|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$214.70
|
|
|
Service Code
|
NDC 65162075710
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna Commercial |
$182.50
|
| Rate for Payer: Aetna Medicare |
$55.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.09
|
| Rate for Payer: BCBS Complete |
$39.74
|
| Rate for Payer: BCBS MAPPO |
$53.67
|
| Rate for Payer: BCBS Trust/PPO |
$176.50
|
| Rate for Payer: BCN Commercial |
$176.50
|
| Rate for Payer: BCN Medicare Advantage |
$53.67
|
| Rate for Payer: Cash Price |
$171.76
|
| Rate for Payer: Cofinity Commercial |
$184.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.67
|
| Rate for Payer: Healthscope Commercial |
$193.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.03
|
| Rate for Payer: Mclaren Medicaid |
$37.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.36
|
| Rate for Payer: Meridian Medicaid |
$39.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.50
|
| Rate for Payer: Nomi Health Commercial |
$176.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.03
|
| Rate for Payer: PACE Senior Care Partners |
$50.99
|
| Rate for Payer: PACE SWMI |
$53.67
|
| Rate for Payer: PHP Commercial |
$182.50
|
| Rate for Payer: PHP Medicare Advantage |
$53.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$186.79
|
| Rate for Payer: Priority Health Medicare |
$54.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.43
|
| Rate for Payer: Railroad Medicare Medicare |
$53.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.94
|
| Rate for Payer: UHC Core |
$179.27
|
| Rate for Payer: UHC Exchange |
$53.67
|
| Rate for Payer: UHC Medicaid |
$37.85
|
| Rate for Payer: UHC Medicare Advantage |
$53.67
|
| Rate for Payer: UHCCP Medicaid |
$37.85
|
| Rate for Payer: VA VA |
$53.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.03
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$142.13
|
|
|
Service Code
|
NDC 50268026013
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$127.92 |
| Rate for Payer: Aetna Commercial |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$117.39
|
| Rate for Payer: BCN Commercial |
$117.39
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cofinity Commercial |
$122.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.70
|
| Rate for Payer: Healthscope Commercial |
$127.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.81
|
| Rate for Payer: Nomi Health Commercial |
$116.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.60
|
| Rate for Payer: PHP Commercial |
$120.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$123.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.07
|
| Rate for Payer: UHC Core |
$118.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.60
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68084041511
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$6.61
|
| Rate for Payer: BCN Commercial |
$6.61
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.80
|
| Rate for Payer: Nomi Health Commercial |
$6.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.00
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.04
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
IP
|
$10,924.33
|
|
|
Service Code
|
APR-DRG 2444
|
| Min. Negotiated Rate |
$10,404.12 |
| Max. Negotiated Rate |
$10,924.33 |
| Rate for Payer: BCBS Complete |
$10,924.33
|
| Rate for Payer: Mclaren Medicaid |
$10,404.12
|
| Rate for Payer: Meridian Medicaid |
$10,924.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,404.12
|
| Rate for Payer: UHC Medicaid |
$10,404.12
|
| Rate for Payer: UHCCP Medicaid |
$10,404.12
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
IP
|
$6,513.58
|
|
|
Service Code
|
APR-DRG 2443
|
| Min. Negotiated Rate |
$6,203.41 |
| Max. Negotiated Rate |
$6,513.58 |
| Rate for Payer: BCBS Complete |
$6,513.58
|
| Rate for Payer: Mclaren Medicaid |
$6,203.41
|
| Rate for Payer: Meridian Medicaid |
$6,513.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,203.41
|
| Rate for Payer: UHC Medicaid |
$6,203.41
|
| Rate for Payer: UHCCP Medicaid |
$6,203.41
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
IP
|
$3,983.24
|
|
|
Service Code
|
APR-DRG 2442
|
| Min. Negotiated Rate |
$3,793.56 |
| Max. Negotiated Rate |
$3,983.24 |
| Rate for Payer: BCBS Complete |
$3,983.24
|
| Rate for Payer: Mclaren Medicaid |
$3,793.56
|
| Rate for Payer: Meridian Medicaid |
$3,983.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,793.56
|
| Rate for Payer: UHC Medicaid |
$3,793.56
|
| Rate for Payer: UHCCP Medicaid |
$3,793.56
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
IP
|
$3,003.60
|
|
|
Service Code
|
APR-DRG 2441
|
| Min. Negotiated Rate |
$2,860.57 |
| Max. Negotiated Rate |
$3,003.60 |
| Rate for Payer: BCBS Complete |
$3,003.60
|
| Rate for Payer: Mclaren Medicaid |
$2,860.57
|
| Rate for Payer: Meridian Medicaid |
$3,003.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,860.57
|
| Rate for Payer: UHC Medicaid |
$2,860.57
|
| Rate for Payer: UHCCP Medicaid |
$2,860.57
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Aetna Commercial |
$77.96
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.66
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCBS Trust/PPO |
$75.40
