|
SOTALOL 80 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$31.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.19
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$100.46
|
| Rate for Payer: BCN Commercial |
$95.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.55
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PACE Senior Care Partners |
$29.02
|
| Rate for Payer: PACE SWMI |
$30.55
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO |
$106.31
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.87
|
| Rate for Payer: Railroad Medicare Medicare |
$30.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.55
|
| Rate for Payer: UHC Exchange |
$30.55
|
| Rate for Payer: UHC Medicare Advantage |
$30.55
|
| Rate for Payer: VA VA |
$30.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$409.92
|
|
|
Service Code
|
NDC 00904714361
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$368.93 |
| Rate for Payer: Aetna Commercial |
$348.43
|
| Rate for Payer: BCBS Trust/PPO |
$334.62
|
| Rate for Payer: BCN Commercial |
$316.79
|
| Rate for Payer: Cash Price |
$327.94
|
| Rate for Payer: Cofinity Commercial |
$352.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.94
|
| Rate for Payer: Healthscope Commercial |
$368.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.43
|
| Rate for Payer: Nomi Health Commercial |
$336.13
|
| Rate for Payer: PHP Commercial |
$348.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.45
|
| Rate for Payer: Priority Health HMO/PPO |
$356.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.73
|
| Rate for Payer: UHC Core |
$342.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.44
|
|
|
SOTALOL 80 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 60505008000
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: BCBS Trust/PPO |
$99.75
|
| Rate for Payer: BCN Commercial |
$94.44
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO |
$106.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$515.13
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.57 |
| Max. Negotiated Rate |
$515.13 |
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
|
|
SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER);
|
Facility
|
OP
|
$515.13
|
|
|
Service Code
|
CPT 62272
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.57 |
| Max. Negotiated Rate |
$515.13 |
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.30 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$71.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.92
|
| Rate for Payer: BCBS Complete |
$109.98
|
| Rate for Payer: BCBS MAPPO |
$68.74
|
| Rate for Payer: BCBS Trust/PPO |
$226.04
|
| Rate for Payer: BCN Commercial |
$213.77
|
| Rate for Payer: BCN Medicare Advantage |
$68.74
|
| 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: Health Alliance Plan Medicare Advantage |
$68.74
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PACE Senior Care Partners |
$65.30
|
| Rate for Payer: PACE SWMI |
$68.74
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Medicare |
$69.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| Rate for Payer: Railroad Medicare Medicare |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.74
|
| Rate for Payer: UHC Exchange |
$68.74
|
| Rate for Payer: UHC Medicare Advantage |
$68.74
|
| Rate for Payer: VA VA |
$68.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 53746051101
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.72 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$224.44
|
| 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 Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.72
|
| Rate for Payer: Priority Health HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.22
|
| 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
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.21
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PACE Senior Care Partners |
$0.92
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: Railroad Medicare Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$0.97
|
| Rate for Payer: VA VA |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.98 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$73.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.12
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$70.50
|
| Rate for Payer: BCBS Trust/PPO |
$231.83
|
| Rate for Payer: BCN Commercial |
$219.26
|
| Rate for Payer: BCN Medicare Advantage |
$70.50
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.50
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: PACE Senior Care Partners |
$66.98
|
| Rate for Payer: PACE SWMI |
$70.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: PHP Medicare Advantage |
$70.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO |
$245.34
|
| Rate for Payer: Priority Health Medicare |
$71.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.94
|
| Rate for Payer: Railroad Medicare Medicare |
$70.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.16
|
| Rate for Payer: UHC Core |
$235.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.50
|
| Rate for Payer: UHC Exchange |
$70.50
|
| Rate for Payer: UHC Medicare Advantage |
$70.50
|
| Rate for Payer: VA VA |
$70.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 00904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.97 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: BCBS Trust/PPO |
$207.18
|
| Rate for Payer: BCN Commercial |
$196.14
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: BCBS Trust/PPO |
$230.20
|
| Rate for Payer: BCN Commercial |
$217.93
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO |
$245.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.16
