|
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
|
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
|
$45.51
|
|
|
Service Code
|
NDC 00904747072
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$40.96 |
| Rate for Payer: Aetna American Axle |
$29.58
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna Medicare |
$22.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.58
|
| Rate for Payer: BCBS Complete |
$18.20
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Advantage |
$31.86
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: Priority Health SBD |
$28.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.58
|
| Rate for Payer: UHC Core |
$23.71
|
| Rate for Payer: UHC Exchange |
$17.89
|
| Rate for Payer: UMR Bronson Commercial |
$16.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$30.15
|
|
|
Service Code
|
NDC 00904747066
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$27.14 |
| Rate for Payer: Aetna American Axle |
$19.60
|
| Rate for Payer: Aetna Commercial |
$25.63
|
| Rate for Payer: Aetna Medicare |
$15.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.60
|
| Rate for Payer: BCBS Complete |
$12.06
|
| 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: MI Amish Medical Board Commercial |
$24.12
|
| 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: UHC All Payor (Choice/PPO) |
$19.60
|
| Rate for Payer: UHC Core |
$15.71
|
| Rate for Payer: UHC Exchange |
$11.85
|
| Rate for Payer: UMR Bronson Commercial |
$11.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.61
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$813.96
|
|
|
Service Code
|
NDC 64380014901
|
| 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
|
OP
|
$42.29
|
|
|
Service Code
|
NDC 68094004359
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$38.06 |
| Rate for Payer: Aetna American Axle |
$27.49
|
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna Medicare |
$21.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.49
|
| Rate for Payer: BCBS Complete |
$16.92
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Cofinity Advantage |
$29.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$29.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.72
|
| Rate for Payer: PHP Commercial |
$35.95
|
| Rate for Payer: Priority Health SBD |
$26.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.49
|
| Rate for Payer: UHC Core |
$22.03
|
| Rate for Payer: UHC Exchange |
$16.62
|
| Rate for Payer: UMR Bronson Commercial |
$15.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
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
|
IP
|
$813.96
|
|
|
Service Code
|
NDC 64380014901
|
| 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
|
$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
|
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
|
$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
|
IP
|
$25.30
|
|
|
Service Code
|
NDC 00121097440
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| 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: 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: UMR Bronson Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$25.40
|
|
|
Service Code
|
NDC 00121097410
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Aetna American Axle |
$16.51
|
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.51
|
| 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: 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: UMR Bronson Commercial |
$11.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.05
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,191.46
|
|
|
Service Code
|
NDC 58914017014
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$440.84 |
| 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 Medicare |
$595.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.45
|
| Rate for Payer: BCBS Complete |
$476.58
|
| 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: MI Amish Medical Board Commercial |
$953.17
|
| 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: UHC All Payor (Choice/PPO) |
$774.45
|
| Rate for Payer: UHC Core |
$620.75
|
| Rate for Payer: UHC Exchange |
$468.24
|
| Rate for Payer: UMR Bronson Commercial |
$440.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$893.60
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$25.40
|
|
|
Service Code
|
NDC 00121097400
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$22.86 |
| Rate for Payer: Aetna American Axle |
$16.51
|
| Rate for Payer: Aetna Commercial |
$21.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.51
|
| 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: 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: UMR Bronson Commercial |
$11.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.05
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$25.59
|
|
|
Service Code
|
NDC 00904726918
|
| 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
|
$25.35
|
|
|
Service Code
|
NDC 69339020919
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna American Axle |
$16.48
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: BCBS Complete |
$10.14
|
| 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: MI Amish Medical Board Commercial |
$20.28
|
| 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: UHC All Payor (Choice/PPO) |
$16.48
|
| Rate for Payer: UHC Core |
$13.21
|
| Rate for Payer: UHC Exchange |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$9.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$41.67
|
|
|
Service Code
|
NDC 00121097450
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Aetna American Axle |
$27.09
|
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Aetna Medicare |
$20.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.09
|
| Rate for Payer: BCBS Complete |
$16.67
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cofinity Advantage |
$29.17
|
| Rate for Payer: Cofinity Commercial |
$35.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.34
|
| Rate for Payer: Healthscope Commercial |
$37.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.25
|
| Rate for Payer: PHP Commercial |
$35.42
|
| Rate for Payer: Priority Health SBD |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.09
|
| Rate for Payer: UHC Core |
$21.71
|
| Rate for Payer: UHC Exchange |
$16.38
|
| Rate for Payer: UMR Bronson Commercial |
$15.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.25
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$33.17
|
|
|
Service Code
|
NDC 60687073808
|
| 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
|
IP
|
$45.51
|
|
|
Service Code
|
NDC 00904747072
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$40.96 |
| Rate for Payer: Aetna American Axle |
$29.58
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.58
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Advantage |
$31.86
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: Priority Health SBD |
$28.67
|
| Rate for Payer: UMR Bronson Commercial |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
NDC 51079075301
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna American Axle |
$2.02
|
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.02
|
| Rate for Payer: UHC Core |
$1.62
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 51079075301
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna American Axle |
$2.02
|
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Advantage |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$310.65
|
|
|
Service Code
|
NDC 51079075320
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna Medicare |
$155.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: BCBS Complete |
$124.26
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Advantage |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.99
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.92
|
| Rate for Payer: UHC Core |
$161.85
|
| Rate for Payer: UHC Exchange |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$114.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
OP
|
$237.50
|
|
|
Service Code
|
NDC 00093221001
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.88 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna American Axle |
$154.38
|
| Rate for Payer: Aetna Commercial |
$201.88
|
| Rate for Payer: Aetna Medicare |
$118.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.38
|
| Rate for Payer: BCBS Complete |
$95.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cofinity Advantage |
$166.25
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$213.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.12
|
| Rate for Payer: PHP Commercial |
$201.88
|
| Rate for Payer: Priority Health SBD |
$149.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.38
|
| Rate for Payer: UHC Core |
$123.74
|
| Rate for Payer: UHC Exchange |
$93.34
|
| Rate for Payer: UMR Bronson Commercial |
$87.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.12
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
|
IP
|
$1,238.76
|
|
|
Service Code
|
NDC 62135043690
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$545.05 |
| Max. Negotiated Rate |
$1,114.88 |
| Rate for Payer: Aetna American Axle |
$805.19
|
| Rate for Payer: Aetna Commercial |
$1,052.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.19
|
| Rate for Payer: Cash Price |
$991.01
|
| Rate for Payer: Cofinity Advantage |
$867.13
|
| Rate for Payer: Cofinity Commercial |
$1,065.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.01
|
| Rate for Payer: Healthscope Commercial |
$1,114.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$867.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.07
|
| Rate for Payer: PHP Commercial |
$1,052.95
|
| Rate for Payer: Priority Health SBD |
$780.42
|
| Rate for Payer: UMR Bronson Commercial |
$545.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.07
|
|
