|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
NDC 6373929101
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna American Axle |
$780.00
|
| Rate for Payer: Aetna Commercial |
$1,020.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$1,032.00
|
| Rate for Payer: Cofinity Commercial |
$840.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.00
|
| Rate for Payer: Healthscope Commercial |
$1,080.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,020.00
|
| Rate for Payer: PHP Commercial |
$1,020.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
| Rate for Payer: Priority Health SBD |
$756.00
|
| Rate for Payer: UMR Bronson Commercial |
$528.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.00
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$321.30
|
|
|
Service Code
|
NDC 904546072
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.37 |
| Max. Negotiated Rate |
$289.17 |
| Rate for Payer: Aetna American Axle |
$208.84
|
| Rate for Payer: Aetna Commercial |
$273.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.84
|
| Rate for Payer: Cash Price |
$257.04
|
| Rate for Payer: Cofinity Commercial |
$224.91
|
| Rate for Payer: Cofinity Commercial |
$276.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.04
|
| Rate for Payer: Healthscope Commercial |
$289.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.10
|
| Rate for Payer: PHP Commercial |
$273.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.91
|
| Rate for Payer: Priority Health SBD |
$202.42
|
| Rate for Payer: UMR Bronson Commercial |
$141.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.98
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$106.70
|
|
|
Service Code
|
NDC 3786408289
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Aetna American Axle |
$69.36
|
| Rate for Payer: Aetna Commercial |
$90.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.36
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cofinity Commercial |
$74.69
|
| Rate for Payer: Cofinity Commercial |
$91.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.36
|
| Rate for Payer: Healthscope Commercial |
$96.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.70
|
| Rate for Payer: PHP Commercial |
$90.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.69
|
| Rate for Payer: Priority Health SBD |
$67.22
|
| Rate for Payer: UMR Bronson Commercial |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.02
|
|
|
CALCIUM CARBONATE 500 MG-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 7733311025
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna American Axle |
$1.17
|
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.17
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.44
|
| Rate for Payer: Healthscope Commercial |
$1.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.53
|
| Rate for Payer: PHP Commercial |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.26
|
| Rate for Payer: Priority Health SBD |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.35
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.65
|
|
|
Service Code
|
NDC 0517-6710-10
|
| 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: 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 Multiplan/Beech St/PHCS |
$28.60
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.56
|
| 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 0517-6710-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$28.60
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.56
|
| 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 SYRINGE
|
Facility
|
OP
|
$60.08
|
|
|
Service Code
|
NDC 0409-4928-34
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna American Axle |
$39.05
|
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.05
|
| Rate for Payer: BCBS Complete |
$24.03
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Cofinity Commercial |
$51.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$54.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.07
|
| Rate for Payer: PHP Commercial |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.06
|
| Rate for Payer: Priority Health SBD |
$37.85
|
| Rate for Payer: UMR Bronson Commercial |
$22.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.06
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$36.23
|
|
|
Service Code
|
NDC 64253-900-91
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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: 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 Multiplan/Beech St/PHCS |
$30.80
|
| Rate for Payer: PHP Commercial |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: Priority Health 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 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.39
|
|
|
Service Code
|
NDC 76329-3304-1
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$35.45 |
| Rate for Payer: Aetna American Axle |
$25.60
|
| Rate for Payer: Aetna Commercial |
$33.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.60
|
| Rate for Payer: BCBS Complete |
$15.76
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Cofinity Commercial |
$33.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.51
|
| Rate for Payer: Healthscope Commercial |
$35.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.48
|
| Rate for Payer: PHP Commercial |
$33.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.57
|
| Rate for Payer: Priority Health SBD |
$24.82
|
| Rate for Payer: UMR Bronson Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.54
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
NDC 64253-900-30
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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: 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 Multiplan/Beech St/PHCS |
$28.14
|
| Rate for Payer: PHP Commercial |
$28.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.18
|
| Rate for Payer: Priority Health 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
|
IP
|
$60.08
|
|
|
Service Code
|
NDC 0409-4928-34
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna American Axle |
$39.05
|
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.05
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Cofinity Commercial |
$51.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$54.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.07
|
| Rate for Payer: PHP Commercial |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.06
|
| Rate for Payer: Priority Health SBD |
$37.85
|
| Rate for Payer: UMR Bronson Commercial |
$26.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.06
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$60.08
|
|
|
Service Code
|
NDC 0409-4928-34
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$54.07 |
| Rate for Payer: Aetna American Axle |
$39.05
|
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.05
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Cofinity Commercial |
$51.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$54.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.07
|
| Rate for Payer: PHP Commercial |
$51.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.06
|
| Rate for Payer: Priority Health SBD |
$37.85
|
| Rate for Payer: UMR Bronson Commercial |
$26.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.06
|
|
|
CALCIUM CITRATE 200 MG (950 MG) TABLET
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
NDC 8068114000
|
| Hospital Charge Code |
1308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna American Axle |
$85.80
|
