|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
NDC 77333011010
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.14 |
| Max. Negotiated Rate |
$151.47 |
| Rate for Payer: Aetna Commercial |
$143.06
|
| Rate for Payer: BCBS Trust/PPO |
$139.00
|
| Rate for Payer: BCN Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$151.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.22
|
| 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: PHP Commercial |
$143.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.10
|
| Rate for Payer: UHC Core |
$140.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.22
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 00904546092
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: BCBS Trust/PPO |
$156.10
|
| Rate for Payer: BCN Commercial |
$156.10
|
| 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 Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
OP
|
$587.50
|
|
|
Service Code
|
NDC 71321080320
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.58 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Aetna Commercial |
$499.38
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$183.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$183.59
|
| Rate for Payer: BCBS Complete |
$108.75
|
| Rate for Payer: BCBS MAPPO |
$146.88
|
| Rate for Payer: BCBS Trust/PPO |
$482.98
|
| Rate for Payer: BCN Commercial |
$482.98
|
| Rate for Payer: BCN Medicare Advantage |
$146.88
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cofinity Commercial |
$505.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$528.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.62
|
| Rate for Payer: Mclaren Medicaid |
$103.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.22
|
| Rate for Payer: Meridian Medicaid |
$108.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$161.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.38
|
| Rate for Payer: Nomi Health Commercial |
$481.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.62
|
| Rate for Payer: PACE Senior Care Partners |
$139.53
|
| Rate for Payer: PACE SWMI |
$146.88
|
| Rate for Payer: PHP Commercial |
$499.38
|
| Rate for Payer: PHP Medicare Advantage |
$146.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$511.12
|
| Rate for Payer: Priority Health Medicare |
$148.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.90
|
| Rate for Payer: Railroad Medicare Medicare |
$146.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.00
|
| Rate for Payer: UHC Core |
$490.56
|
| Rate for Payer: UHC Exchange |
$146.88
|
| Rate for Payer: UHC Medicaid |
$103.58
|
| Rate for Payer: UHC Medicare Advantage |
$146.88
|
| Rate for Payer: UHCCP Medicaid |
$103.58
|
| Rate for Payer: VA VA |
$146.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.62
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
OP
|
$535.80
|
|
|
Service Code
|
NDC 00536133632
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$482.22 |
| Rate for Payer: Aetna Commercial |
$455.43
|
| Rate for Payer: Aetna Medicare |
$139.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.44
|
| Rate for Payer: BCBS Complete |
$99.18
|
| Rate for Payer: BCBS MAPPO |
$133.95
|
| Rate for Payer: BCBS Trust/PPO |
$440.48
|
| Rate for Payer: BCN Commercial |
$440.48
|
| Rate for Payer: BCN Medicare Advantage |
$133.95
|
| Rate for Payer: Cash Price |
$428.64
|
| Rate for Payer: Cofinity Commercial |
$460.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.95
|
| Rate for Payer: Healthscope Commercial |
$482.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.85
|
| Rate for Payer: Mclaren Medicaid |
$94.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.65
|
| Rate for Payer: Meridian Medicaid |
$99.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.43
|
| Rate for Payer: Nomi Health Commercial |
$439.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.85
|
| Rate for Payer: PACE Senior Care Partners |
$127.25
|
| Rate for Payer: PACE SWMI |
$133.95
|
| Rate for Payer: PHP Commercial |
$455.43
|
| Rate for Payer: PHP Medicare Advantage |
$133.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$466.15
|
| Rate for Payer: Priority Health Medicare |
$135.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.92
|
| Rate for Payer: Railroad Medicare Medicare |
$133.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.50
|
| Rate for Payer: UHC Core |
$447.39
|
| Rate for Payer: UHC Exchange |
$133.95
|
| Rate for Payer: UHC Medicaid |
$94.46
|
| Rate for Payer: UHC Medicare Advantage |
$133.95
|
| Rate for Payer: UHCCP Medicaid |
$94.46
|
| Rate for Payer: VA VA |
$133.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.85
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
IP
|
$535.80
|
|
|
Service Code
|
NDC 00536133632
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$372.92 |
