|
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 |
$10.21 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.44
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$35.35
|
| Rate for Payer: BCN Commercial |
$33.43
|
| Rate for Payer: BCN Medicare Advantage |
$10.75
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: PACE Senior Care Partners |
$10.21
|
| Rate for Payer: PACE SWMI |
$10.75
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: PHP Medicare Advantage |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO |
$37.41
|
| Rate for Payer: Priority Health Medicare |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: Railroad Medicare Medicare |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.75
|
| Rate for Payer: UHC Exchange |
$10.75
|
| Rate for Payer: UHC Medicare Advantage |
$10.75
|
| Rate for Payer: VA VA |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
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 |
$27.95 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: BCBS Trust/PPO |
$35.10
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO |
$37.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
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 |
$10.21 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.44
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$35.35
|
| Rate for Payer: BCN Commercial |
$33.43
|
| Rate for Payer: BCN Medicare Advantage |
$10.75
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: PACE Senior Care Partners |
$10.21
|
| Rate for Payer: PACE SWMI |
$10.75
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: PHP Medicare Advantage |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO |
$37.41
|
| Rate for Payer: Priority Health Medicare |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: Railroad Medicare Medicare |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.75
|
| Rate for Payer: UHC Exchange |
$10.75
|
| Rate for Payer: UHC Medicare Advantage |
$10.75
|
| Rate for Payer: VA VA |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
NDC 67457043700
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.32
|
| Rate for Payer: BCN Commercial |
$53.32
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.65
|
| Rate for Payer: Nomi Health Commercial |
$56.58
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health HMO/PPO |
$60.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
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 |
$27.95 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: BCBS Trust/PPO |
$35.10
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO |
$37.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
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 |
$16.21 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna Medicare |
$17.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.33
|
| Rate for Payer: BCBS Complete |
$27.30
|
| Rate for Payer: BCBS MAPPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$56.11
|
| Rate for Payer: BCN Commercial |
$53.06
|
| Rate for Payer: BCN Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.97
|
| Rate for Payer: PACE Senior Care Partners |
$16.21
|
| Rate for Payer: PACE SWMI |
$17.06
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: PHP Medicare Advantage |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.36
|
| Rate for Payer: Priority Health HMO/PPO |
$59.38
|
| Rate for Payer: Priority Health Medicare |
$17.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.73
|
| Rate for Payer: Railroad Medicare Medicare |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.06
|
| Rate for Payer: UHC Core |
$56.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.06
|
| Rate for Payer: UHC Exchange |
$17.06
|
| Rate for Payer: UHC Medicare Advantage |
$17.06
|
| Rate for Payer: VA VA |
$17.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
NDC 67457043710
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna Medicare |
$17.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.56
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$17.25
|
| Rate for Payer: BCBS Trust/PPO |
$56.72
|
| Rate for Payer: BCN Commercial |
$53.65
|
| Rate for Payer: BCN Medicare Advantage |
$17.25
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.65
|
| Rate for Payer: Nomi Health Commercial |
$56.58
|
| Rate for Payer: PACE Senior Care Partners |
$16.39
|
| Rate for Payer: PACE SWMI |
$17.25
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Medicare Advantage |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health HMO/PPO |
$60.03
|
| Rate for Payer: Priority Health Medicare |
$17.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.23
|
| Rate for Payer: Railroad Medicare Medicare |
$17.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.25
|
| Rate for Payer: UHC Exchange |
$17.25
|
| Rate for Payer: UHC Medicare Advantage |
$17.25
|
| Rate for Payer: VA VA |
$17.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
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 |
$44.36 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: BCBS Trust/PPO |
$55.71
|
| Rate for Payer: BCN Commercial |
$52.74
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.97
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.36
|
| Rate for Payer: Priority Health HMO/PPO |
$59.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.06
|
| Rate for Payer: UHC Core |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
NDC 67457043700
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna Medicare |
$17.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.56
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$17.25
|
| Rate for Payer: BCBS Trust/PPO |
$56.72
|
| Rate for Payer: BCN Commercial |
$53.65
|
| Rate for Payer: BCN Medicare Advantage |
$17.25
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.65
|
| Rate for Payer: Nomi Health Commercial |
$56.58
|
| Rate for Payer: PACE Senior Care Partners |
$16.39
|
| Rate for Payer: PACE SWMI |
$17.25
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Medicare Advantage |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health HMO/PPO |
$60.03
|
| Rate for Payer: Priority Health Medicare |
$17.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.23
|
| Rate for Payer: Railroad Medicare Medicare |
$17.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.25
|
| Rate for Payer: UHC Exchange |
$17.25
|
| Rate for Payer: UHC Medicare Advantage |
$17.25
|
| Rate for Payer: VA VA |
