|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$25.83
|
|
|
Service Code
|
NDC 00121097410
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$21.96
|
| Rate for Payer: BCBS Trust/PPO |
$21.09
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Cofinity Commercial |
$22.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$23.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.96
|
| Rate for Payer: Nomi Health Commercial |
$21.18
|
| Rate for Payer: PHP Commercial |
$21.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: Priority Health HMO/PPO |
$22.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.73
|
| Rate for Payer: UHC Core |
$21.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.37
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$29.91
|
|
|
Service Code
|
NDC 00904747066
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$26.92 |
| Rate for Payer: Aetna Commercial |
$25.42
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.35
|
| Rate for Payer: BCBS Complete |
$11.96
|
| Rate for Payer: BCBS MAPPO |
$7.48
|
| Rate for Payer: BCBS Trust/PPO |
$24.59
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: BCN Medicare Advantage |
$7.48
|
| Rate for Payer: Cash Price |
$23.93
|
| Rate for Payer: Cofinity Commercial |
$25.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$26.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.42
|
| Rate for Payer: Nomi Health Commercial |
$24.53
|
| Rate for Payer: PACE Senior Care Partners |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.48
|
| Rate for Payer: PHP Commercial |
$25.42
|
| Rate for Payer: PHP Medicare Advantage |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.44
|
| Rate for Payer: Priority Health HMO/PPO |
$26.02
|
| Rate for Payer: Priority Health Medicare |
$7.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.04
|
| Rate for Payer: Railroad Medicare Medicare |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.32
|
| Rate for Payer: UHC Core |
$24.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.48
|
| Rate for Payer: UHC Exchange |
$7.48
|
| Rate for Payer: UHC Medicare Advantage |
$7.48
|
| Rate for Payer: VA VA |
$7.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.43
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$42.29
|
|
|
Service Code
|
NDC 68094004359
|
| 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
|
IP
|
$29.91
|
|
|
Service Code
|
NDC 00904747066
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.44 |
| Max. Negotiated Rate |
$26.92 |
| Rate for Payer: Aetna Commercial |
$25.42
|
| Rate for Payer: BCBS Trust/PPO |
$24.42
|
| Rate for Payer: BCN Commercial |
$23.11
|
| Rate for Payer: Cash Price |
$23.93
|
| Rate for Payer: Cofinity Commercial |
$25.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.93
|
| Rate for Payer: Healthscope Commercial |
$26.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.42
|
| Rate for Payer: Nomi Health Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$25.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.44
|
| Rate for Payer: Priority Health HMO/PPO |
$26.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.32
|
| Rate for Payer: UHC Core |
$24.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.43
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$26.26
|
|
|
Service Code
|
NDC 00121097440
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.44
|
| Rate for Payer: BCN Commercial |
$20.29
|
| 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: Healthscope Commercial |
$23.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: Nomi Health Commercial |
$21.53
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health HMO/PPO |
$22.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.11
|
| Rate for Payer: UHC Core |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$33.75
|
|
|
Service Code
|
NDC 00121074710
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$30.38 |
| Rate for Payer: Aetna Commercial |
$28.69
|
| Rate for Payer: BCBS Trust/PPO |
$27.55
|
| 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 Commercial |
$28.69
|
| Rate for Payer: Nomi Health Commercial |
$27.68
|
| Rate for Payer: PHP Commercial |
$28.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.94
|
| Rate for Payer: Priority Health HMO/PPO |
$29.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.61
|
| 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
|
OP
|
$42.29
|
|
|
Service Code
|
NDC 68094004359
|
| 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
|
$25.49
|
|
|
Service Code
|
NDC 60687073823
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$22.94 |
| Rate for Payer: Aetna Commercial |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$20.81
|
| Rate for Payer: BCN Commercial |
$19.70
|
| 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: Healthscope Commercial |
$22.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.67
|
| Rate for Payer: Nomi Health Commercial |
$20.90
|
| Rate for Payer: PHP Commercial |
$21.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.43
|
| Rate for Payer: UHC Core |
$21.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$33.75
|
|
|
Service Code
|
NDC 00121074710
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$30.38 |
| Rate for Payer: Aetna Commercial |
$28.69
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.55
|
| Rate for Payer: BCBS Complete |
$13.50
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCBS Trust/PPO |
$27.75
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| 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: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.69
|
| Rate for Payer: Nomi Health Commercial |
$27.68
|
| Rate for Payer: PACE Senior Care Partners |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$28.69
