|
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
|
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
|
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 |
$122.02 |
| 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: 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
|
$285.98
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
118501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.39 |
| Max. Negotiated Rate |
$257.38 |
| Rate for Payer: Aetna Commercial |
$243.08
|
| Rate for Payer: Aetna Commercial |
$141.58
|
| Rate for Payer: Aetna Commercial |
$221.80
|
| Rate for Payer: Aetna Commercial |
$235.35
|
| Rate for Payer: Aetna Commercial |
$154.22
|
| 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 Medicare |
$83.28
|
| Rate for Payer: Aetna Medicare |
$130.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.61
|
| Rate for Payer: BCBS Complete |
$72.57
|
| Rate for Payer: BCBS Complete |
$110.75
|
| Rate for Payer: BCBS Complete |
$66.63
|
| Rate for Payer: BCBS Complete |
$114.39
|
| Rate for Payer: BCBS Complete |
$104.38
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$133.26
|
| Rate for Payer: Cash Price |
$145.14
|
| Rate for Payer: Cash Price |
$208.75
|
| Rate for Payer: Cofinity Commercial |
$193.82
|
| Rate for Payer: Cofinity Commercial |
$245.94
|
| Rate for Payer: Cofinity Commercial |
$200.19
|
| Rate for Payer: Cofinity Commercial |
$116.60
|
| Rate for Payer: Cofinity Commercial |
$143.25
|
| Rate for Payer: Cofinity Commercial |
$156.03
|
| Rate for Payer: Cofinity Commercial |
$127.00
|
| Rate for Payer: Cofinity Commercial |
$238.12
|
| Rate for Payer: Cofinity Commercial |
$224.41
|
| Rate for Payer: Cofinity Commercial |
$182.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.50
|
| Rate for Payer: Healthscope Commercial |
$149.91
|
| Rate for Payer: Healthscope Commercial |
$163.29
|
| Rate for Payer: Healthscope Commercial |
$234.85
|
| Rate for Payer: Healthscope Commercial |
$249.19
|
| Rate for Payer: Healthscope Commercial |
$257.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.80
|
| 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 |
$141.58
|
| Rate for Payer: PHP Commercial |
$243.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.93
|
| Rate for Payer: Priority Health SBD |
$180.17
|
| Rate for Payer: Priority Health SBD |
$164.39
|
| Rate for Payer: Priority Health SBD |
$104.94
|
| Rate for Payer: Priority Health SBD |
$174.43
|
| Rate for Payer: Priority Health SBD |
$114.30
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$1,589.50
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.14 |
| Max. Negotiated Rate |
$1,430.55 |
| Rate for Payer: Aetna Commercial |
$1,351.08
|
| Rate for Payer: Aetna Commercial |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$859.93
|
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Commercial |
$561.08
|
| Rate for Payer: Aetna Medicare |
$112.81
|
| Rate for Payer: Aetna Medicare |
$112.81
|
| Rate for Payer: Aetna Medicare |
$112.81
|
| Rate for Payer: Aetna Medicare |
$112.81
|
| Rate for Payer: Aetna Medicare |
$112.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.59
|
| Rate for Payer: BCBS Complete |
$61.05
|
| Rate for Payer: BCBS Complete |
$61.05
|
| Rate for Payer: BCBS Complete |
$61.05
|
| Rate for Payer: BCBS Complete |
$61.05
|
| Rate for Payer: BCBS Complete |
$61.05
|
| Rate for Payer: BCBS MAPPO |
$108.47
|
| Rate for Payer: BCBS MAPPO |
$108.47
|
| Rate for Payer: BCBS MAPPO |
$108.47
|
| Rate for Payer: BCBS MAPPO |
$108.47
|
| Rate for Payer: BCBS MAPPO |
$108.47
|
| Rate for Payer: BCN Medicare Advantage |
$108.47
|
| Rate for Payer: BCN Medicare Advantage |
$108.47
|
| Rate for Payer: BCN Medicare Advantage |
$108.47
|
| Rate for Payer: BCN Medicare Advantage |
$108.47
|
| Rate for Payer: BCN Medicare Advantage |
$108.47
|
| Rate for Payer: Cash Price |
$1,271.60
|
| Rate for Payer: Cash Price |
$1,195.01
|
| 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 |
$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: Cofinity Commercial |
$567.68
|
| Rate for Payer: Cofinity Commercial |
$708.18
|
| Rate for Payer: Cofinity Commercial |
$462.06
|
| Rate for Payer: Cofinity Commercial |
$1,284.63
|
| Rate for Payer: Cofinity Commercial |
$870.04
|
| Rate for Payer: Cofinity Commercial |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$1,366.97
|
| Rate for Payer: Cofinity Commercial |
$1,112.65
|
