|
CALCIUM ACETATE 667 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 574011302
|
| Hospital Charge Code |
60628582
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
CALCIUM BLD***
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
3010576
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.85
|
|
|
CALCIUM BLD***
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
3010576
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Medicare Advantage |
$5.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.84
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2.47
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
CALCIUM CARBONATE/1.25GM
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60632602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
CALCIUM CARBONATE/1.25GM
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60632602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
CALCIUM CARBONATE 500 MG TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 904188361
|
| Hospital Charge Code |
60627894
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
CALCIUM CARBONATE 500 MG TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 904188361
|
| Hospital Charge Code |
60627894
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
CALCIUM CARBONATE/650MG
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
60632603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
|
|
CALCIUM CARBONATE/650MG
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
60632603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.26
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.13
|
| Rate for Payer: Oxford Commercial |
$0.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.50
|
|
|
CALCIUM CARBONATE LIQUID
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
60634954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.26
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.13
|
| Rate for Payer: Oxford Commercial |
$0.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.50
|
|
|
CALCIUM CARBONATE LIQUID
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
60634954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
|
|
CALCIUM CARBONATE LQ 400MG
|
Facility
|
OP
|
$23.70
|
|
| Hospital Charge Code |
60628583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$11.85 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Medicare Advantage |
$7.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.04
|
| Rate for Payer: Cigna Commercial |
$11.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.08
|
| Rate for Payer: Oxford Commercial |
$11.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.85
|
|
|
CALCIUM CARBONATE LQ 400MG
|
Facility
|
IP
|
$23.70
|
|
| Hospital Charge Code |
60628583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.56
|
|
|
CALCIUM CARBONATE/MG HYDROXIDE
|
Facility
|
IP
|
$26.90
|
|
| Hospital Charge Code |
60629091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.04
|
|
|
CALCIUM CARBONATE/MG HYDROXIDE
|
Facility
|
OP
|
$26.90
|
|
| Hospital Charge Code |
60629091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna Commercial |
$8.07
|
| Rate for Payer: Aetna Medicare Advantage |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.86
|
| Rate for Payer: Cigna Commercial |
$13.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.50
|
| Rate for Payer: Oxford Commercial |
$13.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.04
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.45
|
|
|
CALCIUM CARBONATE OSCAL 500MG
|
Facility
|
IP
|
$1.95
|
|
| Hospital Charge Code |
6024129
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
|
|
CALCIUM CARBONATE OSCAL 500MG
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
6024129
|
|
Hospital Revenue Code
|
251
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: Aetna Medicare Advantage |
$0.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.25
|
| Rate for Payer: Oxford Commercial |
$0.98
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.29
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.98
|
|
|
CALCIUM CARBONATE TAB 420MG
|
Facility
|
IP
|
$2.45
|
|
| Hospital Charge Code |
60627895
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.37
|
|
|
CALCIUM CARBONATE TAB 420MG
|
Facility
|
OP
|
$2.45
|
|
| Hospital Charge Code |
60627895
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare Advantage |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.62
|
| Rate for Payer: Cigna Commercial |
$1.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.32
|
| Rate for Payer: Oxford Commercial |
$1.23
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.23
|
|
|
CALCIUM CARB SUSP 1.25G/5ML
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 54311763
|
| Hospital Charge Code |
60628915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| Rate for Payer: Aetna Medicare Advantage |
$1.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.02
|
| Rate for Payer: Cigna Commercial |
$2.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.52
|
| Rate for Payer: Oxford Commercial |
$2.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.00
|
|
|
CALCIUM CARB SUSP 1.25G/5ML
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 54311763
|
| Hospital Charge Code |
60628915
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.60
|
|
|
CALCIUM CHLORIDE 100 MG/ML INJ
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
NDC 409492834
|
| Hospital Charge Code |
6000848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$13.13 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Aetna Medicare Advantage |
$7.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.70
|
| Rate for Payer: Cigna Commercial |
$13.13
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3.41
|
| Rate for Payer: Oxford Commercial |
$13.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$13.13
|
|
|
CALCIUM CHLORIDE 100 MG/ML INJ
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 409492834
|
| Hospital Charge Code |
6000848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.94
|
|
|
CALCIUM CHLORIDE 10%/1GM
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
60632604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
|
|
CALCIUM CHLORIDE 10%/1GM
|
Facility
|
OP
|
$104.00
|
|
| Hospital Charge Code |
60632604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$31.20
|
| Rate for Payer: Aetna Medicare Advantage |
$31.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$26.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$26.52
|
| Rate for Payer: Cigna Commercial |
$52.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.52
|
| Rate for Payer: Oxford Commercial |
$52.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$15.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$52.00
|
|