|
DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS
|
Facility
|
IP
|
$30.49
|
|
|
Service Code
|
NDC 24208048610
|
| Hospital Charge Code |
22982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Aetna Commercial |
$25.92
|
| Rate for Payer: BCBS Trust/PPO |
$25.18
|
| Rate for Payer: BCN Commercial |
$25.18
|
| Rate for Payer: Cash Price |
$24.39
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.39
|
| Rate for Payer: Healthscope Commercial |
$27.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.92
|
| Rate for Payer: Nomi Health Commercial |
$25.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.87
|
| Rate for Payer: PHP Commercial |
$25.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.83
|
| Rate for Payer: UHC Core |
$25.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.87
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$36.63
|
|
|
Service Code
|
NDC 50383023210
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.45
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$30.11
|
| Rate for Payer: BCN Commercial |
$30.11
|
| Rate for Payer: BCN Medicare Advantage |
$9.16
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.16
|
| Rate for Payer: Healthscope Commercial |
$32.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.47
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.62
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.14
|
| Rate for Payer: Nomi Health Commercial |
$30.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.47
|
| Rate for Payer: PACE Senior Care Partners |
$8.70
|
| Rate for Payer: PACE SWMI |
$9.16
|
| Rate for Payer: PHP Commercial |
$31.14
|
| Rate for Payer: PHP Medicare Advantage |
$9.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.87
|
| Rate for Payer: Priority Health Medicare |
$9.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.23
|
| Rate for Payer: UHC Core |
$30.59
|
| Rate for Payer: UHC Exchange |
$9.16
|
| Rate for Payer: UHC Medicaid |
$6.46
|
| Rate for Payer: UHC Medicare Advantage |
$9.16
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$9.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.47
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$51.62
|
|
|
Service Code
|
NDC 72266019701
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.93 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: BCBS Trust/PPO |
$42.63
|
| Rate for Payer: BCN Commercial |
$42.63
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.30
|
| Rate for Payer: Healthscope Commercial |
$46.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$42.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.72
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.43
|
| Rate for Payer: UHC Core |
$43.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
NDC 72888007715
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.93
|
| Rate for Payer: BCN Commercial |
$30.93
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.09
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$86.03
|
|
|
Service Code
|
NDC 61314001910
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$77.43 |
| Rate for Payer: Aetna Commercial |
$73.13
|
| Rate for Payer: Aetna Medicare |
$22.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.88
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: BCBS MAPPO |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$70.73
|
| Rate for Payer: BCN Commercial |
$70.73
|
| Rate for Payer: BCN Medicare Advantage |
$21.51
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Commercial |
$73.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.51
|
| Rate for Payer: Healthscope Commercial |
$77.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.52
|
| Rate for Payer: Mclaren Medicaid |
$15.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.58
|
| Rate for Payer: Meridian Medicaid |
$15.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.13
|
| Rate for Payer: Nomi Health Commercial |
$70.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.52
|
| Rate for Payer: PACE Senior Care Partners |
$20.43
|
| Rate for Payer: PACE SWMI |
$21.51
|
| Rate for Payer: PHP Commercial |
$73.13
|
| Rate for Payer: PHP Medicare Advantage |
$21.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.85
|
| Rate for Payer: Priority Health Medicare |
$21.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.88
|
| Rate for Payer: Railroad Medicare Medicare |
$21.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.71
|
| Rate for Payer: UHC Core |
$71.84
|
| Rate for Payer: UHC Exchange |
$21.51
|
| Rate for Payer: UHC Medicaid |
$15.17
|
| Rate for Payer: UHC Medicare Advantage |
$21.51
|
| Rate for Payer: UHCCP Medicaid |
$15.17
|
| Rate for Payer: VA VA |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.52
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$86.03
|
|
|
Service Code
|
NDC 61314001910
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.88 |
| Max. Negotiated Rate |
$77.43 |
| Rate for Payer: Aetna Commercial |
$73.13
|
| Rate for Payer: BCBS Trust/PPO |
$71.05
|
| Rate for Payer: BCN Commercial |
$71.05
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Commercial |
