|
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
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$159.31
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$143.38 |
| Rate for Payer: Aetna American Axle |
$103.55
|
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna American Axle |
$51.78
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Commercial |
$135.41
|
| Rate for Payer: Aetna Commercial |
$67.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$127.45
|
| Rate for Payer: Cofinity Commercial |
$137.01
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$68.51
|
| Rate for Payer: Cofinity Commercial |
$55.76
|
| Rate for Payer: Cofinity Commercial |
$111.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$143.38
|
| Rate for Payer: Healthscope Commercial |
$71.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$67.71
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: PHP Commercial |
$135.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.55
|
| Rate for Payer: Priority Health SBD |
$50.19
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: Priority Health SBD |
$100.37
|
| Rate for Payer: UMR Bronson Commercial |
$70.10
|
| Rate for Payer: UMR Bronson Commercial |
$35.05
|
| Rate for Payer: UMR Bronson Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$114.37
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.32 |
| Max. Negotiated Rate |
$102.93 |
| Rate for Payer: Aetna American Axle |
$74.34
|
| Rate for Payer: Aetna American Axle |
$27.54
|
| Rate for Payer: Aetna American Axle |
$74.05
|
| Rate for Payer: Aetna American Axle |
$93.72
|
| Rate for Payer: Aetna Commercial |
$36.01
|
| Rate for Payer: Aetna Commercial |
$97.21
|
| Rate for Payer: Aetna Commercial |
$122.55
|
| Rate for Payer: Aetna Commercial |
$96.83
|
| Rate for Payer: Aetna Medicare |
$72.09
|
| Rate for Payer: Aetna Medicare |
$56.96
|
| Rate for Payer: Aetna Medicare |
$21.18
|
| Rate for Payer: Aetna Medicare |
$57.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.05
|
| Rate for Payer: BCBS Complete |
$45.57
|
| Rate for Payer: BCBS Complete |
$16.95
|
| Rate for Payer: BCBS Complete |
$57.67
|
| Rate for Payer: BCBS Complete |
$45.75
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$115.34
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cofinity Commercial |
$98.36
|
| Rate for Payer: Cofinity Commercial |
$36.44
|
| Rate for Payer: Cofinity Commercial |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$123.99
|
| Rate for Payer: Cofinity Commercial |
$100.93
|
| Rate for Payer: Cofinity Commercial |
$29.66
|
| Rate for Payer: Cofinity Commercial |
$97.97
|
| Rate for Payer: Cofinity Commercial |
$80.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.50
|
| Rate for Payer: Healthscope Commercial |
$129.76
|
| Rate for Payer: Healthscope Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$102.93
|
| Rate for Payer: Healthscope Commercial |
$38.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.55
|
| Rate for Payer: PHP Commercial |
$122.55
|
| Rate for Payer: PHP Commercial |
$97.21
|
| Rate for Payer: PHP Commercial |
$36.01
|
| Rate for Payer: PHP Commercial |
$96.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.05
|
| Rate for Payer: Priority Health SBD |
$90.83
|
| Rate for Payer: Priority Health SBD |
$26.69
|
| Rate for Payer: Priority Health SBD |
$72.05
|
| Rate for Payer: Priority Health SBD |
$71.77
|
| Rate for Payer: UMR Bronson Commercial |
$53.35
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
| Rate for Payer: UMR Bronson Commercial |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$42.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.78
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$79.66
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$71.69 |
| Rate for Payer: Aetna American Axle |
$51.78
|
| Rate for Payer: Aetna American Axle |
$21.52
|
| Rate for Payer: Aetna American Axle |
$103.55
|
| Rate for Payer: Aetna Commercial |
$67.71
|
| Rate for Payer: Aetna Commercial |
$135.41
|
| Rate for Payer: Aetna Commercial |
$28.14
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Aetna Medicare |
$79.66
|
| Rate for Payer: Aetna Medicare |
$39.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.52
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Complete |
$31.86
|
| Rate for Payer: BCBS Complete |
$63.72
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cash Price |
$127.45
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$127.45
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cofinity Commercial |
$28.47
|
| Rate for Payer: Cofinity Commercial |
$111.52
|
| Rate for Payer: Cofinity Commercial |
$137.01
|
| Rate for Payer: Cofinity Commercial |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$55.76
|
| Rate for Payer: Cofinity Commercial |
$68.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.73
|
| Rate for Payer: Healthscope Commercial |
$71.69
|
| Rate for Payer: Healthscope Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$143.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.71
|
| Rate for Payer: PHP Commercial |
$67.71
|
| Rate for Payer: PHP Commercial |
$135.41
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.78
|
| Rate for Payer: Priority Health SBD |
$20.86
|
| Rate for Payer: Priority Health SBD |
$50.19
|
| Rate for Payer: Priority Health SBD |
$100.37
|
| Rate for Payer: UMR Bronson Commercial |
$29.47
|
| Rate for Payer: UMR Bronson Commercial |
$58.94
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.74
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$144.18
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.44 |
| Max. Negotiated Rate |
$129.76 |
| Rate for Payer: Aetna American Axle |
$93.72
|
| Rate for Payer: Aetna American Axle |
$74.34
|
| Rate for Payer: Aetna American Axle |
$74.05
|
| Rate for Payer: Aetna American Axle |
$27.54
|
| Rate for Payer: Aetna Commercial |
$122.55
|
| Rate for Payer: Aetna Commercial |
$36.01
|
| Rate for Payer: Aetna Commercial |
$97.21
|
| Rate for Payer: Aetna Commercial |
$96.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.72
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$115.34
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cofinity Commercial |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$36.44
|