$17.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
NDC 67457043710
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.32
|
| Rate for Payer: BCN Commercial |
$53.32
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.65
|
| Rate for Payer: Nomi Health Commercial |
$56.58
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health HMO/PPO |
$60.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
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 |
$44.36 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: BCBS Trust/PPO |
$55.71
|
| Rate for Payer: BCN Commercial |
$52.74
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$55.97
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.36
|
| Rate for Payer: Priority Health HMO/PPO |
$59.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.06
|
| Rate for Payer: UHC Core |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
NDC 68382091001
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: BCBS Trust/PPO |
$35.10
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO |
$37.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
NDC 68382091001
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.44
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$10.75
|
| Rate for Payer: BCBS Trust/PPO |
$35.35
|
| Rate for Payer: BCN Commercial |
$33.43
|
| Rate for Payer: BCN Medicare Advantage |
$10.75
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.55
|
| Rate for Payer: Nomi Health Commercial |
$35.26
|
| Rate for Payer: PACE Senior Care Partners |
$10.21
|
| Rate for Payer: PACE SWMI |
$10.75
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: PHP Medicare Advantage |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO |
$37.41
|
| Rate for Payer: Priority Health Medicare |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: Railroad Medicare Medicare |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.84
|
| Rate for Payer: UHC Core |
$35.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.75
|
| Rate for Payer: UHC Exchange |
$10.75
|
| Rate for Payer: UHC Medicare Advantage |
$10.75
|
| Rate for Payer: VA VA |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.25
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$88.85
|
|
|
Service Code
|
NDC 68084074321
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$79.97 |
| Rate for Payer: Aetna Commercial |
$75.52
|
| Rate for Payer: BCBS Trust/PPO |
$72.53
|
| Rate for Payer: BCN Commercial |
$68.66
|
| Rate for Payer: Cash Price |
$71.08
|
| Rate for Payer: Cofinity Commercial |
$76.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.08
|
| Rate for Payer: Healthscope Commercial |
$79.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.52
|
| Rate for Payer: Nomi Health Commercial |
$72.86
|
| Rate for Payer: PHP Commercial |
$75.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.75
|
| Rate for Payer: Priority Health HMO/PPO |
$77.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.19
|
| Rate for Payer: UHC Core |
$74.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.64
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$5.86
|
|
|
Service Code
|
NDC 68084074333
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.27 |
| Rate for Payer: Aetna Commercial |
$4.98
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.83
|
| Rate for Payer: BCBS Complete |
$2.34
|
| Rate for Payer: BCBS MAPPO |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$4.82
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: BCN Medicare Advantage |
$1.47
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.47
|
| Rate for Payer: Healthscope Commercial |
$5.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.98
|
| Rate for Payer: Nomi Health Commercial |
$4.81
|
| Rate for Payer: PACE Senior Care Partners |
$1.39
|
| Rate for Payer: PACE SWMI |
$1.47
|
| Rate for Payer: PHP Commercial |
$4.98
|
| Rate for Payer: PHP Medicare Advantage |
$1.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.81
|
| Rate for Payer: Priority Health HMO/PPO |
$5.10
|
| Rate for Payer: Priority Health Medicare |
$1.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.16
|
| Rate for Payer: UHC Core |
$4.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.47
|
| Rate for Payer: UHC Exchange |
$1.47
|
| Rate for Payer: UHC Medicare Advantage |
$1.47
|
| Rate for Payer: VA VA |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.39
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$2.97
|
|
|
Service Code
|
NDC 68084074311
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.93
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: BCBS MAPPO |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: BCN Medicare Advantage |
$0.74
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.44
|
| Rate for Payer: PACE Senior Care Partners |
$0.71
|
| Rate for Payer: PACE SWMI |
$0.74
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: PHP Medicare Advantage |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2.58
|
| Rate for Payer: Priority Health Medicare |
$0.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.99
|
| Rate for Payer: Railroad Medicare Medicare |
$0.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.61
|
| Rate for Payer: UHC Core |
$2.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.74
|
| Rate for Payer: UHC Exchange |
$0.74
|
| Rate for Payer: UHC Medicare Advantage |
$0.74
|
| Rate for Payer: VA VA |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$151.44
|
|
|
Service Code
|
NDC 50268028115
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.44 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial |
$128.72
|
| Rate for Payer: BCBS Trust/PPO |
$123.62
|
| Rate for Payer: BCN Commercial |
$117.03
|
| Rate for Payer: Cash Price |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.15
|
| Rate for Payer: Healthscope Commercial |
$136.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.72
|
| Rate for Payer: Nomi Health Commercial |
$124.18
|
| Rate for Payer: PHP Commercial |
$128.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.44
|
| Rate for Payer: Priority Health HMO/PPO |
$131.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.27
|
| Rate for Payer: UHC Core |
$126.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.58
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$104.03
|
|
|
Service Code
|
NDC 68180065208
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$93.63 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.51
|
| Rate for Payer: BCBS Complete |
$41.61
