Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$604.80

Service Code	NDC 00904636461
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$241.92
Max. Negotiated Rate	$544.32
Rate for Payer: Aetna Commercial	$514.08
Rate for Payer: Aetna Medicare	$302.40
Rate for Payer: Aetna New Business (MI Preferred)	$393.12
Rate for Payer: BCBS Complete	$241.92
Rate for Payer: Cash Price	$483.84
Rate for Payer: Cofinity Commercial	$423.36
Rate for Payer: Cofinity Commercial	$520.13
Rate for Payer: Cofinity Medicare Advantage	$423.36
Rate for Payer: Encore Health Key Benefits Commercial	$483.84
Rate for Payer: Healthscope Commercial	$544.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$514.08
Rate for Payer: PHP Commercial	$514.08
Rate for Payer: Priority Health Cigna Priority Health	$393.12
Rate for Payer: Priority Health SBD	$381.02

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$2,007.25

Service Code	NDC 00074712611
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$802.90
Max. Negotiated Rate	$1,806.52
Rate for Payer: Aetna Commercial	$1,706.16
Rate for Payer: Aetna Medicare	$1,003.62
Rate for Payer: Aetna New Business (MI Preferred)	$1,304.71
Rate for Payer: BCBS Complete	$802.90
Rate for Payer: Cash Price	$1,605.80
Rate for Payer: Cofinity Commercial	$1,405.08
Rate for Payer: Cofinity Commercial	$1,726.24
Rate for Payer: Cofinity Medicare Advantage	$1,405.08
Rate for Payer: Encore Health Key Benefits Commercial	$1,605.80
Rate for Payer: Healthscope Commercial	$1,806.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,706.16
Rate for Payer: PHP Commercial	$1,706.16
Rate for Payer: Priority Health Cigna Priority Health	$1,304.71
Rate for Payer: Priority Health SBD	$1,264.57

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$263.15

Service Code	NDC 65162075710
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$165.78
Max. Negotiated Rate	$236.84
Rate for Payer: Aetna Commercial	$223.68
Rate for Payer: Aetna New Business (MI Preferred)	$171.05
Rate for Payer: Cash Price	$210.52
Rate for Payer: Cofinity Commercial	$184.20
Rate for Payer: Cofinity Commercial	$226.31
Rate for Payer: Cofinity Medicare Advantage	$184.20
Rate for Payer: Encore Health Key Benefits Commercial	$210.52
Rate for Payer: Healthscope Commercial	$236.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.68
Rate for Payer: PHP Commercial	$223.68
Rate for Payer: Priority Health Cigna Priority Health	$171.05
Rate for Payer: Priority Health SBD	$165.78

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$7.86

Service Code	NDC 68084041511
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$6.68
Rate for Payer: Aetna New Business (MI Preferred)	$5.11
Rate for Payer: Cash Price	$6.29
Rate for Payer: Cofinity Commercial	$5.50
Rate for Payer: Cofinity Commercial	$6.76
Rate for Payer: Cofinity Medicare Advantage	$5.50
Rate for Payer: Encore Health Key Benefits Commercial	$6.29
Rate for Payer: Healthscope Commercial	$7.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.68
Rate for Payer: PHP Commercial	$6.68
Rate for Payer: Priority Health Cigna Priority Health	$5.11
Rate for Payer: Priority Health SBD	$4.95

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$263.15

Service Code	NDC 65162075710
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$105.26
Max. Negotiated Rate	$236.84
Rate for Payer: Aetna Commercial	$223.68
Rate for Payer: Aetna Medicare	$131.58
Rate for Payer: Aetna New Business (MI Preferred)	$171.05
Rate for Payer: BCBS Complete	$105.26
Rate for Payer: Cash Price	$210.52
Rate for Payer: Cofinity Commercial	$184.20
Rate for Payer: Cofinity Commercial	$226.31
Rate for Payer: Cofinity Medicare Advantage	$184.20
Rate for Payer: Encore Health Key Benefits Commercial	$210.52
Rate for Payer: Healthscope Commercial	$236.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.68
Rate for Payer: PHP Commercial	$223.68
Rate for Payer: Priority Health Cigna Priority Health	$171.05
Rate for Payer: Priority Health SBD	$165.78