| Max. Negotiated Rate |
$482.22 |
| Rate for Payer: Aetna Commercial |
$455.43
|
| Rate for Payer: BCBS Trust/PPO |
$442.52
|
| Rate for Payer: BCN Commercial |
$442.52
|
| Rate for Payer: Cash Price |
$428.64
|
| Rate for Payer: Cofinity Commercial |
$460.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.64
|
| Rate for Payer: Healthscope Commercial |
$482.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.43
|
| Rate for Payer: Nomi Health Commercial |
$439.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.85
|
| Rate for Payer: PHP Commercial |
$455.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$466.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.50
|
| Rate for Payer: UHC Core |
$447.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.85
|
|
|
CALCIUM ACETATE 667 MG TABLET
|
Facility
|
IP
|
$587.50
|
|
|
Service Code
|
NDC 71321080320
|
| Hospital Charge Code |
192575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.90 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Aetna Commercial |
$499.38
|
| Rate for Payer: BCBS Trust/PPO |
$485.22
|
| Rate for Payer: BCN Commercial |
$485.22
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cofinity Commercial |
$505.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.00
|
| Rate for Payer: Healthscope Commercial |
$528.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.38
|
| Rate for Payer: Nomi Health Commercial |
$481.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.62
|
| Rate for Payer: PHP Commercial |
$499.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$511.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.00
|
| Rate for Payer: UHC Core |
$490.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.62
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 29033002602
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.12 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: BCBS Trust/PPO |
$365.63
|
| Rate for Payer: BCN Commercial |
$365.63
|
| Rate for Payer: Cash Price |
$354.16
|
| 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: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$363.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.02
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$385.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.58
|
| Rate for Payer: UHC Core |
$369.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$442.70
|
|
|
Service Code
|
NDC 29033002602
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.05 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna Medicare |
$115.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.34
|
| Rate for Payer: BCBS Complete |
$81.94
|
| Rate for Payer: BCBS MAPPO |
$110.67
|
| Rate for Payer: BCBS Trust/PPO |
$363.94
|
| Rate for Payer: BCN Commercial |
$363.94
|
| Rate for Payer: BCN Medicare Advantage |
$110.67
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.67
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Mclaren Medicaid |
$78.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.21
|
| Rate for Payer: Meridian Medicaid |
$81.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$363.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.02
|
| Rate for Payer: PACE Senior Care Partners |
$105.14
|
| Rate for Payer: PACE SWMI |
$110.67
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: PHP Medicare Advantage |
$110.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$385.15
|
| Rate for Payer: Priority Health Medicare |
$111.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.12
|
| Rate for Payer: Railroad Medicare Medicare |
$110.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.58
|
| Rate for Payer: UHC Core |
$369.65
|
| Rate for Payer: UHC Exchange |
$110.67
|
| Rate for Payer: UHC Medicaid |
$78.05
|
| Rate for Payer: UHC Medicare Advantage |
$110.67
|
| Rate for Payer: UHCCP Medicaid |
$78.05
|
| Rate for Payer: VA VA |
$110.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.10 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$43.11
|
| Rate for Payer: BCBS Trust/PPO |
$58.26
|
| Rate for Payer: BCBS Trust/PPO |
$32.49
|
| Rate for Payer: BCBS Trust/PPO |
$29.92
|
| Rate for Payer: BCBS Trust/PPO |
$27.35
|
| Rate for Payer: BCN Commercial |
$43.11
|
| Rate for Payer: BCN Commercial |
$32.49
|
| Rate for Payer: BCN Commercial |
$27.35
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: BCN Commercial |
$58.26
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$29.71
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| 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 |
$39.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.91
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.94
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: UHC Core |
$30.25
|
| Rate for Payer: UHC Core |
$43.59
