|
SUCCIMER 100 MG CAPSULE
|
Facility
|
OP
|
$8,152.95
|
|
|
Service Code
|
NDC 55292020111
|
| Hospital Charge Code |
11438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,016.59 |
| Max. Negotiated Rate |
$7,337.65 |
| Rate for Payer: Aetna American Axle |
$5,299.42
|
| Rate for Payer: Aetna Commercial |
$6,930.01
|
| Rate for Payer: Aetna Medicare |
$4,076.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,299.42
|
| Rate for Payer: BCBS Complete |
$3,261.18
|
| Rate for Payer: Cash Price |
$6,522.36
|
| Rate for Payer: Cofinity Advantage |
$5,707.06
|
| Rate for Payer: Cofinity Commercial |
$7,011.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,522.36
|
| Rate for Payer: Healthscope Commercial |
$7,337.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,707.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,114.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,522.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,930.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,114.71
|
| Rate for Payer: PHP Commercial |
$6,930.01
|
| Rate for Payer: Priority Health SBD |
$5,136.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,299.42
|
| Rate for Payer: UHC Core |
$4,247.69
|
| Rate for Payer: UHC Exchange |
$3,204.11
|
| Rate for Payer: UMR Bronson Commercial |
$3,016.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,114.71
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna American Axle |
$14.19
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cofinity Advantage |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$15.28
|
| Rate for Payer: Cofinity Advantage |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.36
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: UMR Bronson Commercial |
$12.53
|
| Rate for Payer: UMR Bronson Commercial |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$23.68
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna American Axle |
$14.19
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Aetna Medicare |
$10.91
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: BCBS Complete |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Advantage |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.36
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.14
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna American Axle |
$14.19
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna American Axle |
$20.98
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$27.43
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.98
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$25.82
|
| Rate for Payer: Cofinity Advantage |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Advantage |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$15.28
|
| Rate for Payer: Cofinity Advantage |
$18.88
|
| Rate for Payer: Cofinity Advantage |
$22.59
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$27.75
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$29.04
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$27.43
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$20.33
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: UMR Bronson Commercial |
$14.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.42
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$12.53
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.20
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$26.97
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna American Axle |
$14.19
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$20.98
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna Commercial |
$27.43
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Medicare |
$10.57
|
| Rate for Payer: Aetna Medicare |
$16.14
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna Medicare |
$10.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$11.39
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$25.82
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$25.82
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Advantage |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$15.28
|
| Rate for Payer: Cofinity Advantage |
$15.13
|
| Rate for Payer: Cofinity Advantage |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$18.88
|
| Rate for Payer: Cofinity Advantage |
$19.94
|
| Rate for Payer: Cofinity Advantage |
$22.59
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$27.75
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.82
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$29.04
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$27.43
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$20.33
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
| Rate for Payer: UMR Bronson Commercial |
$11.94
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$25.59
|
|
|
Service Code
|
NDC 00904726966
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$23.03 |
| Rate for Payer: Aetna American Axle |
$16.63
|
| Rate for Payer: Aetna Commercial |
$21.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.63
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cofinity Advantage |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$22.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.47
|
| Rate for Payer: Healthscope Commercial |
$23.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.19
|
| Rate for Payer: PHP Commercial |
$21.75
|
| Rate for Payer: Priority Health SBD |
$16.12
|
| Rate for Payer: UMR Bronson Commercial |
$11.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.19
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$42.68
|
|
|
Service Code
|
NDC 68094004362
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$38.41 |
| Rate for Payer: Aetna American Axle |
$27.74
|
| Rate for Payer: Aetna Commercial |
$36.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.74
|
| Rate for Payer: Cash Price |
$34.14
|
| Rate for Payer: Cofinity Advantage |
$29.88
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.14
|
| Rate for Payer: Healthscope Commercial |
$38.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.01
|
| Rate for Payer: PHP Commercial |
$36.28
|
| Rate for Payer: Priority Health SBD |
$26.89
|
| Rate for Payer: UMR Bronson Commercial |
$18.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.01
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$33.17
|
|
|
Service Code
|
NDC 60687073808
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$29.85 |
| Rate for Payer: Aetna American Axle |
$21.56
|
| Rate for Payer: Aetna Commercial |
$28.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.56
|
| Rate for Payer: Cash Price |
$26.54
|
| Rate for Payer: Cofinity Advantage |
$23.22
|
| Rate for Payer: Cofinity Commercial |
$28.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.54
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.88
