|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$800.06
|
|
|
Service Code
|
NDC 00517656001
|
| Hospital Charge Code |
190643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$352.03 |
| Max. Negotiated Rate |
$720.05 |
| Rate for Payer: Aetna American Axle |
$520.04
|
| Rate for Payer: Aetna Commercial |
$680.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.04
|
| Rate for Payer: Cash Price |
$640.05
|
| Rate for Payer: Cofinity Advantage |
$560.04
|
| Rate for Payer: Cofinity Commercial |
$688.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.05
|
| Rate for Payer: Healthscope Commercial |
$720.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$560.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.04
|
| Rate for Payer: PHP Commercial |
$680.05
|
| Rate for Payer: Priority Health SBD |
$504.04
|
| Rate for Payer: UMR Bronson Commercial |
$352.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.04
|
|
|
SELENIUM SD 10 MCG/ML IV
|
Facility
|
OP
|
$33.14
|
|
|
Service Code
|
NDC 09900000056
|
| Hospital Charge Code |
157114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna American Axle |
$21.54
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna Medicare |
$16.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.54
|
| Rate for Payer: BCBS Complete |
$13.26
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cofinity Advantage |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$28.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.51
|
| Rate for Payer: Healthscope Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.86
|
| Rate for Payer: PHP Commercial |
$28.17
|
| Rate for Payer: Priority Health SBD |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$17.27
|
| Rate for Payer: UHC Exchange |
$13.02
|
| Rate for Payer: UMR Bronson Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.86
|
|
|
SELENIUM SD 10 MCG/ML IV
|
Facility
|
IP
|
$33.14
|
|
|
Service Code
|
NDC 09900000056
|
| Hospital Charge Code |
157114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna American Axle |
$21.54
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.54
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cofinity Advantage |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$28.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.51
|
| Rate for Payer: Healthscope Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.86
|
| Rate for Payer: PHP Commercial |
$28.17
|
| Rate for Payer: Priority Health SBD |
$20.88
|
| Rate for Payer: UMR Bronson Commercial |
$14.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.86
|
|
|
SELENIUM SULFIDE 2.5 % LOTION
|
Facility
|
OP
|
$36.12
|
|
|
Service Code
|
NDC 45802004064
|
| Hospital Charge Code |
177121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$32.51 |
| Rate for Payer: Aetna American Axle |
$23.48
|
| Rate for Payer: Aetna Commercial |
$30.70
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.48
|
| Rate for Payer: BCBS Complete |
$14.45
|
| Rate for Payer: Cash Price |
$28.90
|
| Rate for Payer: Cofinity Advantage |
$25.28
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.90
|
| Rate for Payer: Healthscope Commercial |
$32.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.09
|
| Rate for Payer: PHP Commercial |
$30.70
|
| Rate for Payer: Priority Health SBD |
$22.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.48
|
| Rate for Payer: UHC Core |
$18.82
|
| Rate for Payer: UHC Exchange |
$14.20
|
| Rate for Payer: UMR Bronson Commercial |
$13.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.09
|
|
|
SELENIUM SULFIDE 2.5 % LOTION
|
Facility
|
IP
|
$36.12
|
|
|
Service Code
|
NDC 45802004064
|
| Hospital Charge Code |
177121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$32.51 |
| Rate for Payer: Aetna American Axle |
$23.48
|
| Rate for Payer: Aetna Commercial |
$30.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.48
|
| Rate for Payer: Cash Price |
$28.90
|
| Rate for Payer: Cofinity Advantage |
$25.28
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.90
|
| Rate for Payer: Healthscope Commercial |
$32.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.09
|
| Rate for Payer: PHP Commercial |
$30.70
|
| Rate for Payer: Priority Health SBD |
$22.76
|
| Rate for Payer: UMR Bronson Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.09
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$44.52
|
|
|
Service Code
|
NDC 67618031030
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$40.07 |
| Rate for Payer: Aetna American Axle |
$28.94
|
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.94
|
| Rate for Payer: Cash Price |
$35.62
|
| Rate for Payer: Cofinity Advantage |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$38.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.62
|
| Rate for Payer: Healthscope Commercial |
$40.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.39
|
| Rate for Payer: PHP Commercial |
$37.84
|
| Rate for Payer: Priority Health SBD |
$28.05
|
| Rate for Payer: UMR Bronson Commercial |
$19.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.39
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$191.10
|
|
|
Service Code
|
NDC 67618031060
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$171.99 |
| Rate for Payer: Aetna American Axle |
$124.22
|
| Rate for Payer: Aetna Commercial |
$162.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.22
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cofinity Advantage |
$133.77
|
| Rate for Payer: Cofinity Commercial |
$164.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.88
|
| Rate for Payer: Healthscope Commercial |
$171.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.32
|
| Rate for Payer: PHP Commercial |
$162.44
|
| Rate for Payer: Priority Health SBD |
$120.39
|
| Rate for Payer: UMR Bronson Commercial |
$84.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.32
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
NDC 60687062211
