinity Advantage |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.91
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: Priority Health SBD |
$44.44
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.85
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Advantage |
$27.54
|
| Rate for Payer: Cofinity Advantage |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.91
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: Priority Health SBD |
$44.44
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Medicare |
$35.27
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.85
|
| Rate for Payer: BCBS Complete |
$28.22
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Advantage |
$27.54
|
| Rate for Payer: Cofinity Advantage |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.91
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: Priority Health SBD |
$44.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.07
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.50
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Cofinity Advantage |
$23.15
|
| Rate for Payer: Cofinity Commercial |
$28.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.46
|
| Rate for Payer: Healthscope Commercial |
$29.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.80
|
| Rate for Payer: PHP Commercial |
$28.11
|
| Rate for Payer: Priority Health SBD |
$20.83
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.07
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$28.11
|
| Rate for Payer: Aetna Medicare |
$16.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.50
|
| Rate for Payer: BCBS Complete |
$13.23
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Cofinity Advantage |
$23.15
|
| Rate for Payer: Cofinity Commercial |
$28.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.46
|
| Rate for Payer: Healthscope Commercial |
$29.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.80
|
| Rate for Payer: PHP Commercial |
$28.11
|
| Rate for Payer: Priority Health SBD |
$20.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS (TPN COMPONENT)
|
Facility
|
OP
|
$167.77
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
180903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| 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: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Advantage |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health SBD |
$105.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS (TPN COMPONENT)
|
Facility
|
IP
|
$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 Advantage |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| 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: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health SBD |
$105.70
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$35.38
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| 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: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCN Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.54
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: Priority Health SBD |
$22.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
IP
|
$35.38
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Advantage |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| 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: Opus (Opus Packaging Group) HMA |
$26.54
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: Priority Health SBD |
$22.29
|
|
|
CALCIUM GLUCONATE 2.5 % GEL 25 GM
|
Facility
|
IP
|
$239.55
|
|
|
Service Code
|
NDC 35181730332
|
| Hospital Charge Code |
301456
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.92 |
| Max. Negotiated Rate |
$215.59 |
| Rate for Payer: Aetna Commercial |
$203.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.71
|
| Rate for Payer: Cash Price |
$191.64
|
| Rate for Payer: Cofinity Advantage |
$167.69
|
| Rate for Payer: Cofinity Commercial |
$206.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.64
|
| Rate for Payer: Healthscope Commercial |
$215.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.66
|
| Rate for Payer: PHP Commercial |
$203.62
|
| Rate for Payer: Priority Health SBD |
$150.92
|
|
|
CALCIUM GLUCONATE 2.5 % GEL 25 GM
|
Facility
|
OP
|
$239.55
|
|
|
Service Code
|
NDC 35181730332
|
| Hospital Charge Code |
301456
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$215.59 |
| Rate for Payer: Aetna Commercial |
$203.62
|
| Rate for Payer: Aetna Medicare |
$119.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.71
|
| Rate for Payer: BCBS Complete |
$95.82
|
| Rate for Payer: Cash Price |
$191.64
|
| Rate for Payer: Cofinity Advantage |
$167.69
|
| Rate for Payer: Cofinity Commercial |
$206.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.64
|
| Rate for Payer: Healthscope Commercial |
$215.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.66
|
| Rate for Payer: PHP Commercial |
$203.62
|
| Rate for Payer: Priority Health SBD |
$150.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.71
|
| Rate for Payer: UHC Core |
$124.81
|
| Rate for Payer: UHC Exchange |
$94.14
|
|
|
CALCIUM GLUCONATE 2.5 % GEL 25 GM
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
NDC 00295752040
|
| Hospital Charge Code |
301456
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: Aetna Medicare |
$96.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.80
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Advantage |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.60
|
| Rate for Payer: Healthscope Commercial |
$172.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.00
|
| Rate for Payer: PHP Commercial |
$163.20
|
| Rate for Payer: Priority Health SBD |
$120.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.80
|
| Rate for Payer: UHC Core |
$100.03
|
| Rate for Payer: UHC Exchange |
$75.46
|
|
|
CALCIUM GLUCONATE 2.5 % GEL 25 GM
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
NDC 00295752040
|
| Hospital Charge Code |
301456
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.96 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Advantage |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.60
|
| Rate for Payer: Healthscope Commercial |
$172.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.00
|
| Rate for Payer: PHP Commercial |
$163.20
|
| Rate for Payer: Priority Health SBD |
$120.96
|
|
|
CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$74.32
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.20
|
| Rate for Payer: BCN Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
|
|
CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health SBD |
$46.82
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
NDC 38779182608
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.58 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Advantage |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.50
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health SBD |
$230.58
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
NDC 38779182608
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.84 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.90
|
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna Medicare |
$183.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Advantage |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.50
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health SBD |
$230.58
|
| Rate for Payer: UHC Core |
$190.69
|
| Rate for Payer: UHC Exchange |
$143.84
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$15.39
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$13.85 |
| Rate for Payer: Aetna Commercial |
$13.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cofinity Advantage |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: Priority Health SBD |
$9.70
|
|