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$785.28

Service Code	NDC 68084041501
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$494.73
Max. Negotiated Rate	$706.75
Rate for Payer: Aetna Commercial	$667.49
Rate for Payer: Aetna New Business (MI Preferred)	$510.43
Rate for Payer: Cash Price	$628.22
Rate for Payer: Cofinity Commercial	$549.70
Rate for Payer: Cofinity Commercial	$675.34
Rate for Payer: Cofinity Medicare Advantage	$549.70
Rate for Payer: Encore Health Key Benefits Commercial	$628.22
Rate for Payer: Healthscope Commercial	$706.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$667.49
Rate for Payer: PHP Commercial	$667.49
Rate for Payer: Priority Health Cigna Priority Health	$510.43
Rate for Payer: Priority Health SBD	$494.73

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$2,007.25

Service Code	NDC 00074712611
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$1,264.57
Max. Negotiated Rate	$1,806.52
Rate for Payer: Aetna Commercial	$1,706.16
Rate for Payer: Aetna New Business (MI Preferred)	$1,304.71
Rate for Payer: Cash Price	$1,605.80
Rate for Payer: Cofinity Commercial	$1,405.08
Rate for Payer: Cofinity Commercial	$1,726.24
Rate for Payer: Cofinity Medicare Advantage	$1,405.08
Rate for Payer: Encore Health Key Benefits Commercial	$1,605.80
Rate for Payer: Healthscope Commercial	$1,806.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,706.16
Rate for Payer: PHP Commercial	$1,706.16
Rate for Payer: Priority Health Cigna Priority Health	$1,304.71
Rate for Payer: Priority Health SBD	$1,264.57

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$7.86

Service Code	NDC 68084041511
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$6.68
Rate for Payer: Aetna Medicare	$3.93
Rate for Payer: Aetna New Business (MI Preferred)	$5.11
Rate for Payer: BCBS Complete	$3.14
Rate for Payer: Cash Price	$6.29
Rate for Payer: Cofinity Commercial	$5.50
Rate for Payer: Cofinity Commercial	$6.76
Rate for Payer: Cofinity Medicare Advantage	$5.50
Rate for Payer: Encore Health Key Benefits Commercial	$6.29
Rate for Payer: Healthscope Commercial	$7.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.68
Rate for Payer: PHP Commercial	$6.68
Rate for Payer: Priority Health Cigna Priority Health	$5.11
Rate for Payer: Priority Health SBD	$4.95

DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION

Facility

$21.61

Service Code	HCPCS J1250
Hospital Charge Code	9892
Hospital Revenue Code	636
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$22.37
Rate for Payer: Aetna Commercial	$18.37
Rate for Payer: Aetna Commercial	$23.00
Rate for Payer: Aetna Medicare	$13.53
Rate for Payer: Aetna Medicare	$10.80
Rate for Payer: Aetna New Business (MI Preferred)	$14.05
Rate for Payer: Aetna New Business (MI Preferred)	$17.59
Rate for Payer: BCBS Complete	$10.82
Rate for Payer: BCBS Complete	$8.64
Rate for Payer: BCBS Trust/PPO	$22.37
Rate for Payer: BCBS Trust/PPO	$22.37
Rate for Payer: BCN Commercial	$22.37
Rate for Payer: BCN Commercial	$22.37
Rate for Payer: Cash Price	$21.65
Rate for Payer: Cash Price	$17.29
Rate for Payer: Cash Price	$17.29
Rate for Payer: Cash Price	$21.65
Rate for Payer: Cofinity Commercial	$18.58
Rate for Payer: Cofinity Commercial	$15.13
Rate for Payer: Cofinity Commercial	$18.94
Rate for Payer: Cofinity Commercial	$23.27
Rate for Payer: Cofinity Medicare Advantage	$15.13
Rate for Payer: Cofinity Medicare Advantage	$18.94
Rate for Payer: Encore Health Key Benefits Commercial	$17.29
Rate for Payer: Encore Health Key Benefits Commercial	$21.65
Rate for Payer: Healthscope Commercial	$24.35
Rate for Payer: Healthscope Commercial	$19.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.37
Rate for Payer: PHP Commercial	$23.00
Rate for Payer: PHP Commercial	$18.37
Rate for Payer: Priority Health Cigna Priority Health	$17.59
Rate for Payer: Priority Health Cigna Priority Health	$14.05
Rate for Payer: Priority Health SBD	$17.05
Rate for Payer: Priority Health SBD	$13.61

DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION

Facility

$27.06

Service Code	HCPCS J1250
Hospital Charge Code	9892
Hospital Revenue Code	636
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$24.35
Rate for Payer: Aetna Commercial	$23.00
Rate for Payer: Aetna Commercial	$18.37
Rate for Payer: Aetna New Business (MI Preferred)	$14.05
Rate for Payer: Aetna New Business (MI Preferred)	$17.59
Rate for Payer: Cash Price	$17.29
Rate for Payer: Cash Price	$21.65
Rate for Payer: Cofinity Commercial	$23.27
Rate for Payer: Cofinity Commercial	$18.94
Rate for Payer: Cofinity Commercial	$15.13
Rate for Payer: Cofinity Commercial	$18.58
Rate for Payer: Cofinity Medicare Advantage	$15.13
Rate for Payer: Cofinity Medicare Advantage	$18.94
Rate for Payer: Encore Health Key Benefits Commercial	$17.29
Rate for Payer: Encore Health Key Benefits Commercial	$21.65
Rate for Payer: Healthscope Commercial	$24.35
Rate for Payer: Healthscope Commercial	$19.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.00
Rate for Payer: PHP Commercial	$23.00
Rate for Payer: PHP Commercial	$18.37
Rate for Payer: Priority Health Cigna Priority Health	$14.05
Rate for Payer: Priority Health Cigna Priority Health	$17.59
Rate for Payer: Priority Health SBD	$13.61
Rate for Payer: Priority Health SBD	$17.05

DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV

Facility

$96.39

Service Code	HCPCS J1250
Hospital Charge Code	18315
Hospital Revenue Code	636
Min. Negotiated Rate	$60.73
Max. Negotiated Rate	$86.75
Rate for Payer: Aetna Commercial	$81.93
Rate for Payer: Aetna New Business (MI Preferred)	$62.65
Rate for Payer: Cash Price	$77.11
Rate for Payer: Cofinity Commercial	$67.47
Rate for Payer: Cofinity Commercial	$82.90
Rate for Payer: Cofinity Medicare Advantage	$67.47
Rate for Payer: Encore Health Key Benefits Commercial	$77.11
Rate for Payer: Healthscope Commercial	$86.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.93
Rate for Payer: PHP Commercial	$81.93
Rate for Payer: Priority Health Cigna Priority Health	$62.65
Rate for Payer: Priority Health SBD	$60.73

DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV

Facility

$96.39

Service Code	HCPCS J1250
Hospital Charge Code	18315
Hospital Revenue Code	636
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$86.75
Rate for Payer: Aetna Commercial	$81.93
Rate for Payer: Aetna Medicare	$48.20
Rate for Payer: Aetna New Business (MI Preferred)	$62.65
Rate for Payer: BCBS Complete	$38.56
Rate for Payer: BCBS Trust/PPO	$22.37
Rate for Payer: BCN Commercial	$22.37
Rate for Payer: Cash Price	$77.11
Rate for Payer: Cash Price	$77.11
Rate for Payer: Cofinity Commercial	$67.47
Rate for Payer: Cofinity Commercial	$82.90
Rate for Payer: Cofinity Medicare Advantage	$67.47
Rate for Payer: Encore Health Key Benefits Commercial	$77.11
Rate for Payer: Healthscope Commercial	$86.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.93
Rate for Payer: PHP Commercial	$81.93
Rate for Payer: Priority Health Cigna Priority Health	$62.65
Rate for Payer: Priority Health SBD	$60.73

DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION

Facility

$895.04

Service Code	HCPCS J9171
Hospital Charge Code	161671
Hospital Revenue Code	636
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$805.54
Rate for Payer: Aetna Commercial	$760.78
Rate for Payer: Aetna Commercial	$294.48
Rate for Payer: Aetna Commercial	$1,633.39
Rate for Payer: Aetna Medicare	$173.22
Rate for Payer: Aetna Medicare	$447.52
Rate for Payer: Aetna Medicare	$960.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,249.06
Rate for Payer: Aetna New Business (MI Preferred)	$225.19
Rate for Payer: Aetna New Business (MI Preferred)	$581.78
Rate for Payer: BCBS Complete	$138.58
Rate for Payer: BCBS Complete	$358.02
Rate for Payer: BCBS Complete	$768.65
Rate for Payer: BCBS Trust/PPO	$2.19
Rate for Payer: BCBS Trust/PPO	$2.19
Rate for Payer: BCBS Trust/PPO	$2.19
Rate for Payer: BCN Commercial	$2.19
Rate for Payer: BCN Commercial	$2.19
Rate for Payer: BCN Commercial	$2.19
Rate for Payer: Cash Price	$1,537.30
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	$277.16
Rate for Payer: Cash Price	$716.03
Rate for Payer: Cofinity Commercial	$242.52
Rate for Payer: Cofinity Commercial	$769.73
Rate for Payer: Cofinity Commercial	$626.53
Rate for Payer: Cofinity Commercial	$297.95
Rate for Payer: Cofinity Commercial	$1,345.14
Rate for Payer: Cofinity Commercial	$1,652.60
Rate for Payer: Cofinity Medicare Advantage	$242.52
Rate for Payer: Cofinity Medicare Advantage	$1,345.14
Rate for Payer: Cofinity Medicare Advantage	$626.53
Rate for Payer: Encore Health Key Benefits Commercial	$716.03
Rate for Payer: Encore Health Key Benefits Commercial	$277.16
Rate for Payer: Encore Health Key Benefits Commercial	$1,537.30
Rate for Payer: Healthscope Commercial	$805.54
Rate for Payer: Healthscope Commercial	$311.80
Rate for Payer: Healthscope Commercial	$1,729.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,633.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$294.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$760.78
Rate for Payer: PHP Commercial	$760.78
Rate for Payer: PHP Commercial	$1,633.39
Rate for Payer: PHP Commercial	$294.48
Rate for Payer: Priority Health Cigna Priority Health	$581.78
Rate for Payer: Priority Health Cigna Priority Health	$225.19
Rate for Payer: Priority Health Cigna Priority Health	$1,249.06
Rate for Payer: Priority Health SBD	$218.26
Rate for Payer: Priority Health SBD	$563.88
Rate for Payer: Priority Health SBD	$1,210.63

DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION

Facility

$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 Commercial	$626.53
Rate for Payer: Cofinity Commercial	$769.73
Rate for Payer: Cofinity Medicare Advantage	$626.53
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: PHP Commercial	$760.78
Rate for Payer: Priority Health Cigna Priority Health	$581.78
Rate for Payer: Priority Health SBD	$563.88

DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION

Facility

$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 Commercial	$1,345.14
Rate for Payer: Cofinity Commercial	$1,652.60
Rate for Payer: Cofinity Medicare Advantage	$1,345.14
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: PHP Commercial	$1,633.39
Rate for Payer: Priority Health Cigna Priority Health	$1,249.06
Rate for Payer: Priority Health SBD	$1,210.63

DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION

Facility

$1,921.63

Service Code	HCPCS J9171
Hospital Charge Code	120029
Hospital Revenue Code	636
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$1,729.47
Rate for Payer: Aetna Commercial	$1,633.39
Rate for Payer: Aetna Commercial	$424.36
Rate for Payer: Aetna Medicare	$249.62
Rate for Payer: Aetna Medicare	$960.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,249.06
Rate for Payer: Aetna New Business (MI Preferred)	$324.51
Rate for Payer: BCBS Complete	$199.70
Rate for Payer: BCBS Complete	$768.65
Rate for Payer: BCBS Trust/PPO	$2.19
Rate for Payer: BCBS Trust/PPO	$2.19
Rate for Payer: BCN Commercial	$2.19
Rate for Payer: BCN Commercial	$2.19
Rate for Payer: Cash Price	$399.40
Rate for Payer: Cash Price	$399.40
Rate for Payer: Cash Price	$1,537.30
Rate for Payer: Cash Price	$1,537.30
Rate for Payer: Cofinity Commercial	$1,345.14
Rate for Payer: Cofinity Commercial	$429.36
Rate for Payer: Cofinity Commercial	$349.48
Rate for Payer: Cofinity Commercial	$1,652.60
Rate for Payer: Cofinity Medicare Advantage	$349.48
Rate for Payer: Cofinity Medicare Advantage	$1,345.14
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: Multiplan/Beech St/PHCS Commercial	$424.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,633.39
Rate for Payer: PHP Commercial	$424.36
Rate for Payer: PHP Commercial	$1,633.39
Rate for Payer: Priority Health Cigna Priority Health	$1,249.06
Rate for Payer: Priority Health Cigna Priority Health	$324.51
Rate for Payer: Priority Health SBD	$314.53
Rate for Payer: Priority Health SBD	$1,210.63

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$100.80

Service Code	NDC 00904699860
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$40.32
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 Commercial	$70.56
Rate for Payer: Cofinity Commercial	$86.69
Rate for Payer: Cofinity Medicare Advantage	$70.56
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: PHP Commercial	$85.68
Rate for Payer: Priority Health Cigna Priority Health	$65.52
Rate for Payer: Priority Health SBD	$63.50

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$189.00

Service Code	NDC 63739047810
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$75.60
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 Commercial	$132.30
Rate for Payer: Cofinity Commercial	$162.54
Rate for Payer: Cofinity Medicare Advantage	$132.30
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: PHP Commercial	$160.65
Rate for Payer: Priority Health Cigna Priority Health	$122.85
Rate for Payer: Priority Health SBD	$119.07

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$180.00

Service Code	NDC 00904718361
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$126.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Cofinity Medicare Advantage	$126.00
Rate for Payer: Encore Health Key Benefits Commercial	$144.00
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health Cigna Priority Health	$117.00
Rate for Payer: Priority Health SBD	$113.40

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$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 Commercial	$12.04
Rate for Payer: Cofinity Commercial	$9.80
Rate for Payer: Cofinity Medicare Advantage	$9.80
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: PHP Commercial	$11.90
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: Priority Health SBD	$8.82

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$693.00

Service Code	NDC 00904699880
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$277.20
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 Commercial	$485.10
Rate for Payer: Cofinity Commercial	$595.98
Rate for Payer: Cofinity Medicare Advantage	$485.10
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: PHP Commercial	$589.05
Rate for Payer: Priority Health Cigna Priority Health	$450.45
Rate for Payer: Priority Health SBD	$436.59

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$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 Commercial	$19.55
Rate for Payer: Cofinity Commercial	$24.02
Rate for Payer: Cofinity Medicare Advantage	$19.55
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: PHP Commercial	$23.74
Rate for Payer: Priority Health Cigna Priority Health	$18.15
Rate for Payer: Priority Health SBD	$17.60

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$27.93

Service Code	NDC 67618010110
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$11.17
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 Commercial	$19.55
Rate for Payer: Cofinity Commercial	$24.02
Rate for Payer: Cofinity Medicare Advantage	$19.55
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: PHP Commercial	$23.74
Rate for Payer: Priority Health Cigna Priority Health	$18.15
Rate for Payer: Priority Health SBD	$17.60

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$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 Commercial	$485.10
Rate for Payer: Cofinity Commercial	$595.98
Rate for Payer: Cofinity Medicare Advantage	$485.10
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: PHP Commercial	$589.05
Rate for Payer: Priority Health Cigna Priority Health	$450.45
Rate for Payer: Priority Health SBD	$436.59

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$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 Commercial	$70.56
Rate for Payer: Cofinity Commercial	$86.69
Rate for Payer: Cofinity Medicare Advantage	$70.56
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: PHP Commercial	$85.68
Rate for Payer: Priority Health Cigna Priority Health	$65.52
Rate for Payer: Priority Health SBD	$63.50

Know your out-of-pocket cost for care.

All Charges