| Rate for Payer: Cofinity Commercial |
$1,045.63
|
| Rate for Payer: Cofinity Commercial |
$687.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$708.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$462.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,045.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,112.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$528.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,271.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.47
|
| Rate for Payer: Healthscope Commercial |
$1,430.55
|
| Rate for Payer: Healthscope Commercial |
$883.98
|
| Rate for Payer: Healthscope Commercial |
$594.08
|
| Rate for Payer: Healthscope Commercial |
$1,344.38
|
| Rate for Payer: Healthscope Commercial |
$910.51
|
| Rate for Payer: Mclaren Medicaid |
$58.14
|
| Rate for Payer: Mclaren Medicaid |
$58.14
|
| Rate for Payer: Mclaren Medicaid |
$58.14
|
| Rate for Payer: Mclaren Medicaid |
$58.14
|
| Rate for Payer: Mclaren Medicaid |
$58.14
|
| Rate for Payer: Mclaren Medicare |
$108.47
|
| Rate for Payer: Mclaren Medicare |
$108.47
|
| Rate for Payer: Mclaren Medicare |
$108.47
|
| Rate for Payer: Mclaren Medicare |
$108.47
|
| Rate for Payer: Mclaren Medicare |
$108.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.89
|
| Rate for Payer: Meridian Medicaid |
$61.05
|
| Rate for Payer: Meridian Medicaid |
$61.05
|
| Rate for Payer: Meridian Medicaid |
$61.05
|
| Rate for Payer: Meridian Medicaid |
$61.05
|
| Rate for Payer: Meridian Medicaid |
$61.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,351.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.87
|
| Rate for Payer: PACE Medicare |
$103.05
|
| Rate for Payer: PACE Medicare |
$103.05
|
| Rate for Payer: PACE Medicare |
$103.05
|
| Rate for Payer: PACE Medicare |
$103.05
|
| Rate for Payer: PACE Medicare |
$103.05
|
| Rate for Payer: PACE SWMI |
$108.47
|
| Rate for Payer: PACE SWMI |
$108.47
|
| Rate for Payer: PACE SWMI |
$108.47
|
| Rate for Payer: PACE SWMI |
$108.47
|
| Rate for Payer: PACE SWMI |
$108.47
|
| Rate for Payer: PHP Commercial |
$1,351.08
|
| Rate for Payer: PHP Commercial |
$561.08
|
| Rate for Payer: PHP Commercial |
$834.87
|
| Rate for Payer: PHP Commercial |
$859.93
|
| Rate for Payer: PHP Commercial |
$1,269.70
|
| Rate for Payer: PHP Medicare Advantage |
$108.47
|
| Rate for Payer: PHP Medicare Advantage |
$108.47
|
| Rate for Payer: PHP Medicare Advantage |
$108.47
|
| Rate for Payer: PHP Medicare Advantage |
$108.47
|
| Rate for Payer: PHP Medicare Advantage |
$108.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.17
|
| 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 |
$429.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.59
|
| Rate for Payer: Priority Health Medicare |
$108.47
|
| Rate for Payer: Priority Health Medicare |
$108.47
|
| Rate for Payer: Priority Health Medicare |
$108.47
|
| Rate for Payer: Priority Health Medicare |
$108.47
|
| Rate for Payer: Priority Health Medicare |
$108.47
|
| Rate for Payer: Priority Health SBD |
$1,001.38
|
| Rate for Payer: Priority Health SBD |
$415.86
|
| 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: Railroad Medicare Medicare |
$108.47
|
| Rate for Payer: Railroad Medicare Medicare |
$108.47
|
| Rate for Payer: Railroad Medicare Medicare |
$108.47
|
| Rate for Payer: Railroad Medicare Medicare |
$108.47
|
| Rate for Payer: Railroad Medicare Medicare |
$108.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.47
|
| Rate for Payer: UHC Medicare Advantage |
$108.47
|
| Rate for Payer: UHC Medicare Advantage |
$108.47
|
| Rate for Payer: UHC Medicare Advantage |
$108.47
|
| Rate for Payer: UHC Medicare Advantage |
$108.47
|
| Rate for Payer: UHC Medicare Advantage |
$108.47
|
| Rate for Payer: UHCCP Medicaid |
$61.07
|
| Rate for Payer: UHCCP Medicaid |
$61.07
|
| Rate for Payer: UHCCP Medicaid |
$61.07
|
| Rate for Payer: UHCCP Medicaid |
$61.07
|
| Rate for Payer: UHCCP Medicaid |
$61.07
|
| Rate for Payer: VA VA |
$108.47
|
| Rate for Payer: VA VA |
$108.47
|
| Rate for Payer: VA VA |
$108.47
|
| Rate for Payer: VA VA |
$108.47
|
| Rate for Payer: VA VA |
$108.47
|
|
|
DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$982.20
|
|
|
Service Code
|
HCPCS Q2050
|
| Hospital Charge Code |
27431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$618.79 |
| Max. Negotiated Rate |
$883.98 |
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Commercial |
$561.08
