|
SUCRALFATE 1 GRAM TABLET
|
Facility
IP
|
$226.10
|
|
|
Service Code
|
NDC 63739-943-10
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.27 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: ASR ASR |
$219.32
|
| Rate for Payer: BCBS Trust/PPO |
$175.30
|
| Rate for Payer: BCN Commercial |
$175.30
|
| Rate for Payer: Cash Price |
$180.88
|
| Rate for Payer: Cofinity Commercial |
$212.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.88
|
| Rate for Payer: Healthscope Commercial |
$226.10
|
| Rate for Payer: Healthscope Whirlpool |
$219.32
|
| Rate for Payer: Mclaren Commercial |
$203.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.97
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$428.06
|
|
|
Service Code
|
NDC 0006-5423-12
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$299.64 |
| Max. Negotiated Rate |
$428.06 |
| Rate for Payer: Aetna Commercial |
$385.25
|
| Rate for Payer: ASR ASR |
$415.22
|
| Rate for Payer: BCBS Trust/PPO |
$331.87
|
| Rate for Payer: BCN Commercial |
$331.87
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cofinity Commercial |
$402.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.45
|
| Rate for Payer: Healthscope Commercial |
$428.06
|
| Rate for Payer: Healthscope Whirlpool |
$415.22
|
| Rate for Payer: Mclaren Commercial |
$385.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.69
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$428.06
|
|
|
Service Code
|
NDC 0006-5423-02
|
| Hospital Charge Code |
177099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$299.64 |
| Max. Negotiated Rate |
$428.06 |
| Rate for Payer: Aetna Commercial |
$385.25
|
| Rate for Payer: ASR ASR |
$415.22
|
| Rate for Payer: BCBS Trust/PPO |
$331.87
|
| Rate for Payer: BCN Commercial |
$331.87
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cofinity Commercial |
$402.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.45
|
| Rate for Payer: Healthscope Commercial |
$428.06
|
| Rate for Payer: Healthscope Whirlpool |
$415.22
|
| Rate for Payer: Mclaren Commercial |
$385.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.69
|
|
|
SULFACETAMIDE-PREDNISOLONE 10 %-0.23 % (0.25 %) EYE DROPS
|
Facility
IP
|
$43.78
|
|
|
Service Code
|
NDC 24208-317-05
|
| Hospital Charge Code |
70392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.65 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$39.40
|
| Rate for Payer: ASR ASR |
$42.47
|
| Rate for Payer: BCBS Trust/PPO |
$33.94
|
| Rate for Payer: BCN Commercial |
$33.94
|
| Rate for Payer: Cash Price |
$35.03
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.02
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Healthscope Whirlpool |
$42.47
|
| Rate for Payer: Mclaren Commercial |
$39.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.53
|
|
|
SULFACETAMIDE SODIUM 10 % EYE DROPS
|
Facility
IP
|
$120.07
|
|
|
Service Code
|
NDC 24208-670-04
|
| Hospital Charge Code |
7359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.05 |
| Max. Negotiated Rate |
$120.07 |
| Rate for Payer: Aetna Commercial |
$108.06
|
| Rate for Payer: ASR ASR |
$116.47
|
| Rate for Payer: BCBS Trust/PPO |
$93.09
|
| Rate for Payer: BCN Commercial |
$93.09
|
| Rate for Payer: Cash Price |
$96.05
|
| Rate for Payer: Cofinity Commercial |
$112.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.06
|
| Rate for Payer: Healthscope Commercial |
$120.07
|
| Rate for Payer: Healthscope Whirlpool |
$116.47
|
| Rate for Payer: Mclaren Commercial |
$108.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.66
|
|
|
SULFACETAMIDE SODIUM 10 % EYE DROPS
|
Facility
IP
|
$145.37
|
|
|
Service Code
|
NDC 61314-701-01
|
| Hospital Charge Code |
7359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$145.37 |
| Rate for Payer: Aetna Commercial |
$130.83
|
| Rate for Payer: ASR ASR |
$141.01
|
| Rate for Payer: BCBS Trust/PPO |
$112.71
|
| Rate for Payer: BCN Commercial |
$112.71
|
| Rate for Payer: Cash Price |
$116.30
|
| Rate for Payer: Cofinity Commercial |
$136.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.30
|
| Rate for Payer: Healthscope Commercial |
$145.37
|
| Rate for Payer: Healthscope Whirlpool |
$141.01
|
| Rate for Payer: Mclaren Commercial |
$130.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.93
|
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$34.19
|
|
|
Service Code
|
NDC 0121-0853-20
|
| Hospital Charge Code |
22560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$34.19 |
| Rate for Payer: Aetna Commercial |
$30.77
|
| Rate for Payer: ASR ASR |
