|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,149.96
|
|
|
Service Code
|
NDC 00074382611
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$747.47 |
| Max. Negotiated Rate |
$1,034.96 |
| Rate for Payer: Aetna Commercial |
$977.47
|
| Rate for Payer: BCBS Trust/PPO |
$938.71
|
| Rate for Payer: BCN Commercial |
$888.69
|
| Rate for Payer: Cash Price |
$919.97
|
| Rate for Payer: Cofinity Commercial |
$988.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.97
|
| Rate for Payer: Healthscope Commercial |
$1,034.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.47
|
| Rate for Payer: Nomi Health Commercial |
$942.97
|
| Rate for Payer: PHP Commercial |
$977.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,000.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,011.96
|
| Rate for Payer: UHC Core |
$960.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.47
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,149.96
|
|
|
Service Code
|
NDC 00074382611
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.12 |
| Max. Negotiated Rate |
$1,034.96 |
| Rate for Payer: Aetna Commercial |
$977.47
|
| Rate for Payer: Aetna Medicare |
$298.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.36
|
| Rate for Payer: BCBS Complete |
$459.98
|
| Rate for Payer: BCBS MAPPO |
$287.49
|
| Rate for Payer: BCBS Trust/PPO |
$945.38
|
| Rate for Payer: BCN Commercial |
$894.09
|
| Rate for Payer: BCN Medicare Advantage |
$287.49
|
| Rate for Payer: Cash Price |
$919.97
|
| Rate for Payer: Cofinity Commercial |
$988.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.49
|
| Rate for Payer: Healthscope Commercial |
$1,034.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$330.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.47
|
| Rate for Payer: Nomi Health Commercial |
$942.97
|
| Rate for Payer: PACE Senior Care Partners |
$273.12
|
| Rate for Payer: PACE SWMI |
$287.49
|
| Rate for Payer: PHP Commercial |
$977.47
|
| Rate for Payer: PHP Medicare Advantage |
$287.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,000.47
|
| Rate for Payer: Priority Health Medicare |
$290.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.47
|
| Rate for Payer: Railroad Medicare Medicare |
$287.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,011.96
|
| Rate for Payer: UHC Core |
$960.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.49
|
| Rate for Payer: UHC Exchange |
$287.49
|
| Rate for Payer: UHC Medicare Advantage |
$287.49
|
| Rate for Payer: VA VA |
$287.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.47
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$228.95
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$206.06 |
| Rate for Payer: Aetna Commercial |
$194.61
|
| Rate for Payer: Aetna Medicare |
$59.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.55
|
| Rate for Payer: BCBS Complete |
$91.58
|
| Rate for Payer: BCBS MAPPO |
$57.24
|
| Rate for Payer: BCBS Trust/PPO |
$188.22
|
| Rate for Payer: BCN Commercial |
$178.01
|
| Rate for Payer: BCN Medicare Advantage |
$57.24
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.24
|
| Rate for Payer: Healthscope Commercial |
$206.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.61
|
| Rate for Payer: Nomi Health Commercial |
$187.74
|
| Rate for Payer: PACE Senior Care Partners |
$54.38
|
| Rate for Payer: PACE SWMI |
$57.24
|
| Rate for Payer: PHP Commercial |
$194.61
|
| Rate for Payer: PHP Medicare Advantage |
$57.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.82
|
| Rate for Payer: Priority Health HMO/PPO |
$199.19
|
| Rate for Payer: Priority Health Medicare |
$57.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.40
|
| Rate for Payer: Railroad Medicare Medicare |
$57.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.48
|
| Rate for Payer: UHC Core |
$191.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.24
|
| Rate for Payer: UHC Exchange |
$57.24
|
| Rate for Payer: UHC Medicare Advantage |
$57.24
|
| Rate for Payer: VA VA |
$57.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.71
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
NDC 55111053301
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.25 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare |
$98.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.75
|
| Rate for Payer: BCBS Complete |
$152.00
|
| Rate for Payer: BCBS MAPPO |
$95.00
|
| Rate for Payer: BCBS Trust/PPO |
$312.40
|
| Rate for Payer: BCN Commercial |
$295.45
|
| Rate for Payer: BCN Medicare Advantage |
$95.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Nomi Health Commercial |
$311.60
|
| Rate for Payer: PACE Senior Care Partners |
$90.25
|
| Rate for Payer: PACE SWMI |
$95.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: PHP Medicare Advantage |
$95.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.00
|
| Rate for Payer: Priority Health HMO/PPO |
$330.60
|
| Rate for Payer: Priority Health Medicare |
$95.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.60
|
| Rate for Payer: Railroad Medicare Medicare |
$95.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.40
|
| Rate for Payer: UHC Core |
$317.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.00
|
| Rate for Payer: UHC Exchange |
$95.00
|
| Rate for Payer: UHC Medicare Advantage |
$95.00
|
| Rate for Payer: VA VA |
$95.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$397.49 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: BCBS Trust/PPO |
$499.18
|
| Rate for Payer: BCN Commercial |
$472.58
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: Nomi Health Commercial |
$501.45
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health HMO/PPO |
$532.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.14
|
| Rate for Payer: UHC Core |