|
| Rate for Payer: UHC Core |
$235.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 00904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$65.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.31
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: BCBS MAPPO |
$63.45
|
| Rate for Payer: BCBS Trust/PPO |
$208.65
|
| Rate for Payer: BCN Commercial |
$197.33
|
| Rate for Payer: BCN Medicare Advantage |
$63.45
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$218.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.45
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: PACE Senior Care Partners |
$60.28
|
| Rate for Payer: PACE SWMI |
$63.45
|
| Rate for Payer: PHP Commercial |
$215.73
|
| Rate for Payer: PHP Medicare Advantage |
$63.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.97
|
| Rate for Payer: Priority Health HMO/PPO |
$220.81
|
| Rate for Payer: Priority Health Medicare |
$64.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.05
|
| Rate for Payer: Railroad Medicare Medicare |
$63.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.34
|
| Rate for Payer: UHC Core |
$211.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.45
|
| Rate for Payer: UHC Exchange |
$63.45
|
| Rate for Payer: UHC Medicare Advantage |
$63.45
|
| Rate for Payer: VA VA |
$63.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.35
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$79.35
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$71.42 |
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Medicare |
$20.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.80
|
| Rate for Payer: BCBS Complete |
$31.74
|
| Rate for Payer: BCBS MAPPO |
$19.84
|
| Rate for Payer: BCBS Trust/PPO |
$65.23
|
| Rate for Payer: BCN Commercial |
$61.69
|
| Rate for Payer: BCN Medicare Advantage |
$19.84
|
| 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: Health Alliance Plan Medicare Advantage |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: Nomi Health Commercial |
$65.07
|
| Rate for Payer: PACE Senior Care Partners |
$18.85
|
| Rate for Payer: PACE SWMI |
$19.84
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: PHP Medicare Advantage |
$19.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health HMO/PPO |
$69.03
|
| Rate for Payer: Priority Health Medicare |
$20.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.16
|
| Rate for Payer: Railroad Medicare Medicare |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.83
|
| Rate for Payer: UHC Core |
$66.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.84
|
| Rate for Payer: UHC Exchange |
$19.84
|
| Rate for Payer: UHC Medicare Advantage |
$19.84
|
| Rate for Payer: VA VA |
$19.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
|
|
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 |
$51.58 |
| Max. Negotiated Rate |
$71.42 |
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: BCBS Trust/PPO |
$64.77
|
| 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 Commercial |
$67.45
|
| Rate for Payer: Nomi Health Commercial |
$65.07
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health HMO/PPO |
$69.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.16
|
| 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
|
$79.35
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$71.42 |
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: BCBS Trust/PPO |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$64.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.64
|
| Rate for Payer: BCBS Trust/PPO |
$17.30
|
| Rate for Payer: BCBS Trust/PPO |
$13.48
|
| Rate for Payer: BCN Commercial |
$20.84
|
| Rate for Payer: BCN Commercial |
$16.70
|
| Rate for Payer: BCN Commercial |
$12.76
|
| Rate for Payer: BCN Commercial |
$16.38
|
| Rate for Payer: BCN Commercial |
$61.32
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Nomi Health Commercial |
$13.54
|
| Rate for Payer: Nomi Health Commercial |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$17.72
|
| Rate for Payer: Nomi Health Commercial |
$22.12
|
| Rate for Payer: Nomi Health Commercial |
$65.07
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health HMO/PPO |
$14.36
|
| Rate for Payer: Priority Health HMO/PPO |
$69.03
|
| Rate for Payer: Priority Health HMO/PPO |
$18.80
|
| Rate for Payer: Priority Health HMO/PPO |
$23.46
|
| Rate for Payer: Priority Health HMO/PPO |
$18.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.73
|
| Rate for Payer: UHC Core |
$13.79
|
| Rate for Payer: UHC Core |
$17.69
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: UHC Core |
$66.26
|
| Rate for Payer: UHC Core |
$18.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$21.19
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$19.07 |
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Medicare |
$5.62
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna Medicare |
$20.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.43
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Complete |
$31.74
|
| Rate for Payer: BCBS MAPPO |
$5.40
|
| Rate for Payer: BCBS MAPPO |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$5.30
|
| Rate for Payer: BCBS MAPPO |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$19.84
|
| Rate for Payer: BCBS Trust/PPO |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$17.42
|
| Rate for Payer: BCBS Trust/PPO |
$17.77
|
| Rate for Payer: BCBS Trust/PPO |
$65.23
|
| Rate for Payer: BCBS Trust/PPO |
$22.17
|
| Rate for Payer: BCN Commercial |
$61.69
|
| Rate for Payer: BCN Commercial |
$12.84
|
| Rate for Payer: BCN Commercial |
$16.48
|
| Rate for Payer: BCN Commercial |
$16.80
|
