|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0536-7415-51
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.07 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: BCBS Trust/PPO |
$24.16
|
| Rate for Payer: BCN Commercial |
$24.16
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.57
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.51
|
| Rate for Payer: UHC Core |
$26.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.44
|
|
|
SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA
|
Facility
IP
|
$31.26
|
|
|
Service Code
|
NDC 0132-0201-40
|
| Hospital Charge Code |
11395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.07 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$26.57
|
| Rate for Payer: BCBS Trust/PPO |
$24.16
|
| Rate for Payer: BCN Commercial |
$24.16
|
| Rate for Payer: Cash Price |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$26.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.57
|
| Rate for Payer: PHP Commercial |
$26.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.51
|
| Rate for Payer: UHC Core |
$26.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.44
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
IP
|
$175.99
|
|
|
Service Code
|
NDC 0310-1110-39
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.34 |
| Max. Negotiated Rate |
$158.39 |
| Rate for Payer: Aetna Commercial |
$149.59
|
| Rate for Payer: BCBS Trust/PPO |
$136.01
|
| Rate for Payer: BCN Commercial |
$136.01
|
| Rate for Payer: Cash Price |
$140.79
|
| Rate for Payer: Cofinity Commercial |
$151.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.79
|
| Rate for Payer: Healthscope Commercial |
$158.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.59
|
| Rate for Payer: PHP Commercial |
$149.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.87
|
| Rate for Payer: UHC Core |
$146.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.99
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET
|
Facility
IP
|
$16.00
|
|
|
Service Code
|
NDC 0310-1110-01
|
| Hospital Charge Code |
188049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.60
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.08
|
| Rate for Payer: UHC Core |
$13.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
SOTALOL 80 MG TABLET
|
Facility
IP
|
$117.50
|
|
|
Service Code
|
NDC 60505-0080-0
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: BCBS Trust/PPO |
$90.80
|
| Rate for Payer: BCN Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.40
|
| Rate for Payer: UHC Core |
$98.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
SOTALOL 80 MG TABLET
|
Facility
IP
|
$247.00
|
|
|
Service Code
|
NDC 0093-1061-01
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: BCBS Trust/PPO |
$190.88
|
| Rate for Payer: BCN Commercial |
$190.88
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.95
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.36
|
| Rate for Payer: UHC Core |
$206.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
|
|
SOTALOL 80 MG TABLET
|
Facility
IP
|
$397.44
|
|
|
Service Code
|
NDC 0904-7143-61
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$357.70 |
| Rate for Payer: Aetna Commercial |
$337.82
|
| Rate for Payer: BCBS Trust/PPO |
$307.14
|
| Rate for Payer: BCN Commercial |
$307.14
|
| Rate for Payer: Cash Price |
$317.95
|
| Rate for Payer: Cofinity Commercial |
$341.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.95
|
| Rate for Payer: Healthscope Commercial |
$357.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.82
|
| Rate for Payer: PHP Commercial |
$337.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.75
|
| Rate for Payer: UHC Core |
$331.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.08
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
OP
|
$476.33
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$453.65 |
| Max. Negotiated Rate |
$476.33 |
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
|
|
SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER);
|
Facility
OP
|
$476.33
|
|
|
Service Code
|
CPT 62272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$453.65 |
| Max. Negotiated Rate |
$476.33 |
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746-511-01
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.69 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$212.48
|
| Rate for Payer: BCN Commercial |
$212.48
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.71
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
IP
|
$3.84
|
|
|
Service Code
|
NDC 51079-103-01
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.97
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.38
|
| Rate for Payer: UHC Core |
$3.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.88
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
IP
|
$251.45
|
|
|
Service Code
|
NDC 0904-6927-61
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.36 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$194.32
|
| Rate for Payer: BCN Commercial |
$194.32
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.73
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
IP
|
$79.35
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$71.42 |
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: BCBS Trust/PPO |
$61.32
|
| Rate for Payer: BCN Commercial |
$61.32
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.45
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.83
|
| Rate for Payer: UHC Core |
$66.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$21.19
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$16.36
|
| Rate for Payer: BCBS Trust/PPO |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$61.32
|
| Rate for Payer: BCN Commercial |
$18.70
|
| Rate for Payer: BCN Commercial |
$18.30
|
| Rate for Payer: BCN Commercial |
$16.36
|
| Rate for Payer: BCN Commercial |
$61.32
|
| Rate for Payer: BCN Commercial |
$16.38
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$21.78
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.57
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$20.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.83
|
| Rate for Payer: UHC Core |
$17.69
|
| Rate for Payer: UHC Core |
$19.77
|
| Rate for Payer: UHC Core |
$66.26
|
| Rate for Payer: UHC Core |
$17.68
|
| Rate for Payer: UHC Core |
$20.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.15
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
IP
|
$31.54
|
|
|
Service Code
|
NDC 0121-0747-40
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$28.39 |
| Rate for Payer: Aetna Commercial |
$26.81
|
| Rate for Payer: BCBS Trust/PPO |
$24.37
|
