|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: ASR ASR |
$3.58
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$3.04
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Healthscope Whirlpool |
$3.69
|
| Rate for Payer: Mclaren Commercial |
$3.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.23
|
| Rate for Payer: Priority Health Narrow Network |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.25
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: Aetna Medicare |
$124.34
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: BCBS Trust/PPO |
$277.07
|
| Rate for Payer: BCN Commercial |
$277.07
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$325.97
|
| Rate for Payer: Healthscope Whirlpool |
$336.05
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.45
|
| Rate for Payer: Priority Health Narrow Network |
$235.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 904692761
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.04 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: BCBS Trust/PPO |
$275.96
|
| Rate for Payer: BCN Commercial |
$275.96
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$325.97
|
| Rate for Payer: Healthscope Whirlpool |
$336.05
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: ASR ASR |
$273.54
|
| Rate for Payer: BCBS Trust/PPO |
$231.58
|
| Rate for Payer: BCN Commercial |
$231.58
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$265.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$273.54
|
| Rate for Payer: Healthscope Whirlpool |
$282.00
|
| Rate for Payer: Mclaren Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.16
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.34 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Medicare |
$104.34
|
| Rate for Payer: ASR ASR |
$273.54
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS Trust/PPO |
$232.51
|
| Rate for Payer: BCN Commercial |
$232.51
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$265.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$273.54
|
| Rate for Payer: Healthscope Whirlpool |
$282.00
|
| Rate for Payer: Mclaren Commercial |
$253.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$247.09
|
| Rate for Payer: Priority Health Narrow Network |
$197.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.16
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 51079010301
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: ASR ASR |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Healthscope Whirlpool |
$3.69
|
| Rate for Payer: Mclaren Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Nomi Health Commercial |
$3.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.25
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$9,193.85
|
|
|
Service Code
|
APR-DRG 6501
|
| Min. Negotiated Rate |
$8,312.34 |
| Max. Negotiated Rate |
$9,193.85 |
| Rate for Payer: BCBS Complete |
$9,193.85
|
| Rate for Payer: Mclaren Medicaid |
$8,756.05
|
| Rate for Payer: Meridian Medicaid |
$9,193.85
|
| Rate for Payer: PHP Medicaid |
$8,312.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,756.05
|
| Rate for Payer: UHC Medicaid |
$8,756.05
|
| Rate for Payer: UHCCP Medicaid |
$8,756.05
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$12,563.82
|
|
|
Service Code
|
APR-DRG 6502
|
| Min. Negotiated Rate |
$11,359.20 |
| Max. Negotiated Rate |
$12,563.82 |
| Rate for Payer: BCBS Complete |
$12,563.82
|
| Rate for Payer: Mclaren Medicaid |
$11,965.55
|
| Rate for Payer: Meridian Medicaid |
$12,563.82
|
| Rate for Payer: PHP Medicaid |
$11,359.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,965.55
|
| Rate for Payer: UHC Medicaid |
$11,965.55
|
| Rate for Payer: UHCCP Medicaid |
$11,965.55
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$22,186.00
|
|
|
Service Code
|
APR-DRG 6504
|
| Min. Negotiated Rate |
$20,058.80 |
| Max. Negotiated Rate |
$22,186.00 |
| Rate for Payer: BCBS Complete |
$22,186.00
|
| Rate for Payer: Mclaren Medicaid |
$21,129.53
|
| Rate for Payer: Meridian Medicaid |
$22,186.00
|
| Rate for Payer: PHP Medicaid |
$20,058.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,129.53
|
| Rate for Payer: UHC Medicaid |
$21,129.53
|
| Rate for Payer: UHCCP Medicaid |
$21,129.53
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$15,771.40
|
|
|
Service Code
|
APR-DRG 6503
|
| Min. Negotiated Rate |
$14,259.23 |
| Max. Negotiated Rate |
$15,771.40 |
| Rate for Payer: BCBS Complete |
$15,771.40
|
| Rate for Payer: Mclaren Medicaid |
$15,020.38
|
| Rate for Payer: Meridian Medicaid |
$15,771.40
|
| Rate for Payer: PHP Medicaid |
$14,259.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,020.38
|
| Rate for Payer: UHC Medicaid |
$15,020.38
|
| Rate for Payer: UHCCP Medicaid |
$15,020.38
|
|
|
SPLENIC PROCEDURES WITH CC
|
Facility
