|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$5.09
|
|
|
Service Code
|
NDC 00904727966
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna American Axle |
$3.31
|
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| 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: 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: UMR Bronson Commercial |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$7.89
|
|
|
Service Code
|
NDC 48433022010
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.13
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Exchange |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
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
|
$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
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 50383034910
|
| 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
|
$3.32
|
|
|
Service Code
|
NDC 50383034910
|
| 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
|
$7.89
|
|
|
Service Code
|
NDC 48433022040
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.13
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Exchange |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.89
|
|
|
Service Code
|
NDC 48433022010
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UMR Bronson Commercial |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
NDC 48433020510
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Aetna American Axle |
$5.30
|
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Advantage |
$5.71
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.12
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: Priority Health SBD |
$5.14
|
| Rate for Payer: UMR Bronson Commercial |
$3.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.12
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 09900000306
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna American Axle |
$2.78
|
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: Aetna Medicare |
$2.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Advantage |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.21
|
| Rate for Payer: PHP Commercial |
$3.64
|
| Rate for Payer: Priority Health SBD |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.78
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Exchange |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.21
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$5.09
|
|
|
Service Code
|
NDC 00904727972
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna American Axle |
$3.31
|
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| 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: 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: UMR Bronson Commercial |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$7.89
|
|
|
Service Code
|
NDC 48433022040
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Advantage |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UMR Bronson Commercial |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
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
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 00069580043
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna American Axle |
$0.61
|
| Rate for Payer: Aetna Commercial |
$0.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.61
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cofinity Advantage |
$0.66
|
| Rate for Payer: Cofinity Commercial |
$0.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.75
|
| Rate for Payer: Healthscope Commercial |
$0.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.71
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: Priority Health SBD |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$0.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.71
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 00069580043
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna American Axle |
$0.61
|
| Rate for Payer: Aetna Commercial |
$0.80
|
| Rate for Payer: Aetna Medicare |
$0.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.61
|
| Rate for Payer: BCBS Complete |
$0.38
|
| Rate for Payer: Cash Price |
$0.75
|
| Rate for Payer: Cofinity Advantage |
$0.66
|
| Rate for Payer: Cofinity Commercial |
$0.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.75
|
| Rate for Payer: Healthscope Commercial |
$0.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.71
|
| Rate for Payer: PHP Commercial |
$0.80
|
| Rate for Payer: Priority Health SBD |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC Core |
$0.49
|
| Rate for Payer: UHC Exchange |
$0.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.71
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
OP
|
$864.92
|
|
|
Service Code
|
NDC 59762003702
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$320.02 |
| Max. Negotiated Rate |
$778.43 |
| Rate for Payer: Aetna American Axle |
$562.20
|
| Rate for Payer: Aetna Commercial |
$735.18
|
| Rate for Payer: Aetna Medicare |
$432.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.20
|
| Rate for Payer: BCBS Complete |
$345.97
|
| Rate for Payer: Cash Price |
$691.94
|
| Rate for Payer: Cofinity Advantage |
$605.44
|
| Rate for Payer: Cofinity Commercial |
$743.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.94
|
| Rate for Payer: Healthscope Commercial |
$778.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$691.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.69
|
| Rate for Payer: PHP Commercial |
$735.18
|
| Rate for Payer: Priority Health SBD |
$544.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$562.20
|
| Rate for Payer: UHC Core |
$450.62
|
| Rate for Payer: UHC Exchange |
$339.91
|
| Rate for Payer: UMR Bronson Commercial |
$320.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.69
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
OP
|
$139.65
|
|
|
Service Code
|
NDC 72205003960
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Aetna American Axle |
$90.77
|
| Rate for Payer: Aetna Commercial |
$118.70
|
| Rate for Payer: Aetna Medicare |
$69.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.77
|
| Rate for Payer: BCBS Complete |
$55.86
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cofinity Advantage |
$97.75
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.72
|
| Rate for Payer: Healthscope Commercial |
$125.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.74
|
| Rate for Payer: PHP Commercial |
$118.70
|
| Rate for Payer: Priority Health SBD |
$87.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.77
|
| Rate for Payer: UHC Core |
$72.76
|
| Rate for Payer: UHC Exchange |
$54.88
|
| Rate for Payer: UMR Bronson Commercial |
$51.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.74
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
OP
|
$429.41
|
|
|
Service Code
|
NDC 47335006186
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$386.47 |
| Rate for Payer: Aetna American Axle |
$279.12
|
| Rate for Payer: Aetna Commercial |
$365.00
|
| Rate for Payer: Aetna Medicare |
$214.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.12
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: Cash Price |
$343.53
|
| Rate for Payer: Cofinity Advantage |
$300.59
|
