|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
NDC 77333011010
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: BCBS Complete |
$67.32
|
| Rate for Payer: BCBS Trust/PPO |
$138.76
|
| Rate for Payer: BCN Commercial |
$138.76
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$163.25
|
| Rate for Payer: Healthscope Whirlpool |
$168.30
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.46
|
| Rate for Payer: Priority Health Narrow Network |
$117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Trust/PPO |
$154.39
|
| Rate for Payer: BCN Commercial |
$154.39
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
NDC 77333011010
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: BCBS Trust/PPO |
$138.21
|
| Rate for Payer: BCN Commercial |
$138.21
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$163.25
|
| Rate for Payer: Healthscope Whirlpool |
$168.30
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 10006070038
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Medicare |
$69.56
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$155.01
|
| Rate for Payer: BCN Commercial |
$155.01
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.73
|
| Rate for Payer: Priority Health Narrow Network |
$131.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
OP
|
$106.70
|
|
|
Service Code
|
NDC 37864008289
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Aetna Commercial |
$96.03
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: ASR ASR |
$103.50
|
| Rate for Payer: BCBS Complete |
$42.68
|
| Rate for Payer: BCBS Trust/PPO |
$87.97
|
| Rate for Payer: BCN Commercial |
$87.97
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cofinity Commercial |
$100.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.36
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Healthscope Whirlpool |
$106.70
|
| Rate for Payer: Mclaren Commercial |
$96.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.69
|
| Rate for Payer: Nomi Health Commercial |
$87.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$93.49
|
| Rate for Payer: Priority Health Narrow Network |
$74.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.90
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 77333011025
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: ASR ASR |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$1.38
|
| Rate for Payer: BCN Commercial |
$1.38
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$1.63
|
| Rate for Payer: Healthscope Whirlpool |
$1.68
|
| Rate for Payer: Mclaren Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.43
|
| Rate for Payer: Nomi Health Commercial |
$1.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.48
|
|
|
CALCIUM 500 MG (AS CARBONATE)-VITAMIN D3 5 MCG (200 UNIT) TABLET
|
Facility
|
IP
|
$106.70
|
|
|
Service Code
|
NDC 37864008289
|
| Hospital Charge Code |
19483
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Aetna Commercial |
$96.03
|
| Rate for Payer: ASR ASR |
$103.50
|
| Rate for Payer: BCBS Trust/PPO |
$87.62
|
| Rate for Payer: BCN Commercial |
$87.62
|
| Rate for Payer: Cash Price |
$85.36
|
| Rate for Payer: Cofinity Commercial |
$100.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.36
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Healthscope Whirlpool |
$106.70
|
| Rate for Payer: Mclaren Commercial |
$96.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.69
|
| Rate for Payer: Nomi Health Commercial |
$87.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.90
|
|
|
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 |
$5.04 |
| Rate for Payer: Aetna Commercial |
$4.53
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: ASR ASR |
$4.88
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$4.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.88
|
| Rate for Payer: Healthscope Whirlpool |
$5.04
|
| Rate for Payer: Mclaren Commercial |
$4.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: Nomi Health Commercial |
$4.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.41
|
| Rate for Payer: Priority Health Narrow Network |
$3.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.43
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$565.44
|
|
|
Service Code
|
NDC 781208102
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$424.08 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$508.90
|
| Rate for Payer: ASR ASR |
$548.48
|
| Rate for Payer: BCBS Trust/PPO |
$464.34
|
| Rate for Payer: BCN Commercial |
$464.34
|
| Rate for Payer: Cash Price |
$452.35
|
| Rate for Payer: Cofinity Commercial |
$531.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.35
|
| Rate for Payer: Healthscope Commercial |
$548.48
|
