|
CALCIUM ACETATE 667 MG TABLET
|
Facility
IP
|
$559.30
|
|
|
Service Code
|
NDC 7132180320
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.12 |
| Max. Negotiated Rate |
$503.37 |
| Rate for Payer: Aetna Commercial |
$475.40
|
| Rate for Payer: BCBS Trust/PPO |
$432.23
|
| Rate for Payer: BCN Commercial |
$432.23
|
| Rate for Payer: Cash Price |
$447.44
|
| Rate for Payer: Cofinity Commercial |
$481.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$447.44
|
| Rate for Payer: Healthscope Commercial |
$503.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$419.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$475.40
|
| Rate for Payer: PHP Commercial |
$475.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.18
|
| Rate for Payer: UHC Core |
$467.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$419.48
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
IP
|
$512.30
|
|
|
Service Code
|
NDC 536133632
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.45 |
| Max. Negotiated Rate |
$461.07 |
| Rate for Payer: Aetna Commercial |
$435.46
|
| Rate for Payer: BCBS Trust/PPO |
$395.91
|
| Rate for Payer: BCN Commercial |
$395.91
|
| Rate for Payer: Cash Price |
$409.84
|
| Rate for Payer: Cofinity Commercial |
$440.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.84
|
| Rate for Payer: Healthscope Commercial |
$461.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$435.46
|
| Rate for Payer: PHP Commercial |
$435.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.82
|
| Rate for Payer: UHC Core |
$427.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.22
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
IP
|
$626.88
|
|
|
Service Code
|
NDC 29033-026-02
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.33 |
| Max. Negotiated Rate |
$564.19 |
| Rate for Payer: Aetna Commercial |
$532.85
|
| Rate for Payer: BCBS Trust/PPO |
$484.45
|
| Rate for Payer: BCN Commercial |
$484.45
|
| Rate for Payer: Cash Price |
$501.50
|
| 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: Lakeland Regional Health Systems Commercial |
$470.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$532.85
|
| Rate for Payer: PHP Commercial |
$532.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.65
|
| Rate for Payer: UHC Core |
$523.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$470.16
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
IP
|
$141.75
|
|
|
Service Code
|
NDC 0536-1007-15
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$127.58 |
| Rate for Payer: Aetna Commercial |
$120.49
|
| Rate for Payer: BCBS Trust/PPO |
$109.54
|
| Rate for Payer: BCN Commercial |
$109.54
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cofinity Commercial |
$121.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.40
|
| Rate for Payer: Healthscope Commercial |
$127.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.49
|
| Rate for Payer: PHP Commercial |
$120.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.74
|
| Rate for Payer: UHC Core |
$118.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.31
|
|
|
CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET
|
Facility
IP
|
$245.70
|
|
|
Service Code
|
NDC 766074152
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.85 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: BCBS Trust/PPO |
$189.88
|
| Rate for Payer: BCN Commercial |
$189.88
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$211.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Healthscope Commercial |
$221.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.84
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.22
|
| Rate for Payer: UHC Core |
$205.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.28
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$170.10
|
|
|
Service Code
|
NDC 5789674201
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.74 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: BCBS Trust/PPO |
$131.45
|
| Rate for Payer: BCN Commercial |
$131.45
|
| Rate for Payer: Aetna Commercial |
$144.58
|
| Rate for Payer: Cash Price |
$136.08
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.08
|
| Rate for Payer: Healthscope Commercial |
$153.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.58
|
| Rate for Payer: PHP Commercial |
$144.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.69
|
| Rate for Payer: UHC Core |
$142.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.58
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
NDC 904546092
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.27 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: BCBS Trust/PPO |
$146.06
|
| Rate for Payer: BCN Commercial |
$146.06
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
NDC 1000670038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.90 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Aetna Commercial |
$146.20
|
| Rate for Payer: BCBS Trust/PPO |
$132.92
|
| Rate for Payer: BCN Commercial |
$132.92
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.60
|
| Rate for Payer: Healthscope Commercial |
$154.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.20
|
| Rate for Payer: PHP Commercial |
$146.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.36
|
| Rate for Payer: UHC Core |
$143.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.00
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
NDC 6373929101
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$731.88 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$1,020.00
|
| Rate for Payer: BCBS Trust/PPO |
$927.36
|
| Rate for Payer: BCN Commercial |
$927.36
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$1,032.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.00
|
| Rate for Payer: Healthscope Commercial |
$1,080.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.00
|
| Rate for Payer: PHP Commercial |
$1,020.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,044.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.00
|
| Rate for Payer: UHC Core |
$1,002.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.00
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
IP
|
$83.16
|
|
|
Service Code
|
NDC 536781708
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$74.84 |
| Rate for Payer: Aetna Commercial |
$70.69
|
| Rate for Payer: BCBS Trust/PPO |
$64.27
|
| Rate for Payer: BCN Commercial |
$64.27
|
| Rate for Payer: Cash Price |
$66.53
|
| Rate for Payer: Cofinity Commercial |
$71.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.53
|
| Rate for Payer: Healthscope Commercial |
$74.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.69
|
| Rate for Payer: PHP Commercial |
$70.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.18
|
| Rate for Payer: UHC Core |
