|
CALCITRATE 950MG(=200MG
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41647043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CALCITRATE 950MG(=200MG
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41657043
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CALCITRIOL 0.25 MCG CAP
|
Facility
OP
|
$1.66
|
|
| Hospital Charge Code |
41655246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.08
|
|
|
CALCITRIOL 0.25 MCG CAP
|
Facility
OP
|
$1.66
|
|
| Hospital Charge Code |
41645246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.08
|
|
|
CALCITRIOL 0.5 MCG CAP
|
Facility
OP
|
$1.78
|
|
| Hospital Charge Code |
41645247
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
CALCITRIOL 0.5 MCG CAP
|
Facility
OP
|
$1.78
|
|
| Hospital Charge Code |
41655247
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
CALCITRIOL 1 MCG/ML INJ
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0636
|
| Hospital Charge Code |
41644212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
|
CALCITRIOL 1 MCG/ML INJ
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0636
|
| Hospital Charge Code |
41654212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
|
|
CALCITRIOL 1 MCG/ML INJ
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0636
|
| Hospital Charge Code |
41654212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.72
|
| Rate for Payer: Aetna Government |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.72
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
CALCITRIOL 1 MCG/ML INJ
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0636
|
| Hospital Charge Code |
41644212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.72
|
| Rate for Payer: Aetna Government |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.72
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
CALCIUM
|
Facility
OP
|
$12.90
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
40602100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Government |
$5.16
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Cash Price |
$5.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.16
|
| Rate for Payer: EmblemHealth Commercial |
$5.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.59
|
| Rate for Payer: Group Health Inc Commercial |
$5.16
|
| Rate for Payer: Group Health Inc Medicare |
$5.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.16
|
| Rate for Payer: Healthfirst QHP |
$5.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.13
|
| Rate for Payer: Wellcare Medicare |
$4.64
|
|
|
CALCIUM 24 HOUR URINE
|
Facility
OP
|
$15.08
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
40602635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.03
|
| Rate for Payer: Aetna Government |
$6.03
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.03
|
| Rate for Payer: EmblemHealth Commercial |
$6.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.37
|
| Rate for Payer: Group Health Inc Commercial |
$6.03
|
| Rate for Payer: Group Health Inc Medicare |
$6.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.03
|
| Rate for Payer: Healthfirst QHP |
$6.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.82
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
|
|
CALCIUM ACETATE 667 MG CAP
|
Facility
OP
|
$1.15
|
|
| Hospital Charge Code |
41643143
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
CALCIUM ACETATE 667 MG CAP
|
Facility
OP
|
$1.15
|
|
| Hospital Charge Code |
41653143
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
Calcium Alginate Dressing
|
Facility
OP
|
$20.56
|
|
| Hospital Charge Code |
40200865
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.28
|
| Rate for Payer: Aetna Government |
$10.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.98
|
| Rate for Payer: Group Health Inc Commercial |
$10.28
|
| Rate for Payer: Group Health Inc Medicare |
$7.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.28
|
|
|
CALCIUM CARBONATE 1250 MG/5 ML SUSP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41655400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CALCIUM CARBONATE 1250 MG/5 ML SUSP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41645400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CALCIUM CARBONATE 1250 MG TAB
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41642228
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CALCIUM CARBONATE 1250 MG TAB
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41652228
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CALCIUM CARBONATE SUS 1250MG/5ML
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41646032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CALCIUM CARBONATE SUS 1250MG/5ML
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41656032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CALCIUM CHLORIDE 10% INJ SYRINGE 10 ML
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41653820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
CALCIUM CHLORIDE 10% INJ SYRINGE 10 ML
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41643820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
CALCIUM CITRATE 950MG TAB
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41648419
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
CALCIUM CITRATE 950MG TAB
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41658419
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