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna American Axle |
$1.04
|
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.04
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Advantage |
$1.12
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.20
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: Priority Health SBD |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 60687062211
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna American Axle |
$1.04
|
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.04
|
| Rate for Payer: BCBS Complete |
$0.64
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Advantage |
$1.12
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.20
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: Priority Health SBD |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.04
|
| Rate for Payer: UHC Core |
$0.83
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UMR Bronson Commercial |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
NDC 69618006501
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna American Axle |
$102.38
|
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Advantage |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.12
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health SBD |
$99.22
|
| Rate for Payer: UMR Bronson Commercial |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$146.16
|
|
|
Service Code
|
NDC 67618011060
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$131.54 |
| Rate for Payer: Aetna American Axle |
$95.00
|
| Rate for Payer: Aetna Commercial |
$124.24
|
| Rate for Payer: Aetna Medicare |
$73.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.00
|
| Rate for Payer: BCBS Complete |
$58.46
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cofinity Advantage |
$102.31
|
| Rate for Payer: Cofinity Commercial |
$125.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.93
|
| Rate for Payer: Healthscope Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.62
|
| Rate for Payer: PHP Commercial |
$124.24
|
| Rate for Payer: Priority Health SBD |
$92.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.00
|
| Rate for Payer: UHC Core |
$76.15
|
| Rate for Payer: UHC Exchange |
$57.44
|
| Rate for Payer: UMR Bronson Commercial |
$54.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.62
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$84.63
|
|
|
Service Code
|
NDC 67618011030
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$76.17 |
| Rate for Payer: Aetna American Axle |
$55.01
|
| Rate for Payer: Aetna Commercial |
$71.94
|
| Rate for Payer: Aetna Medicare |
$42.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.01
|
| Rate for Payer: BCBS Complete |
$33.85
|
| Rate for Payer: Cash Price |
$67.70
|
| Rate for Payer: Cofinity Advantage |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$72.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.70
|
| Rate for Payer: Healthscope Commercial |
$76.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.47
|
| Rate for Payer: PHP Commercial |
$71.94
|
| Rate for Payer: Priority Health SBD |
$53.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.01
|
| Rate for Payer: UHC Core |
$44.09
|
| Rate for Payer: UHC Exchange |
$33.26
|
| Rate for Payer: UMR Bronson Commercial |
$31.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.47
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$146.16
|
|
|
Service Code
|
NDC 67618011060
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$131.54 |
| Rate for Payer: Aetna American Axle |
$95.00
|
| Rate for Payer: Aetna Commercial |
$124.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.00
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cofinity Advantage |
$102.31
|
| Rate for Payer: Cofinity Commercial |
$125.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.93
|
| Rate for Payer: Healthscope Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.62
|
| Rate for Payer: PHP Commercial |
$124.24
|
| Rate for Payer: Priority Health SBD |
$92.08
|
| Rate for Payer: UMR Bronson Commercial |
$64.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.62
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
NDC 69618006501
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna American Axle |
$102.38
|
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna Medicare |
$78.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: BCBS Complete |
$63.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Advantage |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.12
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health SBD |
$99.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.38
|
| Rate for Payer: UHC Core |
$82.06
|
| Rate for Payer: UHC Exchange |
$61.90
|
| Rate for Payer: UMR Bronson Commercial |
$58.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 00536124701
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.20
|
| Rate for Payer: UHC Core |
$77.11
|
| Rate for Payer: UHC Exchange |
$58.16
|
| Rate for Payer: UMR Bronson Commercial |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$191.10
|
|
|
Service Code
|
NDC 67618031060
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.71 |
| Max. Negotiated Rate |
$171.99 |
| Rate for Payer: Aetna American Axle |
$124.22
|
| Rate for Payer: Aetna Commercial |
$162.44
|
| Rate for Payer: Aetna Medicare |
$95.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.22
|
| Rate for Payer: BCBS Complete |
$76.44
|
| Rate for Payer: Cash Price |
$152.88
|
| Rate for Payer: Cofinity Advantage |
$133.77
|
| Rate for Payer: Cofinity Commercial |
$164.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.88
|
| Rate for Payer: Healthscope Commercial |
$171.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.32
|
| Rate for Payer: PHP Commercial |
$162.44
|
| Rate for Payer: Priority Health SBD |
$120.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.22
|
| Rate for Payer: UHC Core |