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$92.40
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health SBD |
$83.16
|
| Rate for Payer: UMR Bronson Commercial |
$58.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
CALCIUM CITRATE 200 MG (950 MG) TABLET
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
NDC 904506260
|
| Hospital Charge Code |
1308
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna American Axle |
$102.38
|
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health SBD |
$99.22
|
| Rate for Payer: UMR Bronson Commercial |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna American Axle |
$25.57
|
| Rate for Payer: Aetna American Axle |
$109.05
|
| Rate for Payer: Aetna American Axle |
$54.53
|
| Rate for Payer: Aetna Commercial |
$142.60
|
| Rate for Payer: Aetna Commercial |
$71.31
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$134.22
|
| Rate for Payer: Cash Price |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$144.28
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$72.15
|
| Rate for Payer: Cofinity Commercial |
$58.72
|
| Rate for Payer: Cofinity Commercial |
$27.54
|
| Rate for Payer: Cofinity Commercial |
$117.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.22
|
| Rate for Payer: Healthscope Commercial |
$150.99
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Healthscope Commercial |
$75.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.31
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: PHP Commercial |
$71.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.44
|
| Rate for Payer: Priority Health SBD |
$105.70
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: Priority Health SBD |
$52.85
|
| Rate for Payer: UMR Bronson Commercial |
$17.31
|
| Rate for Payer: UMR Bronson Commercial |
$73.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.83
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44.59
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$40.13 |
| Rate for Payer: Aetna American Axle |
$28.98
|
| Rate for Payer: Aetna Commercial |
$37.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.98
|
| Rate for Payer: Cash Price |
$35.67
|
| Rate for Payer: Cofinity Commercial |
$31.21
|
| Rate for Payer: Cofinity Commercial |
$38.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.67
|
| Rate for Payer: Healthscope Commercial |
$40.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.90
|
| Rate for Payer: PHP Commercial |
$37.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.21
|
| Rate for Payer: Priority Health SBD |
$28.09
|
| Rate for Payer: UMR Bronson Commercial |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.44
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$39.34
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| 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 |
$0.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.06
|
| Rate for Payer: BCBS Complete |
$0.03
|
| Rate for Payer: BCBS MAPPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Medicare Advantage |
$0.05
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$27.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.05
|
| 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: Mclaren Medicaid |
$0.03
|
| Rate for Payer: Mclaren Medicare |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.44
|
| Rate for Payer: PACE Medicare |
$0.05
|
| Rate for Payer: PACE SWMI |
$0.05
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Medicare Advantage |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Medicare |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: Railroad Medicare Medicare |
$0.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.05
|
| Rate for Payer: UHC Medicare Advantage |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$14.56
|
| Rate for Payer: VA VA |
$0.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
|
|
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: 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 Multiplan/Beech St/PHCS |
$142.60
|
| Rate for Payer: PHP Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.44
|
| 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
|
IP
|
$35.38
|
|
|
Service Code
|
HCPCS J0613
|
| 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 Commercial |
$30.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.07
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.77
|
| Rate for Payer: Priority Health SBD |
$22.29
|
| Rate for Payer: UMR Bronson Commercial |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.97
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION
|
Facility
|
OP
|
$35.38
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
189461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna American Axle |
$23.00
|
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.10
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Medicare Advantage |
$0.08
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.08
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Mclaren Medicaid |
$0.04
|
| Rate for Payer: Mclaren Medicare |
$0.08
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.07
|
| Rate for Payer: PACE Medicare |
$0.08
|
| Rate for Payer: PACE SWMI |
$0.08
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: PHP Medicare Advantage |
$0.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Medicare |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health SBD |
$22.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: VA VA |
$0.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
|
|
CALCIUM GLUCONATE 2.5 % GEL 25 GM
|
Facility
|
IP
|
$67.78
|
|
|
Service Code
|
NDC 9900-0019-31
|
| 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: 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 Multiplan/Beech St/PHCS |
$57.61
|
| Rate for Payer: PHP Commercial |
$57.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| 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 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: 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 Multiplan/Beech St/PHCS |
$63.17
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.02
|
| 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
|
OP
|
$74.32
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
190608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| 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 |
$0.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.10
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Medicare Advantage |
$0.08
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.08
|
| 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: Mclaren Medicaid |
$0.04
|
| Rate for Payer: Mclaren Medicare |
$0.08
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.17
|
| Rate for Payer: PACE Medicare |
$0.08
|
| Rate for Payer: PACE SWMI |
$0.08
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: PHP Medicare Advantage |
$0.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Medicare |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: Railroad Medicare Medicare |
$0.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$27.50
|
| Rate for Payer: VA VA |
$0.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.74
|
|
|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 9900-0009-80
|
| 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: 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 Multiplan/Beech St/PHCS |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.62
|
| 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
|
|