| Rate for Payer: Healthscope Whirlpool |
$565.44
|
| Rate for Payer: Mclaren Commercial |
$508.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.62
|
| Rate for Payer: Nomi Health Commercial |
$463.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$424.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.59
|
|
|
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 |
$3.78 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna Commercial |
$4.53
|
| Rate for Payer: ASR ASR |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$4.14
|
| Rate for Payer: BCN Commercial |
$4.14
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$4.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.88
|
| Rate for Payer: Healthscope Whirlpool |
$5.04
|
| Rate for Payer: Mclaren Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: Nomi Health Commercial |
$4.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.43
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$125.40
|
|
|
Service Code
|
NDC 54008813
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna Commercial |
$112.86
|
| Rate for Payer: Aetna Medicare |
$46.40
|
| Rate for Payer: ASR ASR |
$121.64
|
| Rate for Payer: BCBS Complete |
$50.16
|
| Rate for Payer: BCBS Trust/PPO |
$103.39
|
| Rate for Payer: BCN Commercial |
$103.39
|
| Rate for Payer: Cash Price |
$100.32
|
| Rate for Payer: Cofinity Commercial |
$117.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.32
|
| Rate for Payer: Healthscope Commercial |
$121.64
|
| Rate for Payer: Healthscope Whirlpool |
$125.40
|
| Rate for Payer: Mclaren Commercial |
$112.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.59
|
| Rate for Payer: Nomi Health Commercial |
$102.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.88
|
| Rate for Payer: Priority Health Narrow Network |
$87.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.35
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$565.44
|
|
|
Service Code
|
NDC 781208102
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.21 |
| Max. Negotiated Rate |
$565.44 |
| Rate for Payer: Aetna Commercial |
$508.90
|
| Rate for Payer: Aetna Medicare |
$209.21
|
| Rate for Payer: ASR ASR |
$548.48
|
| Rate for Payer: BCBS Complete |
$226.18
|
| Rate for Payer: BCBS Trust/PPO |
$466.21
|
| Rate for Payer: BCN Commercial |
$466.21
|
| Rate for Payer: Cash Price |
$452.35
|
| Rate for Payer: Cofinity Commercial |
$531.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.35
|
| Rate for Payer: Healthscope Commercial |
$548.48
|
| Rate for Payer: Healthscope Whirlpool |
$565.44
|
| Rate for Payer: Mclaren Commercial |
$508.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.62
|
| Rate for Payer: Nomi Health Commercial |
$463.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$424.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$495.44
|
| Rate for Payer: Priority Health Narrow Network |
$396.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$497.59
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$125.40
|
|
|
Service Code
|
NDC 54008813
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna Commercial |
$112.86
|
| Rate for Payer: ASR ASR |
$121.64
|
| Rate for Payer: BCBS Trust/PPO |
$102.98
|
| Rate for Payer: BCN Commercial |
$102.98
|
| Rate for Payer: Cash Price |
$100.32
|
| Rate for Payer: Cofinity Commercial |
$117.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.32
|
| Rate for Payer: Healthscope Commercial |
$121.64
|
| Rate for Payer: Healthscope Whirlpool |
$125.40
|
| Rate for Payer: Mclaren Commercial |
$112.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.59
|
| Rate for Payer: Nomi Health Commercial |
$102.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.35
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
IP
|
$507.84
|
|
|
Service Code
|
NDC 54008826
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.88 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$457.06
|
| Rate for Payer: ASR ASR |
$492.60
|
| Rate for Payer: BCBS Trust/PPO |
$417.04
|
| Rate for Payer: BCN Commercial |
$417.04
|
| Rate for Payer: Cash Price |
$406.27
|
| Rate for Payer: Cofinity Commercial |
$477.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.27
|
| Rate for Payer: Healthscope Commercial |
$492.60
|
| Rate for Payer: Healthscope Whirlpool |
$507.84
|
| Rate for Payer: Mclaren Commercial |
$457.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.66
|
| Rate for Payer: Nomi Health Commercial |
$416.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.90
|
|
|
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE
|
Facility
|
OP
|
$507.84
|
|
|
Service Code
|
NDC 54008826
|
| Hospital Charge Code |
