|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$346.45
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
161671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$311.81 |
| Rate for Payer: Aetna Commercial |
$294.48
|
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Medicare |
$447.52
|
| Rate for Payer: Aetna Medicare |
$173.22
|
| Rate for Payer: Aetna Medicare |
$960.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: BCBS Complete |
$358.02
|
| Rate for Payer: BCBS Complete |
$768.65
|
| Rate for Payer: BCBS Complete |
$138.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$277.16
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$716.03
|
| Rate for Payer: Cash Price |
$277.16
|
| Rate for Payer: Cash Price |
$716.03
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cofinity Advantage |
$242.51
|
| Rate for Payer: Cofinity Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Advantage |
$626.53
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Commercial |
$297.95
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.03
|
| Rate for Payer: Healthscope Commercial |
$805.54
|
| Rate for Payer: Healthscope Commercial |
$311.81
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$716.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,537.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,441.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.84
|
| Rate for Payer: PHP Commercial |
$294.48
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: Priority Health SBD |
$563.88
|
| Rate for Payer: Priority Health SBD |
$218.26
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$895.04
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
161671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$563.88 |
| Max. Negotiated Rate |
$805.54 |
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.78
|
| Rate for Payer: Cash Price |
$716.03
|
| Rate for Payer: Cofinity Advantage |
$626.53
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.03
|
| Rate for Payer: Healthscope Commercial |
$805.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.28
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: Priority Health SBD |
$563.88
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$499.25
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
120029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$449.32 |
| Rate for Payer: Aetna Commercial |
$424.36
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Medicare |
$960.82
|
| Rate for Payer: Aetna Medicare |
$249.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: BCBS Complete |
$199.70
|
| Rate for Payer: BCBS Complete |
$768.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$399.40
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$399.40
|
| Rate for Payer: Cofinity Advantage |
$349.48
|
| Rate for Payer: Cofinity Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$429.36
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.40
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$449.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,537.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,441.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.44
|
| Rate for Payer: PHP Commercial |
$424.36
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: Priority Health SBD |
$314.53
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,921.63
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
120029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,210.63 |
| Max. Negotiated Rate |
$1,729.47 |
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cofinity Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,441.22
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 63739047802
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health SBD |
$8.82
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Advantage |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.61 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$50.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.52
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Advantage |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.60
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health SBD |
$63.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.52
|
| Rate for Payer: UHC Core |
$52.52
|
| Rate for Payer: UHC Exchange |
$39.61
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.92 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Advantage |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health SBD |
$115.92
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.52
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Advantage |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.60
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health SBD |
$63.50
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 63739047802
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.10
|
| Rate for Payer: UHC Core |
$7.29
|
| Rate for Payer: UHC Exchange |
$5.50
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$1,228.50
|
|
|
Service Code
|
NDC 63739047801
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$773.96 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$1,044.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.52
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cofinity Advantage |
$859.95
|
| Rate for Payer: Cofinity Commercial |
$1,056.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.80
|
| Rate for Payer: Healthscope Commercial |
$1,105.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.38
|
| Rate for Payer: PHP Commercial |
$1,044.22
|
| Rate for Payer: Priority Health SBD |
$773.96
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.31 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Advantage |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.60
|
| Rate for Payer: UHC Core |
$95.86
|
| Rate for Payer: UHC Exchange |
$72.31
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$27.93
|
|
|
Service Code
|
NDC 67618010110
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna Commercial |
$23.74
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
| Rate for Payer: BCBS Complete |
$11.17
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cofinity Advantage |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.95
|
| Rate for Payer: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health SBD |
$17.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.15
|
| Rate for Payer: UHC Core |
$14.55
|
| Rate for Payer: UHC Exchange |
$10.98
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