$33.16
|
| Rate for Payer: BCBS Trust/PPO |
$26.51
|
| Rate for Payer: BCN Commercial |
$26.51
|
| Rate for Payer: Cash Price |
$27.35
|
| Rate for Payer: Cofinity Commercial |
$32.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.35
|
| Rate for Payer: Healthscope Commercial |
$34.19
|
| Rate for Payer: Healthscope Whirlpool |
$33.16
|
| Rate for Payer: Mclaren Commercial |
$30.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.09
|
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$308.02
|
|
|
Service Code
|
NDC 50383-823-16
|
| Hospital Charge Code |
22560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.61 |
| Max. Negotiated Rate |
$308.02 |
| Rate for Payer: Aetna Commercial |
$277.22
|
| Rate for Payer: ASR ASR |
$298.78
|
| Rate for Payer: BCBS Trust/PPO |
$238.81
|
| Rate for Payer: BCN Commercial |
$238.81
|
| Rate for Payer: Cash Price |
$246.41
|
| Rate for Payer: Cofinity Commercial |
$289.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.42
|
| Rate for Payer: Healthscope Commercial |
$308.02
|
| Rate for Payer: Healthscope Whirlpool |
$298.78
|
| Rate for Payer: Mclaren Commercial |
$277.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.06
|
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$7.72
|
|
|
Service Code
|
NDC 17856-0007-5
|
| Hospital Charge Code |
22560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna Commercial |
$6.95
|
| Rate for Payer: ASR ASR |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$5.99
|
| Rate for Payer: BCN Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$6.17
|
| Rate for Payer: Cofinity Commercial |
$7.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$7.72
|
| Rate for Payer: Healthscope Whirlpool |
$7.49
|
| Rate for Payer: Mclaren Commercial |
$6.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.79
|
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$148.76
|
|
|
Service Code
|
NDC 65862-496-47
|
| Hospital Charge Code |
22560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.13 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: ASR ASR |
$144.30
|
| Rate for Payer: BCBS Trust/PPO |
$115.33
|
| Rate for Payer: BCN Commercial |
$115.33
|
| Rate for Payer: Cash Price |
$119.01
|
| Rate for Payer: Cofinity Commercial |
$139.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.01
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Healthscope Whirlpool |
$144.30
|
| Rate for Payer: Mclaren Commercial |
$133.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.91
|
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 9900-0011-65
|
| Hospital Charge Code |
22560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: ASR ASR |
$2.66
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.74
|
| Rate for Payer: Healthscope Whirlpool |
$2.66
|
| Rate for Payer: Mclaren Commercial |
$2.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.41
|
|
|
SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$34.19
|
|
|
Service Code
|
NDC 0121-0853-40
|
| Hospital Charge Code |
22560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$34.19 |
| Rate for Payer: Aetna Commercial |
$30.77
|
| Rate for Payer: ASR ASR |
$33.16
|
| Rate for Payer: BCBS Trust/PPO |
$26.51
|
| Rate for Payer: BCN Commercial |
$26.51
|
| Rate for Payer: Cash Price |
$27.35
|
| Rate for Payer: Cofinity Commercial |
$32.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.35
|
| Rate for Payer: Healthscope Commercial |
$34.19
|
| Rate for Payer: Healthscope Whirlpool |
$33.16
|
| Rate for Payer: Mclaren Commercial |
$30.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.09
|
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$32.75
|
|
|
Service Code
|
NDC 0703-9514-93
|
| Hospital Charge Code |
7556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$32.75 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: ASR ASR |
$31.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.39
|
| Rate for Payer: BCN Commercial |
$25.39
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.20
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Healthscope Whirlpool |
$31.77
|
| Rate for Payer: Mclaren Commercial |
$29.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.82
|
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$32.75
|
|
|
Service Code
|
NDC 0703-9514-91
|
| Hospital Charge Code |
7556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$32.75 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: ASR ASR |
$31.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.39
|
| Rate for Payer: BCN Commercial |