$73.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Healthscope Commercial |
$77.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.13
|
| Rate for Payer: Nomi Health Commercial |
$70.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.52
|
| Rate for Payer: PHP Commercial |
$73.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.71
|
| Rate for Payer: UHC Core |
$71.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.52
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$29.27
|
|
|
Service Code
|
NDC 70069050101
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Aetna Commercial |
$24.88
|
| Rate for Payer: Aetna Medicare |
$7.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.15
|
| Rate for Payer: BCBS Complete |
$5.42
|
| Rate for Payer: BCBS MAPPO |
$7.32
|
| Rate for Payer: BCBS Trust/PPO |
$24.06
|
| Rate for Payer: BCN Commercial |
$24.06
|
| Rate for Payer: BCN Medicare Advantage |
$7.32
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cofinity Commercial |
$25.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.32
|
| Rate for Payer: Healthscope Commercial |
$26.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.95
|
| Rate for Payer: Mclaren Medicaid |
$5.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$5.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.88
|
| Rate for Payer: Nomi Health Commercial |
$24.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PACE Senior Care Partners |
$6.95
|
| Rate for Payer: PACE SWMI |
$7.32
|
| Rate for Payer: PHP Commercial |
$24.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.46
|
| Rate for Payer: Priority Health Medicare |
$7.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.37
|
| Rate for Payer: Railroad Medicare Medicare |
$7.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.76
|
| Rate for Payer: UHC Core |
$24.44
|
| Rate for Payer: UHC Exchange |
$7.32
|
| Rate for Payer: UHC Medicaid |
$5.16
|
| Rate for Payer: UHC Medicare Advantage |
$7.32
|
| Rate for Payer: UHCCP Medicaid |
$5.16
|
| Rate for Payer: VA VA |
$7.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.95
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
NDC 72888007715
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$30.79
|
| Rate for Payer: BCN Commercial |
$30.79
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$6.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$6.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$30.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.09
|
| Rate for Payer: PACE Senior Care Partners |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.58
|
| Rate for Payer: Priority Health Medicare |
$9.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.07
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.96
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: UHC Exchange |
$9.36
|
| Rate for Payer: UHC Medicaid |
$6.60
|
| Rate for Payer: UHC Medicare Advantage |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
| Rate for Payer: VA VA |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.09
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$36.63
|
|
|
Service Code
|
NDC 50383023210
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$32.97 |
| Rate for Payer: Aetna Commercial |
$31.14
|
| Rate for Payer: BCBS Trust/PPO |
$30.25
|
| Rate for Payer: BCN Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$32.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.14
|
| Rate for Payer: Nomi Health Commercial |
$30.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.47
|
| Rate for Payer: PHP Commercial |
$31.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.23
|
| Rate for Payer: UHC Core |
$30.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.47
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
IP
|
$29.27
|
|
|
Service Code
|
NDC 70069050101
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Aetna Commercial |
$24.88
|
| Rate for Payer: BCBS Trust/PPO |
$24.17
|
| Rate for Payer: BCN Commercial |
$24.17
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cofinity Commercial |
$25.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.42
|
| Rate for Payer: Healthscope Commercial |
$26.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.88
|
| Rate for Payer: Nomi Health Commercial |
$24.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PHP Commercial |
$24.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.76
|
| Rate for Payer: UHC Core |
$24.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.95
|
|
|
DORZOLAMIDE 2 % EYE DROPS
|
Facility
|
OP
|
$51.62
|
|
|
Service Code
|
NDC 72266019701
|
| Hospital Charge Code |
14471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$46.46 |
| Rate for Payer: Aetna Commercial |
$43.88
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.13
|
| Rate for Payer: BCBS Complete |
$9.55
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.44
|
| Rate for Payer: BCN Commercial |
$42.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cofinity Commercial |
$44.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$46.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.72
|
| Rate for Payer: Mclaren Medicaid |
$9.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.55
