|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
IP
|
$287.55
|
|
|
Service Code
|
NDC 05391530190
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna American Axle |
$186.91
|
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Commercial |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.42
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.91
|
| Rate for Payer: Priority Health SBD |
$181.16
|
| Rate for Payer: UMR Bronson Commercial |
$126.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.66
|
|
|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
OP
|
$287.55
|
|
|
Service Code
|
NDC 05391530190
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.39 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna American Axle |
$186.91
|
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna Medicare |
$143.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: BCBS Complete |
$115.02
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Commercial |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.42
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.91
|
| Rate for Payer: Priority Health SBD |
$181.16
|
| Rate for Payer: UMR Bronson Commercial |
$106.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.66
|
|
|
SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 30140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$171.43 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.82
|
| Rate for Payer: BCN Commercial |
$1,708.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.57
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$171.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
SUCCIMER 100 MG CAPSULE
|
Facility
|
IP
|
$8,152.95
|
|
|
Service Code
|
NDC 55292020111
|
| Hospital Charge Code |
11438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,587.30 |
| Max. Negotiated Rate |
$7,337.66 |
| Rate for Payer: Aetna American Axle |
$5,299.42
|
| Rate for Payer: Aetna Commercial |
$6,930.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,299.42
|
| Rate for Payer: Cash Price |
$6,522.36
|
| Rate for Payer: Cofinity Commercial |
$5,707.06
|
| Rate for Payer: Cofinity Commercial |
$7,011.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,707.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,522.36
|
| Rate for Payer: Healthscope Commercial |
$7,337.66
|
| 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: Multiplan/Beech St/PHCS Commercial |
$6,930.01
|
| Rate for Payer: PHP Commercial |
$6,930.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,299.42
|
| Rate for Payer: Priority Health SBD |
$5,136.36
|
| Rate for Payer: UMR Bronson Commercial |
$3,587.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,114.71
|
|
|
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 |
$7,337.66 |
| Rate for Payer: Aetna American Axle |
$5,299.42
|
| Rate for Payer: Aetna Commercial |
$6,930.01
|
| Rate for Payer: Aetna Medicare |
$4,076.48
|
| 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 Commercial |
$5,707.06
|
| Rate for Payer: Cofinity Commercial |
$7,011.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,707.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,522.36
|
| Rate for Payer: Healthscope Commercial |
$7,337.66
|
| 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: Multiplan/Beech St/PHCS Commercial |
$6,930.01
|
| Rate for Payer: PHP Commercial |
$6,930.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,299.42
|
| Rate for Payer: Priority Health SBD |
$5,136.36
|
| 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
|
OP
|
$79.35
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$71.42 |
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna Medicare |
$39.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: BCBS Complete |
$11.39
|
| Rate for Payer: BCBS Complete |
$31.74
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$55.54
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.36
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$55.54
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$34.91
|
| Rate for Payer: UMR Bronson Commercial |
$12.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| 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 |
$20.80
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Commercial |
$27.20
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| 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) |
$20.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$55.54
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.60
|
| 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 |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$27.20
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health SBD |
$20.16
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: UMR Bronson Commercial |
$34.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.08
|
| Rate for Payer: UMR Bronson Commercial |
$12.53
|
| Rate for Payer: UMR Bronson Commercial |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$79.35
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$71.42 |
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$20.80
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$27.20
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Medicare |
$39.68
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$10.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.80
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Complete |
$11.39
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Complete |
$31.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$55.54
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$55.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Commercial |
$27.20
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$20.16
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: UMR Bronson Commercial |
$11.84
|
| Rate for Payer: UMR Bronson Commercial |
$29.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
|
|
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 Commercial |
$1,024.66
|
| Rate for Payer: Cofinity Commercial |
$834.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$834.02
|
| 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: PHP Commercial |
$1,012.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$774.45
|
| Rate for Payer: Priority Health SBD |
$750.62
|
| 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
|
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 |
$12.80
|
| 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 Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$22.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.91
|
| 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: PHP Commercial |
$21.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.63
|
| Rate for Payer: Priority Health SBD |
$16.12
|
| 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
|
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 Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$22.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.91
|
| 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: PHP Commercial |
$21.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.63
|
| 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
|
$29.91
|
|
|
Service Code
|
NDC 00904747066
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$26.92 |
| Rate for Payer: Aetna American Axle |
$19.44
|
| Rate for Payer: Aetna Commercial |