| Rate for Payer: BCN Commercial |
$20.97
|
| Rate for Payer: BCN Medicare Advantage |
$19.84
|
| Rate for Payer: BCN Medicare Advantage |
$6.74
|
| Rate for Payer: BCN Medicare Advantage |
$4.13
|
| Rate for Payer: BCN Medicare Advantage |
$5.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.40
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.40
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: Nomi Health Commercial |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$22.12
|
| Rate for Payer: Nomi Health Commercial |
$17.72
|
| Rate for Payer: Nomi Health Commercial |
$65.07
|
| Rate for Payer: Nomi Health Commercial |
$13.54
|
| Rate for Payer: PACE Senior Care Partners |
$3.92
|
| Rate for Payer: PACE Senior Care Partners |
$6.41
|
| Rate for Payer: PACE Senior Care Partners |
$5.03
|
| Rate for Payer: PACE Senior Care Partners |
$5.13
|
| Rate for Payer: PACE Senior Care Partners |
$18.85
|
| Rate for Payer: PACE SWMI |
$4.13
|
| Rate for Payer: PACE SWMI |
$6.74
|
| Rate for Payer: PACE SWMI |
$5.40
|
| Rate for Payer: PACE SWMI |
$5.30
|
| Rate for Payer: PACE SWMI |
$19.84
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Medicare Advantage |
$5.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.74
|
| Rate for Payer: PHP Medicare Advantage |
$19.84
|
| Rate for Payer: PHP Medicare Advantage |
$4.13
|
| Rate for Payer: PHP Medicare Advantage |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health HMO/PPO |
$14.36
|
| Rate for Payer: Priority Health HMO/PPO |
$18.80
|
| Rate for Payer: Priority Health HMO/PPO |
$69.03
|
| Rate for Payer: Priority Health HMO/PPO |
$23.46
|
| Rate for Payer: Priority Health HMO/PPO |
$18.44
|
| Rate for Payer: Priority Health Medicare |
$20.04
|
| Rate for Payer: Priority Health Medicare |
$5.46
|
| Rate for Payer: Priority Health Medicare |
$5.35
|
| Rate for Payer: Priority Health Medicare |
$6.81
|
| Rate for Payer: Priority Health Medicare |
$4.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.16
|
| Rate for Payer: Railroad Medicare Medicare |
$6.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.40
|
| Rate for Payer: Railroad Medicare Medicare |
$4.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5.30
|
| Rate for Payer: Railroad Medicare Medicare |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.02
|
| Rate for Payer: UHC Core |
$17.69
|
| Rate for Payer: UHC Core |
$66.26
|
| Rate for Payer: UHC Core |
$18.04
|
| Rate for Payer: UHC Core |
$22.52
|
| Rate for Payer: UHC Core |
$13.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.40
|
| Rate for Payer: UHC Exchange |
$5.40
|
| Rate for Payer: UHC Exchange |
$19.84
|
| Rate for Payer: UHC Exchange |
$4.13
|
| Rate for Payer: UHC Exchange |
$6.74
|
| Rate for Payer: UHC Exchange |
$5.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.30
|
| Rate for Payer: UHC Medicare Advantage |
$19.84
|
| Rate for Payer: UHC Medicare Advantage |
$5.40
|
| Rate for Payer: UHC Medicare Advantage |
$4.13
|
| Rate for Payer: UHC Medicare Advantage |
$6.74
|
| Rate for Payer: VA VA |
$4.13
|
| Rate for Payer: VA VA |
$6.74
|
| Rate for Payer: VA VA |
$5.30
|
| Rate for Payer: VA VA |
$19.84
|
| Rate for Payer: VA VA |
$5.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
NDC 00904747072
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.49
|
| Rate for Payer: BCBS Complete |
$18.54
|
| Rate for Payer: BCBS MAPPO |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$38.11
|
| Rate for Payer: BCN Commercial |
$36.04
|
| Rate for Payer: BCN Medicare Advantage |
$11.59
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.59
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Nomi Health Commercial |
$38.02
|
| Rate for Payer: PACE Senior Care Partners |
$11.01
|
| Rate for Payer: PACE SWMI |
$11.59
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: PHP Medicare Advantage |
$11.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.13
|
| Rate for Payer: Priority Health HMO/PPO |
$40.33
|
| Rate for Payer: Priority Health Medicare |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.80
|
| Rate for Payer: UHC Core |
$38.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.59
|
| Rate for Payer: UHC Exchange |
$11.59
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: VA VA |
$11.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$32.88
|
|
|
Service Code
|
NDC 60687073842
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: BCBS Trust/PPO |
$26.84
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$28.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.30
|
| Rate for Payer: Healthscope Commercial |
$29.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$26.96
|
| Rate for Payer: PHP Commercial |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.37
|
| Rate for Payer: Priority Health HMO/PPO |
$28.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.93
|
| Rate for Payer: UHC Core |
$27.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.66
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$26.26
|
|
|
Service Code
|
NDC 00121097440
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna Medicare |
$6.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.21
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: BCBS MAPPO |
$6.56
|
| Rate for Payer: BCBS Trust/PPO |
$21.59
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: BCN Medicare Advantage |
$6.56
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.56
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Nomi Health Commercial |
$21.53
|
| Rate for Payer: PACE Senior Care Partners |
$6.24
|
| Rate for Payer: PACE SWMI |
$6.56