| Rate for Payer: Cofinity Commercial |
$29.66
|
| Rate for Payer: Cofinity Commercial |
$100.93
|
| Rate for Payer: Cofinity Commercial |
$80.06
|
| Rate for Payer: Cofinity Commercial |
$98.36
|
| Rate for Payer: Cofinity Commercial |
$123.99
|
| Rate for Payer: Cofinity Commercial |
$97.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.50
|
| Rate for Payer: Healthscope Commercial |
$129.76
|
| Rate for Payer: Healthscope Commercial |
$102.53
|
| Rate for Payer: Healthscope Commercial |
$102.93
|
| Rate for Payer: Healthscope Commercial |
$38.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.55
|
| Rate for Payer: PHP Commercial |
$122.55
|
| Rate for Payer: PHP Commercial |
$36.01
|
| Rate for Payer: PHP Commercial |
$96.83
|
| Rate for Payer: PHP Commercial |
$97.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.05
|
| Rate for Payer: Priority Health SBD |
$26.69
|
| Rate for Payer: Priority Health SBD |
$71.77
|
| Rate for Payer: Priority Health SBD |
$72.05
|
| Rate for Payer: Priority Health SBD |
$90.83
|
| Rate for Payer: UMR Bronson Commercial |
$63.44
|
| Rate for Payer: UMR Bronson Commercial |
$18.64
|
| Rate for Payer: UMR Bronson Commercial |
$50.32
|
| Rate for Payer: UMR Bronson Commercial |
$50.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.14
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS (TPN COMPONENT)
|
Facility
|
OP
|
$167.77
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
180903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna American Axle |
$109.05
|
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna Medicare |
$83.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: BCBS Complete |
$67.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Commercial |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.05
|
| Rate for Payer: Priority Health SBD |
$105.70
|
| Rate for Payer: UMR Bronson Commercial |
$62.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.83
|
|
|
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 |
$73.82 |
| Max. Negotiated Rate |
$150.99 |
| Rate for Payer: Aetna American Axle |
$109.05
|
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cofinity Commercial |
$117.44
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.60
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.05
|
| Rate for Payer: Priority Health SBD |
$105.70
|
| Rate for Payer: UMR Bronson Commercial |
$73.82
|
| 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
|
OP
|
$40.94
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Aetna American Axle |
$26.61
|
| Rate for Payer: Aetna American Axle |
$24.73
|
| Rate for Payer: Aetna American Axle |
$23.00
|
| Rate for Payer: Aetna Commercial |
$34.80
|
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Medicare |
$19.02
|
| Rate for Payer: Aetna Medicare |
$17.69
|
| Rate for Payer: Aetna Medicare |
$20.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS Complete |
$16.38
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$32.75
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$32.75
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Cofinity Commercial |
$28.66
|
| Rate for Payer: Cofinity Commercial |
$35.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.75
|
| Rate for Payer: Healthscope Commercial |
$36.85
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.80
|
| Rate for Payer: PHP Commercial |
$34.80
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.61
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| Rate for Payer: Priority Health SBD |
$25.79
|
| Rate for Payer: Priority Health SBD |
$22.29
|
| Rate for Payer: UMR Bronson Commercial |
$15.15
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$14.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.70
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
IP
|
$35.38
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna American Axle |
$23.00
|
| Rate for Payer: Aetna American Axle |
$24.73
|
| Rate for Payer: Aetna American Axle |
$26.61
|
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Commercial |
$34.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: Cash Price |
$32.75
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Cofinity Commercial |
$35.21
|
| Rate for Payer: Cofinity Commercial |
$28.66
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$36.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$34.80
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health SBD |
$25.79
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| Rate for Payer: Priority Health SBD |
$22.29
|
| Rate for Payer: UMR Bronson Commercial |
$15.57
|
| Rate for Payer: UMR Bronson Commercial |
$18.01
|
| Rate for Payer: UMR Bronson Commercial |
$16.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.54
|
|
|
CALCIUM GLUCONATE 2.5 % GEL 25 GM
|
Facility
|
IP
|
$67.78
|
|
|
Service Code
|
NDC 09900001931
|
| Hospital Charge Code |
301456
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna American Axle |
$44.06
|
| Rate for Payer: Aetna Commercial |
$57.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.06
|
| Rate for Payer: Cash Price |
$54.22
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Cofinity Commercial |
$58.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.22
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.61
|
| Rate for Payer: PHP Commercial |
$57.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.06
|
| Rate for Payer: Priority Health SBD |
$42.70
|
| Rate for Payer: UMR Bronson Commercial |
$29.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.84
|
|
|
CALCIUM GLUCONATE 2.5 % GEL 25 GM
|
Facility
|
OP
|
$67.78
|
|
|
Service Code
|
NDC 09900001931
|
| Hospital Charge Code |
301456
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna American Axle |
$44.06
|
| Rate for Payer: Aetna Commercial |
$57.61
|
| Rate for Payer: Aetna Medicare |
$33.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.06
|
| Rate for Payer: BCBS Complete |
$27.11
|
| Rate for Payer: Cash Price |
$54.22
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Cofinity Commercial |
$58.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.22
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.61
|
| Rate for Payer: PHP Commercial |
$57.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.06
|