$510.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$263.15
|
|
|
Service Code
|
NDC 65162075710
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$236.84 |
| Rate for Payer: Aetna Commercial |
$223.68
|
| Rate for Payer: Aetna Medicare |
$68.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.23
|
| Rate for Payer: BCBS Complete |
$105.26
|
| Rate for Payer: BCBS MAPPO |
$65.79
|
| Rate for Payer: BCBS Trust/PPO |
$216.34
|
| Rate for Payer: BCN Commercial |
$204.60
|
| Rate for Payer: BCN Medicare Advantage |
$65.79
|
| Rate for Payer: Cash Price |
$210.52
|
| Rate for Payer: Cofinity Commercial |
$226.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.79
|
| Rate for Payer: Healthscope Commercial |
$236.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.68
|
| Rate for Payer: Nomi Health Commercial |
$215.78
|
| Rate for Payer: PACE Senior Care Partners |
$62.50
|
| Rate for Payer: PACE SWMI |
$65.79
|
| Rate for Payer: PHP Commercial |
$223.68
|
| Rate for Payer: PHP Medicare Advantage |
$65.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO |
$228.94
|
| Rate for Payer: Priority Health Medicare |
$66.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.31
|
| Rate for Payer: Railroad Medicare Medicare |
$65.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.57
|
| Rate for Payer: UHC Core |
$219.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.79
|
| Rate for Payer: UHC Exchange |
$65.79
|
| Rate for Payer: UHC Medicare Advantage |
$65.79
|
| Rate for Payer: VA VA |
$65.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.36
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7.86
|
|
|
Service Code
|
NDC 68084041511
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$6.42
|
| Rate for Payer: BCN Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health HMO/PPO |
$6.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.92
|
| Rate for Payer: UHC Core |
$6.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.90
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$263.15
|
|
|
Service Code
|
NDC 65162075710
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.05 |
| Max. Negotiated Rate |
$236.84 |
| Rate for Payer: Aetna Commercial |
$223.68
|
| Rate for Payer: BCBS Trust/PPO |
$214.81
|
| Rate for Payer: BCN Commercial |
$203.36
|
| Rate for Payer: Cash Price |
$210.52
|
| Rate for Payer: Cofinity Commercial |
$226.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.52
|
| Rate for Payer: Healthscope Commercial |
$236.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.68
|
| Rate for Payer: Nomi Health Commercial |
$215.78
|
| Rate for Payer: PHP Commercial |
$223.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.05
|
| Rate for Payer: Priority Health HMO/PPO |
$228.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.57
|
| Rate for Payer: UHC Core |
$219.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.36
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$785.28
|
|
|
Service Code
|
NDC 68084041501
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.50 |
| Max. Negotiated Rate |
$706.75 |
| Rate for Payer: Aetna Commercial |
$667.49
|
| Rate for Payer: Aetna Medicare |
$204.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.40
|
| Rate for Payer: BCBS Complete |
$314.11
|
| Rate for Payer: BCBS MAPPO |
$196.32
|
| Rate for Payer: BCBS Trust/PPO |
$645.58
|
| Rate for Payer: BCN Commercial |
$610.56
|
| Rate for Payer: BCN Medicare Advantage |
$196.32
|
| Rate for Payer: Cash Price |
$628.22
|
| Rate for Payer: Cofinity Commercial |
$675.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.32
|
| Rate for Payer: Healthscope Commercial |
$706.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$588.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.49
|
| Rate for Payer: Nomi Health Commercial |
$643.93
|
| Rate for Payer: PACE Senior Care Partners |
$186.50
|
| Rate for Payer: PACE SWMI |
$196.32
|
| Rate for Payer: PHP Commercial |
$667.49
|
| Rate for Payer: PHP Medicare Advantage |
$196.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.43
|
| Rate for Payer: Priority Health HMO/PPO |
$683.19
|
| Rate for Payer: Priority Health Medicare |
$198.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.14
|
| Rate for Payer: Railroad Medicare Medicare |
$196.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.05
|
| Rate for Payer: UHC Core |
$655.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.32
|
| Rate for Payer: UHC Exchange |
$196.32
|
| Rate for Payer: UHC Medicare Advantage |
$196.32
|
| Rate for Payer: VA VA |
$196.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$588.96
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$7.86
|
|
|
Service Code
|
NDC 68084041511
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.46
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: BCBS MAPPO |
$1.96
|
| Rate for Payer: BCBS Trust/PPO |
$6.46
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Medicare Advantage |
$1.96
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: Nomi Health Commercial |
$6.45
|
| Rate for Payer: PACE Senior Care Partners |
$1.87
|
| Rate for Payer: PACE SWMI |
$1.96
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: PHP Medicare Advantage |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health HMO/PPO |
$6.84
|
| Rate for Payer: Priority Health Medicare |
$1.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.92
|
| Rate for Payer: UHC Core |
$6.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Medicare Advantage |
$1.96
|
| Rate for Payer: VA VA |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.90
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: Aetna Medicare |
$159.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.10
|
| Rate for Payer: BCBS Complete |