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: PHP Medicare Advantage |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health HMO/PPO |
$22.85
|
| Rate for Payer: Priority Health Medicare |
$6.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.56
|
| Rate for Payer: UHC Exchange |
$6.56
|
| Rate for Payer: UHC Medicare Advantage |
$6.56
|
| Rate for Payer: VA VA |
$6.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$32.88
|
|
|
Service Code
|
NDC 60687073842
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$8.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.28
|
| Rate for Payer: BCBS Complete |
$13.15
|
| Rate for Payer: BCBS MAPPO |
$8.22
|
| Rate for Payer: BCBS Trust/PPO |
$27.03
|
| Rate for Payer: BCN Commercial |
$25.56
|
| Rate for Payer: BCN Medicare Advantage |
$8.22
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$28.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.22
|
| Rate for Payer: Healthscope Commercial |
$29.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$26.96
|
| Rate for Payer: PACE Senior Care Partners |
$7.81
|
| Rate for Payer: PACE SWMI |
$8.22
|
| Rate for Payer: PHP Commercial |
$27.95
|
| Rate for Payer: PHP Medicare Advantage |
$8.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.37
|
| Rate for Payer: Priority Health HMO/PPO |
$28.61
|
| Rate for Payer: Priority Health Medicare |
$8.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.03
|
| Rate for Payer: Railroad Medicare Medicare |
$8.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.93
|
| Rate for Payer: UHC Core |
$27.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.22
|
| Rate for Payer: UHC Exchange |
$8.22
|
| Rate for Payer: UHC Medicare Advantage |
$8.22
|
| Rate for Payer: VA VA |
$8.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.66
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$31.54
|
|
|
Service Code
|
NDC 00121074740
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$28.39 |
| Rate for Payer: Aetna Commercial |
$26.81
|
| Rate for Payer: BCBS Trust/PPO |
$25.75
|
| 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 Commercial |
$26.81
|
| Rate for Payer: Nomi Health Commercial |
$25.86
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.50
|
| Rate for Payer: Priority Health HMO/PPO |
$27.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.13
|
| 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
|
OP
|
$42.29
|
|
|
Service Code
|
NDC 68094004361
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$38.06 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.22
|
| Rate for Payer: BCBS Complete |
$16.92
|
| Rate for Payer: BCBS MAPPO |
$10.57
|
| Rate for Payer: BCBS Trust/PPO |
$34.77
|
| Rate for Payer: BCN Commercial |
$32.88
|
| Rate for Payer: BCN Medicare Advantage |
$10.57
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$36.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.57
|
| Rate for Payer: Healthscope Commercial |
$38.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Nomi Health Commercial |
$34.68
|
| Rate for Payer: PACE Senior Care Partners |
$10.04
|
| Rate for Payer: PACE SWMI |
$10.57
|
| Rate for Payer: PHP Commercial |
$35.95
|
| Rate for Payer: PHP Medicare Advantage |
$10.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.49
|
| Rate for Payer: Priority Health HMO/PPO |
$36.79
|
| Rate for Payer: Priority Health Medicare |
$10.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.33
|
| Rate for Payer: Railroad Medicare Medicare |
$10.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.22
|
| Rate for Payer: UHC Core |
$35.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.57
|
| Rate for Payer: UHC Exchange |
$10.57
|
| Rate for Payer: UHC Medicare Advantage |
$10.57
|
| Rate for Payer: VA VA |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$42.29
|
|
|
Service Code
|
NDC 68094004361
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.49 |
| Max. Negotiated Rate |
$38.06 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: BCBS Trust/PPO |
$34.52
|
| Rate for Payer: BCN Commercial |
$32.68
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$36.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.83
|
| Rate for Payer: Healthscope Commercial |
$38.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Nomi Health Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$35.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.49
|
| Rate for Payer: Priority Health HMO/PPO |
$36.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.22
|
| Rate for Payer: UHC Core |
$35.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$25.49
|
|
|
Service Code
|
NDC 60687073823
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Aetna Commercial |
$21.67
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$6.37
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCN Commercial |
$19.82
|
| Rate for Payer: BCN Medicare Advantage |
$6.37
|
| Rate for Payer: Cash Price |
$20.39
|
| Rate for Payer: Cofinity Commercial |
$21.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.37
|
| Rate for Payer: Healthscope Commercial |
$22.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.67
|
| Rate for Payer: Nomi Health Commercial |
$20.90
|
| Rate for Payer: PACE Senior Care Partners |
$6.05
|
| Rate for Payer: PACE SWMI |
$6.37
|
| Rate for Payer: PHP Commercial |
$21.67
|
| Rate for Payer: PHP Medicare Advantage |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.43
|
| Rate for Payer: UHC Core |
$21.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.37
|
| Rate for Payer: UHC Exchange |
$6.37
|
| Rate for Payer: UHC Medicare Advantage |
$6.37
|
| Rate for Payer: VA VA |
$6.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