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: UHC Core |
$32.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna Medicare |
$10.23
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: BCBS Complete |
$6.71
|
| Rate for Payer: BCBS Complete |
$6.13
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: BCBS Complete |
$9.66
|
| Rate for Payer: BCBS MAPPO |
$17.64
|
| Rate for Payer: BCBS MAPPO |
$9.06
|
| Rate for Payer: BCBS MAPPO |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$9.84
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$32.34
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCBS Trust/PPO |
$29.78
|
| Rate for Payer: BCBS Trust/PPO |
$57.99
|
| Rate for Payer: BCBS Trust/PPO |
$42.91
|
| Rate for Payer: BCN Commercial |
$32.34
|
| Rate for Payer: BCN Commercial |
$29.78
|
| Rate for Payer: BCN Commercial |
$27.22
|
| Rate for Payer: BCN Commercial |
$57.99
|
| Rate for Payer: BCN Commercial |
$42.91
|
| Rate for Payer: BCN Medicare Advantage |
$17.64
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: BCN Medicare Advantage |
$9.84
|
| Rate for Payer: BCN Medicare Advantage |
$9.06
|
| Rate for Payer: BCN Medicare Advantage |
$8.28
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.84
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.50
|
| Rate for Payer: Mclaren Medicaid |
$6.39
|
| Rate for Payer: Mclaren Medicaid |
$9.20
|
| Rate for Payer: Mclaren Medicaid |
$6.94
|
| Rate for Payer: Mclaren Medicaid |
$12.44
|
| Rate for Payer: Mclaren Medicaid |
$5.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.33
|
| Rate for Payer: Meridian Medicaid |
$6.71
|
| Rate for Payer: Meridian Medicaid |
$6.13
|
| Rate for Payer: Meridian Medicaid |
$7.28
|
| Rate for Payer: Meridian Medicaid |
$9.66
|
| Rate for Payer: Meridian Medicaid |
$13.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$29.71
|
| 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 |
$39.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.91
|
| Rate for Payer: PACE Senior Care Partners |
$7.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.60
|
| Rate for Payer: PACE Senior Care Partners |
$16.75
|
| Rate for Payer: PACE Senior Care Partners |
$12.40
|
| Rate for Payer: PACE Senior Care Partners |
$9.34
|
| Rate for Payer: PACE SWMI |
$8.28
|
| Rate for Payer: PACE SWMI |
$9.06
|
| Rate for Payer: PACE SWMI |
$9.84
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PACE SWMI |
$17.64
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$28.14
|
| 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 Medicare Advantage |
$9.06
|
| Rate for Payer: PHP Medicare Advantage |
$17.64
|
| Rate for Payer: PHP Medicare Advantage |
$8.28
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: PHP Medicare Advantage |
$9.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.52
|
| Rate for Payer: Priority Health Medicare |
$9.15
|
| Rate for Payer: Priority Health Medicare |
$17.81
|
| Rate for Payer: Priority Health Medicare |
$8.36
|
| Rate for Payer: Priority Health Medicare |
$13.18
|
| Rate for Payer: Priority Health Medicare |
$9.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: Railroad Medicare Medicare |
$17.64
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: Railroad Medicare Medicare |
$9.84
|
| Rate for Payer: Railroad Medicare Medicare |
$8.28
|
| Rate for Payer: Railroad Medicare Medicare |
$9.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$43.59
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: UHC Core |
$32.85
|
| Rate for Payer: UHC Core |
$30.25
|
| Rate for Payer: UHC Exchange |
$8.28
|
| Rate for Payer: UHC Exchange |
$13.05
|
| Rate for Payer: UHC Exchange |
$9.06
|
| Rate for Payer: UHC Exchange |
$17.64
|
| Rate for Payer: UHC Exchange |
$9.84
|
| Rate for Payer: UHC Medicaid |
$12.44
|
| Rate for Payer: UHC Medicaid |
$9.20
|
| Rate for Payer: UHC Medicaid |
$6.39
|
| Rate for Payer: UHC Medicaid |
$6.94
|
| Rate for Payer: UHC Medicaid |
$5.84
|
| Rate for Payer: UHC Medicare Advantage |
$9.84
|
| Rate for Payer: UHC Medicare Advantage |
$8.28
|
| Rate for Payer: UHC Medicare Advantage |
$17.64
|
| Rate for Payer: UHC Medicare Advantage |
$9.06
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: UHCCP Medicaid |
$9.20
|
| Rate for Payer: UHCCP Medicaid |
$12.44
|
| Rate for Payer: UHCCP Medicaid |
$6.94
|
| Rate for Payer: UHCCP Medicaid |
$5.84
|
| Rate for Payer: UHCCP Medicaid |
$6.39
|
| Rate for Payer: VA VA |
$17.64
|
| Rate for Payer: VA VA |
$8.28
|
| Rate for Payer: VA VA |
$13.05
|
| Rate for Payer: VA VA |
$9.06
|
| Rate for Payer: VA VA |
$9.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$52.20
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: BCBS Complete |
$9.66
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCBS MAPPO |
$17.64
|
| Rate for Payer: BCBS Trust/PPO |
$42.91
|
| Rate for Payer: BCBS Trust/PPO |