|
IP
|
$38,597.78
|
|
|
Service Code
|
MSDRG 800
|
| Min. Negotiated Rate |
$20,886.36 |
| Max. Negotiated Rate |
$38,597.78 |
| Rate for Payer: Aetna Medicare |
$21,985.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,482.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,482.05
|
| Rate for Payer: BCBS MAPPO |
$21,985.64
|
| Rate for Payer: BCN Medicare Advantage |
$21,985.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,985.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,985.64
|
| Rate for Payer: Mclaren Medicare |
$21,985.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,084.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,283.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,184.20
|
| Rate for Payer: PACE Medicare |
$20,886.36
|
| Rate for Payer: PACE SWMI |
$21,985.64
|
| Rate for Payer: PHP Commercial |
$24,184.20
|
| Rate for Payer: PHP Medicare Advantage |
$21,985.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$38,597.78
|
| Rate for Payer: Priority Health Medicare |
$21,985.64
|
| Rate for Payer: Priority Health Narrow Network |
$30,878.23
|
| Rate for Payer: Railroad Medicare Medicare |
$21,985.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,985.64
|
| Rate for Payer: UHC Exchange |
$34,077.74
|
| Rate for Payer: UHCCP DNSP |
$21,985.64
|
| Rate for Payer: VA VA |
$21,985.64
|
|
|
SPLENIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$62,221.65
|
|
|
Service Code
|
MSDRG 799
|
| Min. Negotiated Rate |
$32,649.76 |
| Max. Negotiated Rate |
$62,221.65 |
| Rate for Payer: Aetna Medicare |
$34,368.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,960.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,960.21
|
| Rate for Payer: BCBS MAPPO |
$34,368.17
|
| Rate for Payer: BCN Medicare Advantage |
$34,368.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,368.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$34,368.17
|
| Rate for Payer: Mclaren Medicare |
$34,368.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36,086.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,523.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$37,804.99
|
| Rate for Payer: PACE Medicare |
$32,649.76
|
| Rate for Payer: PACE SWMI |
$34,368.17
|
| Rate for Payer: PHP Commercial |
$37,804.99
|
| Rate for Payer: PHP Medicare Advantage |
$34,368.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62,221.65
|
| Rate for Payer: Priority Health Medicare |
$34,368.17
|
| Rate for Payer: Priority Health Narrow Network |
$49,777.32
|
| Rate for Payer: Railroad Medicare Medicare |
$34,368.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34,368.17
|
| Rate for Payer: UHC Exchange |
$53,270.66
|
| Rate for Payer: UHCCP DNSP |
$34,368.17
|
| Rate for Payer: VA VA |
$34,368.17
|
|
|
SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,226.00
|
|
|
Service Code
|
MSDRG 801
|
| Min. Negotiated Rate |
$14,725.86 |
| Max. Negotiated Rate |
$26,226.00 |
| Rate for Payer: Aetna Medicare |
$15,500.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,376.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,376.14
|
| Rate for Payer: BCBS MAPPO |
$15,500.91
|
| Rate for Payer: BCN Medicare Advantage |
$15,500.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,500.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,500.91
|
| Rate for Payer: Mclaren Medicare |
$15,500.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,275.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,826.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,051.00
|
| Rate for Payer: PACE Medicare |
$14,725.86
|
| Rate for Payer: PACE SWMI |
$15,500.91
|
| Rate for Payer: PHP Commercial |
$17,051.00
|
| Rate for Payer: PHP Medicare Advantage |
$15,500.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,226.00
|
| Rate for Payer: Priority Health Medicare |
$15,500.91
|
| Rate for Payer: Priority Health Narrow Network |
$20,980.80
|
| Rate for Payer: Railroad Medicare Medicare |
$15,500.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,500.91
|
| Rate for Payer: UHC Exchange |
$24,026.41
|
| Rate for Payer: UHCCP DNSP |
$15,500.91
|
| Rate for Payer: VA VA |
$15,500.91
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
|
IP
|
$13,371.25
|
|
|
Service Code
|
MSDRG 537
|
| Min. Negotiated Rate |
$8,195.28 |
| Max. Negotiated Rate |
$13,371.25 |
| Rate for Payer: Aetna Medicare |
$8,626.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,783.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,783.26
|
| Rate for Payer: BCBS MAPPO |
$8,626.61
|
| Rate for Payer: BCN Medicare Advantage |
$8,626.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,626.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,626.61
|
| Rate for Payer: Mclaren Medicare |
