|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$462.89
|
|
|
Service Code
|
HCPCS J9172
|
| Hospital Charge Code |
152334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$416.60 |
| Rate for Payer: Aetna American Axle |
$300.88
|
| Rate for Payer: Aetna Commercial |
$393.46
|
| Rate for Payer: Aetna Medicare |
$52.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.48
|
| Rate for Payer: BCBS Complete |
$28.58
|
| Rate for Payer: BCBS MAPPO |
$50.78
|
| Rate for Payer: BCN Medicare Advantage |
$50.78
|
| Rate for Payer: Cash Price |
$370.31
|
| Rate for Payer: Cash Price |
$370.31
|
| Rate for Payer: Cofinity Commercial |
$398.09
|
| Rate for Payer: Cofinity Commercial |
$324.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.78
|
| Rate for Payer: Healthscope Commercial |
$416.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.17
|
| Rate for Payer: Mclaren Medicaid |
$27.22
|
| Rate for Payer: Mclaren Medicare |
$50.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.32
|
| Rate for Payer: Meridian Medicaid |
$28.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.46
|
| Rate for Payer: PACE Medicare |
$48.24
|
| Rate for Payer: PACE SWMI |
$50.78
|
| Rate for Payer: PHP Commercial |
$393.46
|
| Rate for Payer: PHP Medicare Advantage |
$50.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.88
|
| Rate for Payer: Priority Health Medicare |
$50.78
|
| Rate for Payer: Priority Health SBD |
$291.62
|
| Rate for Payer: Railroad Medicare Medicare |
$50.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.78
|
| Rate for Payer: UHC Exchange |
$97.05
|
| Rate for Payer: UHC Medicare Advantage |
$50.78
|
| Rate for Payer: UHCCP Medicaid |
$27.22
|
| Rate for Payer: UMR Bronson Commercial |
$171.27
|
| Rate for Payer: VA VA |
$50.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.17
|
|
|
DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$462.89
|
|
|
Service Code
|
HCPCS J9172
|
| Hospital Charge Code |
152334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.67 |
| Max. Negotiated Rate |
$416.60 |
| Rate for Payer: Aetna American Axle |
$300.88
|
| Rate for Payer: Aetna Commercial |
$393.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.88
|
| Rate for Payer: Cash Price |
$370.31
|
| Rate for Payer: Cofinity Commercial |
$324.02
|
| Rate for Payer: Cofinity Commercial |
$398.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.31
|
| Rate for Payer: Healthscope Commercial |
$416.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.46
|
| Rate for Payer: PHP Commercial |
$393.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.88
|
| Rate for Payer: Priority Health SBD |
$291.62
|
| Rate for Payer: UMR Bronson Commercial |
$203.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.17
|
|
|
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 Commercial |
$116.31
|
| Rate for Payer: Cofinity Commercial |
$94.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.67
|
| 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: PHP Commercial |
$114.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.91
|
| 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
|
$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 Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| 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: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| 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
|
$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 Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.30
|
| 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: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health SBD |
$119.07
|
| 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 Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| 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: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| 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
|
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 Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.80
|
| 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: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| 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
|
$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 Commercial |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.55
|
| 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: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| Rate for Payer: Priority Health SBD |
$17.60
|
| 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
|
$1.89
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna American Axle |
$1.23
|
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.23
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.32
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$1.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: PHP Commercial |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.23
|
| Rate for Payer: Priority Health SBD |
$1.19
|
| Rate for Payer: UMR Bronson Commercial |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
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 Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| 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: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| 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
|
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 Commercial |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.56
|
| 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: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| Rate for Payer: Priority Health SBD |
$63.50
|
| 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
|
$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 Commercial |
$116.31
|
| Rate for Payer: Cofinity Commercial |
$94.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.67
|
| 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: PHP Commercial |
$114.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.91
|
| Rate for Payer: Priority Health SBD |
$85.20
|
| 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
|
$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 Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.80
|
| 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: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| 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
|
IP
|
$188.10
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna American Axle |
$122.27
|
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.27
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.27
|
| Rate for Payer: Priority Health SBD |
$118.50
|
| Rate for Payer: UMR Bronson Commercial |
$82.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.07
|
|
|
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 Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.30
|
| 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: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| 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
|
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 Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| 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: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| 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
|
$1.89
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna American Axle |
$1.23
|
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.23
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.32
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$1.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: PHP Commercial |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.23
|
| Rate for Payer: Priority Health SBD |
$1.19
|
| Rate for Payer: UMR Bronson Commercial |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
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 Commercial |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$86.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.56
|
| 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: PHP Commercial |
$85.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.52
|
| 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
|
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 Commercial |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.55
|
| 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: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| 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
|
$188.10
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna American Axle |
$122.27
|
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna Medicare |
$94.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.27
|
| Rate for Payer: BCBS Complete |
$75.24
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.27
|
| Rate for Payer: Priority Health SBD |
$118.50
|
| Rate for Payer: UMR Bronson Commercial |
$69.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.07
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 00904727972
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
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 Commercial |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.52
|
| 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: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| 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
|
$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 Commercial |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.52
|
| 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: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| 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
|
$4.95
|
|
|
Service Code
|
NDC 00904727966
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
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 Commercial |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.51
|
| 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: PHP Commercial |
$29.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.76
|
| Rate for Payer: Priority Health SBD |
$22.06
|
| Rate for Payer: UMR Bronson Commercial |
$12.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.26
|
|