$57.99
|
| Rate for Payer: BCN Commercial |
$57.99
|
| Rate for Payer: BCN Commercial |
$42.91
|
| Rate for Payer: BCN Medicare Advantage |
$17.64
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| 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 |
$41.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.91
|
| Rate for Payer: Mclaren Medicaid |
$12.44
|
| Rate for Payer: Mclaren Medicaid |
$9.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: Meridian Medicaid |
$9.66
|
| Rate for Payer: Meridian Medicaid |
$13.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.91
|
| Rate for Payer: PACE Senior Care Partners |
$16.75
|
| Rate for Payer: PACE Senior Care Partners |
$12.40
|
| Rate for Payer: PACE SWMI |
$17.64
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: PHP Medicare Advantage |
$17.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.41
|
| Rate for Payer: Priority Health Medicare |
$17.81
|
| Rate for Payer: Priority Health Medicare |
$13.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: UHC Core |
$43.59
|
| Rate for Payer: UHC Exchange |
$17.64
|
| Rate for Payer: UHC Exchange |
$13.05
|
| Rate for Payer: UHC Medicaid |
$12.44
|
| Rate for Payer: UHC Medicaid |
$9.20
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: UHC Medicare Advantage |
$17.64
|
| Rate for Payer: UHCCP Medicaid |
$9.20
|
| Rate for Payer: UHCCP Medicaid |
$12.44
|
| Rate for Payer: VA VA |
$13.05
|
| Rate for Payer: VA VA |
$17.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$52.20
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.33 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: BCBS Trust/PPO |
$43.11
|
| Rate for Payer: BCBS Trust/PPO |
$58.26
|
| Rate for Payer: BCN Commercial |
$43.11
|
| Rate for Payer: BCN Commercial |
$58.26
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.91
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$43.59
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.91
|
|
|
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 |
$23.02 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$28.11
|
| Rate for Payer: BCBS Trust/PPO |
$27.31
|
| Rate for Payer: BCN Commercial |
$27.31
|
| Rate for Payer: Cash Price |
$26.46
|
| 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: Lakeland Regional Health Systems Commercial |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.11
|
| Rate for Payer: Nomi Health Commercial |
$27.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.80
|
| Rate for Payer: PHP Commercial |
$28.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.10
|
| Rate for Payer: UHC Core |
$27.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.80
|
|
|
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 |
$5.83 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$28.11
|
| Rate for Payer: Aetna Medicare |
$8.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.33
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS MAPPO |
$8.27
|
| Rate for Payer: BCBS Trust/PPO |
$27.19
|
| Rate for Payer: BCN Commercial |
$27.19
|
| Rate for Payer: BCN Medicare Advantage |
$8.27
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Cofinity Commercial |
$28.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.27
|
| Rate for Payer: Healthscope Commercial |
$29.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.80
|
| Rate for Payer: Mclaren Medicaid |
$5.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.68
|
| Rate for Payer: Meridian Medicaid |
$6.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.11
|
| Rate for Payer: Nomi Health Commercial |
$27.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.80
|
| Rate for Payer: PACE Senior Care Partners |
$7.85
|
| Rate for Payer: PACE SWMI |
$8.27
|
| Rate for Payer: PHP Commercial |
$28.11
|
| Rate for Payer: PHP Medicare Advantage |
$8.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.77
|
| Rate for Payer: Priority Health Medicare |
$8.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: Railroad Medicare Medicare |
$8.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.10
|
| Rate for Payer: UHC Core |
$27.61
|
| Rate for Payer: UHC Exchange |
$8.27
|
| Rate for Payer: UHC Medicaid |
$5.83
|
| Rate for Payer: UHC Medicare Advantage |
$8.27
|
| Rate for Payer: UHCCP Medicaid |
$5.83
|
| Rate for Payer: VA VA |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.80
|
|
|
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 |
$116.77 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$138.56
|
| Rate for Payer: Cash Price |
$134.22
|
| 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: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Nomi Health Commercial |
$137.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.64
|
| Rate for Payer: UHC Core |
$140.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.83