NDC 00904699880
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.35 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.45
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Advantage |
$485.10
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Healthscope Commercial |
$623.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$554.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health SBD |
$436.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.45
|
| Rate for Payer: UHC Core |
$361.05
|
| Rate for Payer: UHC Exchange |
$272.35
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.28 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Advantage |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.85
|
| Rate for Payer: UHC Core |
$98.47
|
| Rate for Payer: UHC Exchange |
$74.28
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$27.93
|
|
|
Service Code
|
NDC 67618010110
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna Commercial |
$23.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cofinity Advantage |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.95
|
| Rate for Payer: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health SBD |
$17.60
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
NDC 00904699880
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$436.59 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.45
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Advantage |
$485.10
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Healthscope Commercial |
$623.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health SBD |
$436.59
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$1,228.50
|
|
|
Service Code
|
NDC 63739047801
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$482.80 |
| Max. Negotiated Rate |
$1,105.65 |
| Rate for Payer: Aetna Commercial |
$1,044.22
|
| Rate for Payer: Aetna Medicare |
$614.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.52
|
| Rate for Payer: BCBS Complete |
$491.40
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cofinity Advantage |
$859.95
|
| Rate for Payer: Cofinity Commercial |
$1,056.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.80
|
| Rate for Payer: Healthscope Commercial |
$1,105.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$982.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.38
|
| Rate for Payer: PHP Commercial |
$1,044.22
|
| Rate for Payer: Priority Health SBD |
$773.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.52
|
| Rate for Payer: UHC Core |
$640.05
|
| Rate for Payer: UHC Exchange |
$482.80
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.92
|
|
|
Service Code
|
NDC 00121187010
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.15
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Advantage |
$5.54
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$7.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.94
|
| Rate for Payer: PHP Commercial |
$6.73
|
| Rate for Payer: Priority Health SBD |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: UHC Exchange |
$3.11
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.92
|
|
|
Service Code
|
NDC 00121187010
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.15
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Advantage |
$5.54
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.94
|
| Rate for Payer: PHP Commercial |
$6.73
|
| Rate for Payer: Priority Health SBD |
$4.99
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.92
|
|
|
Service Code
|
NDC 00121187000
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.15
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Advantage |
$5.54
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$7.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.94
|
| Rate for Payer: PHP Commercial |
$6.73
|
| Rate for Payer: Priority Health SBD |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: UHC Exchange |
$3.11
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.92
|
|
|
Service Code
|
NDC 00121187000
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.15
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Advantage |
$5.54
|
| Rate for Payer: Cofinity Commercial |
$6.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.94
|
| Rate for Payer: PHP Commercial |
$6.73
|
| Rate for Payer: Priority Health SBD |
$4.99
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
OP
|
$163.01
|
|
|
Service Code
|
NDC 69452013117
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$146.71 |
| Rate for Payer: Aetna Commercial |
$138.56
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.96
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: Cash Price |
$130.41
|
| Rate for Payer: Cofinity Advantage |
$114.11
|
| Rate for Payer: Cofinity Commercial |
$140.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.41
|
| Rate for Payer: Healthscope Commercial |
$146.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.26
|
| Rate for Payer: PHP Commercial |
$138.56
|
| Rate for Payer: Priority Health SBD |
$102.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.96
|
| Rate for Payer: UHC Core |
$84.93
|
| Rate for Payer: UHC Exchange |
$64.06
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
IP
|
$2,310.80
|
|
|
Service Code
|
NDC 00069580060
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,455.80 |
| Max. Negotiated Rate |
$2,079.72 |
| Rate for Payer: Aetna Commercial |
$1,964.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,502.02
|
| Rate for Payer: Cash Price |
$1,848.64
|
| Rate for Payer: Cofinity Advantage |
$1,617.56
|
| Rate for Payer: Cofinity Commercial |
$1,987.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,848.64
|
| Rate for Payer: Healthscope Commercial |
$2,079.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,964.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,733.10
|
| Rate for Payer: PHP Commercial |
$1,964.18
|
| Rate for Payer: Priority Health SBD |
$1,455.80
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
IP
|
$396.35
|
|
|
Service Code
|
NDC 00904752208
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$356.71 |
| Rate for Payer: Aetna Commercial |
$336.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.63
|
| Rate for Payer: Cash Price |
$317.08
|
| Rate for Payer: Cofinity Advantage |
$277.44
|
| Rate for Payer: Cofinity Commercial |
$340.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.08
|
| Rate for Payer: Healthscope Commercial |
$356.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.26
|
| Rate for Payer: PHP Commercial |
$336.90
|
| Rate for Payer: Priority Health SBD |
$249.70
|
|