|
| Rate for Payer: Meridian Medicaid |
$9.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$42.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.72
|
| Rate for Payer: PACE Senior Care Partners |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$43.88
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.91
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.43
|
| Rate for Payer: UHC Core |
$43.10
|
| Rate for Payer: UHC Exchange |
$12.90
|
| Rate for Payer: UHC Medicaid |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$12.90
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
| Rate for Payer: VA VA |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.72
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
NDC 69238117009
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.41 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$359.55
|
| Rate for Payer: BCBS Trust/PPO |
$349.36
|
| Rate for Payer: BCN Commercial |
$349.36
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cofinity Commercial |
$363.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.40
|
| Rate for Payer: Healthscope Commercial |
$380.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.55
|
| Rate for Payer: Nomi Health Commercial |
$346.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.25
|
| Rate for Payer: PHP Commercial |
$359.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$368.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.24
|
| Rate for Payer: UHC Core |
$353.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.25
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 51079043701
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.81
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 51079043701
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.80
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Mclaren Medicaid |
$0.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: Meridian Medicaid |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.89
|
| Rate for Payer: Nomi Health Commercial |
$2.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.55
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.96
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.84
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicaid |
$0.60
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: UHCCP Medicaid |
$0.60
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$339.84
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$305.86 |
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: Aetna Medicare |
$88.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.20
|
| Rate for Payer: BCBS Complete |
$62.90
|
| Rate for Payer: BCBS MAPPO |
$84.96
|
| Rate for Payer: BCBS Trust/PPO |
$279.38
|
| Rate for Payer: BCN Commercial |
$279.38
|
| Rate for Payer: BCN Medicare Advantage |
$84.96
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.96
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.88
|
| Rate for Payer: Mclaren Medicaid |
$59.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.21
|
| Rate for Payer: Meridian Medicaid |
$62.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.86
|
| Rate for Payer: Nomi Health Commercial |
$278.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.88
|
| Rate for Payer: PACE Senior Care Partners |
$80.71
|
| Rate for Payer: PACE SWMI |
$84.96
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: PHP Medicare Advantage |
$84.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.66
|
| Rate for Payer: Priority Health Medicare |
$85.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.53
|
| Rate for Payer: Railroad Medicare Medicare |
$84.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.06
|
| Rate for Payer: UHC Core |
$283.77
|
| Rate for Payer: UHC Exchange |
$84.96
|
| Rate for Payer: UHC Medicaid |
$59.91
|
| Rate for Payer: UHC Medicare Advantage |
$84.96
|
| Rate for Payer: UHCCP Medicaid |
$59.91
|
| Rate for Payer: VA VA |
$84.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.88
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
NDC 69238117009
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.57 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Aetna Commercial |
$359.55
|
| Rate for Payer: Aetna Medicare |
$109.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.19
|
| Rate for Payer: BCBS Complete |
$78.30
|
| Rate for Payer: BCBS MAPPO |
$105.75
|
| Rate for Payer: BCBS Trust/PPO |
$347.75
|
| Rate for Payer: BCN Commercial |
$347.75
|
| Rate for Payer: BCN Medicare Advantage |
$105.75
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cofinity Commercial |
$363.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.75
|
| Rate for Payer: Healthscope Commercial |
$380.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.25
|
| Rate for Payer: Mclaren Medicaid |
$74.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.04
|
| Rate for Payer: Meridian Medicaid |
$78.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.55
|
| Rate for Payer: Nomi Health Commercial |
$346.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.25
|
| Rate for Payer: PACE Senior Care Partners |
$100.46
|