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.94
|
| Rate for Payer: Priority Health HMO/PPO |
$29.36
|
| Rate for Payer: Priority Health Medicare |
$8.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.70
|
| Rate for Payer: UHC Core |
$28.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Exchange |
$8.44
|
| Rate for Payer: UHC Medicare Advantage |
$8.44
|
| Rate for Payer: VA VA |
$8.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.31
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$46.36
|
|
|
Service Code
|
NDC 00904747072
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.13 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: BCBS Trust/PPO |
$37.84
|
| Rate for Payer: BCN Commercial |
$35.83
|
| 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: Healthscope Commercial |
$41.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: Nomi Health Commercial |
$38.02
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.13
|
| Rate for Payer: Priority Health HMO/PPO |
$40.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.80
|
| Rate for Payer: UHC Core |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.77
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$25.83
|
|
|
Service Code
|
NDC 00121097410
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$21.96
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.07
|
| Rate for Payer: BCBS Complete |
$10.33
|
| Rate for Payer: BCBS MAPPO |
$6.46
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.08
|
| Rate for Payer: BCN Medicare Advantage |
$6.46
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Cofinity Commercial |
$22.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$23.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.96
|
| Rate for Payer: Nomi Health Commercial |
$21.18
|
| Rate for Payer: PACE Senior Care Partners |
$6.13
|
| Rate for Payer: PACE SWMI |
$6.46
|
| Rate for Payer: PHP Commercial |
$21.96
|
| Rate for Payer: PHP Medicare Advantage |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: Priority Health HMO/PPO |
$22.47
|
| Rate for Payer: Priority Health Medicare |
$6.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.31
|
| Rate for Payer: Railroad Medicare Medicare |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.73
|
| Rate for Payer: UHC Core |
$21.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.46
|
| Rate for Payer: UHC Exchange |
$6.46
|
| Rate for Payer: UHC Medicare Advantage |
$6.46
|
| Rate for Payer: VA VA |
$6.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.37
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$31.54
|
|
|
Service Code
|
NDC 00121074740
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$28.39 |
| Rate for Payer: Aetna Commercial |
$26.81
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.86
|
| Rate for Payer: BCBS Complete |
$12.62
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.93
|
| Rate for Payer: BCN Commercial |
$24.52
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| 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: Health Alliance Plan Medicare Advantage |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$28.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.81
|
| Rate for Payer: Nomi Health Commercial |
$25.86
|
| Rate for Payer: PACE Senior Care Partners |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.50
|
| Rate for Payer: Priority Health HMO/PPO |
$27.44
|
| Rate for Payer: Priority Health Medicare |
$7.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.13
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.76
|
| Rate for Payer: UHC Core |
$26.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.88
|
| Rate for Payer: UHC Exchange |
$7.88
|
| Rate for Payer: UHC Medicare Advantage |
$7.88
|
| Rate for Payer: VA VA |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.66
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 00093221001
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.73 |
| Max. Negotiated Rate |
$211.18 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$61.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.33
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: BCBS MAPPO |
$58.66
|
| Rate for Payer: BCBS Trust/PPO |
$192.91
|
| Rate for Payer: BCN Commercial |
$182.44
|
| Rate for Payer: BCN Medicare Advantage |
$58.66
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.66
|
| Rate for Payer: Healthscope Commercial |
$211.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: PACE Senior Care Partners |
$55.73
|
| Rate for Payer: PACE SWMI |
$58.66
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: PHP Medicare Advantage |
$58.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Medicare |
$59.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.22
|
| Rate for Payer: Railroad Medicare Medicare |
$58.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.66
|
| Rate for Payer: UHC Exchange |
$58.66
|
| Rate for Payer: UHC Medicare Advantage |
$58.66
|
| Rate for Payer: VA VA |
$58.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$3.15
|
|
|
Service Code
|
NDC 51079075301
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.57
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.52
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.68
|
| Rate for Payer: Nomi Health Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.77
|
| Rate for Payer: UHC Core |
$2.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.36
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 00093221001
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$211.18 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: BCBS Trust/PPO |
$191.54
|
| Rate for Payer: BCN Commercial |
$181.34
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$3.15
|
|
|
Service Code
|
NDC 51079075301