| Rate for Payer: Priority Health SBD |
$42.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.84
|
|
|
CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$74.32
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$72.54
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna American Axle |
$59.59
|
| Rate for Payer: Aetna Commercial |
$77.92
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna Medicare |
$36.27
|
| Rate for Payer: Aetna Medicare |
$45.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.59
|
| Rate for Payer: BCBS Complete |
$36.67
|
| Rate for Payer: BCBS Complete |
$29.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$73.34
|
| Rate for Payer: Cash Price |
$73.34
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cofinity Commercial |
$78.84
|
| Rate for Payer: Cofinity Commercial |
$50.78
|
| Rate for Payer: Cofinity Commercial |
$64.17
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.03
|
| Rate for Payer: Healthscope Commercial |
$82.50
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.92
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: PHP Commercial |
$77.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.59
|
| Rate for Payer: Priority Health SBD |
$57.75
|
| Rate for Payer: Priority Health SBD |
$45.70
|
| Rate for Payer: UMR Bronson Commercial |
$26.84
|
| Rate for Payer: UMR Bronson Commercial |
$33.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.40
|
|
|
CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Aetna American Axle |
$48.31
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.31
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION
|
Facility
|
IP
|
$72.54
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna American Axle |
$47.15
|
| Rate for Payer: Aetna American Axle |
$59.59
|
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna Commercial |
$77.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.59
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cash Price |
$73.34
|
| Rate for Payer: Cofinity Commercial |
$78.84
|
| Rate for Payer: Cofinity Commercial |
$64.17
|
| Rate for Payer: Cofinity Commercial |
$50.78
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.34
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Healthscope Commercial |
$82.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.66
|
| Rate for Payer: PHP Commercial |
$77.92
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.59
|
| Rate for Payer: Priority Health SBD |
$45.70
|
| Rate for Payer: Priority Health SBD |
$57.75
|
| Rate for Payer: UMR Bronson Commercial |
$31.92
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.75
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
NDC 38779182608
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.04 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna American Axle |
$237.90
|
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.10
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health SBD |
$230.58
|
| Rate for Payer: UMR Bronson Commercial |
$161.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.50
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 09900000980
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.19
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
NDC 38779182608
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna American Axle |
$237.90
|
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna Medicare |
$183.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.10
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health SBD |
$230.58
|
| Rate for Payer: UMR Bronson Commercial |
$135.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.50
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 09900000980
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 00536430611
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 00904250091
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UMR Bronson Commercial |
$49.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$120.56
|
|
|
Service Code
|
NDC 00536430611
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.61 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$60.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: BCBS Complete |
$48.22
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$44.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 00904250091
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna Medicare |
$56.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: BCBS Complete |
$44.84
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UMR Bronson Commercial |
$41.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
CAMPHOR 4 %-METHYL SALICYLATE 30 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
IP
|
$16.79
|
|
|
Service Code
|
NDC 96295013062
|
| Hospital Charge Code |
103884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna American Axle |
$10.91
|
| Rate for Payer: Aetna Commercial |
$14.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.91
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$11.75
|
| Rate for Payer: Cofinity Commercial |
$14.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.43
|
| Rate for Payer: Healthscope Commercial |
$15.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.27
|
| Rate for Payer: PHP Commercial |
$14.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health SBD |
$10.58
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.59
|
|
|
CAMPHOR 4 %-METHYL SALICYLATE 30 %-MENTHOL 10 % TOPICAL CREAM
|
Facility
|
OP
|
$16.79
|
|
|
Service Code
|
NDC 96295013062
|
| Hospital Charge Code |
103884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$15.11 |
| Rate for Payer: Aetna American Axle |
$10.91
|
| Rate for Payer: Aetna Commercial |
$14.27
|
| Rate for Payer: Aetna Medicare |
$8.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.91
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$11.75
|
| Rate for Payer: Cofinity Commercial |
$14.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.43
|
| Rate for Payer: Healthscope Commercial |
$15.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.27
|
| Rate for Payer: PHP Commercial |
$14.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health SBD |
$10.58
|
| Rate for Payer: UMR Bronson Commercial |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.59
|
|
