|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253090030
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$27.03
|
| 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 Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| 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
|
$39.34
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.57 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| 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 Commercial |
$33.44
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.57
|
| Rate for Payer: Priority Health HMO/PPO |
$34.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.36
|
| 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 CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.34
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Medicare |
$10.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.29
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS MAPPO |
$9.84
|
| Rate for Payer: BCBS Trust/PPO |
$32.34
|
| Rate for Payer: BCN Commercial |
$30.59
|
| Rate for Payer: BCN Medicare Advantage |
$9.84
|
| 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: Health Alliance Plan Medicare Advantage |
$9.84
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: PACE Senior Care Partners |
$9.34
|
| Rate for Payer: PACE SWMI |
$9.84
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Medicare Advantage |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.57
|
| Rate for Payer: Priority Health HMO/PPO |
$34.23
|
| Rate for Payer: Priority Health Medicare |
$9.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.36
|
| Rate for Payer: Railroad Medicare Medicare |
$9.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.62
|
| Rate for Payer: UHC Core |
$32.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.84
|
| Rate for Payer: UHC Exchange |
$9.84
|
| Rate for Payer: UHC Medicare Advantage |
$9.84
|
| Rate for Payer: VA VA |
$9.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
NDC 00409492811
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCN Commercial |
$54.51
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.85
|
| Rate for Payer: Priority Health HMO/PPO |
$61.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.91
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
NDC 00409492811
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: BCBS Complete |
$28.22
|
| Rate for Payer: BCBS MAPPO |
$17.64
|
| Rate for Payer: BCBS Trust/PPO |
$57.99
|
| Rate for Payer: BCN Commercial |
$54.84
|
| Rate for Payer: BCN Medicare Advantage |
$17.64
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: PACE Senior Care Partners |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.64
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: PHP Medicare Advantage |
$17.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.85
|
| Rate for Payer: Priority Health HMO/PPO |
$61.37
|
| Rate for Payer: Priority Health Medicare |
$17.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.26
|
| Rate for Payer: Railroad Medicare Medicare |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.64
|
| Rate for Payer: UHC Exchange |
$17.64
|
| Rate for Payer: UHC Medicare Advantage |
$17.64
|
| Rate for Payer: VA VA |
$17.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.91
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$52.20
|
|
|
Service Code
|
NDC 00409163110
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: BCBS Complete |
$20.88
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$42.91
|
| Rate for Payer: BCN Commercial |
$40.59
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.40
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health HMO/PPO |
$45.41
|
| Rate for Payer: Priority Health Medicare |
$13.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.97
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.94
|
| Rate for Payer: UHC Core |
$43.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.05
|
| Rate for Payer: UHC Exchange |
$13.05
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: VA VA |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253090036
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$27.03
|
| 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 Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| 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
|
OP
|
$33.11
|
|
|
Service Code
|
NDC 64253090030
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.35
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCN Commercial |
$25.74
|
| Rate for Payer: BCN Medicare Advantage |
$8.28
|
| 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: Health Alliance Plan Medicare Advantage |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PACE Senior Care Partners |
$7.86
|
| Rate for Payer: PACE SWMI |
$8.28
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Medicare Advantage |
$8.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Medicare |
$8.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| Rate for Payer: Railroad Medicare Medicare |
$8.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.28
|
| Rate for Payer: UHC Exchange |
$8.28
|
| Rate for Payer: UHC Medicare Advantage |
$8.28
|
| Rate for Payer: VA VA |
$8.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$52.20
|
|
|
Service Code
|
NDC 00409163110
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: BCBS Trust/PPO |
$42.61
|
| Rate for Payer: BCN Commercial |
$40.34
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health HMO/PPO |
$45.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.94
|
| Rate for Payer: UHC Core |
$43.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$52.20
|
|
|
Service Code
|
NDC 00409163110
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.31
|
| Rate for Payer: BCBS Complete |
$20.88
|
| Rate for Payer: BCBS MAPPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$42.91
|
| Rate for Payer: BCN Commercial |
$40.59
|
| Rate for Payer: BCN Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.40
|
| Rate for Payer: PACE SWMI |
$13.05
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Medicare Advantage |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health HMO/PPO |
$45.41
|
| Rate for Payer: Priority Health Medicare |