30961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.90 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$457.06
|
| Rate for Payer: Aetna Medicare |
$187.90
|
| Rate for Payer: ASR ASR |
$492.60
|
| Rate for Payer: BCBS Complete |
$203.14
|
| Rate for Payer: BCBS Trust/PPO |
$418.71
|
| Rate for Payer: BCN Commercial |
$418.71
|
| Rate for Payer: Cash Price |
$406.27
|
| Rate for Payer: Cofinity Commercial |
$477.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$406.27
|
| Rate for Payer: Healthscope Commercial |
$492.60
|
| Rate for Payer: Healthscope Whirlpool |
$507.84
|
| Rate for Payer: Mclaren Commercial |
$457.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$406.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$431.66
|
| Rate for Payer: Nomi Health Commercial |
$416.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$444.97
|
| Rate for Payer: Priority Health Narrow Network |
$356.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$446.90
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$52.20
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.15 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Aetna Commercial |
$35.40
|
| Rate for Payer: Aetna Commercial |
$63.48
|
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$68.42
|
| Rate for Payer: ASR ASR |
$50.63
|
| Rate for Payer: ASR ASR |
$38.16
|
| Rate for Payer: ASR ASR |
$32.11
|
| Rate for Payer: BCBS Trust/PPO |
$42.87
|
| Rate for Payer: BCBS Trust/PPO |
$27.19
|
| Rate for Payer: BCBS Trust/PPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$57.92
|
| Rate for Payer: BCN Commercial |
$27.19
|
| Rate for Payer: BCN Commercial |
$57.92
|
| Rate for Payer: BCN Commercial |
$32.30
|
| Rate for Payer: BCN Commercial |
$42.87
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$49.07
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$50.63
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Commercial |
$38.16
|
| Rate for Payer: Healthscope Commercial |
$68.42
|
| Rate for Payer: Healthscope Whirlpool |
$52.20
|
| Rate for Payer: Healthscope Whirlpool |
$70.53
|
| Rate for Payer: Healthscope Whirlpool |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$39.34
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Mclaren Commercial |
$63.48
|
| Rate for Payer: Mclaren Commercial |
$35.40
|
| Rate for Payer: Mclaren Commercial |
$46.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.07
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$70.53
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$63.48
|
| Rate for Payer: Aetna Commercial |
$35.40
|
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: Aetna Medicare |
$26.10
|
| Rate for Payer: Aetna Medicare |
$19.31
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: ASR ASR |
$50.63
|
| Rate for Payer: ASR ASR |
$38.16
|
| Rate for Payer: ASR ASR |
$32.11
|
| Rate for Payer: ASR ASR |
$68.42
|
| Rate for Payer: BCBS Complete |
$20.88
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Complete |
$28.21
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS Trust/PPO |
$32.43
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCBS Trust/PPO |
$43.04
|
| Rate for Payer: BCBS Trust/PPO |
$27.30
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: BCN Commercial |
$43.04
|
| Rate for Payer: BCN Commercial |
$27.30
|
| Rate for Payer: BCN Commercial |
$32.43
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$49.07
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.76
|
| Rate for Payer: Healthscope Commercial |
$68.42
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Commercial |
$38.16
|
| Rate for Payer: Healthscope Commercial |
$50.63
|
| Rate for Payer: Healthscope Whirlpool |
$33.11
|
| Rate for Payer: Healthscope Whirlpool |
$52.20
|
| Rate for Payer: Healthscope Whirlpool |
$70.53
|
| Rate for Payer: Healthscope Whirlpool |
$39.34
|
| Rate for Payer: Mclaren Commercial |
$46.98
|
| Rate for Payer: Mclaren Commercial |
$35.40
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Mclaren Commercial |
$63.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.95
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$42.80
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.62
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$70.53
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$63.48
|
| Rate for Payer: Aetna Commercial |
$35.40
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Aetna Medicare |
$26.10
|
| Rate for Payer: ASR ASR |
$68.42
|
| Rate for Payer: ASR ASR |
$38.16
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS Complete |
$28.21
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCBS Trust/PPO |
$32.43
|
| Rate for Payer: BCN Commercial |