$25.39
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.20
|
| Rate for Payer: Healthscope Commercial |
$32.75
|
| Rate for Payer: Healthscope Whirlpool |
$31.77
|
| Rate for Payer: Mclaren Commercial |
$29.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.82
|
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$27.68
|
|
|
Service Code
|
NDC 70069-362-01
|
| Hospital Charge Code |
7556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$27.68 |
| Rate for Payer: Aetna Commercial |
$24.91
|
| Rate for Payer: ASR ASR |
$26.85
|
| Rate for Payer: BCBS Trust/PPO |
$21.46
|
| Rate for Payer: BCN Commercial |
$21.46
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cofinity Commercial |
$26.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Healthscope Commercial |
$27.68
|
| Rate for Payer: Healthscope Whirlpool |
$26.85
|
| Rate for Payer: Mclaren Commercial |
$24.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.36
|
|
|
SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$27.68
|
|
|
Service Code
|
NDC 70069-362-10
|
| Hospital Charge Code |
7556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$27.68 |
| Rate for Payer: Aetna Commercial |
$24.91
|
| Rate for Payer: ASR ASR |
$26.85
|
| Rate for Payer: BCBS Trust/PPO |
$21.46
|
| Rate for Payer: BCN Commercial |
$21.46
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cofinity Commercial |
$26.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.14
|
| Rate for Payer: Healthscope Commercial |
$27.68
|
| Rate for Payer: Healthscope Whirlpool |
$26.85
|
| Rate for Payer: Mclaren Commercial |
$24.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.36
|
|
|
SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET
|
Facility
IP
|
$136.30
|
|
|
Service Code
|
NDC 53746-272-01
|
| Hospital Charge Code |
7555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.41 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial |
$122.67
|
| Rate for Payer: ASR ASR |
$132.21
|
| Rate for Payer: BCBS Trust/PPO |
$105.67
|
| Rate for Payer: BCN Commercial |
$105.67
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$128.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$136.30
|
| Rate for Payer: Healthscope Whirlpool |
$132.21
|
| Rate for Payer: Mclaren Commercial |
$122.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.94
|
|
|
SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET
|
Facility
IP
|
$286.70
|
|
|
Service Code
|
NDC 0904-2725-61
|
| Hospital Charge Code |
7555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.69 |
| Max. Negotiated Rate |
$286.70 |
| Rate for Payer: Aetna Commercial |
$258.03
|
| Rate for Payer: ASR ASR |
$278.10
|
| Rate for Payer: BCBS Trust/PPO |
$222.28
|
| Rate for Payer: BCN Commercial |
$222.28
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cofinity Commercial |
$269.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Healthscope Commercial |
$286.70
|
| Rate for Payer: Healthscope Whirlpool |
$278.10
|
| Rate for Payer: Mclaren Commercial |
$258.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.30
|
|
|
SULFASALAZINE 500 MG TABLET
|
Facility
IP
|
$3.51
|
|
|
Service Code
|
NDC 50268-730-11
|
| Hospital Charge Code |
7562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: ASR ASR |
$3.40
|
| Rate for Payer: BCBS Trust/PPO |
$2.72
|
| Rate for Payer: BCN Commercial |
$2.72
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.81
|
| Rate for Payer: Healthscope Commercial |
$3.51
|
| Rate for Payer: Healthscope Whirlpool |
$3.40
|
| Rate for Payer: Mclaren Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.09
|
|
|
SULFASALAZINE 500 MG TABLET
|
Facility
IP
|
$404.20
|
|
|
Service Code
|
NDC 59762-5000-5
|
| Hospital Charge Code |
7562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.94 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: BCBS Trust/PPO |
$313.38
|
| Rate for Payer: BCN Commercial |
$313.38
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$404.20
|
| Rate for Payer: Healthscope Whirlpool |
$392.07
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
SULFASALAZINE 500 MG TABLET
|
Facility
IP
|
$175.28
|
|
|
Service Code
|
NDC 50268-730-15
|
| Hospital Charge Code |
7562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.70 |
| Max. Negotiated Rate |
$175.28 |
| Rate for Payer: Aetna Commercial |
$157.75
|
| Rate for Payer: ASR ASR |
$170.02
|
| Rate for Payer: BCBS Trust/PPO |
$135.89
|
| Rate for Payer: BCN Commercial |
$135.89
|
| Rate for Payer: Cash Price |
$140.22
|
| Rate for Payer: Cofinity Commercial |