$13.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.97
|
| Rate for Payer: Railroad Medicare Medicare |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.94
|
| Rate for Payer: UHC Core |
$43.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.05
|
| Rate for Payer: UHC Exchange |
$13.05
|
| Rate for Payer: UHC Medicare Advantage |
$13.05
|
| Rate for Payer: VA VA |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
NDC 00409492834
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: BCBS Complete |
$28.22
|
| Rate for Payer: BCBS MAPPO |
$17.64
|
| Rate for Payer: BCBS Trust/PPO |
$57.99
|
| Rate for Payer: BCN Commercial |
$54.84
|
| Rate for Payer: BCN Medicare Advantage |
$17.64
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: PACE Senior Care Partners |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.64
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: PHP Medicare Advantage |
$17.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.85
|
| Rate for Payer: Priority Health HMO/PPO |
$61.37
|
| Rate for Payer: Priority Health Medicare |
$17.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.26
|
| Rate for Payer: Railroad Medicare Medicare |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.64
|
| Rate for Payer: UHC Exchange |
$17.64
|
| Rate for Payer: UHC Medicare Advantage |
$17.64
|
| Rate for Payer: VA VA |
$17.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.91
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
NDC 00409492834
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCN Commercial |
$54.51
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.85
|
| Rate for Payer: Priority Health HMO/PPO |
$61.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.91
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: BCBS Trust/PPO |
$27.03
|
| 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 Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| 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 GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.35
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS MAPPO |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCN Commercial |
$25.74
|
| Rate for Payer: BCN Medicare Advantage |
$8.28
|
| 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: Health Alliance Plan Medicare Advantage |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: PACE Senior Care Partners |
$7.86
|
| Rate for Payer: PACE SWMI |
$8.28
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Medicare Advantage |
$8.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Medicare |
$8.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.18
|
| Rate for Payer: Railroad Medicare Medicare |
$8.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.14
|
| Rate for Payer: UHC Core |
$27.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.28
|
| Rate for Payer: UHC Exchange |
$8.28
|
| Rate for Payer: UHC Medicare Advantage |
$8.28
|
| Rate for Payer: VA VA |
$8.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$35.38
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Medicare |
$9.20
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.29
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS MAPPO |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$29.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.07
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: BCN Commercial |
$25.60
|
| Rate for Payer: BCN Medicare Advantage |
$8.85
|
| Rate for Payer: BCN Medicare Advantage |
$8.23
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.85
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Nomi Health Commercial |
$29.01
|
| Rate for Payer: Nomi Health Commercial |
$27.00
|
| Rate for Payer: PACE Senior Care Partners |
$8.40
|
| Rate for Payer: PACE Senior Care Partners |
$7.82
|
| Rate for Payer: PACE SWMI |
$8.85
|
| Rate for Payer: PACE SWMI |
$8.23
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Medicare Advantage |
$8.23
|
| Rate for Payer: PHP Medicare Advantage |
$8.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health HMO/PPO |
$28.65
|
| Rate for Payer: Priority Health HMO/PPO |
$30.78
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health Medicare |
$8.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8.23
|
| Rate for Payer: Railroad Medicare Medicare |
$8.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.13
|
| Rate for Payer: UHC Core |
$29.54
|
| Rate for Payer: UHC Core |
$27.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.23
|
| Rate for Payer: UHC Exchange |
$8.23
|
| Rate for Payer: UHC Exchange |
$8.85
|
| Rate for Payer: UHC Medicare Advantage |
$8.23
|
| Rate for Payer: UHC Medicare Advantage |
$8.85
|
| Rate for Payer: VA VA |
$8.23
|
| Rate for Payer: VA VA |
$8.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
| 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
|
IP
|
$32.93
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$28.88
|
| Rate for Payer: BCN Commercial |
$25.45
|
| Rate for Payer: BCN Commercial |
$27.34
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$27.00
|
| Rate for Payer: Nomi Health Commercial |
$29.01
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health HMO/PPO |
$30.78
|
| Rate for Payer: Priority Health HMO/PPO |
$28.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.13
|
| Rate for Payer: UHC Core |
$27.50
|
| Rate for Payer: UHC Core |
$29.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$4.11
|
|
|
Service Code
|
NDC 77333012025
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.29
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.49
|
| Rate for Payer: Nomi Health Commercial |
$3.37
|
| Rate for Payer: PHP Commercial |
$3.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health HMO/PPO |
$3.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.62
|
| Rate for Payer: UHC Core |
$3.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$4.11
|
|
|
Service Code
|
NDC 77333012025
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.28
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: BCBS MAPPO |
$1.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.38
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: BCN Medicare Advantage |
$1.03