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$85.52
|
| Rate for Payer: BCN Commercial |
$80.88
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$83.22
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$93.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.30
|
| Rate for Payer: PACE Senior Care Partners |
$24.71
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.62
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Medicare |
$26.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.70
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.55
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.01
|
| Rate for Payer: UHC Exchange |
$26.01
|
| Rate for Payer: UHC Medicare Advantage |
$26.01
|
| Rate for Payer: VA VA |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.02
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$104.03
|
|
|
Service Code
|
NDC 68180065208
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$93.63 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: BCBS Trust/PPO |
$84.92
|
| Rate for Payer: BCN Commercial |
$80.39
|
| Rate for Payer: Cash Price |
$83.22
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.22
|
| Rate for Payer: Healthscope Commercial |
$93.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.30
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.62
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.55
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.02
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 68084074311
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: BCBS Trust/PPO |
$2.42
|
| Rate for Payer: BCN Commercial |
$2.30
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Nomi Health Commercial |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.61
|
| Rate for Payer: UHC Core |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$88.85
|
|
|
Service Code
|
NDC 68084074321
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$79.97 |
| Rate for Payer: Aetna Commercial |
$75.52
|
| Rate for Payer: Aetna Medicare |
$23.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.77
|
| Rate for Payer: BCBS Complete |
$35.54
|
| Rate for Payer: BCBS MAPPO |
$22.21
|
| Rate for Payer: BCBS Trust/PPO |
$73.04
|
| Rate for Payer: BCN Commercial |
$69.08
|
| Rate for Payer: BCN Medicare Advantage |
$22.21
|
| Rate for Payer: Cash Price |
$71.08
|
| Rate for Payer: Cofinity Commercial |
$76.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.21
|
| Rate for Payer: Healthscope Commercial |
$79.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.52
|
| Rate for Payer: Nomi Health Commercial |
$72.86
|
| Rate for Payer: PACE Senior Care Partners |
$21.10
|
| Rate for Payer: PACE SWMI |
$22.21
|
| Rate for Payer: PHP Commercial |
$75.52
|
| Rate for Payer: PHP Medicare Advantage |
$22.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.75
|
| Rate for Payer: Priority Health HMO/PPO |
$77.30
|
| Rate for Payer: Priority Health Medicare |
$22.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.53
|
| Rate for Payer: Railroad Medicare Medicare |
$22.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.19
|
| Rate for Payer: UHC Core |
$74.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.21
|
| Rate for Payer: UHC Exchange |
$22.21
|
| Rate for Payer: UHC Medicare Advantage |
$22.21
|
| Rate for Payer: VA VA |
$22.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.64
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 50268028111
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.95
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.49
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: PACE Senior Care Partners |
$0.72
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: Railroad Medicare Medicare |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.67
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: VA VA |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
OP
|
$151.44
|
|
|
Service Code
|
NDC 50268028115
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$136.30 |
| Rate for Payer: Aetna Commercial |
$128.72
|
| Rate for Payer: Aetna Medicare |
$39.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.33
|
| Rate for Payer: BCBS Complete |
$60.58
|
| Rate for Payer: BCBS MAPPO |
$37.86
|
| Rate for Payer: BCBS Trust/PPO |
$124.50
|
| Rate for Payer: BCN Commercial |
$117.74
|
| Rate for Payer: BCN Medicare Advantage |
$37.86
|
| Rate for Payer: Cash Price |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.86
|
| Rate for Payer: Healthscope Commercial |
$136.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.72
|
| Rate for Payer: Nomi Health Commercial |
$124.18
|
| Rate for Payer: PACE Senior Care Partners |
$35.97
|
| Rate for Payer: PACE SWMI |
$37.86
|
| Rate for Payer: PHP Commercial |
$128.72
|
| Rate for Payer: PHP Medicare Advantage |
$37.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.44
|
| Rate for Payer: Priority Health HMO/PPO |
$131.75
|
| Rate for Payer: Priority Health Medicare |
$38.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.46
|
| Rate for Payer: Railroad Medicare Medicare |
$37.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.27
|
| Rate for Payer: UHC Core |
$126.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.86
|
| Rate for Payer: UHC Exchange |
$37.86
|
| Rate for Payer: UHC Medicare Advantage |
$37.86
|
| Rate for Payer: VA VA |
$37.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.58
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 50268028111
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.67
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE
|
Facility
|
IP
|
$117.03
|
|
|
Service Code
|
NDC 68084074332
|
| Hospital Charge Code |
9900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.07 |
| Max. Negotiated Rate |
$105.33 |
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: BCBS Trust/PPO |
$95.53
|
| Rate for Payer: BCN Commercial |
$90.44
|
| Rate for Payer: Cash Price |
$93.62
|
| Rate for Payer: Cofinity Commercial |
$100.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.62
|
| Rate for Payer: Healthscope Commercial |
$105.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.48
|
| Rate for Payer: Nomi Health Commercial |
$95.96
|
| Rate for Payer: PHP Commercial |
$99.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.07
|
| Rate for Payer: Priority Health HMO/PPO |
$101.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.99
|
| Rate for Payer: UHC Core |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.77
|
|