$69.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.37
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253-900-30
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.19 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$25.59
|
| Rate for Payer: BCN Commercial |
$25.59
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253-900-36
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.19 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$25.59
|
| Rate for Payer: BCN Commercial |
$25.59
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$36.23
|
|
|
Service Code
|
NDC 64253-900-91
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$32.61 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: BCBS Trust/PPO |
$28.00
|
| Rate for Payer: BCN Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.80
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC Core |
$30.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$60.08
|
|
|
Service Code
|
NDC 0409-4928-34
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$46.43
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cofinity Commercial |
$51.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$54.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.07
|
| Rate for Payer: PHP Commercial |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.87
|
| Rate for Payer: UHC Core |
$50.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.06
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$39.39
|
|
|
Service Code
|
NDC 76329-3304-1
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$35.45 |
| Rate for Payer: Aetna Commercial |
$33.48
|
| Rate for Payer: BCBS Trust/PPO |
$30.44
|
| Rate for Payer: BCN Commercial |
$30.44
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cofinity Commercial |
$33.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.51
|
| Rate for Payer: Healthscope Commercial |
$35.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.48
|
| Rate for Payer: PHP Commercial |
$33.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.66
|
| Rate for Payer: UHC Core |
$32.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.54
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$60.08
|
|
|
Service Code
|
NDC 0409-4928-11
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$46.43
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cofinity Commercial |
$51.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$54.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.07
|
| Rate for Payer: PHP Commercial |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.87
|
| Rate for Payer: UHC Core |
$50.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.06
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
IP
|
$44.59
|
|
|
Service Code
|
NDC 0409-1631-10
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$40.13 |
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: BCBS Trust/PPO |
$34.46
|
| Rate for Payer: BCN Commercial |
$34.46
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.67
|
| Rate for Payer: Healthscope Commercial |
$40.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.90
|
| Rate for Payer: PHP Commercial |
$37.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.24
|
| Rate for Payer: UHC Core |
$37.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.44
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
IP
|
$44.59
|
|
|
Service Code
|
NDC 0409-1631-10
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$40.13 |
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: BCBS Trust/PPO |
$34.46
|
| Rate for Payer: BCN Commercial |
$34.46
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.67
|
| Rate for Payer: Healthscope Commercial |
$40.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.90
|
| Rate for Payer: PHP Commercial |
$37.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.24
|
| Rate for Payer: UHC Core |
$37.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.44
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
IP
|
$60.08
|
|
|
Service Code
|
NDC 0409-4928-34
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$46.43
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cofinity Commercial |
$51.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$54.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.07
|
| Rate for Payer: PHP Commercial |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.87
|
| Rate for Payer: UHC Core |
$50.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.06
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.99 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: BCBS Trust/PPO |
$30.40
|
| Rate for Payer: BCN Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.44
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.62
|
| Rate for Payer: UHC Core |
$32.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
|
|
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 |
$21.58 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$27.34
|
| Rate for Payer: BCN Commercial |
$27.34
|
| Rate for Payer: Cash Price |
$28.30
|
| 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: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.07
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.13
|
| Rate for Payer: UHC Core |
$29.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
IP
|
$32.93
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: BCBS Trust/PPO |
$25.45
|
| Rate for Payer: BCN Commercial |
$25.45
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.99
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.98
|
| Rate for Payer: UHC Core |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
IP
|
$90.24
|
|
|
Service Code
|
NDC 0536-4306-08
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: BCBS Trust/PPO |
$69.74
|
| Rate for Payer: BCN Commercial |
$69.74
|
| Rate for Payer: Cash Price |
$72.19
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.70
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.41
|
| Rate for Payer: UHC Core |
$75.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.68
|
|
|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT
|
Facility
IP
|
$19.58
|
|
|
Service Code
|
NDC 2390000361
|
| Hospital Charge Code |
76967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.64
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.68
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
IP
|
$326.65
|
|
|
Service Code
|
NDC 75834-221-01
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.22 |
| Max. Negotiated Rate |
$293.98 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: BCBS Trust/PPO |
$252.44
|
| Rate for Payer: BCN Commercial |
$252.44
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.45
|
| Rate for Payer: UHC Core |
$272.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