$8,626.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,057.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,920.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,489.27
|
| Rate for Payer: PACE Medicare |
$8,195.28
|
| Rate for Payer: PACE SWMI |
$8,626.61
|
| Rate for Payer: PHP Commercial |
$9,489.27
|
| Rate for Payer: PHP Medicare Advantage |
$8,626.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,110.94
|
| Rate for Payer: Priority Health Medicare |
$8,626.61
|
| Rate for Payer: Priority Health Narrow Network |
$10,488.75
|
| Rate for Payer: Railroad Medicare Medicare |
$8,626.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,626.61
|
| Rate for Payer: UHC Exchange |
$13,371.25
|
| Rate for Payer: UHCCP DNSP |
$8,626.61
|
| Rate for Payer: VA VA |
$8,626.61
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC
|
Facility
|
IP
|
$10,759.34
|
|
|
Service Code
|
MSDRG 538
|
| Min. Negotiated Rate |
$6,594.43 |
| Max. Negotiated Rate |
$10,759.34 |
| Rate for Payer: Aetna Medicare |
$6,941.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,676.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,676.89
|
| Rate for Payer: BCBS MAPPO |
$6,941.51
|
| Rate for Payer: BCN Medicare Advantage |
$6,941.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,941.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,941.51
|
| Rate for Payer: Mclaren Medicare |
$6,941.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,288.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,982.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,635.66
|
| Rate for Payer: PACE Medicare |
$6,594.43
|
| Rate for Payer: PACE SWMI |
$6,941.51
|
| Rate for Payer: PHP Commercial |
$7,635.66
|
| Rate for Payer: PHP Medicare Advantage |
$6,941.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,896.06
|
| Rate for Payer: Priority Health Medicare |
$6,941.51
|
| Rate for Payer: Priority Health Narrow Network |
$7,916.85
|
| Rate for Payer: Railroad Medicare Medicare |
$6,941.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,941.51
|
| Rate for Payer: UHC Exchange |
$10,759.34
|
| Rate for Payer: UHCCP DNSP |
$6,941.51
|
| Rate for Payer: VA VA |
$6,941.51
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
|
IP
|
$33,580.37
|
|
|
Service Code
|
MSDRG 327
|
| Min. Negotiated Rate |
$18,387.94 |
| Max. Negotiated Rate |
$33,580.37 |
| Rate for Payer: Aetna Medicare |
$19,355.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,194.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,194.66
|
| Rate for Payer: BCBS MAPPO |
$19,355.73
|
| Rate for Payer: BCN Medicare Advantage |
$19,355.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,355.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,355.73
|
| Rate for Payer: Mclaren Medicare |
$19,355.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,323.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,259.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,291.30
|
| Rate for Payer: PACE Medicare |
$18,387.94
|
| Rate for Payer: PACE SWMI |
$19,355.73
|
| Rate for Payer: PHP Commercial |
$21,291.30
|
| Rate for Payer: PHP Medicare Advantage |
$19,355.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33,580.37
|
| Rate for Payer: Priority Health Medicare |
$19,355.73
|
| Rate for Payer: Priority Health Narrow Network |
$26,864.30
|
| Rate for Payer: Railroad Medicare Medicare |
$19,355.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,355.73
|
| Rate for Payer: UHC Exchange |
$30,001.38
|
| Rate for Payer: UHCCP DNSP |
$19,355.73
|
| Rate for Payer: VA VA |
$19,355.73
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$68,520.89
|
|
|
Service Code
|
MSDRG 326
|
| Min. Negotiated Rate |
$35,786.44 |
| Max. Negotiated Rate |
$68,520.89 |
| Rate for Payer: Aetna Medicare |
$37,669.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,087.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,087.43
|
| Rate for Payer: BCBS MAPPO |
$37,669.94
|
| Rate for Payer: BCN Medicare Advantage |
$37,669.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,669.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$37,669.94
|
| Rate for Payer: Mclaren Medicare |
$37,669.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39,553.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,320.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$41,436.93
|
| Rate for Payer: PACE Medicare |
$35,786.44
|
| Rate for Payer: PACE SWMI |
$37,669.94
|
| Rate for Payer: PHP Commercial |
$41,436.93
|
| Rate for Payer: PHP Medicare Advantage |
$37,669.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68,520.89
|
| Rate for Payer: Priority Health Medicare |
$37,669.94
|
| Rate for Payer: Priority Health Narrow Network |
$54,816.71
|
| Rate for Payer: Railroad Medicare Medicare |