|
| 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 |
$844.69
|
| Rate for Payer: Cofinity Commercial |
$687.54
|
| Rate for Payer: Cofinity Commercial |
$462.06
|
| Rate for Payer: Cofinity Commercial |
$567.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$462.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$687.54
|
| 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 |
$883.98
|
| Rate for Payer: Healthscope Commercial |
$594.08
|
| 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 |
$834.87
|
| Rate for Payer: PHP Commercial |
$561.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.43
|
| Rate for Payer: Priority Health SBD |
$415.86
|
| Rate for Payer: Priority Health SBD |
$618.79
|
|
|
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
|
OP
|
$68.25
|
|
|
Service Code
|
NDC 63323013013
|
| 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 |
$47.77
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.77
|
| 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
|
$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 |
$47.77
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.77
|
| 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
|
$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
|
$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
|
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
|
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
|
$68.25
|
|
|
Service Code
|
NDC 63323013013
|
| 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 |
$47.77
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.77
|
| 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
|
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 |
$47.77
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.77
|
| 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
|
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
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
301731
|
|
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 IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
301731
|
|
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 TABLET
|
Facility
|
IP
|
$377.52
|
|
|
Service Code
|
NDC 50268027915
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.84 |
| Max. Negotiated Rate |
$339.77 |
| Rate for Payer: Aetna Commercial |
$320.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.39
|
| Rate for Payer: Cash Price |
$302.02
|
| Rate for Payer: Cofinity Commercial |
$264.26
|
| Rate for Payer: Cofinity Commercial |
$324.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.02
|
| Rate for Payer: Healthscope Commercial |
$339.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.89
|
| Rate for Payer: PHP Commercial |
$320.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.39
|
| Rate for Payer: Priority Health SBD |
$237.84
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
OP
|
$198.58
|
|
|
Service Code
|
NDC 00143211250
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$178.72 |
| Rate for Payer: Aetna Commercial |
$168.79
|
| Rate for Payer: Aetna Medicare |
$99.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.08
|
| Rate for Payer: BCBS Complete |
$79.43
|
| Rate for Payer: Cash Price |
$158.86
|
| Rate for Payer: Cofinity Commercial |
$139.01
|
| Rate for Payer: Cofinity Commercial |
$170.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.86
|
| Rate for Payer: Healthscope Commercial |
$178.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.79
|
| Rate for Payer: PHP Commercial |
$168.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.08
|
| Rate for Payer: Priority Health SBD |
$125.11
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
OP
|
$207.36
|
|
|
Service Code
|
NDC 00904043004
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$186.62 |
| Rate for Payer: Aetna Commercial |
$176.26
|
| Rate for Payer: Aetna Medicare |
$103.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.78
|
| Rate for Payer: BCBS Complete |
$82.94
|
| Rate for Payer: Cash Price |
$165.89
|
| Rate for Payer: Cofinity Commercial |
$145.15
|
| Rate for Payer: Cofinity Commercial |
$178.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.89
|
| Rate for Payer: Healthscope Commercial |
$186.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.26
|
| Rate for Payer: PHP Commercial |
$176.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.78
|
| Rate for Payer: Priority Health SBD |
$130.64
|
|