| Rate for Payer: BCN Commercial |
$24.37
|
| Rate for Payer: Cash Price |
$25.23
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.23
|
| Rate for Payer: Healthscope Commercial |
$28.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.81
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.76
|
| Rate for Payer: UHC Core |
$26.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.66
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
IP
|
$33.75
|
|
|
Service Code
|
NDC 0121-0747-10
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$30.38 |
| Rate for Payer: Aetna Commercial |
$28.69
|
| Rate for Payer: BCBS Trust/PPO |
$26.08
|
| Rate for Payer: BCN Commercial |
$26.08
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cofinity Commercial |
$29.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.00
|
| Rate for Payer: Healthscope Commercial |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.69
|
| Rate for Payer: PHP Commercial |
$28.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.70
|
| Rate for Payer: UHC Core |
$28.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.31
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
IP
|
$29.48
|
|
|
Service Code
|
NDC 0121-0974-10
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$26.53 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: BCBS Trust/PPO |
$22.78
|
| Rate for Payer: BCN Commercial |
$22.78
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Cofinity Commercial |
$25.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.58
|
| Rate for Payer: Healthscope Commercial |
$26.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.06
|
| Rate for Payer: PHP Commercial |
$25.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.94
|
| Rate for Payer: UHC Core |
$24.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.11
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
IP
|
$40.28
|
|
|
Service Code
|
NDC 68094-043-59
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$36.25 |
| Rate for Payer: Aetna Commercial |
$34.24
|
| Rate for Payer: BCBS Trust/PPO |
$31.13
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: Cash Price |
$32.22
|
| Rate for Payer: Cofinity Commercial |
$34.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.22
|
| Rate for Payer: Healthscope Commercial |
$36.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.24
|
| Rate for Payer: PHP Commercial |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.45
|
| Rate for Payer: UHC Core |
$33.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.21
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
IP
|
$27.03
|
|
|
Service Code
|
NDC 0121-0974-40
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$24.33 |
| Rate for Payer: Aetna Commercial |
$22.98
|
| Rate for Payer: BCBS Trust/PPO |
$20.89
|
| Rate for Payer: BCN Commercial |
$20.89
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cofinity Commercial |
$23.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.62
|
| Rate for Payer: Healthscope Commercial |
$24.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.98
|
| Rate for Payer: PHP Commercial |
$22.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.79
|
| Rate for Payer: UHC Core |
$22.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.27
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
IP
|
$40.28
|
|
|
Service Code
|
NDC 68094-043-61
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$36.25 |
| Rate for Payer: Aetna Commercial |
$34.24
|
| Rate for Payer: BCBS Trust/PPO |
$31.13
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: Cash Price |
$32.22
|
| Rate for Payer: Cofinity Commercial |
$34.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.22
|
| Rate for Payer: Healthscope Commercial |
$36.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.24
|
| Rate for Payer: PHP Commercial |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.45
|
| Rate for Payer: UHC Core |
$33.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.21
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
IP
|
$279.30
|
|
|
Service Code
|
NDC 51079-753-20
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.35 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: BCBS Trust/PPO |
$215.84
|
| Rate for Payer: BCN Commercial |
$215.84
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
IP
|
$2.80
|
|
|
Service Code
|
NDC 51079-753-01
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cofinity Commercial |
$2.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.24
|
| Rate for Payer: Healthscope Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.38
|
| Rate for Payer: PHP Commercial |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.46
|
| Rate for Payer: UHC Core |
$2.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.10
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
IP
|
$238.45
|
|
|
Service Code
|
NDC 0093-2210-01
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: BCBS Trust/PPO |
$184.27
|
| Rate for Payer: BCN Commercial |
$184.27
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.84
|
| Rate for Payer: UHC Core |
$199.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$428.08
|
|
|
Service Code
|
NDC 0006-5423-02
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$261.09 |
| Max. Negotiated Rate |
$385.27 |
| Rate for Payer: Aetna Commercial |
$363.87
|
| Rate for Payer: BCBS Trust/PPO |
$330.82
|
| Rate for Payer: BCN Commercial |
$330.82
|
| Rate for Payer: Cash Price |
$342.46
|
| Rate for Payer: Cofinity Commercial |
$368.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.46
|
| Rate for Payer: Healthscope Commercial |
$385.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.87
|
| Rate for Payer: PHP Commercial |
$363.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.71
|
| Rate for Payer: UHC Core |
$357.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.06
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$428.08
|
|
|
Service Code
|
NDC 0006-5423-12
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$261.09 |
| Max. Negotiated Rate |
$385.27 |
| Rate for Payer: Aetna Commercial |
$363.87
|
| Rate for Payer: BCBS Trust/PPO |
$330.82
|
| Rate for Payer: BCN Commercial |
$330.82
|
| Rate for Payer: Cash Price |
$342.46
|
| Rate for Payer: Cofinity Commercial |
$368.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.46
|
| Rate for Payer: Healthscope Commercial |
$385.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.87
|
| Rate for Payer: PHP Commercial |
$363.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.71
|
| Rate for Payer: UHC Core |
$357.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.06
|
|
