|
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 |
$163.80 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.76
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: BCBS Complete |
$177.08
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.76
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$163.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 68084047911
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
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 |
$194.79 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.76
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.76
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$194.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$507.84
|
|
|
Service Code
|
NDC 00054008826
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.90 |
| Max. Negotiated Rate |
$457.06 |
| Rate for Payer: Aetna American Axle |
$330.10
|
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Aetna Medicare |
$253.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.10
|
| Rate for Payer: BCBS Complete |
$203.14
|
| Rate for Payer: Cash Price |
$406.27
|
| Rate for Payer: Cofinity Commercial |
$355.49
|
| Rate for Payer: Cofinity Commercial |
$436.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$355.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.27
|
| Rate for Payer: Healthscope Commercial |
$457.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.66
|
| Rate for Payer: PHP Commercial |
$431.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.10
|
| Rate for Payer: Priority Health SBD |
$319.94
|
| Rate for Payer: UMR Bronson Commercial |
$187.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.88
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$503.52
|
|
|
Service Code
|
NDC 68084047901
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$453.17 |
| Rate for Payer: Aetna American Axle |
$327.29
|
| Rate for Payer: Aetna Commercial |
$427.99
|
| Rate for Payer: Aetna Medicare |
$251.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.29
|
| Rate for Payer: BCBS Complete |
$201.41
|
| Rate for Payer: Cash Price |
$402.82
|
| Rate for Payer: Cofinity Commercial |
$352.46
|
| Rate for Payer: Cofinity Commercial |
$433.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.82
|
| Rate for Payer: Healthscope Commercial |
$453.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.99
|
| Rate for Payer: PHP Commercial |
$427.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.29
|
| Rate for Payer: Priority Health SBD |
$317.22
|
| Rate for Payer: UMR Bronson Commercial |
$186.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.64
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 68084047911
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$565.44
|
|
|
Service Code
|
NDC 00781208102
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.21 |
| Max. Negotiated Rate |
$508.90 |
| Rate for Payer: Aetna American Axle |
$367.54
|
| Rate for Payer: Aetna Commercial |
$480.62
|
| Rate for Payer: Aetna Medicare |
$282.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.54
|
| Rate for Payer: BCBS Complete |
$226.18
|
| Rate for Payer: Cash Price |
$452.35
|
| Rate for Payer: Cofinity Commercial |
$395.81
|
| Rate for Payer: Cofinity Commercial |
$486.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.35
|
| Rate for Payer: Healthscope Commercial |
$508.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.62
|
| Rate for Payer: PHP Commercial |
$480.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.54
|
| Rate for Payer: Priority Health SBD |
$356.23
|
| Rate for Payer: UMR Bronson Commercial |
$209.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.08
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$440.80
|
|
|
Service Code
|
NDC 16571081320
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.95 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Aetna American Axle |
$286.52
|
| Rate for Payer: Aetna Commercial |
$374.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.52
|
| Rate for Payer: Cash Price |
$352.64
|
| Rate for Payer: Cofinity Commercial |
$308.56
|
| Rate for Payer: Cofinity Commercial |
$379.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.64
|
| Rate for Payer: Healthscope Commercial |
$396.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.68
|
| Rate for Payer: PHP Commercial |
$374.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.52
|
| Rate for Payer: Priority Health SBD |
$277.70
|
| Rate for Payer: UMR Bronson Commercial |
$193.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.60
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$442.70
|
|
|
Service Code
|
NDC 23155053102
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.76
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: BCBS Complete |
$177.08
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.76
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$163.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.65
|
|
|
Service Code
|
NDC 00517671010
|
| Hospital Charge Code |
108968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$30.28 |
| Rate for Payer: Aetna American Axle |
$21.87
|
| Rate for Payer: Aetna Commercial |
$28.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.87
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.92
|
| Rate for Payer: Healthscope Commercial |
$30.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.87
|
| Rate for Payer: Priority Health SBD |
$21.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.65
|
|
|
Service Code
|
NDC 00517671001
|
| Hospital Charge Code |
108968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$30.28 |
| Rate for Payer: Aetna American Axle |
$21.87
|
| Rate for Payer: Aetna Commercial |
$28.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.87
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.92
|
| Rate for Payer: Healthscope Commercial |
$30.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.87
|
| Rate for Payer: Priority Health SBD |
$21.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.65
|
|
|
Service Code
|
NDC 00517671010
|
| Hospital Charge Code |
108968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$30.28 |
| Rate for Payer: Aetna American Axle |
$21.87
|
| Rate for Payer: Aetna Commercial |
$28.60
|
| Rate for Payer: Aetna Medicare |