$99.56
|
| Rate for Payer: UHC Exchange |
$75.10
|
| Rate for Payer: UMR Bronson Commercial |
$70.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.32
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 00536124701
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$84.63
|
|
|
Service Code
|
NDC 67618011030
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$76.17 |
| Rate for Payer: Aetna American Axle |
$55.01
|
| Rate for Payer: Aetna Commercial |
$71.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.01
|
| Rate for Payer: Cash Price |
$67.70
|
| Rate for Payer: Cofinity Advantage |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$72.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.70
|
| Rate for Payer: Healthscope Commercial |
$76.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.47
|
| Rate for Payer: PHP Commercial |
$71.94
|
| Rate for Payer: Priority Health SBD |
$53.32
|
| Rate for Payer: UMR Bronson Commercial |
$37.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.47
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
NDC 00536124801
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna American Axle |
$102.38
|
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Advantage |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.12
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health SBD |
$99.22
|
| Rate for Payer: UMR Bronson Commercial |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$103.62
|
|
|
Service Code
|
NDC 60258095106
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.59 |
| Max. Negotiated Rate |
$93.26 |
| Rate for Payer: Aetna American Axle |
$67.35
|
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.35
|
| Rate for Payer: Cash Price |
$82.90
|
| Rate for Payer: Cofinity Advantage |
$72.53
|
| Rate for Payer: Cofinity Commercial |
$89.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.90
|
| Rate for Payer: Healthscope Commercial |
$93.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.72
|
| Rate for Payer: PHP Commercial |
$88.08
|
| Rate for Payer: Priority Health SBD |
$65.28
|
| Rate for Payer: UMR Bronson Commercial |
$45.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.72
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 00761035920
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.20
|
| Rate for Payer: UHC Core |
$77.11
|
| Rate for Payer: UHC Exchange |
$58.16
|
| Rate for Payer: UMR Bronson Commercial |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
NDC 00536124801
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna American Axle |
$102.38
|
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna Medicare |
$78.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: BCBS Complete |
$63.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Advantage |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.12
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health SBD |
$99.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.38
|
| Rate for Payer: UHC Core |
$82.06
|
| Rate for Payer: UHC Exchange |
$61.90
|
| Rate for Payer: UMR Bronson Commercial |
$58.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$44.52
|
|
|
Service Code
|
NDC 67618031030
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$40.07 |
| Rate for Payer: Aetna American Axle |
$28.94
|
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: Aetna Medicare |
$22.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.94
|
| Rate for Payer: BCBS Complete |
$17.81
|
| Rate for Payer: Cash Price |
$35.62
|
| Rate for Payer: Cofinity Advantage |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$38.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.62
|
| Rate for Payer: Healthscope Commercial |
$40.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.39
|
| Rate for Payer: PHP Commercial |
$37.84
|
| Rate for Payer: Priority Health SBD |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.94
|
| Rate for Payer: UHC Core |
$23.19
|
| Rate for Payer: UHC Exchange |
$17.50
|
| Rate for Payer: UMR Bronson Commercial |
$16.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.39
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$159.50
|
|
|
Service Code
|
NDC 60687062201
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$143.55 |
| Rate for Payer: Aetna American Axle |
$103.67
|
| Rate for Payer: Aetna Commercial |
$135.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.67
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cofinity Advantage |
$111.65
|
| Rate for Payer: Cofinity Commercial |
$137.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.60
|
| Rate for Payer: Healthscope Commercial |
$143.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.62
|
| Rate for Payer: PHP Commercial |
$135.57
|
| Rate for Payer: Priority Health SBD |
$100.48
|
| Rate for Payer: UMR Bronson Commercial |
$70.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.62
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$159.50
|
|
|
Service Code
|
NDC 60687062201
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$143.55 |
| Rate for Payer: Aetna American Axle |
$103.67
|
| Rate for Payer: Aetna Commercial |
$135.57
|
| Rate for Payer: Aetna Medicare |
$79.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.67
|
| Rate for Payer: BCBS Complete |
$63.80
|
| Rate for Payer: Cash Price |
$127.60
|
| Rate for Payer: Cofinity Advantage |
$111.65
|
| Rate for Payer: Cofinity Commercial |
$137.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.60
|
| Rate for Payer: Healthscope Commercial |
$143.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.62
|
| Rate for Payer: PHP Commercial |
$135.57
|
| Rate for Payer: Priority Health SBD |
$100.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.67
|
| Rate for Payer: UHC Core |
$83.10
|
| Rate for Payer: UHC Exchange |
$62.68
|
| Rate for Payer: UMR Bronson Commercial |
$59.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.62
|
|
