|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Advantage |
$1.23
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.32
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health SBD |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.14
|
| Rate for Payer: UHC Core |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.32
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 63739047802
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna American Axle |
$9.10
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: UMR Bronson Commercial |
$6.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$151.20
|
|
|
Service Code
|
NDC 57896040101
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.94 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$75.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: BCBS Complete |
$60.48
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Advantage |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.40
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.28
|
| Rate for Payer: UHC Core |
$78.78
|
| Rate for Payer: UHC Exchange |
$59.42
|
| Rate for Payer: UMR Bronson Commercial |
$55.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.44 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna American Axle |
$114.40
|
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Advantage |
$123.20
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$123.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health SBD |
$110.88
|
| Rate for Payer: UMR Bronson Commercial |
$77.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 63739047802
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna American Axle |
$9.10
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.10
|
| Rate for Payer: UHC Core |
$7.29
|
| Rate for Payer: UHC Exchange |
$5.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.30 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna American Axle |
$65.52
|
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$50.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.52
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Advantage |
$70.56
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$70.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.60
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health SBD |
$63.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.52
|
| Rate for Payer: UHC Core |
$52.52
|
| Rate for Payer: UHC Exchange |
$39.61
|
| Rate for Payer: UMR Bronson Commercial |
$37.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna American Axle |
$119.60
|
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Advantage |
$128.80
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$128.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.60
|
| Rate for Payer: UHC Core |
$95.86
|
| Rate for Payer: UHC Exchange |
$72.31
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna American Axle |
$114.40
|
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Advantage |
$123.20
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$123.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health SBD |
$110.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.40
|
| Rate for Payer: UHC Core |
$91.70
|
| Rate for Payer: UHC Exchange |
$69.17
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$100.80
|
|
|
Service Code
|
NDC 00904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna American Axle |
$65.52
|
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.52
|
| Rate for Payer: Cash Price |
$80.64
|
| Rate for Payer: Cofinity Advantage |
$70.56
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$70.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.60
|
| Rate for Payer: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health SBD |
$63.50
|
| Rate for Payer: UMR Bronson Commercial |
$44.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.60
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$151.20
|
|
|
Service Code
|
NDC 45802048678
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.94 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$75.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: BCBS Complete |
$60.48
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Advantage |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.40
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.28
|
| Rate for Payer: UHC Core |
$78.78
|
| Rate for Payer: UHC Exchange |
$59.42
|
| Rate for Payer: UMR Bronson Commercial |
$55.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$135.24
|
|
|
Service Code
|
NDC 67618010160
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$121.72 |
| Rate for Payer: Aetna American Axle |
$87.91
|
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna Medicare |
$67.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.91
|
| Rate for Payer: BCBS Complete |
$54.10
|
| Rate for Payer: Cash Price |
$108.19
|
| Rate for Payer: Cofinity Advantage |
$94.67
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.19
|
| Rate for Payer: Healthscope Commercial |
$121.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.43
|
| Rate for Payer: PHP Commercial |
$114.95
|
| Rate for Payer: Priority Health SBD |
$85.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.91
|
| Rate for Payer: UHC Core |
$70.46
|
| Rate for Payer: UHC Exchange |
$53.15
|
| Rate for Payer: UMR Bronson Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.43
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Advantage |
$1.23
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.32
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health SBD |
$1.11
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.32
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Advantage |
$132.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UMR Bronson Commercial |
$83.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$135.24
|
|
|
Service Code
|
NDC 67618010160
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$121.72 |
| Rate for Payer: Aetna American Axle |
$87.91
|
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.91
|
| Rate for Payer: Cash Price |
$108.19
|
| Rate for Payer: Cofinity Advantage |
$94.67
|
| Rate for Payer: Cofinity Commercial |
$116.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.19
|
| Rate for Payer: Healthscope Commercial |
$121.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.43
|
| Rate for Payer: PHP Commercial |
$114.95
|
| Rate for Payer: Priority Health SBD |
$85.20
|
| Rate for Payer: UMR Bronson Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.43
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$27.93
|
|
|
Service Code
|
NDC 67618010110
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna American Axle |
$18.15
|
| Rate for Payer: Aetna Commercial |
$23.74
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
| Rate for Payer: BCBS Complete |
$11.17
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cofinity Advantage |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.95
|
| Rate for Payer: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health SBD |
$17.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.15
|
| Rate for Payer: UHC Core |
$14.55
|
| Rate for Payer: UHC Exchange |
$10.98
|
| Rate for Payer: UMR Bronson Commercial |
$10.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.95
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
NDC 45802048678
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Advantage |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.40
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$66.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
NDC 00904718361
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.96 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna American Axle |
$119.60
|
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Advantage |
$128.80
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$128.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: UMR Bronson Commercial |
$80.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$27.93
|
|
|
Service Code
|
NDC 67618010110
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna American Axle |
$18.15
|
| Rate for Payer: Aetna Commercial |
$23.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cofinity Advantage |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.95
|
| Rate for Payer: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health SBD |
$17.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.95
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna American Axle |
$122.85
|
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Advantage |
$132.30
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$132.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.85
|
| Rate for Payer: UHC Core |
$98.47
|
| Rate for Payer: UHC Exchange |
$74.28
|
| Rate for Payer: UMR Bronson Commercial |
$69.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.75
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
NDC 57896040101
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Advantage |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.40
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$66.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 50383034911
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Advantage |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.49
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 50383034911
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Advantage |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.49
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.16
|
| Rate for Payer: UHC Core |
$1.73
|
| Rate for Payer: UHC Exchange |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$35.01
|
|
|
Service Code
|
NDC 00536130485
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$31.51 |
| Rate for Payer: Aetna American Axle |
$22.76
|
| Rate for Payer: Aetna Commercial |
$29.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.76
|
| Rate for Payer: Cash Price |
$28.01
|
| Rate for Payer: Cofinity Advantage |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.01
|
| Rate for Payer: Healthscope Commercial |
$31.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.26
|
| Rate for Payer: PHP Commercial |
$29.76
|
| Rate for Payer: Priority Health SBD |
$22.06
|
| Rate for Payer: UMR Bronson Commercial |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.26
|
|
|
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 |
$1.88 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna American Axle |
$3.31
|
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Advantage |
$3.56
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.82
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health SBD |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.31
|
| Rate for Payer: UHC Core |
$2.65
|
| Rate for Payer: UHC Exchange |
$2.00
|
| Rate for Payer: UMR Bronson Commercial |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$35.01
|
|
|
Service Code
|
NDC 00536130485
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$31.51 |
| Rate for Payer: Aetna American Axle |
$22.76
|
| Rate for Payer: Aetna Commercial |
$29.76
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.76
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.01
|
| Rate for Payer: Cofinity Advantage |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.01
|
| Rate for Payer: Healthscope Commercial |
$31.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.26
|
| Rate for Payer: PHP Commercial |
$29.76
|
| Rate for Payer: Priority Health SBD |
$22.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.76
|
| Rate for Payer: UHC Core |
$18.24
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.26
|
|
