|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$36.63
|
|
|
Service Code
|
NDC 50383023210
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: Aetna Medicare |
$18.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.81
|
| Rate for Payer: BCBS Complete |
$14.65
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Cofinity Commercial |
$25.64
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$32.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.14
|
| Rate for Payer: PHP Commercial |
$31.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.81
|
| Rate for Payer: Priority Health SBD |
$23.08
|
|
|
DOXEPIN 100 MG CAPSULE
|
Facility
|
OP
|
$735.36
|
|
|
Service Code
|
NDC 00904705561
|
| Hospital Charge Code |
2609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.14 |
| Max. Negotiated Rate |
$661.82 |
| Rate for Payer: Aetna Commercial |
$625.06
|
| Rate for Payer: Aetna Medicare |
$367.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.98
|
| Rate for Payer: BCBS Complete |
$294.14
|
| Rate for Payer: Cash Price |
$588.29
|
| Rate for Payer: Cofinity Commercial |
$514.75
|
| Rate for Payer: Cofinity Commercial |
$632.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.29
|
| Rate for Payer: Healthscope Commercial |
$661.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.06
|
| Rate for Payer: PHP Commercial |
$625.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.98
|
| Rate for Payer: Priority Health SBD |
$463.28
|
|
|
DOXEPIN 100 MG CAPSULE
|
Facility
|
IP
|
$735.36
|
|
|
Service Code
|
NDC 00904705561
|
| Hospital Charge Code |
2609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$463.28 |
| Max. Negotiated Rate |
$661.82 |
| Rate for Payer: Aetna Commercial |
$625.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.98
|
| Rate for Payer: Cash Price |
$588.29
|
| Rate for Payer: Cofinity Commercial |
$514.75
|
| Rate for Payer: Cofinity Commercial |
$632.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.29
|
| Rate for Payer: Healthscope Commercial |
$661.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.06
|
| Rate for Payer: PHP Commercial |
$625.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.98
|
| Rate for Payer: Priority Health SBD |
$463.28
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
IP
|
$261.12
|
|
|
Service Code
|
NDC 51079043620
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.51 |
| Max. Negotiated Rate |
$235.01 |
| Rate for Payer: Aetna Commercial |
$221.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.73
|
| Rate for Payer: Cash Price |
$208.90
|
| Rate for Payer: Cofinity Commercial |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$224.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.90
|
| Rate for Payer: Healthscope Commercial |
$235.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.95
|
| Rate for Payer: PHP Commercial |
$221.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.73
|
| Rate for Payer: Priority Health SBD |
$164.51
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
NDC 51079043601
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna Medicare |
$1.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: BCBS Complete |
$1.05
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.65
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
OP
|
$261.12
|
|
|
Service Code
|
NDC 51079043620
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$235.01 |
| Rate for Payer: Aetna Commercial |
$221.95
|
| Rate for Payer: Aetna Medicare |
$130.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.73
|
| Rate for Payer: BCBS Complete |
$104.45
|
| Rate for Payer: Cash Price |
$208.90
|
| Rate for Payer: Cofinity Commercial |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$224.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.90
|
| Rate for Payer: Healthscope Commercial |
$235.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.95
|
| Rate for Payer: PHP Commercial |
$221.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.73
|
| Rate for Payer: Priority Health SBD |
$164.51
|
|
|
DOXEPIN 10 MG CAPSULE
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
NDC 51079043601
|
| Hospital Charge Code |
2608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.65
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$339.84
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.10 |
| Max. Negotiated Rate |
$305.86 |
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.90
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cofinity Commercial |
$237.89
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.86
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.90
|
| Rate for Payer: Priority Health SBD |
$214.10
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 51079043701
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$2.14
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$339.84
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.94 |
| Max. Negotiated Rate |
$305.86 |
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: Aetna Medicare |
$169.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.90
|
| Rate for Payer: BCBS Complete |
$135.94
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cofinity Commercial |
$237.89
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.86
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.90
|
| Rate for Payer: Priority Health SBD |
$214.10
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 51079043701
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.21
|
| Rate for Payer: Priority Health SBD |
$2.14
|
|
|
DOXORUBICIN 20 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$305.04
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118503