|
| Rate for Payer: PHP Commercial |
$28.19
|
| Rate for Payer: Priority Health SBD |
$20.90
|
| Rate for Payer: UMR Bronson Commercial |
$14.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.88
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$42.68
|
|
|
Service Code
|
NDC 68094004362
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$38.41 |
| Rate for Payer: Aetna American Axle |
$27.74
|
| Rate for Payer: Aetna Commercial |
$36.28
|
| Rate for Payer: Aetna Medicare |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.74
|
| Rate for Payer: BCBS Complete |
$17.07
|
| Rate for Payer: Cash Price |
$34.14
|
| Rate for Payer: Cofinity Advantage |
$29.88
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.14
|
| Rate for Payer: Healthscope Commercial |
$38.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.01
|
| Rate for Payer: PHP Commercial |
$36.28
|
| Rate for Payer: Priority Health SBD |
$26.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.74
|
| Rate for Payer: UHC Core |
$22.24
|
| Rate for Payer: UHC Exchange |
$16.77
|
| Rate for Payer: UMR Bronson Commercial |
$15.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.01
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$25.59
|
|
|
Service Code
|
NDC 00904726918
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$23.03 |
| Rate for Payer: Aetna American Axle |
$16.63
|
| Rate for Payer: Aetna Commercial |
$21.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.63
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cofinity Advantage |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$22.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.47
|
| Rate for Payer: Healthscope Commercial |
$23.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.19
|
| Rate for Payer: PHP Commercial |
$21.75
|
| Rate for Payer: Priority Health SBD |
$16.12
|
| Rate for Payer: UMR Bronson Commercial |
$11.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.19
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$33.32
|
|
|
Service Code
|
NDC 00121097494
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Aetna American Axle |
$21.66
|
| Rate for Payer: Aetna Commercial |
$28.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.66
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Cofinity Advantage |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$28.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.66
|
| Rate for Payer: Healthscope Commercial |
$29.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.99
|
| Rate for Payer: PHP Commercial |
$28.32
|
| Rate for Payer: Priority Health SBD |
$20.99
|
| Rate for Payer: UMR Bronson Commercial |
$14.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.99
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$813.96
|
|
|
Service Code
|
NDC 82182010614
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$732.56 |
| Rate for Payer: Aetna American Axle |
$529.07
|
| Rate for Payer: Aetna Commercial |
$691.87
|
| Rate for Payer: Aetna Medicare |
$406.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.07
|
| Rate for Payer: BCBS Complete |
$325.58
|
| Rate for Payer: Cash Price |
$651.17
|
| Rate for Payer: Cofinity Advantage |
$569.77
|
| Rate for Payer: Cofinity Commercial |
$700.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.17
|
| Rate for Payer: Healthscope Commercial |
$732.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$569.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$610.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$651.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$610.47
|
| Rate for Payer: PHP Commercial |
$691.87
|
| Rate for Payer: Priority Health SBD |
$512.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.07
|
| Rate for Payer: UHC Core |
$424.07
|
| Rate for Payer: UHC Exchange |
$319.89
|
| Rate for Payer: UMR Bronson Commercial |
$301.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$610.47
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$30.15
|
|
|
Service Code
|
NDC 00904747066
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$27.14 |
| Rate for Payer: Aetna American Axle |
$19.60
|
| Rate for Payer: Aetna Commercial |
$25.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.60
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Cofinity Advantage |
$21.11
|
| Rate for Payer: Cofinity Commercial |
$25.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.12
|
| Rate for Payer: Healthscope Commercial |
$27.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.61
|
| Rate for Payer: PHP Commercial |
$25.63
|
| Rate for Payer: Priority Health SBD |
$18.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.61
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$25.40
|
|
|
Service Code
|
NDC 00121097400
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Aetna American Axle |
$16.51
|
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: Aetna Medicare |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.51
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Cofinity Advantage |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.32
|
| Rate for Payer: Healthscope Commercial |
$22.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.05
|
| Rate for Payer: PHP Commercial |
$21.59
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.51
|
| Rate for Payer: UHC Core |
$13.23
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UMR Bronson Commercial |
$9.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.05
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$33.17
|
|
|
Service Code
|
NDC 60687073842
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$29.85 |
| Rate for Payer: Aetna American Axle |
$21.56
|
| Rate for Payer: Aetna Commercial |
$28.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.56
|
| Rate for Payer: Cash Price |
$26.54
|
| Rate for Payer: Cofinity Advantage |
$23.22
|
| Rate for Payer: Cofinity Commercial |
$28.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.54
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.88
|
| Rate for Payer: PHP Commercial |
$28.19
|
| Rate for Payer: Priority Health SBD |
$20.90
|
| Rate for Payer: UMR Bronson Commercial |
$14.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.88
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$39.48
|
|
|
Service Code
|
NDC 09900000804
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna Medicare |
$19.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: BCBS Complete |
$15.79
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Advantage |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.61
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.66
|
| Rate for Payer: UHC Core |
$20.57
|
| Rate for Payer: UHC Exchange |
$15.52
|
| Rate for Payer: UMR Bronson Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$25.40