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.68
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.98
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: BCBS MAPPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.59
|
| Rate for Payer: BCN Commercial |
$2.45
|
| Rate for Payer: BCN Medicare Advantage |
$0.79
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.79
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.68
|
| Rate for Payer: Nomi Health Commercial |
$2.58
|
| Rate for Payer: PACE Senior Care Partners |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.79
|
| Rate for Payer: PHP Commercial |
$2.68
|
| Rate for Payer: PHP Medicare Advantage |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2.74
|
| Rate for Payer: Priority Health Medicare |
$0.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.77
|
| Rate for Payer: UHC Core |
$2.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Medicare Advantage |
$0.79
|
| Rate for Payer: VA VA |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.36
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$314.45
|
|
|
Service Code
|
NDC 51079075320
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.68 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: Aetna Medicare |
$81.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.27
|
| Rate for Payer: BCBS Complete |
$125.78
|
| Rate for Payer: BCBS MAPPO |
$78.61
|
| Rate for Payer: BCBS Trust/PPO |
$258.51
|
| Rate for Payer: BCN Commercial |
$244.48
|
| Rate for Payer: BCN Medicare Advantage |
$78.61
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.61
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Nomi Health Commercial |
$257.85
|
| Rate for Payer: PACE Senior Care Partners |
$74.68
|
| Rate for Payer: PACE SWMI |
$78.61
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: PHP Medicare Advantage |
$78.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.39
|
| Rate for Payer: Priority Health HMO/PPO |
$273.57
|
| Rate for Payer: Priority Health Medicare |
$79.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.68
|
| Rate for Payer: Railroad Medicare Medicare |
$78.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.72
|
| Rate for Payer: UHC Core |
$262.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.61
|
| Rate for Payer: UHC Exchange |
$78.61
|
| Rate for Payer: UHC Medicare Advantage |
$78.61
|
| Rate for Payer: VA VA |
$78.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 51079075320
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.39 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: BCBS Trust/PPO |
$256.69
|
| Rate for Payer: BCN Commercial |
$243.01
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.28
|
| Rate for Payer: Nomi Health Commercial |
$257.85
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.39
|
| Rate for Payer: Priority Health HMO/PPO |
$273.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.72
|
| Rate for Payer: UHC Core |
$262.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$449.46
|
|
|
Service Code
|
NDC 00006542302
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$292.15 |
| Max. Negotiated Rate |
$404.51 |
| Rate for Payer: Aetna Commercial |
$382.04
|
| Rate for Payer: BCBS Trust/PPO |
$366.89
|
| Rate for Payer: BCN Commercial |
$347.34
|
| Rate for Payer: Cash Price |
$359.57
|
| Rate for Payer: Cofinity Commercial |
$386.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.57
|
| Rate for Payer: Healthscope Commercial |
$404.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.04
|
| Rate for Payer: Nomi Health Commercial |
$368.56
|
| Rate for Payer: PHP Commercial |
$382.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.15
|
| Rate for Payer: Priority Health HMO/PPO |
$391.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.52
|
| Rate for Payer: UHC Core |
$375.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.10
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$449.46
|
|
|
Service Code
|
NDC 00006542302
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$404.51 |
| Rate for Payer: Aetna Commercial |
$382.04
|
| Rate for Payer: Aetna Medicare |
$116.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.46
|
| Rate for Payer: BCBS Complete |
$179.78
|
| Rate for Payer: BCBS MAPPO |
$112.36
|
| Rate for Payer: BCBS Trust/PPO |
$369.50
|
| Rate for Payer: BCN Commercial |
$349.46
|
| Rate for Payer: BCN Medicare Advantage |
$112.36
|
| Rate for Payer: Cash Price |
$359.57
|
| Rate for Payer: Cofinity Commercial |
$386.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.36
|
| Rate for Payer: Healthscope Commercial |
$404.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.04
|
| Rate for Payer: Nomi Health Commercial |
$368.56
|
| Rate for Payer: PACE Senior Care Partners |
$106.75
|
| Rate for Payer: PACE SWMI |
$112.36
|
| Rate for Payer: PHP Commercial |
$382.04
|
| Rate for Payer: PHP Medicare Advantage |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.15
|
| Rate for Payer: Priority Health HMO/PPO |
$391.03
|
| Rate for Payer: Priority Health Medicare |
$113.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.14
|
| Rate for Payer: Railroad Medicare Medicare |
$112.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.52
|
| Rate for Payer: UHC Core |
$375.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.36
|
| Rate for Payer: UHC Exchange |
$112.36
|
| Rate for Payer: UHC Medicare Advantage |
$112.36
|
| Rate for Payer: VA VA |
$112.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.10
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$449.46
|
|
|
Service Code
|
NDC 00006542312
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$404.51 |
| Rate for Payer: Aetna Commercial |
$382.04
|
| Rate for Payer: Aetna Medicare |
$116.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.46