$244.61
|
| Rate for Payer: BCBS MAPPO |
$152.88
|
| Rate for Payer: BCBS Trust/PPO |
$502.73
|
| Rate for Payer: BCN Commercial |
$475.46
|
| Rate for Payer: BCN Medicare Advantage |
$152.88
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.88
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: Nomi Health Commercial |
$501.45
|
| Rate for Payer: PACE Senior Care Partners |
$145.24
|
| Rate for Payer: PACE SWMI |
$152.88
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: PHP Medicare Advantage |
$152.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health HMO/PPO |
$532.02
|
| Rate for Payer: Priority Health Medicare |
$154.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.72
|
| Rate for Payer: Railroad Medicare Medicare |
$152.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.14
|
| Rate for Payer: UHC Core |
$510.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.88
|
| Rate for Payer: UHC Exchange |
$152.88
|
| Rate for Payer: UHC Medicare Advantage |
$152.88
|
| Rate for Payer: VA VA |
$152.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$785.28
|
|
|
Service Code
|
NDC 68084041501
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$510.43 |
| Max. Negotiated Rate |
$706.75 |
| Rate for Payer: Aetna Commercial |
$667.49
|
| Rate for Payer: BCBS Trust/PPO |
$641.02
|
| Rate for Payer: BCN Commercial |
$606.86
|
| Rate for Payer: Cash Price |
$628.22
|
| Rate for Payer: Cofinity Commercial |
$675.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.22
|
| Rate for Payer: Healthscope Commercial |
$706.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$588.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$667.49
|
| Rate for Payer: Nomi Health Commercial |
$643.93
|
| Rate for Payer: PHP Commercial |
$667.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.43
|
| Rate for Payer: Priority Health HMO/PPO |
$683.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.05
|
| Rate for Payer: UHC Core |
$655.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$588.96
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$604.80
|
|
|
Service Code
|
NDC 00904636461
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.64 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$514.08
|
| Rate for Payer: Aetna Medicare |
$157.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.00
|
| Rate for Payer: BCBS Complete |
$241.92
|
| Rate for Payer: BCBS MAPPO |
$151.20
|
| Rate for Payer: BCBS Trust/PPO |
$497.21
|
| Rate for Payer: BCN Commercial |
$470.23
|
| Rate for Payer: BCN Medicare Advantage |
$151.20
|
| Rate for Payer: Cash Price |
$483.84
|
| Rate for Payer: Cofinity Commercial |
$520.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$544.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$514.08
|
| Rate for Payer: Nomi Health Commercial |
$495.94
|
| Rate for Payer: PACE Senior Care Partners |
$143.64
|
| Rate for Payer: PACE SWMI |
$151.20
|
| Rate for Payer: PHP Commercial |
$514.08
|
| Rate for Payer: PHP Medicare Advantage |
$151.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.12
|
| Rate for Payer: Priority Health HMO/PPO |
$526.18
|
| Rate for Payer: Priority Health Medicare |
$152.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.22
|
| Rate for Payer: Railroad Medicare Medicare |
$151.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.22
|
| Rate for Payer: UHC Core |
$505.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.20
|
| Rate for Payer: UHC Exchange |
$151.20
|
| Rate for Payer: UHC Medicare Advantage |
$151.20
|
| Rate for Payer: VA VA |
$151.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.60
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$604.80
|
|
|
Service Code
|
NDC 00904636461
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$514.08
|
| Rate for Payer: BCBS Trust/PPO |
$493.70
|
| Rate for Payer: BCN Commercial |
$467.39
|
| Rate for Payer: Cash Price |
$483.84
|
| Rate for Payer: Cofinity Commercial |
$520.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.84
|
| Rate for Payer: Healthscope Commercial |
$544.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$453.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$514.08
|
| Rate for Payer: Nomi Health Commercial |
$495.94
|
| Rate for Payer: PHP Commercial |
$514.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.12
|
| Rate for Payer: Priority Health HMO/PPO |
$526.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.22
|
| Rate for Payer: UHC Core |
$505.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$453.60
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: BCBS Trust/PPO |
$71.61
|
| Rate for Payer: BCN Commercial |
$67.80
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Nomi Health Commercial |
$71.94
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO |
$76.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.20
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.84 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Medicare |
$22.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.42
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS MAPPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$72.12
|
| Rate for Payer: BCN Commercial |
$68.21
|
| Rate for Payer: BCN Medicare Advantage |
$21.93
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Nomi Health Commercial |
$71.94
|
| Rate for Payer: PACE Senior Care Partners |
$20.84
|
| Rate for Payer: PACE SWMI |
$21.93
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Medicare Advantage |
$21.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO |
$76.33
|
| Rate for Payer: Priority Health Medicare |
$22.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.78
|
| Rate for Payer: Railroad Medicare Medicare |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.20