| Rate for Payer: PACE SWMI |
$105.75
|
| Rate for Payer: PHP Commercial |
$359.55
|
| Rate for Payer: PHP Medicare Advantage |
$105.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$368.01
|
| Rate for Payer: Priority Health Medicare |
$106.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.41
|
| Rate for Payer: Railroad Medicare Medicare |
$105.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.24
|
| Rate for Payer: UHC Core |
$353.20
|
| Rate for Payer: UHC Exchange |
$105.75
|
| Rate for Payer: UHC Medicaid |
$74.57
|
| Rate for Payer: UHC Medicare Advantage |
$105.75
|
| Rate for Payer: UHCCP Medicaid |
$74.57
|
| Rate for Payer: VA VA |
$105.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.25
|
|
|
DOXEPIN 25 MG CAPSULE
|
Facility
|
IP
|
$339.84
|
|
|
Service Code
|
NDC 51079043720
|
| Hospital Charge Code |
2611
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.53 |
| Max. Negotiated Rate |
$305.86 |
| Rate for Payer: Aetna Commercial |
$288.86
|
| Rate for Payer: BCBS Trust/PPO |
$280.67
|
| Rate for Payer: BCN Commercial |
$280.67
|
| Rate for Payer: Cash Price |
$271.87
|
| Rate for Payer: Cofinity Commercial |
$292.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.87
|
| Rate for Payer: Healthscope Commercial |
$305.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.86
|
| Rate for Payer: Nomi Health Commercial |
$278.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.88
|
| Rate for Payer: PHP Commercial |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.06
|
| Rate for Payer: UHC Core |
$283.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.88
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$17.94
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.56
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS Complete |
$12.77
|
| Rate for Payer: BCBS MAPPO |
$17.25
|
| Rate for Payer: BCBS MAPPO |
$9.33
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$30.68
|
| Rate for Payer: BCBS Trust/PPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$56.72
|
| Rate for Payer: BCN Commercial |
$37.73
|
| Rate for Payer: BCN Commercial |
$56.72
|
| Rate for Payer: BCN Commercial |
$30.68
|
| Rate for Payer: BCN Medicare Advantage |
$17.25
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: BCN Medicare Advantage |
$9.33
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.33
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Mclaren Medicaid |
$6.58
|
| Rate for Payer: Mclaren Medicaid |
$12.16
|
| Rate for Payer: Mclaren Medicaid |
$8.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.11
|
| Rate for Payer: Meridian Medicaid |
$12.77
|
| Rate for Payer: Meridian Medicaid |
$6.91
|
| Rate for Payer: Meridian Medicaid |
$8.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$56.58
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: Nomi Health Commercial |
$30.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.86
|
| Rate for Payer: PACE Senior Care Partners |
$16.39
|
| Rate for Payer: PACE SWMI |
$17.25
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PACE SWMI |
$9.33
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: PHP Medicare Advantage |
$9.33
|
| Rate for Payer: PHP Medicare Advantage |
$17.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.03
|
| Rate for Payer: Priority Health Medicare |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$11.59
|
| Rate for Payer: Priority Health Medicare |
$9.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.25
|
| Rate for Payer: Railroad Medicare Medicare |
$9.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.84
|
| Rate for Payer: UHC Core |
$31.16
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Exchange |
$17.25
|
| Rate for Payer: UHC Exchange |
$11.47
|
| Rate for Payer: UHC Exchange |
$9.33
|
| Rate for Payer: UHC Medicaid |
$6.58
|
| Rate for Payer: UHC Medicaid |
$12.16
|
| Rate for Payer: UHC Medicaid |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$11.47
|
| Rate for Payer: UHC Medicare Advantage |
$9.33
|
| Rate for Payer: UHC Medicare Advantage |
$17.25
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
| Rate for Payer: UHCCP Medicaid |
$6.58
|
| Rate for Payer: UHCCP Medicaid |
$12.16
|
| Rate for Payer: VA VA |
$9.33
|
| Rate for Payer: VA VA |
$17.25
|
| Rate for Payer: VA VA |
$11.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
2622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$37.91
|
| Rate for Payer: BCBS Trust/PPO |
$30.82
|
| Rate for Payer: BCBS Trust/PPO |
$56.99
|
| Rate for Payer: BCN Commercial |
$37.91
|
| Rate for Payer: BCN Commercial |
$30.82
|
| Rate for Payer: BCN Commercial |
$56.99
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.65
|
| Rate for Payer: Nomi Health Commercial |
$30.60
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: Nomi Health Commercial |
$56.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.75
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.84
|
| Rate for Payer: UHC Core |
$31.16
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.66
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS MAPPO |
$9.33
|
| Rate for Payer: BCBS Trust/PPO |
$30.68
|
| Rate for Payer: BCN Commercial |