|
| Rate for Payer: BCBS Complete |
$179.78
|
| Rate for Payer: BCBS MAPPO |
$112.36
|
| Rate for Payer: BCBS Trust/PPO |
$369.50
|
| Rate for Payer: BCN Commercial |
$349.46
|
| Rate for Payer: BCN Medicare Advantage |
$112.36
|
| Rate for Payer: Cash Price |
$359.57
|
| Rate for Payer: Cofinity Commercial |
$386.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.36
|
| Rate for Payer: Healthscope Commercial |
$404.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.04
|
| Rate for Payer: Nomi Health Commercial |
$368.56
|
| Rate for Payer: PACE Senior Care Partners |
$106.75
|
| Rate for Payer: PACE SWMI |
$112.36
|
| Rate for Payer: PHP Commercial |
$382.04
|
| Rate for Payer: PHP Medicare Advantage |
$112.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.15
|
| Rate for Payer: Priority Health HMO/PPO |
$391.03
|
| Rate for Payer: Priority Health Medicare |
$113.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.14
|
| Rate for Payer: Railroad Medicare Medicare |
$112.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.52
|
| Rate for Payer: UHC Core |
$375.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.36
|
| Rate for Payer: UHC Exchange |
$112.36
|
| Rate for Payer: UHC Medicare Advantage |
$112.36
|
| Rate for Payer: VA VA |
$112.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.10
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$449.46
|
|
|
Service Code
|
NDC 00006542312
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$292.15 |
| Max. Negotiated Rate |
$404.51 |
| Rate for Payer: Aetna Commercial |
$382.04
|
| Rate for Payer: BCBS Trust/PPO |
$366.89
|
| Rate for Payer: BCN Commercial |
$347.34
|
| Rate for Payer: Cash Price |
$359.57
|
| Rate for Payer: Cofinity Commercial |
$386.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.57
|
| Rate for Payer: Healthscope Commercial |
$404.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.04
|
| Rate for Payer: Nomi Health Commercial |
$368.56
|
| Rate for Payer: PHP Commercial |
$382.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.15
|
| Rate for Payer: Priority Health HMO/PPO |
$391.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.52
|
| Rate for Payer: UHC Core |
$375.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.10
|
|
|
SULFACETAMIDE SODIUM 10 % EYE DROPS
|
Facility
|
OP
|
$139.71
|
|
|
Service Code
|
NDC 24208067004
|
| Hospital Charge Code |
7359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$125.74 |
| Rate for Payer: Aetna Commercial |
$118.75
|
| Rate for Payer: Aetna Medicare |
$36.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.66
|
| Rate for Payer: BCBS Complete |
$55.88
|
| Rate for Payer: BCBS MAPPO |
$34.93
|
| Rate for Payer: BCBS Trust/PPO |
$114.86
|
| Rate for Payer: BCN Commercial |
$108.62
|
| Rate for Payer: BCN Medicare Advantage |
$34.93
|
| Rate for Payer: Cash Price |
$111.77
|
| Rate for Payer: Cofinity Commercial |
$120.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.93
|
| Rate for Payer: Healthscope Commercial |
$125.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.75
|
| Rate for Payer: Nomi Health Commercial |
$114.56
|
| Rate for Payer: PACE Senior Care Partners |
$33.18
|
| Rate for Payer: PACE SWMI |
$34.93
|
| Rate for Payer: PHP Commercial |
$118.75
|
| Rate for Payer: PHP Medicare Advantage |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.81
|
| Rate for Payer: Priority Health HMO/PPO |
$121.55
|
| Rate for Payer: Priority Health Medicare |
$35.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.61
|
| Rate for Payer: Railroad Medicare Medicare |
$34.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.94
|
| Rate for Payer: UHC Core |
$116.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.93
|
| Rate for Payer: UHC Exchange |
$34.93
|
| Rate for Payer: UHC Medicare Advantage |
$34.93
|
| Rate for Payer: VA VA |
$34.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.78
|
|
|
SULFACETAMIDE SODIUM 10 % EYE DROPS
|
Facility
|
IP
|
$139.71
|
|
|
Service Code
|
NDC 24208067004
|
| Hospital Charge Code |
7359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.81 |
| Max. Negotiated Rate |
$125.74 |
| Rate for Payer: Aetna Commercial |
$118.75
|
| Rate for Payer: BCBS Trust/PPO |
$114.05
|
| Rate for Payer: BCN Commercial |
$107.97
|
| Rate for Payer: Cash Price |
$111.77
|
| Rate for Payer: Cofinity Commercial |
$120.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.77
|
| Rate for Payer: Healthscope Commercial |
$125.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.75
|
| Rate for Payer: Nomi Health Commercial |
$114.56
|
| Rate for Payer: PHP Commercial |
$118.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.81
|
| Rate for Payer: Priority Health HMO/PPO |
$121.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.94
|
| Rate for Payer: UHC Core |
$116.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.78
|
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$148.76
|
|
|
Service Code
|
NDC 65862049647
|
| Hospital Charge Code |
22560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.69 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna Commercial |
$126.45
|
| Rate for Payer: BCBS Trust/PPO |
$121.43
|
| Rate for Payer: BCN Commercial |
$114.96
|
| Rate for Payer: Cash Price |
$119.01
|
| Rate for Payer: Cofinity Commercial |
$127.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.01
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.45
|
| Rate for Payer: Nomi Health Commercial |
$121.98
|
| Rate for Payer: PHP Commercial |
$126.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.69
|
| Rate for Payer: Priority Health HMO/PPO |
$129.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.91
|
| Rate for Payer: UHC Core |
$124.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.57
|
|