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.03
|
| Rate for Payer: Healthscope Commercial |
$3.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.49
|
| Rate for Payer: Nomi Health Commercial |
$3.37
|
| Rate for Payer: PACE Senior Care Partners |
$0.98
|
| Rate for Payer: PACE SWMI |
$1.03
|
| Rate for Payer: PHP Commercial |
$3.49
|
| Rate for Payer: PHP Medicare Advantage |
$1.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health HMO/PPO |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$1.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.62
|
| Rate for Payer: UHC Core |
$3.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.03
|
| Rate for Payer: UHC Exchange |
$1.03
|
| Rate for Payer: UHC Medicare Advantage |
$1.03
|
| Rate for Payer: VA VA |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$23.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.64
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: BCBS MAPPO |
$22.91
|
| Rate for Payer: BCBS Trust/PPO |
$75.35
|
| Rate for Payer: BCN Commercial |
$71.26
|
| Rate for Payer: BCN Medicare Advantage |
$22.91
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: PACE Senior Care Partners |
$21.77
|
| Rate for Payer: PACE SWMI |
$22.91
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: PHP Medicare Advantage |
$22.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Medicare |
$23.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.41
|
| Rate for Payer: Railroad Medicare Medicare |
$22.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.91
|
| Rate for Payer: UHC Exchange |
$22.91
|
| Rate for Payer: UHC Medicare Advantage |
$22.91
|
| Rate for Payer: VA VA |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: BCBS Trust/PPO |
$74.81
|
| Rate for Payer: BCN Commercial |
$70.83
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Nomi Health Commercial |
$75.15
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health HMO/PPO |
$79.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: BCBS Trust/PPO |
$167.50
|
| Rate for Payer: BCN Commercial |
$158.58
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.73 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$53.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.12
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$51.30
|
| Rate for Payer: BCBS Trust/PPO |
$168.69
|
| Rate for Payer: BCN Commercial |
$159.54
|
| Rate for Payer: BCN Medicare Advantage |
$51.30
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.30
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: Nomi Health Commercial |
$168.26
|
| Rate for Payer: PACE Senior Care Partners |
$48.73
|
| Rate for Payer: PACE SWMI |
$51.30
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: PHP Medicare Advantage |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health HMO/PPO |
$178.52
|
| Rate for Payer: Priority Health Medicare |
$51.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.48
|
| Rate for Payer: Railroad Medicare Medicare |
$51.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.58
|
| Rate for Payer: UHC Core |
$171.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.30
|
| Rate for Payer: UHC Exchange |
$51.30
|
| Rate for Payer: UHC Medicare Advantage |
$51.30
|
| Rate for Payer: VA VA |
$51.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT
|
Facility
|
IP
|
$19.58
|
|
|
Service Code
|
NDC 23900000361
|
| Hospital Charge Code |
76967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| 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 |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.12
|
| 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 |
$14.69
|
|
|
CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8 %-1.2 %-2.6 % TOPICAL OINTMENT
|
Facility
|
OP
|
$19.58
|
|
|
Service Code
|
NDC 23900000361
|
| Hospital Charge Code |
76967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.12
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS MAPPO |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Commercial |
$15.22
|
| Rate for Payer: BCN Medicare Advantage |
$4.89
|
| 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: Health Alliance Plan Medicare Advantage |
$4.89
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.65
|
| Rate for Payer: PACE SWMI |
$4.89
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.12
|
| Rate for Payer: Railroad Medicare Medicare |
$4.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.89
|
| Rate for Payer: UHC Exchange |
$4.89
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: VA VA |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
CARBAMAZEPINE 200 MG TABLET
|
Facility
|
OP
|
$274.08
|
|
|
Service Code
|
NDC 68084044401
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.09 |
| Max. Negotiated Rate |
$246.67 |
| Rate for Payer: Aetna Commercial |
$232.97
|
| Rate for Payer: Aetna Medicare |
$71.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.65
|
| Rate for Payer: BCBS Complete |
$109.63
|
| Rate for Payer: BCBS MAPPO |
$68.52
|
| Rate for Payer: BCBS Trust/PPO |
$225.32
|
| Rate for Payer: BCN Commercial |
$213.10
|
| Rate for Payer: BCN Medicare Advantage |
$68.52
|
| Rate for Payer: Cash Price |
$219.26
|
| Rate for Payer: Cofinity Commercial |
$235.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.52
|
| Rate for Payer: Healthscope Commercial |
$246.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.97
|
| Rate for Payer: Nomi Health Commercial |
$224.75
|
| Rate for Payer: PACE Senior Care Partners |
$65.09
|
| Rate for Payer: PACE SWMI |
$68.52
|
| Rate for Payer: PHP Commercial |
$232.97
|
| Rate for Payer: PHP Medicare Advantage |
$68.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.15
|
| Rate for Payer: Priority Health HMO/PPO |
$238.45
|
| Rate for Payer: Priority Health Medicare |
$69.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.63
|
| Rate for Payer: Railroad Medicare Medicare |
$68.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.19
|
| Rate for Payer: UHC Core |
$228.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.52
|
| Rate for Payer: UHC Exchange |
$68.52
|
| Rate for Payer: UHC Medicare Advantage |
$68.52
|
| Rate for Payer: VA VA |
$68.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.56
|
|