|
| Rate for Payer: BCN Commercial |
$75.40
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cofinity Commercial |
$78.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Healthscope Commercial |
$82.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.79
|
| Rate for Payer: Mclaren Medicaid |
$16.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Meridian Medicaid |
$16.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Nomi Health Commercial |
$75.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.79
|
| Rate for Payer: PACE Senior Care Partners |
$21.78
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Commercial |
$77.96
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.80
|
| Rate for Payer: Priority Health Medicare |
$23.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.84
|
| Rate for Payer: Railroad Medicare Medicare |
$22.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.71
|
| Rate for Payer: UHC Core |
$76.59
|
| Rate for Payer: UHC Exchange |
$22.93
|
| Rate for Payer: UHC Medicaid |
$16.17
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
| Rate for Payer: UHCCP Medicaid |
$16.17
|
| Rate for Payer: VA VA |
$22.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.79
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$91.72
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Aetna Commercial |
$77.96
|
| Rate for Payer: BCBS Trust/PPO |
$75.75
|
| Rate for Payer: BCN Commercial |
$75.75
|
| Rate for Payer: Cash Price |
$73.38
|
| Rate for Payer: Cofinity Commercial |
$78.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.38
|
| Rate for Payer: Healthscope Commercial |
$82.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Nomi Health Commercial |
$75.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.79
|
| Rate for Payer: PHP Commercial |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.71
|
| Rate for Payer: UHC Core |
$76.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.79
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
OP
|
$168.20
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.65 |
| Max. Negotiated Rate |
$151.38 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$43.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.56
|
| Rate for Payer: BCBS Complete |
$31.13
|
| Rate for Payer: BCBS MAPPO |
$42.05
|
| Rate for Payer: BCBS Trust/PPO |
$138.28
|
| Rate for Payer: BCN Commercial |
$138.28
|
| Rate for Payer: BCN Medicare Advantage |
$42.05
|
| Rate for Payer: Cash Price |
$134.56
|
| Rate for Payer: Cofinity Commercial |
$144.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.05
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.15
|
| Rate for Payer: Mclaren Medicaid |
$29.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.15
|
| Rate for Payer: Meridian Medicaid |
$31.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.97
|
| Rate for Payer: Nomi Health Commercial |
$137.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.15
|
| Rate for Payer: PACE Senior Care Partners |
$39.95
|
| Rate for Payer: PACE SWMI |
$42.05
|
| Rate for Payer: PHP Commercial |
$142.97
|
| Rate for Payer: PHP Medicare Advantage |
$42.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.33
|
| Rate for Payer: Priority Health Medicare |
$42.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.07
|
| Rate for Payer: Railroad Medicare Medicare |
$42.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.02
|
| Rate for Payer: UHC Core |
$140.45
|
| Rate for Payer: UHC Exchange |
$42.05
|
| Rate for Payer: UHC Medicaid |
$29.65
|
| Rate for Payer: UHC Medicare Advantage |
$42.05
|
| Rate for Payer: UHCCP Medicaid |
$29.65
|
| Rate for Payer: VA VA |
$42.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.15
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
IP
|
$168.20
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.07 |
| Max. Negotiated Rate |
$151.38 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: BCBS Trust/PPO |
$138.92
|
| Rate for Payer: BCN Commercial |
$138.92
|
| Rate for Payer: Cash Price |
$134.56
|
| Rate for Payer: Cofinity Commercial |
$144.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.56
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.97
|
| Rate for Payer: Nomi Health Commercial |
$137.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.15
|
| Rate for Payer: PHP Commercial |
$142.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.02
|
| Rate for Payer: UHC Core |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.15
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.03 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna Medicare |
$45.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.00
|
| Rate for Payer: BCBS Complete |
$32.58
|
| Rate for Payer: BCBS MAPPO |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$144.69
|
| Rate for Payer: BCN Commercial |
$144.69
|
| Rate for Payer: BCN Medicare Advantage |
$44.00
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.00
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Mclaren Medicaid |
$31.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.20
|
| Rate for Payer: Meridian Medicaid |
$32.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: Nomi Health Commercial |