|
|
|
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 |
$29.58 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna Medicare |
$43.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.43
|
| Rate for Payer: BCBS Complete |
$31.05
|
| Rate for Payer: BCBS MAPPO |
$41.94
|
| Rate for Payer: BCBS Trust/PPO |
$137.92
|
| Rate for Payer: BCN Commercial |
$137.92
|
| Rate for Payer: BCN Medicare Advantage |
$41.94
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.94
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: Mclaren Medicaid |
$29.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.04
|
| Rate for Payer: Meridian Medicaid |
$31.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: Nomi Health Commercial |
$137.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.83
|
| Rate for Payer: PACE Senior Care Partners |
$39.85
|
| Rate for Payer: PACE SWMI |
$41.94
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: PHP Medicare Advantage |
$41.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.96
|
| Rate for Payer: Priority Health Medicare |
$42.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.77
|
| Rate for Payer: Railroad Medicare Medicare |
$41.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.64
|
| Rate for Payer: UHC Core |
$140.09
|
| Rate for Payer: UHC Exchange |
$41.94
|
| Rate for Payer: UHC Medicaid |
$29.58
|
| Rate for Payer: UHC Medicare Advantage |
$41.94
|
| Rate for Payer: UHCCP Medicaid |
$29.58
|
| Rate for Payer: VA VA |
$41.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.83
|
|
|
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 |
$24.62 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$29.22
|
| Rate for Payer: BCN Commercial |
$29.22
|
| 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 Commercial |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$29.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.54
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.62
|
| 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
|
OP
|
$35.38
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Medicare |
$9.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.06
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: BCBS MAPPO |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$29.09
|
| Rate for Payer: BCN Commercial |
$29.09
|
| Rate for Payer: BCN Medicare Advantage |
$8.85
|
| 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: Health Alliance Plan Medicare Advantage |
$8.85
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Mclaren Medicaid |
$6.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.29
|
| Rate for Payer: Meridian Medicaid |
$6.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$29.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.54
|
| Rate for Payer: PACE Senior Care Partners |
$8.40
|
| Rate for Payer: PACE SWMI |
$8.85
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: PHP Medicare Advantage |
$8.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.78
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.13
|
| Rate for Payer: UHC Core |
$29.54
|
| Rate for Payer: UHC Exchange |
$8.85
|
| Rate for Payer: UHC Medicaid |
$6.24
|
| Rate for Payer: UHC Medicare Advantage |
$8.85
|
| Rate for Payer: UHCCP Medicaid |
$6.24
|
| Rate for Payer: VA VA |
$8.85
|
| 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 |
$22.92 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: BCBS Trust/PPO |
$27.20
|
| Rate for Payer: BCN Commercial |
$27.20
|
| 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 Commercial |
$27.99
|
| Rate for Payer: Nomi Health Commercial |
$27.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.70
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.92
|
| 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 GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$32.93
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.29
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$8.23
|
| Rate for Payer: BCBS Trust/PPO |
$27.07
|
| Rate for Payer: BCN Commercial |
$27.07
|
| Rate for Payer: BCN Medicare Advantage |
$8.23
|
| 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: Health Alliance Plan Medicare Advantage |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Mclaren Medicaid |
$5.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.64
|
| Rate for Payer: Meridian Medicaid |
$6.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Nomi Health Commercial |
$27.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.70
|
| Rate for Payer: PACE Senior Care Partners |
$7.82
|
| Rate for Payer: PACE SWMI |
$8.23
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Medicare Advantage |
$8.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.65
|
| Rate for Payer: Priority Health Medicare |
$8.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.92