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.93
|
| Rate for Payer: UHC Exchange |
$21.93
|
| Rate for Payer: UHC Medicare Advantage |
$21.93
|
| Rate for Payer: VA VA |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
IP
|
$96.39
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.65 |
| Max. Negotiated Rate |
$86.75 |
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: BCBS Trust/PPO |
$78.68
|
| Rate for Payer: BCN Commercial |
$74.49
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.93
|
| Rate for Payer: Nomi Health Commercial |
$79.04
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health HMO/PPO |
$83.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.82
|
| Rate for Payer: UHC Core |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
OP
|
$96.39
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$86.75 |
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: Aetna Medicare |
$25.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.12
|
| Rate for Payer: BCBS Complete |
$38.56
|
| Rate for Payer: BCBS MAPPO |
$24.10
|
| Rate for Payer: BCBS Trust/PPO |
$79.24
|
| Rate for Payer: BCN Commercial |
$74.94
|
| Rate for Payer: BCN Medicare Advantage |
$24.10
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.10
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.93
|
| Rate for Payer: Nomi Health Commercial |
$79.04
|
| Rate for Payer: PACE Senior Care Partners |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.10
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: PHP Medicare Advantage |
$24.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health HMO/PPO |
$83.86
|
| Rate for Payer: Priority Health Medicare |
$24.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.58
|
| Rate for Payer: Railroad Medicare Medicare |
$24.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.82
|
| Rate for Payer: UHC Core |
$80.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.10
|
| Rate for Payer: UHC Exchange |
$24.10
|
| Rate for Payer: UHC Medicare Advantage |
$24.10
|
| Rate for Payer: VA VA |
$24.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$188.10
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna Medicare |
$48.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.78
|
| Rate for Payer: BCBS Complete |
$75.24
|
| Rate for Payer: BCBS MAPPO |
$47.02
|
| Rate for Payer: BCBS Trust/PPO |
$154.64
|
| Rate for Payer: BCN Commercial |
$146.25
|
| Rate for Payer: BCN Medicare Advantage |
$47.02
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.02
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: Nomi Health Commercial |
$154.24
|
| Rate for Payer: PACE Senior Care Partners |
$44.67
|
| Rate for Payer: PACE SWMI |
$47.02
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: PHP Medicare Advantage |
$47.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.26
|
| Rate for Payer: Priority Health HMO/PPO |
$163.65
|
| Rate for Payer: Priority Health Medicare |
$47.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.03
|
| Rate for Payer: Railroad Medicare Medicare |
$47.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.53
|
| Rate for Payer: UHC Core |
$157.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.02
|
| Rate for Payer: UHC Exchange |
$47.02
|
| Rate for Payer: UHC Medicare Advantage |
$47.02
|
| Rate for Payer: VA VA |
$47.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.08
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.98
|
| Rate for Payer: BCN Commercial |
$139.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.60
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: BCBS Trust/PPO |
$82.28
|
| Rate for Payer: BCN Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.70
|
| Rate for Payer: UHC Core |
$84.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$146.93
|
| Rate for Payer: BCN Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$1.89
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.54
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: Nomi Health Commercial |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.66
|
| Rate for Payer: UHC Core |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: Aetna Medicare |
$0.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.59
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$0.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: BCN Commercial |
$1.47
|
| Rate for Payer: BCN Medicare Advantage |
$0.47
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$1.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: Nomi Health Commercial |
$1.55
|
| Rate for Payer: PACE Senior Care Partners |
$0.45
|
| Rate for Payer: PACE SWMI |
$0.47
|
| Rate for Payer: PHP Commercial |
$1.61
|
| Rate for Payer: PHP Medicare Advantage |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1.64
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.27
|
| Rate for Payer: Railroad Medicare Medicare |
$0.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.66
|
| Rate for Payer: UHC Core |
$1.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.47
|
| Rate for Payer: VA VA |
$0.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.50
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$82.87
|
| Rate for Payer: BCN Commercial |
$78.37
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: PACE Senior Care Partners |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.54
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.70
|
| Rate for Payer: UHC Core |
$84.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.20
|
| Rate for Payer: UHC Exchange |
$25.20
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
| Rate for Payer: VA VA |
$25.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