$30.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.33
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.33
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.99
|
| Rate for Payer: Mclaren Medicaid |
$6.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.80
|
| Rate for Payer: Meridian Medicaid |
$6.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Nomi Health Commercial |
$30.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: PACE Senior Care Partners |
$8.86
|
| Rate for Payer: PACE SWMI |
$9.33
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: PHP Medicare Advantage |
$9.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.47
|
| Rate for Payer: Priority Health Medicare |
$9.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.97
|
| Rate for Payer: Railroad Medicare Medicare |
$9.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.84
|
| Rate for Payer: UHC Core |
$31.16
|
| Rate for Payer: UHC Exchange |
$9.33
|
| Rate for Payer: UHC Medicaid |
$6.58
|
| Rate for Payer: UHC Medicare Advantage |
$9.33
|
| Rate for Payer: UHCCP Medicaid |
$6.58
|
| Rate for Payer: VA VA |
$9.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.99
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$37.32
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
301731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$33.59 |
| Rate for Payer: Aetna Commercial |
$31.72
|
| Rate for Payer: BCBS Trust/PPO |
$30.82
|
| Rate for Payer: BCN Commercial |
$30.82
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$32.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Healthscope Commercial |
$33.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.72
|
| Rate for Payer: Nomi Health Commercial |
$30.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.99
|
| Rate for Payer: PHP Commercial |
$31.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.84
|
| Rate for Payer: UHC Core |
$31.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.99
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
OP
|
$7.73
|
|
|
Service Code
|
NDC 50268027911
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna Commercial |
$6.57
|
| Rate for Payer: Aetna Medicare |
$2.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.43
|
| Rate for Payer: BCBS MAPPO |
$1.93
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.93
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$6.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Mclaren Medicaid |
$1.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.03
|
| Rate for Payer: Meridian Medicaid |
$1.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.57
|
| Rate for Payer: Nomi Health Commercial |
$6.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.80
|
| Rate for Payer: PACE Senior Care Partners |
$1.84
|
| Rate for Payer: PACE SWMI |
$1.93
|
| Rate for Payer: PHP Commercial |
$6.57
|
| Rate for Payer: PHP Medicare Advantage |
$1.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.73
|
| Rate for Payer: Priority Health Medicare |
$1.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.80
|
| Rate for Payer: UHC Core |
$6.45
|
| Rate for Payer: UHC Exchange |
$1.93
|
| Rate for Payer: UHC Medicaid |
$1.36
|
| Rate for Payer: UHC Medicare Advantage |
$1.93
|
| Rate for Payer: UHCCP Medicaid |
$1.36
|
| Rate for Payer: VA VA |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 00143211250
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$47.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.28
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$150.69
|
| Rate for Payer: BCN Medicare Advantage |
$45.83
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.83
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.83
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: Railroad Medicare Medicare |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicaid |
$32.32
|
| Rate for Payer: UHC Medicare Advantage |
$45.83
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$45.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 00143211250
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: BCBS Trust/PPO |
$151.39
|
| Rate for Payer: BCN Commercial |
$151.39
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
DOXYCYCLINE HYCLATE 100 MG TABLET
|
Facility
|
IP
|
$351.12
|
|
|
Service Code
|
NDC 00904043006
|
| Hospital Charge Code |
2625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.38 |
| Max. Negotiated Rate |
$316.01 |
| Rate for Payer: Aetna Commercial |
$298.45
|
| Rate for Payer: BCBS Trust/PPO |
$289.99
|
| Rate for Payer: BCN Commercial |
$289.99
|
| Rate for Payer: Cash Price |
$280.90
|
| Rate for Payer: Cofinity Commercial |
$301.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.90
|
| Rate for Payer: Healthscope Commercial |
$316.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.45
|
| Rate for Payer: Nomi Health Commercial |
$287.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.34
|
| Rate for Payer: PHP Commercial |
$298.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$305.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.99
|
| Rate for Payer: UHC Core |
$293.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.34
|
|