|
| Rate for Payer: Railroad Medicare Medicare |
$8.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.98
|
| Rate for Payer: UHC Core |
$27.50
|
| Rate for Payer: UHC Exchange |
$8.23
|
| Rate for Payer: UHC Medicaid |
$5.81
|
| Rate for Payer: UHC Medicare Advantage |
$8.23
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: VA VA |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$100.11
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Aetna Commercial |
$85.09
|
| Rate for Payer: Aetna Medicare |
$26.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.28
|
| Rate for Payer: BCBS Complete |
$18.53
|
| Rate for Payer: BCBS MAPPO |
$25.03
|
| Rate for Payer: BCBS Trust/PPO |
$82.30
|
| Rate for Payer: BCN Commercial |
$82.30
|
| Rate for Payer: BCN Medicare Advantage |
$25.03
|
| Rate for Payer: Cash Price |
$80.09
|
| Rate for Payer: Cofinity Commercial |
$86.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$90.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.08
|
| Rate for Payer: Mclaren Medicaid |
$17.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.28
|
| Rate for Payer: Meridian Medicaid |
$18.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.09
|
| Rate for Payer: Nomi Health Commercial |
$82.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.08
|
| Rate for Payer: PACE Senior Care Partners |
$23.78
|
| Rate for Payer: PACE SWMI |
$25.03
|
| Rate for Payer: PHP Commercial |
$85.09
|
| Rate for Payer: PHP Medicare Advantage |
$25.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.10
|
| Rate for Payer: Priority Health Medicare |
$25.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.68
|
| Rate for Payer: Railroad Medicare Medicare |
$25.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.10
|
| Rate for Payer: UHC Core |
$83.59
|
| Rate for Payer: UHC Exchange |
$25.03
|
| Rate for Payer: UHC Medicaid |
$17.65
|
| Rate for Payer: UHC Medicare Advantage |
$25.03
|
| Rate for Payer: UHCCP Medicaid |
$17.65
|
| Rate for Payer: VA VA |
$25.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$100.11
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Aetna Commercial |
$85.09
|
| Rate for Payer: BCBS Trust/PPO |
$82.68
|
| Rate for Payer: BCN Commercial |
$82.68
|
| Rate for Payer: Cash Price |
$80.09
|
| Rate for Payer: Cofinity Commercial |
$86.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.09
|
| Rate for Payer: Healthscope Commercial |
$90.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.09
|
| Rate for Payer: Nomi Health Commercial |
$82.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.08
|
| Rate for Payer: PHP Commercial |
$85.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.10
|
| Rate for Payer: UHC Core |
$83.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$4.71
|
|
|
Service Code
|
NDC 77333012025
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.47
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.87
|
| Rate for Payer: BCN Medicare Advantage |
$1.18
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.53
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.24
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.53
|
| Rate for Payer: PACE Senior Care Partners |
$1.12
|
| Rate for Payer: PACE SWMI |
$1.18
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.10
|
| Rate for Payer: Priority Health Medicare |
$1.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.14
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UHC Medicaid |
$0.83
|
| Rate for Payer: UHC Medicare Advantage |
$1.18
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: VA VA |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.53
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$4.71
|
|
|
Service Code
|
NDC 77333012025
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.77
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.53
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.14
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.53
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$235.13
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.65 |
| Max. Negotiated Rate |
$211.62 |
| Rate for Payer: Aetna Commercial |
$199.86
|
| Rate for Payer: BCBS Trust/PPO |
$194.19
|
| Rate for Payer: BCN Commercial |
$194.19
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cofinity Commercial |
$202.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.10
|
| Rate for Payer: Healthscope Commercial |
$211.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.86
|
| Rate for Payer: Nomi Health Commercial |
$192.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.35
|
| Rate for Payer: PHP Commercial |
$199.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.91
|
| Rate for Payer: UHC Core |
$196.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.35
|
|