$32.43
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$68.42
|
| Rate for Payer: Healthscope Commercial |
$38.16
|
| Rate for Payer: Healthscope Whirlpool |
$70.53
|
| Rate for Payer: Healthscope Whirlpool |
$39.34
|
| Rate for Payer: Mclaren Commercial |
$63.48
|
| Rate for Payer: Mclaren Commercial |
$35.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.95
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.07
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
163711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$39.34 |
| Rate for Payer: Aetna Commercial |
$35.40
|
| Rate for Payer: Aetna Commercial |
$63.48
|
| Rate for Payer: ASR ASR |
$68.42
|
| Rate for Payer: ASR ASR |
$38.16
|
| Rate for Payer: BCBS Trust/PPO |
$57.92
|
| Rate for Payer: BCBS Trust/PPO |
$32.30
|
| Rate for Payer: BCN Commercial |
$57.92
|
| Rate for Payer: BCN Commercial |
$32.30
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$38.16
|
| Rate for Payer: Healthscope Commercial |
$68.42
|
| Rate for Payer: Healthscope Whirlpool |
$70.53
|
| Rate for Payer: Healthscope Whirlpool |
$39.34
|
| Rate for Payer: Mclaren Commercial |
$63.48
|
| Rate for Payer: Mclaren Commercial |
$35.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Nomi Health Commercial |
$57.84
|
| Rate for Payer: Nomi Health Commercial |
$32.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.07
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: ASR ASR |
$32.11
|
| Rate for Payer: BCBS Trust/PPO |
$27.19
|
| Rate for Payer: BCN Commercial |
$27.19
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Whirlpool |
$33.11
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$29.80
|
| Rate for Payer: Aetna Medicare |
$12.25
|
| Rate for Payer: ASR ASR |
$32.11
|
| Rate for Payer: BCBS Complete |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$27.30
|
| Rate for Payer: BCN Commercial |
$27.30
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cash Price |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Whirlpool |
$33.11
|
| Rate for Payer: Mclaren Commercial |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.14
|
| Rate for Payer: Nomi Health Commercial |
$27.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.03
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.14
|
|
|
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 |
$0.07 |
| Max. Negotiated Rate |
$35.38 |
| Rate for Payer: Aetna Commercial |
$31.84
|
| Rate for Payer: Aetna Medicare |
$13.09
|
| Rate for Payer: ASR ASR |
$34.32
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$29.17
|
| Rate for Payer: BCN Commercial |
$29.17
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$34.32
|
| Rate for Payer: Healthscope Whirlpool |
$35.38
|
| Rate for Payer: Mclaren Commercial |
$31.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$29.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
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 |
$26.53 |
| Max. Negotiated Rate |
$35.38 |
| Rate for Payer: Aetna Commercial |
$31.84
|
| Rate for Payer: ASR ASR |
$34.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.05
|
| Rate for Payer: BCN Commercial |
$29.05
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$34.32
|
| Rate for Payer: Healthscope Whirlpool |
$35.38
|
| Rate for Payer: Mclaren Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Nomi Health Commercial |
$29.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
OP
|
$15.39
|
|
|
Service Code
|
NDC 536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$15.39 |
| Rate for Payer: Aetna Commercial |
$13.85
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: ASR ASR |
$14.93
|
| Rate for Payer: BCBS Complete |
$6.16
|
| Rate for Payer: BCBS Trust/PPO |
$12.69
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$14.93
|
| Rate for Payer: Healthscope Whirlpool |
$15.39
|
| Rate for Payer: Mclaren Commercial |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| Rate for Payer: Nomi Health Commercial |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.48
|
| Rate for Payer: Priority Health Narrow Network |
$10.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.54
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$15.39
|
|
|
Service Code
|
NDC 536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$15.39 |
| Rate for Payer: Aetna Commercial |
$13.85
|
| Rate for Payer: ASR ASR |
$14.93
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$14.93
|
| Rate for Payer: Healthscope Whirlpool |
$15.39
|
| Rate for Payer: Mclaren Commercial |
$13.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| Rate for Payer: Nomi Health Commercial |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.54
|
|