$37,669.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37,669.94
|
| Rate for Payer: UHC Exchange |
$58,388.41
|
| Rate for Payer: UHCCP DNSP |
$37,669.94
|
| Rate for Payer: VA VA |
$37,669.94
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,013.68
|
|
|
Service Code
|
MSDRG 328
|
| Min. Negotiated Rate |
$12,628.37 |
| Max. Negotiated Rate |
$22,013.68 |
| Rate for Payer: Aetna Medicare |
$13,293.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,616.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,616.28
|
| Rate for Payer: BCBS MAPPO |
$13,293.02
|
| Rate for Payer: BCN Medicare Advantage |
$13,293.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,293.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,293.02
|
| Rate for Payer: Mclaren Medicare |
$13,293.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,957.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,286.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,622.32
|
| Rate for Payer: PACE Medicare |
$12,628.37
|
| Rate for Payer: PACE SWMI |
$13,293.02
|
| Rate for Payer: PHP Commercial |
$14,622.32
|
| Rate for Payer: PHP Medicare Advantage |
$13,293.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,013.68
|
| Rate for Payer: Priority Health Medicare |
$13,293.02
|
| Rate for Payer: Priority Health Narrow Network |
$17,610.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13,293.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,293.02
|
| Rate for Payer: UHC Exchange |
$20,604.18
|
| Rate for Payer: UHCCP DNSP |
$13,293.02
|
| Rate for Payer: VA VA |
$13,293.02
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$23.67 |
| Rate for Payer: Aetna Commercial |
$21.31
|
| Rate for Payer: Aetna Medicare |
$8.76
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: BCBS Trust/PPO |
$19.52
|
| Rate for Payer: BCN Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Healthscope Whirlpool |
$23.67
|
| Rate for Payer: Mclaren Commercial |
$21.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.12
|
| Rate for Payer: Nomi Health Commercial |
$19.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$23.67 |
| Rate for Payer: Aetna Commercial |
$21.31
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: BCBS Trust/PPO |
$19.44
|
| Rate for Payer: BCN Commercial |
$19.44
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Healthscope Whirlpool |
$23.67
|
| Rate for Payer: Mclaren Commercial |
$21.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.12
|
| Rate for Payer: Nomi Health Commercial |
$19.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.82
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Commercial |
$21.31
|
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$18.26
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR ASR |
$19.68
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: ASR ASR |
$26.63
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCBS Trust/PPO |
$19.44
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCBS Trust/PPO |
$22.55
|
| Rate for Payer: BCBS Trust/PPO |
$20.36
|
| Rate for Payer: BCBS Trust/PPO |
$16.66
|
| Rate for Payer: BCN Commercial |
$20.36
|
| Rate for Payer: BCN Commercial |
$15.46
|
| Rate for Payer: BCN Commercial |
$22.55
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.66
|
| Rate for Payer: BCN Commercial |
$19.44
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.96
|
| Rate for Payer: Healthscope Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Healthscope Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Healthscope Whirlpool |
$23.67
|
| Rate for Payer: Healthscope Whirlpool |
$20.29
|
| Rate for Payer: Healthscope Whirlpool |
$24.79
|
| Rate for Payer: Healthscope Whirlpool |
$18.82
|
| Rate for Payer: Healthscope Whirlpool |
$27.45
|
| Rate for Payer: Mclaren Commercial |
$22.31
|
| Rate for Payer: Mclaren Commercial |
$24.71
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$18.26
|
| Rate for Payer: Mclaren Commercial |
$21.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Nomi Health Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$19.41
|
| Rate for Payer: Nomi Health Commercial |
$15.44
|
| Rate for Payer: Nomi Health Commercial |
$20.33
|
| Rate for Payer: Nomi Health Commercial |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$27.45
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Aetna Commercial |
$24.71
|
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$21.31
|
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$8.76
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: Aetna Medicare |
$7.51
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Aetna Medicare |
$6.96
|
| Rate for Payer: ASR ASR |
$19.68
|
| Rate for Payer: ASR ASR |
$26.63
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR ASR |
$18.26