$144.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: PACE Senior Care Partners |
$41.80
|
| Rate for Payer: PACE SWMI |
$44.00
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: PHP Medicare Advantage |
$44.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.12
|
| Rate for Payer: Priority Health Medicare |
$44.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.50
|
| Rate for Payer: Railroad Medicare Medicare |
$44.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.88
|
| Rate for Payer: UHC Core |
$146.96
|
| Rate for Payer: UHC Exchange |
$44.00
|
| Rate for Payer: UHC Medicaid |
$31.03
|
| Rate for Payer: UHC Medicare Advantage |
$44.00
|
| Rate for Payer: UHCCP Medicaid |
$31.03
|
| Rate for Payer: VA VA |
$44.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.06 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: BCBS Trust/PPO |
$151.97
|
| Rate for Payer: BCN Commercial |
$151.97
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.40
|
| Rate for Payer: Nomi Health Commercial |
$150.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$160.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.92
|
| Rate for Payer: UHC Core |
$153.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: BCBS Trust/PPO |
$156.10
|
| Rate for Payer: BCN Commercial |
$156.10
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.16 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: BCBS Trust/PPO |
$83.25
|
| Rate for Payer: BCN Commercial |
$83.25
|
| 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: Opus (Opus Packaging Group) HMA |
$75.60
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.16
|
| 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
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.45
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: BCN Medicare Advantage |
$0.44
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.44
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.32
|
| Rate for Payer: Mclaren Medicaid |
$0.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.46
|
| Rate for Payer: Meridian Medicaid |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.32
|
| Rate for Payer: PACE Senior Care Partners |
$0.42
|
| Rate for Payer: PACE SWMI |
$0.44
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: PHP Medicare Advantage |
$0.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.53
|
| Rate for Payer: Priority Health Medicare |
$0.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.22
|
| Rate for Payer: Railroad Medicare Medicare |
$0.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.55
|
| Rate for Payer: UHC Core |
$1.47
|
| Rate for Payer: UHC Exchange |
$0.44
|
| Rate for Payer: UHC Medicaid |
$0.31
|
| Rate for Payer: UHC Medicare Advantage |
$0.44
|
| Rate for Payer: UHCCP Medicaid |
$0.31
|
| Rate for Payer: VA VA |
$0.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.32
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$49.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.06
|
| Rate for Payer: BCBS Complete |
$34.98
|
| Rate for Payer: BCBS MAPPO |
$47.25
|
| Rate for Payer: BCBS Trust/PPO |
$155.38
|
| Rate for Payer: BCN Commercial |
$155.38
|
| Rate for Payer: BCN Medicare Advantage |
$47.25
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.25
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Mclaren Medicaid |
$33.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.61
|
| Rate for Payer: Meridian Medicaid |
$34.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PACE Senior Care Partners |
$44.89
|
| Rate for Payer: PACE SWMI |
$47.25
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: PHP Medicare Advantage |
$47.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.43
|
| Rate for Payer: Priority Health Medicare |
$47.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.54
|
| Rate for Payer: Railroad Medicare Medicare |
$47.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.32
|
| Rate for Payer: UHC Core |
$157.81
|
| Rate for Payer: UHC Exchange |
$47.25
|
| Rate for Payer: UHC Medicaid |
$33.32
|
| Rate for Payer: UHC Medicare Advantage |
$47.25
|
| Rate for Payer: UHCCP Medicaid |
$33.32
|
| Rate for Payer: VA VA |
$47.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.45
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.32
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.55
|
| Rate for Payer: UHC Core |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.32
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: BCBS Trust/PPO |
$145.36
|
| Rate for Payer: BCN Commercial |
$145.36
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: Nomi Health Commercial |
$144.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.88
|
| Rate for Payer: UHC Core |
$146.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.44 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna Medicare |
$47.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.50
|
| Rate for Payer: BCBS Complete |
$34.06
|
| Rate for Payer: BCBS MAPPO |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$151.27
|
| Rate for Payer: BCN Commercial |
$151.27
|
| Rate for Payer: BCN Medicare Advantage |
$46.00