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$274.54 |
| Rate for Payer: Aetna Commercial |
$259.28
|
| Rate for Payer: Aetna Medicare |
$152.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.28
|
| Rate for Payer: BCBS Complete |
$122.02
|
| Rate for Payer: BCBS Trust/PPO |
$9.15
|
| Rate for Payer: BCN Commercial |
$9.15
|
| Rate for Payer: Cash Price |
$244.03
|
| Rate for Payer: Cash Price |
$244.03
|
| Rate for Payer: Cofinity Commercial |
$213.53
|
| Rate for Payer: Cofinity Commercial |
$262.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.03
|
| Rate for Payer: Healthscope Commercial |
$274.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.28
|
| Rate for Payer: PHP Commercial |
$259.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.28
|
| Rate for Payer: Priority Health SBD |
$192.18
|
|
|
DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$276.88
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$249.19 |
| Rate for Payer: Aetna Commercial |
$235.35
|
| Rate for Payer: Aetna Commercial |
$141.58
|
| Rate for Payer: Aetna Commercial |
$243.08
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Aetna Commercial |
$221.80
|
| Rate for Payer: Aetna Medicare |
$83.28
|
| Rate for Payer: Aetna Medicare |
$130.47
|
| Rate for Payer: Aetna Medicare |
$138.44
|
| Rate for Payer: Aetna Medicare |
$142.99
|
| Rate for Payer: Aetna Medicare |
$90.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: BCBS Complete |
$110.75
|
| Rate for Payer: BCBS Complete |
$114.39
|
| Rate for Payer: BCBS Complete |
$104.38
|
| Rate for Payer: BCBS Complete |
$72.57
|
| Rate for Payer: BCBS Complete |
$66.63
|
| Rate for Payer: BCBS Trust/PPO |
$9.15
|
| Rate for Payer: BCBS Trust/PPO |
$9.15
|
| Rate for Payer: BCBS Trust/PPO |
$9.15
|
| Rate for Payer: BCBS Trust/PPO |
$9.15
|
| Rate for Payer: BCBS Trust/PPO |
$9.15
|
| Rate for Payer: BCN Commercial |
$9.15
|
| Rate for Payer: BCN Commercial |
$9.15
|
| Rate for Payer: BCN Commercial |
$9.15
|
| Rate for Payer: BCN Commercial |
$9.15
|
| Rate for Payer: BCN Commercial |
$9.15
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cash Price |
$133.26
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cash Price |
$208.75
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$208.75
|
| Rate for Payer: Cash Price |
$133.26
|
| Rate for Payer: Cofinity Commercial |
$182.66
|
| Rate for Payer: Cofinity Commercial |
$156.03
|
| Rate for Payer: Cofinity Commercial |
$143.25
|
| Rate for Payer: Cofinity Commercial |
$116.60
|
| Rate for Payer: Cofinity Commercial |
$127.00
|
| Rate for Payer: Cofinity Commercial |
$224.41
|
| Rate for Payer: Cofinity Commercial |
$193.82
|
| Rate for Payer: Cofinity Commercial |
$238.12
|
| Rate for Payer: Cofinity Commercial |
$200.19
|
| Rate for Payer: Cofinity Commercial |
$245.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.50
|
| Rate for Payer: Healthscope Commercial |
$257.38
|
| Rate for Payer: Healthscope Commercial |
$234.85
|
| Rate for Payer: Healthscope Commercial |
$249.19
|
| Rate for Payer: Healthscope Commercial |
$149.91
|
| Rate for Payer: Healthscope Commercial |
$163.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.58
|
| Rate for Payer: PHP Commercial |
$141.58
|
| Rate for Payer: PHP Commercial |
$221.80
|
| Rate for Payer: PHP Commercial |
$235.35
|
| Rate for Payer: PHP Commercial |
$154.22
|
| Rate for Payer: PHP Commercial |
$243.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.93
|
| Rate for Payer: Priority Health SBD |
$174.43
|
| Rate for Payer: Priority Health SBD |
$104.94
|
| Rate for Payer: Priority Health SBD |
$114.30
|
| Rate for Payer: Priority Health SBD |
$164.39
|
| Rate for Payer: Priority Health SBD |
$180.17
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$1,493.76
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.92 |
| Max. Negotiated Rate |
$1,344.38 |
| Rate for Payer: Aetna Commercial |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$859.93
|
| Rate for Payer: Aetna Commercial |
$561.08
|
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Commercial |
$1,351.08
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna Medicare |
$141.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.06
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS Complete |
$76.57
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS MAPPO |
$136.05
|
| Rate for Payer: BCBS Trust/PPO |
$375.92
|
| Rate for Payer: BCBS Trust/PPO |
$375.92
|
| Rate for Payer: BCBS Trust/PPO |
$375.92
|
| Rate for Payer: BCBS Trust/PPO |
$375.92
|
| Rate for Payer: BCBS Trust/PPO |
$375.92
|
| Rate for Payer: BCN Commercial |
$375.92
|
| Rate for Payer: BCN Commercial |
$375.92
|
| Rate for Payer: BCN Commercial |
$375.92
|
| Rate for Payer: BCN Commercial |
$375.92
|
| Rate for Payer: BCN Commercial |
$375.92
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: BCN Medicare Advantage |
$136.05
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cash Price |
$1,195.01
|
| Rate for Payer: Cash Price |
$809.34
|
| Rate for Payer: Cash Price |
$809.34
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cash Price |
$528.07
|
| Rate for Payer: Cash Price |
$528.07
|
| Rate for Payer: Cash Price |
$1,271.60
|
| Rate for Payer: Cash Price |
$1,195.01
|
| Rate for Payer: Cash Price |
$1,271.60
|
| Rate for Payer: Cofinity Commercial |
$567.68
|
| Rate for Payer: Cofinity Commercial |
$1,366.97
|
| Rate for Payer: Cofinity Commercial |
$1,112.65
|
| Rate for Payer: Cofinity Commercial |
$687.54
|
| Rate for Payer: Cofinity Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$870.04
|
| Rate for Payer: Cofinity Commercial |
$1,045.63
|
| Rate for Payer: Cofinity Commercial |
$1,284.63
|
| Rate for Payer: Cofinity Commercial |
$708.18
|