|
|
|
Service Code
|
NDC 00121097410
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Aetna American Axle |
$16.51
|
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: Aetna Medicare |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.51
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Cofinity Advantage |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.32
|
| Rate for Payer: Healthscope Commercial |
$22.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.05
|
| Rate for Payer: PHP Commercial |
$21.59
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.51
|
| Rate for Payer: UHC Core |
$13.23
|
| Rate for Payer: UHC Exchange |
$9.98
|
| Rate for Payer: UMR Bronson Commercial |
$9.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.05
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,191.46
|
|
|
Service Code
|
NDC 58914017014
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$524.24 |
| Max. Negotiated Rate |
$1,072.31 |
| Rate for Payer: Aetna American Axle |
$774.45
|
| Rate for Payer: Aetna Commercial |
$1,012.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.45
|
| Rate for Payer: Cash Price |
$953.17
|
| Rate for Payer: Cofinity Advantage |
$834.02
|
| Rate for Payer: Cofinity Commercial |
$1,024.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$953.17
|
| Rate for Payer: Healthscope Commercial |
$1,072.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$834.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$893.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$893.60
|
| Rate for Payer: PHP Commercial |
$1,012.74
|
| Rate for Payer: Priority Health SBD |
$750.62
|
| Rate for Payer: UMR Bronson Commercial |
$524.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$893.60
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$25.35
|
|
|
Service Code
|
NDC 69339020919
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna American Axle |
$16.48
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cofinity Advantage |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.01
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: UMR Bronson Commercial |
$11.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$813.96
|
|
|
Service Code
|
NDC 82182010614
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$358.14 |
| Max. Negotiated Rate |
$732.56 |
| Rate for Payer: Aetna American Axle |
$529.07
|
| Rate for Payer: Aetna Commercial |
$691.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.07
|
| Rate for Payer: Cash Price |
$651.17
|
| Rate for Payer: Cofinity Advantage |
$569.77
|
| Rate for Payer: Cofinity Commercial |
$700.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$651.17
|
| Rate for Payer: Healthscope Commercial |
$732.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$569.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$610.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$610.47
|
| Rate for Payer: PHP Commercial |
$691.87
|
| Rate for Payer: Priority Health SBD |
$512.79
|
| Rate for Payer: UMR Bronson Commercial |
$358.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$610.47
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$25.59
|
|
|
Service Code
|
NDC 00904726966
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$23.03 |
| Rate for Payer: Aetna American Axle |
$16.63
|
| Rate for Payer: Aetna Commercial |
$21.75
|
| Rate for Payer: Aetna Medicare |
$12.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.63
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: Cash Price |
$20.47
|
| Rate for Payer: Cofinity Advantage |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$22.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.47
|
| Rate for Payer: Healthscope Commercial |
$23.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.19
|
| Rate for Payer: PHP Commercial |
$21.75
|
| Rate for Payer: Priority Health SBD |
$16.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.63
|
| Rate for Payer: UHC Core |
$13.33
|
| Rate for Payer: UHC Exchange |
$10.06
|
| Rate for Payer: UMR Bronson Commercial |
$9.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.19
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$33.17
|
|
|
Service Code
|
NDC 60687073842
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$29.85 |
| Rate for Payer: Aetna American Axle |
$21.56
|
| Rate for Payer: Aetna Commercial |
$28.19
|
| Rate for Payer: Aetna Medicare |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.56
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: Cash Price |
$26.54
|
| Rate for Payer: Cofinity Advantage |
$23.22
|
| Rate for Payer: Cofinity Commercial |
$28.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.54
|
| Rate for Payer: Healthscope Commercial |
$29.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.88
|
| Rate for Payer: PHP Commercial |
$28.19
|
| Rate for Payer: Priority Health SBD |
$20.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.56
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Exchange |
$13.04
|
| Rate for Payer: UMR Bronson Commercial |
$12.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.88
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$33.32
|
|
|
Service Code
|
NDC 00121097494
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Aetna American Axle |
$21.66
|
| Rate for Payer: Aetna Commercial |
$28.32
|
| Rate for Payer: Aetna Medicare |
$16.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.66
|
| Rate for Payer: BCBS Complete |
$13.33
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Cofinity Advantage |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$28.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.66
|
| Rate for Payer: Healthscope Commercial |
$29.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.99
|
| Rate for Payer: PHP Commercial |
$28.32
|
| Rate for Payer: Priority Health SBD |
$20.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.66
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: UHC Exchange |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$12.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.99
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$39.48
|
|
|
Service Code
|
NDC 09900000804
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Advantage |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.61
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UMR Bronson Commercial |
$17.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$25.30
|
|
|
Service Code
|
NDC 00121097440
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Advantage |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.98
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.45
|
| Rate for Payer: UHC Core |
$13.18
|
| Rate for Payer: UHC Exchange |
$9.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