$164.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.22
|
| Rate for Payer: Healthscope Commercial |
$175.28
|
| Rate for Payer: Healthscope Whirlpool |
$170.02
|
| Rate for Payer: Mclaren Commercial |
$157.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.25
|
|
|
SULFASALAZINE 500 MG TABLET
|
Facility
IP
|
$1,212.60
|
|
|
Service Code
|
NDC 59762-5000-6
|
| Hospital Charge Code |
7562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$848.82 |
| Max. Negotiated Rate |
$1,212.60 |
| Rate for Payer: Aetna Commercial |
$1,091.34
|
| Rate for Payer: ASR ASR |
$1,176.22
|
| Rate for Payer: BCBS Trust/PPO |
$940.13
|
| Rate for Payer: BCN Commercial |
$940.13
|
| Rate for Payer: Cash Price |
$970.08
|
| Rate for Payer: Cofinity Commercial |
$1,139.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.08
|
| Rate for Payer: Healthscope Commercial |
$1,212.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.22
|
| Rate for Payer: Mclaren Commercial |
$1,091.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,030.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.09
|
|
|
SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION
|
Facility
IP
|
$18.82
|
|
|
Service Code
|
HCPCS J3030
|
| Hospital Charge Code |
97342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Commercial |
$200.55
|
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Commercial |
$22.39
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: ASR ASR |
$18.26
|
| Rate for Payer: ASR ASR |
$24.13
|
| Rate for Payer: ASR ASR |
$216.15
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$26.37
|
| Rate for Payer: BCBS Trust/PPO |
$21.08
|
| Rate for Payer: BCBS Trust/PPO |
$14.59
|
| Rate for Payer: BCBS Trust/PPO |
$19.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.29
|
| Rate for Payer: BCBS Trust/PPO |
$172.76
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: BCN Commercial |
$172.76
|
| Rate for Payer: BCN Commercial |
$21.08
|
| Rate for Payer: BCN Commercial |
$14.59
|
| Rate for Payer: BCN Commercial |
$19.29
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Cash Price |
$178.27
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$23.39
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Commercial |
$209.46
|
| Rate for Payer: Cofinity Commercial |
$25.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Healthscope Commercial |
$27.19
|
| Rate for Payer: Healthscope Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$222.83
|
| Rate for Payer: Healthscope Commercial |
$24.88
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$216.15
|
| Rate for Payer: Healthscope Whirlpool |
$24.13
|
| Rate for Payer: Healthscope Whirlpool |
$26.37
|
| Rate for Payer: Healthscope Whirlpool |
$18.26
|
| Rate for Payer: Mclaren Commercial |
$24.47
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$22.39
|
| Rate for Payer: Mclaren Commercial |
$200.55
|
| Rate for Payer: Mclaren Commercial |
$16.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.93
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
IP
|
$11,239.58
|
|
|
Service Code
|
MS-DRG 312
|
| Min. Negotiated Rate |
$8,542.08 |
| Max. Negotiated Rate |
$11,239.58 |
| Rate for Payer: Aetna Medicare |
$8,991.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,239.58
|
| Rate for Payer: BCBS MAPPO |
$8,991.66
|
| Rate for Payer: BCN Medicare Advantage |
$8,991.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,991.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,991.66
|
| Rate for Payer: Mclaren Medicare |
$8,991.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,441.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,340.41
|
| Rate for Payer: PACE Medicare |
$8,542.08
|
| Rate for Payer: PACE SWMI |
$8,991.66
|
| Rate for Payer: PHP Commercial |
$9,890.83
|
| Rate for Payer: PHP Medicare Advantage |
$8,991.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,087.34
|
| Rate for Payer: Priority Health Medicare |
$8,991.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,869.87
|
| Rate for Payer: Railroad Medicare Medicare |
$8,991.66
|
| Rate for Payer: UHC Medicare Advantage |
$9,261.41
|
| Rate for Payer: VA VA |
$8,991.66
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
IP
|
$2.89
|
|
|
Service Code
|
NDC 51079-294-01
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.60
|
| Rate for Payer: ASR ASR |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Healthscope Whirlpool |
$2.80
|
| Rate for Payer: Mclaren Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.54
|
|