$25.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.44
|
| Rate for Payer: Cash Price |
$23.93
|
| Rate for Payer: Cofinity Commercial |
$20.94
|
| Rate for Payer: Cofinity Commercial |
$25.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.93
|
| Rate for Payer: Healthscope Commercial |
$26.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.42
|
| Rate for Payer: PHP Commercial |
$25.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.44
|
| Rate for Payer: Priority Health SBD |
$18.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.43
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$34.80
|
|
|
Service Code
|
NDC 00121097494
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$31.32 |
| Rate for Payer: Aetna American Axle |
$22.62
|
| Rate for Payer: Aetna Commercial |
$29.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.62
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.84
|
| Rate for Payer: Healthscope Commercial |
$31.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.58
|
| Rate for Payer: PHP Commercial |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.62
|
| Rate for Payer: Priority Health SBD |
$21.92
|
| Rate for Payer: UMR Bronson Commercial |
$15.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.10
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$46.36
|
|
|
Service Code
|
NDC 00904747072
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Aetna American Axle |
$30.13
|
| Rate for Payer: Aetna Commercial |
$39.41
|
| Rate for Payer: Aetna Medicare |
$23.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.13
|
| Rate for Payer: BCBS Complete |
$18.54
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cofinity Commercial |
$32.45
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.09
|
| Rate for Payer: Healthscope Commercial |
$41.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.41
|
| Rate for Payer: PHP Commercial |
$39.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.13
|
| Rate for Payer: Priority Health SBD |
$29.21
|
| Rate for Payer: UMR Bronson Commercial |
$17.15
|
| 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 |
$9.56 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna American Axle |
$16.79
|
| Rate for Payer: Aetna Commercial |
$21.96
|
| Rate for Payer: Aetna Medicare |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.79
|
| Rate for Payer: BCBS Complete |
$10.33
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Cofinity Commercial |
$18.08
|
| Rate for Payer: Cofinity Commercial |
$22.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$23.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.96
|
| Rate for Payer: PHP Commercial |
$21.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: Priority Health SBD |
$16.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.37
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$44.16
|
|
|
Service Code
|
NDC 00121097450
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$39.74 |
| Rate for Payer: Aetna American Axle |
$28.70
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: BCBS Complete |
$17.66
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.70
|
| Rate for Payer: Priority Health SBD |
$27.82
|
| Rate for Payer: UMR Bronson Commercial |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.12
|
|
|
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 |
$11.55 |
| Max. Negotiated Rate |
$23.63 |
| Rate for Payer: Aetna American Axle |
$17.07
|
| Rate for Payer: Aetna Commercial |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.07
|
| Rate for Payer: Cash Price |
$21.01
|
| Rate for Payer: Cofinity Commercial |
$18.38
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.01
|
| Rate for Payer: Healthscope Commercial |
$23.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.32
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: UMR Bronson Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.70
|
|
|
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 Commercial |
$569.77
|
| Rate for Payer: Cofinity Commercial |
$700.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$569.77
|
| 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: PHP Commercial |
$691.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.07
|
| 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 Commercial |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.64
|
| 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: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.66
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| 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
|
$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 Commercial |
$29.88
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.88
|
| 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: PHP Commercial |
$36.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.74
|
| 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
|
OP
|
$34.80
|
|
|
Service Code
|
NDC 00121097494
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$31.32 |
| Rate for Payer: Aetna American Axle |
$22.62
|
| Rate for Payer: Aetna Commercial |
$29.58
|
| Rate for Payer: Aetna Medicare |
$17.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.62
|
| Rate for Payer: BCBS Complete |
$13.92
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.84
|
| Rate for Payer: Healthscope Commercial |
$31.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.58
|
| Rate for Payer: PHP Commercial |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.62
|
| Rate for Payer: Priority Health SBD |
$21.92
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.10
|
|
|
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 |
$18.61 |
| Max. Negotiated Rate |
$38.06 |
| Rate for Payer: Aetna American Axle |
$27.49
|
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.49
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Cofinity Commercial |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$36.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.60
|
| 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: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: PHP Commercial |
$35.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.49
|
| Rate for Payer: Priority Health SBD |
$26.64
|
| Rate for Payer: UMR Bronson Commercial |
$18.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
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 |
$11.67 |
| Max. Negotiated Rate |
$28.39 |
| Rate for Payer: Aetna American Axle |
$20.50
|
| Rate for Payer: Aetna Commercial |
$26.81
|
| Rate for Payer: Aetna Medicare |
$15.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.50
|
| Rate for Payer: BCBS Complete |
$12.62
|
| Rate for Payer: Cash Price |
$25.23
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.23
|
| Rate for Payer: Healthscope Commercial |
$28.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.81
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.50
|
| Rate for Payer: Priority Health SBD |
$19.87
|
| Rate for Payer: UMR Bronson Commercial |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.66
|
|
|
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 Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$22.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.91
|
| 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: PHP Commercial |
$21.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.63
|
| 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
|
|