| Rate for Payer: Cofinity Commercial |
$369.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.53
|
| Rate for Payer: Healthscope Commercial |
$386.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.06
|
| Rate for Payer: PHP Commercial |
$365.00
|
| Rate for Payer: Priority Health SBD |
$270.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.12
|
| Rate for Payer: UHC Core |
$223.72
|
| Rate for Payer: UHC Exchange |
$168.76
|
| Rate for Payer: UMR Bronson Commercial |
$158.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.06
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
OP
|
$1,443.23
|
|
|
Service Code
|
NDC 51862012560
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$534.00 |
| Max. Negotiated Rate |
$1,298.91 |
| Rate for Payer: Aetna American Axle |
$938.10
|
| Rate for Payer: Aetna Commercial |
$1,226.75
|
| Rate for Payer: Aetna Medicare |
$721.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$938.10
|
| Rate for Payer: BCBS Complete |
$577.29
|
| Rate for Payer: Cash Price |
$1,154.58
|
| Rate for Payer: Cofinity Advantage |
$1,010.26
|
| Rate for Payer: Cofinity Commercial |
$1,241.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.58
|
| Rate for Payer: Healthscope Commercial |
$1,298.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,010.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,082.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,154.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,226.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,082.42
|
| Rate for Payer: PHP Commercial |
$1,226.75
|
| Rate for Payer: Priority Health SBD |
$909.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$938.10
|
| Rate for Payer: UHC Core |
$751.92
|
| Rate for Payer: UHC Exchange |
$567.19
|
| Rate for Payer: UMR Bronson Commercial |
$534.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,082.42
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
IP
|
$1,443.23
|
|
|
Service Code
|
NDC 51862012560
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$635.02 |
| Max. Negotiated Rate |
$1,298.91 |
| Rate for Payer: Aetna American Axle |
$938.10
|
| Rate for Payer: Aetna Commercial |
$1,226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$938.10
|
| Rate for Payer: Cash Price |
$1,154.58
|
| Rate for Payer: Cofinity Advantage |
$1,010.26
|
| Rate for Payer: Cofinity Commercial |
$1,241.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.58
|
| Rate for Payer: Healthscope Commercial |
$1,298.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,010.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,082.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,226.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,082.42
|
| Rate for Payer: PHP Commercial |
$1,226.75
|
| Rate for Payer: Priority Health SBD |
$909.23
|
| Rate for Payer: UMR Bronson Commercial |
$635.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,082.42
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
IP
|
$864.92
|
|
|
Service Code
|
NDC 59762003702
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.56 |
| Max. Negotiated Rate |
$778.43 |
| Rate for Payer: Aetna American Axle |
$562.20
|
| Rate for Payer: Aetna Commercial |
$735.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.20
|
| Rate for Payer: Cash Price |
$691.94
|
| Rate for Payer: Cofinity Advantage |
$605.44
|
| Rate for Payer: Cofinity Commercial |
$743.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.94
|
| Rate for Payer: Healthscope Commercial |
$778.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.69
|
| Rate for Payer: PHP Commercial |
$735.18
|
| Rate for Payer: Priority Health SBD |
$544.90
|
| Rate for Payer: UMR Bronson Commercial |
$380.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.69
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
IP
|
$429.41
|
|
|
Service Code
|
NDC 47335006186
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.94 |
| Max. Negotiated Rate |
$386.47 |
| Rate for Payer: Aetna American Axle |
$279.12
|
| Rate for Payer: Aetna Commercial |
$365.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.12
|
| Rate for Payer: Cash Price |
$343.53
|
| Rate for Payer: Cofinity Advantage |
$300.59
|
| Rate for Payer: Cofinity Commercial |
$369.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.53
|
| Rate for Payer: Healthscope Commercial |
$386.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.06
|
| Rate for Payer: PHP Commercial |
$365.00
|
| Rate for Payer: Priority Health SBD |
$270.53
|
| Rate for Payer: UMR Bronson Commercial |
$188.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.06
|
|
|
DOFETILIDE 125 MCG CAPSULE
|
Facility
|
IP
|
$139.65
|
|
|
Service Code
|
NDC 72205003960
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.45 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Aetna American Axle |
$90.77
|
| Rate for Payer: Aetna Commercial |
$118.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.77
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cofinity Advantage |
$97.75
|
| Rate for Payer: Cofinity Commercial |
$120.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.72
|
| Rate for Payer: Healthscope Commercial |
$125.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.74
|
| Rate for Payer: PHP Commercial |
$118.70
|
| Rate for Payer: Priority Health SBD |
$87.98
|
| Rate for Payer: UMR Bronson Commercial |
$61.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.74
|
|
|
DOFETILIDE 250 MCG CAPSULE
|
Facility
|
IP
|
$532.66
|
|
|
Service Code
|
NDC 00904752308
|
| Hospital Charge Code |
26966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.37 |
| Max. Negotiated Rate |
$479.39 |
| Rate for Payer: Aetna American Axle |
$346.23
|
| Rate for Payer: Aetna Commercial |
$452.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.23
|
| Rate for Payer: Cash Price |
$426.13
|
| Rate for Payer: Cofinity Advantage |
$372.86
|
| Rate for Payer: Cofinity Commercial |
$458.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.13
|
| Rate for Payer: Healthscope Commercial |
$479.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$399.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.50
|
| Rate for Payer: PHP Commercial |
$452.76
|
| Rate for Payer: Priority Health SBD |
$335.58
|
| Rate for Payer: UMR Bronson Commercial |
$234.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$399.50
|
|
|
DOFETILIDE 250 MCG CAPSULE
|
Facility
|
IP
|
$864.92
|
|
|
Service Code
|
NDC 59762003802
|
| Hospital Charge Code |
26966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.56 |
| Max. Negotiated Rate |
$778.43 |
| Rate for Payer: Aetna American Axle |
$562.20
|
| Rate for Payer: Aetna Commercial |
$735.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.20
|
| Rate for Payer: Cash Price |
$691.94
|
| Rate for Payer: Cofinity Advantage |
$605.44
|
| Rate for Payer: Cofinity Commercial |
$743.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.94
|
| Rate for Payer: Healthscope Commercial |
$778.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.69
|
| Rate for Payer: PHP Commercial |
$735.18
|
| Rate for Payer: Priority Health SBD |
$544.90
|
| Rate for Payer: UMR Bronson Commercial |
$380.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.69
|
|