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.00
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Mclaren Medicaid |
$32.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.30
|
| Rate for Payer: Meridian Medicaid |
$34.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.40
|
| Rate for Payer: Nomi Health Commercial |
$150.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
| Rate for Payer: PACE Senior Care Partners |
$43.70
|
| Rate for Payer: PACE SWMI |
$46.00
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: PHP Medicare Advantage |
$46.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$160.08
|
| Rate for Payer: Priority Health Medicare |
$46.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.06
|
| Rate for Payer: Railroad Medicare Medicare |
$46.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.92
|
| Rate for Payer: UHC Core |
$153.64
|
| Rate for Payer: UHC Exchange |
$46.00
|
| Rate for Payer: UHC Medicaid |
$32.44
|
| Rate for Payer: UHC Medicare Advantage |
$46.00
|
| Rate for Payer: UHCCP Medicaid |
$32.44
|
| Rate for Payer: VA VA |
$46.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.77 |
| 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 |
$18.66
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$82.87
|
| Rate for Payer: BCN Commercial |
$82.87
|
| 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: Mclaren Medicaid |
$17.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.46
|
| Rate for Payer: Meridian Medicaid |
$18.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Nomi Health Commercial |
$82.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.60
|
| 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 Choice Medicaid |
$17.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.16
|
| 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 Exchange |
$25.20
|
| Rate for Payer: UHC Medicaid |
$17.77
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
| Rate for Payer: UHCCP Medicaid |
$17.77
|
| Rate for Payer: VA VA |
$25.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$5.09
|
|
|
Service Code
|
NDC 00904727966
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.59
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS MAPPO |
$1.27
|
| Rate for Payer: BCBS Trust/PPO |
$4.18
|
| Rate for Payer: BCN Commercial |
$4.18
|
| Rate for Payer: BCN Medicare Advantage |
$1.27
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.27
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Mclaren Medicaid |
$0.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.34
|
| Rate for Payer: Meridian Medicaid |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.82
|
| Rate for Payer: PACE Senior Care Partners |
$1.21
|
| Rate for Payer: PACE SWMI |
$1.27
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.43
|
| Rate for Payer: Priority Health Medicare |
$1.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.48
|
| Rate for Payer: UHC Core |
$4.25
|
| Rate for Payer: UHC Exchange |
$1.27
|
| Rate for Payer: UHC Medicaid |
$0.90
|
| Rate for Payer: UHC Medicare Advantage |
$1.27
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: VA VA |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$5.09
|
|
|
Service Code
|
NDC 00904727966
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: BCBS Trust/PPO |
$4.20
|
| Rate for Payer: BCN Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.07
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.82
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.48
|
| Rate for Payer: UHC Core |
$4.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$5.09
|
|
|
Service Code
|
NDC 00904727972
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.59
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS MAPPO |
$1.27
|
| Rate for Payer: BCBS Trust/PPO |
$4.18
|
| Rate for Payer: BCN Commercial |
$4.18
|
| Rate for Payer: BCN Medicare Advantage |
$1.27
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.27
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Mclaren Medicaid |
$0.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.34
|
| Rate for Payer: Meridian Medicaid |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.82
|
| Rate for Payer: PACE Senior Care Partners |
$1.21
|
| Rate for Payer: PACE SWMI |
$1.27
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: PHP Medicare Advantage |
$1.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.43
|
| Rate for Payer: Priority Health Medicare |
$1.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.48
|
| Rate for Payer: UHC Core |
$4.25
|
| Rate for Payer: UHC Exchange |
$1.27
|
| Rate for Payer: UHC Medicaid |
$0.90
|
| Rate for Payer: UHC Medicare Advantage |
$1.27
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: VA VA |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$5.09
|
|
|
Service Code
|
NDC 00904727972
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: BCBS Trust/PPO |
$4.20
|
| Rate for Payer: BCN Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.07
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.82
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.48
|
| Rate for Payer: UHC Core |
$4.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