| Rate for Payer: Cofinity Commercial |
$462.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,045.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$708.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$462.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,112.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.05
|
| Rate for Payer: Healthscope Commercial |
$1,344.38
|
| Rate for Payer: Healthscope Commercial |
$910.51
|
| Rate for Payer: Healthscope Commercial |
$1,430.55
|
| Rate for Payer: Healthscope Commercial |
$594.08
|
| Rate for Payer: Healthscope Commercial |
$883.98
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$72.92
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Mclaren Medicare |
$136.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.85
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$76.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,351.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.70
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: Nomi Health Commercial |
$408.15
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE Medicare |
$129.25
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PACE SWMI |
$136.05
|
| Rate for Payer: PHP Commercial |
$1,269.70
|
| Rate for Payer: PHP Commercial |
$834.87
|
| Rate for Payer: PHP Commercial |
$1,351.08
|
| Rate for Payer: PHP Commercial |
$859.93
|
| Rate for Payer: PHP Commercial |
$561.08
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: PHP Medicare Advantage |
$136.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Medicare |
$136.05
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health Narrow Network |
$306.39
|
| Rate for Payer: Priority Health SBD |
$637.36
|
| Rate for Payer: Priority Health SBD |
$941.07
|
| Rate for Payer: Priority Health SBD |
$618.79
|
| Rate for Payer: Priority Health SBD |
$1,001.38
|
| Rate for Payer: Priority Health SBD |
$415.86
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: Railroad Medicare Medicare |
$136.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHC Medicare Advantage |
$136.05
|
| Rate for Payer: UHCCP Medicaid |
$76.60
|
| Rate for Payer: UHCCP Medicaid |
$76.60
|
| Rate for Payer: UHCCP Medicaid |
$76.60
|
| Rate for Payer: UHCCP Medicaid |
$76.60
|
| Rate for Payer: UHCCP Medicaid |
$76.60
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
| Rate for Payer: VA VA |
$136.05
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$660.09
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$415.86 |
| Max. Negotiated Rate |
$594.08 |
| Rate for Payer: Aetna Commercial |
$561.08
|
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.43
|
| Rate for Payer: Cash Price |
$528.07
|
| Rate for Payer: Cash Price |
$785.76
|
| Rate for Payer: Cofinity Commercial |
$462.06
|
| Rate for Payer: Cofinity Commercial |
$687.54
|
| Rate for Payer: Cofinity Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$567.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$462.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.76
|
| Rate for Payer: Healthscope Commercial |
$594.08
|
| Rate for Payer: Healthscope Commercial |
$883.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.87
|
| Rate for Payer: PHP Commercial |
$561.08
|
| Rate for Payer: PHP Commercial |
$834.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.06
|
| Rate for Payer: Priority Health SBD |
$618.79
|
| Rate for Payer: Priority Health SBD |
$415.86
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$50.08
|
|
|
Service Code
|
NDC 00143938101
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: BCBS Complete |
$20.03
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.57
|
| Rate for Payer: PHP Commercial |
$42.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.55
|
| Rate for Payer: Priority Health SBD |
$31.55
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$50.08
|
|
|
Service Code
|
NDC 00143938101
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.57
|
| Rate for Payer: PHP Commercial |
$42.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.55
|
| Rate for Payer: Priority Health SBD |
$31.55
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$50.08
|
|
|
Service Code
|
NDC 00143938110
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.57
|
| Rate for Payer: PHP Commercial |
$42.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.55
|
| Rate for Payer: Priority Health SBD |
$31.55
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
NDC 68382091001
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
NDC 63323013011
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna Medicare |
$34.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.36
|
| Rate for Payer: BCBS Complete |
$27.30
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$47.78
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.36
|
| Rate for Payer: Priority Health SBD |
$43.00
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 68382091001
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$50.08
|
|
|
Service Code
|
NDC 00143938110
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Aetna Commercial |
$42.57
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: BCBS Complete |
$20.03
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.57
|
| Rate for Payer: PHP Commercial |
$42.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.55
|
| Rate for Payer: Priority Health SBD |
$31.55
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
NDC 63323013011
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.36
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$47.78
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.36
|
| Rate for Payer: Priority Health SBD |
$43.00
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