$16.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.87
|
| Rate for Payer: BCBS Complete |
$13.46
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.92
|
| Rate for Payer: Healthscope Commercial |
$30.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.87
|
| Rate for Payer: Priority Health SBD |
$21.20
|
| Rate for Payer: UMR Bronson Commercial |
$12.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.65
|
|
|
Service Code
|
NDC 00517671001
|
| Hospital Charge Code |
108968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$30.28 |
| Rate for Payer: Aetna American Axle |
$21.87
|
| Rate for Payer: Aetna Commercial |
$28.60
|
| Rate for Payer: Aetna Medicare |
$16.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.87
|
| Rate for Payer: BCBS Complete |
$13.46
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.92
|
| Rate for Payer: Healthscope Commercial |
$30.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.87
|
| Rate for Payer: Priority Health SBD |
$21.20
|
| Rate for Payer: UMR Bronson Commercial |
$12.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$52.20
|
|
|
Service Code
|
NDC 00409163110
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna American Axle |
$33.93
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.93
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health SBD |
$32.89
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| 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
|
NDC 00409492834
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna American Axle |
$45.85
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Medicare |
$35.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.85
|
| Rate for Payer: BCBS Complete |
$28.22
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.85
|
| Rate for Payer: Priority Health SBD |
$44.44
|
| Rate for Payer: UMR Bronson Commercial |
$26.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.90
|
|
|
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 |
$12.25 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253090030
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: UMR Bronson Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
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 |
$19.31 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna American Axle |
$33.93
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Medicare |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.93
|
| Rate for Payer: BCBS Complete |
$20.88
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health SBD |
$32.89
|
| Rate for Payer: UMR Bronson Commercial |
$19.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$36.23
|
|
|
Service Code
|
NDC 64253090091
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$32.61 |
| Rate for Payer: Aetna American Axle |
$23.55
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna Medicare |
$18.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.55
|
| Rate for Payer: BCBS Complete |
$14.49
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cofinity Commercial |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.55
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: UMR Bronson Commercial |
$13.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$52.20
|
|
|
Service Code
|
NDC 00409163140
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna American Axle |
$33.93
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.93
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health SBD |
$32.89
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
NDC 00409492834
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna American Axle |
$45.85
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.85
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.85
|
| Rate for Payer: Priority Health SBD |
$44.44
|
| Rate for Payer: UMR Bronson Commercial |
$31.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.90
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$52.20
|
|
|
Service Code
|
NDC 00409163140
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$46.98 |
| Rate for Payer: Aetna American Axle |
$33.93
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna Medicare |
$26.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.93
|
| Rate for Payer: BCBS Complete |
$20.88
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.93
|
| Rate for Payer: Priority Health SBD |
$32.89
|
| Rate for Payer: UMR Bronson Commercial |
$19.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.15
|
|
|
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 |
$14.56 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna American Axle |
$25.57
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$27.54
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.57
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: UMR Bronson Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$36.23
|
|
|
Service Code
|
NDC 64253090091
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$32.61 |
| Rate for Payer: Aetna American Axle |
$23.55
|
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.55
|
| Rate for Payer: Cash Price |
$28.98
|
| Rate for Payer: Cofinity Commercial |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.98
|
| Rate for Payer: Healthscope Commercial |
$32.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.55
|
| Rate for Payer: Priority Health SBD |
$22.82
|
| Rate for Payer: UMR Bronson Commercial |
$15.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.17
|
|
|
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 |
$26.10 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Aetna American Axle |
$45.85
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Medicare |
$35.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.85
|
| Rate for Payer: BCBS Complete |
$28.22
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cofinity Commercial |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$60.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Healthscope Commercial |
$63.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.96
|
| Rate for Payer: PHP Commercial |
$59.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.85
|
| Rate for Payer: Priority Health SBD |
$44.44
|
| Rate for Payer: UMR Bronson Commercial |
$26.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.90
|
|