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS Complete |
$7.53
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS Complete |
$9.47
|
| Rate for Payer: BCBS Complete |
$10.98
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$20.44
|
| Rate for Payer: BCBS Trust/PPO |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$15.52
|
| Rate for Payer: BCBS Trust/PPO |
$16.73
|
| Rate for Payer: BCBS Trust/PPO |
$22.64
|
| Rate for Payer: BCN Commercial |
$22.64
|
| Rate for Payer: BCN Commercial |
$16.73
|
| Rate for Payer: BCN Commercial |
$15.52
|
| Rate for Payer: BCN Commercial |
$17.06
|
| Rate for Payer: BCN Commercial |
$20.44
|
| Rate for Payer: BCN Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Commercial |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$22.96
|
| Rate for Payer: Healthscope Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Healthscope Commercial |
$24.04
|
| Rate for Payer: Healthscope Commercial |
$26.63
|
| Rate for Payer: Healthscope Whirlpool |
$23.67
|
| Rate for Payer: Healthscope Whirlpool |
$20.29
|
| Rate for Payer: Healthscope Whirlpool |
$18.82
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Healthscope Whirlpool |
$24.79
|
| Rate for Payer: Healthscope Whirlpool |
$27.45
|
| Rate for Payer: Mclaren Commercial |
$18.26
|
| Rate for Payer: Mclaren Commercial |
$24.71
|
| Rate for Payer: Mclaren Commercial |
$22.31
|
| Rate for Payer: Mclaren Commercial |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$21.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.00
|
| Rate for Payer: Nomi Health Commercial |
$15.44
|
| Rate for Payer: Nomi Health Commercial |
$20.33
|
| Rate for Payer: Nomi Health Commercial |
$19.41
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$16.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.87
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: Priority Health Narrow Network |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.16
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$794.47
|
|
|
Service Code
|
NDC 66689030516
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.95 |
| Max. Negotiated Rate |
$794.47 |
| Rate for Payer: Aetna Commercial |
$715.02
|
| Rate for Payer: Aetna Medicare |
$293.95
|
| Rate for Payer: ASR ASR |
$770.63
|
| Rate for Payer: BCBS Complete |
$317.79
|
| Rate for Payer: BCBS Trust/PPO |
$655.04
|
| Rate for Payer: BCN Commercial |
$655.04
|
| Rate for Payer: Cash Price |
$635.57
|
| Rate for Payer: Cofinity Commercial |
$746.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.57
|
| Rate for Payer: Healthscope Commercial |
$770.63
|
| Rate for Payer: Healthscope Whirlpool |
$794.47
|
| Rate for Payer: Mclaren Commercial |
$715.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$635.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.30
|
| Rate for Payer: Nomi Health Commercial |
$651.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$595.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$696.11
|
| Rate for Payer: Priority Health Narrow Network |
$556.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$699.13
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$30.14
|
|
|
Service Code
|
NDC 904747066
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$30.14 |
| Rate for Payer: Aetna Commercial |
$27.13
|
| Rate for Payer: ASR ASR |
$29.24
|
| Rate for Payer: BCBS Trust/PPO |
$24.75
|
| Rate for Payer: BCN Commercial |
$24.75
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Cofinity Commercial |
$28.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.12
|
| Rate for Payer: Healthscope Commercial |
$29.24
|
| Rate for Payer: Healthscope Whirlpool |
$30.14
|
| Rate for Payer: Mclaren Commercial |
$27.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.62
|
| Rate for Payer: Nomi Health Commercial |
$24.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.53
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$45.13
|
|
|
Service Code
|
NDC 904747018
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$40.61
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: ASR ASR |
$43.77
|
| Rate for Payer: BCBS Complete |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$37.21
|
| Rate for Payer: BCN Commercial |
$37.21
|
| Rate for Payer: Cash Price |
$36.10
|
| Rate for Payer: Cofinity Commercial |
$42.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.10
|
| Rate for Payer: Healthscope Commercial |
$43.77
|
| Rate for Payer: Healthscope Whirlpool |
$45.12
|
| Rate for Payer: Mclaren Commercial |
$40.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.36
|
| Rate for Payer: Nomi Health Commercial |
$37.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.54
|
| Rate for Payer: Priority Health Narrow Network |
$31.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.71
|
|
