|
DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$645.14
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
152336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$580.63 |
| Rate for Payer: Aetna American Axle |
$419.34
|
| Rate for Payer: Aetna American Axle |
$435.60
|
| Rate for Payer: Aetna Commercial |
$569.63
|
| Rate for Payer: Aetna Commercial |
$548.37
|
| Rate for Payer: Aetna Medicare |
$322.57
|
| Rate for Payer: Aetna Medicare |
$335.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.60
|
| Rate for Payer: BCBS Complete |
$268.06
|
| Rate for Payer: BCBS Complete |
$258.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$536.12
|
| Rate for Payer: Cash Price |
$536.12
|
| Rate for Payer: Cash Price |
$516.11
|
| Rate for Payer: Cash Price |
$516.11
|
| Rate for Payer: Cofinity Commercial |
$576.33
|
| Rate for Payer: Cofinity Commercial |
$451.60
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Cofinity Commercial |
$554.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$451.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.11
|
| Rate for Payer: Healthscope Commercial |
$603.14
|
| Rate for Payer: Healthscope Commercial |
$580.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$451.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$483.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.63
|
| Rate for Payer: PHP Commercial |
$548.37
|
| Rate for Payer: PHP Commercial |
$569.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.60
|
| Rate for Payer: Priority Health SBD |
$422.19
|
| Rate for Payer: Priority Health SBD |
$406.44
|
| Rate for Payer: UMR Bronson Commercial |
$238.70
|
| Rate for Payer: UMR Bronson Commercial |
$247.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$483.86
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$895.04
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
161671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$805.54 |
| Rate for Payer: Aetna American Axle |
$581.78
|
| Rate for Payer: Aetna American Axle |
$468.98
|
| Rate for Payer: Aetna American Axle |
$1,249.06
|
| Rate for Payer: Aetna American Axle |
$225.19
|
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna Commercial |
$294.48
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Commercial |
$613.28
|
| Rate for Payer: Aetna Medicare |
$360.75
|
| Rate for Payer: Aetna Medicare |
$173.22
|
| Rate for Payer: Aetna Medicare |
$960.82
|
| Rate for Payer: Aetna Medicare |
$447.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.19
|
| Rate for Payer: BCBS Complete |
$288.60
|
| Rate for Payer: BCBS Complete |
$768.65
|
| Rate for Payer: BCBS Complete |
$358.02
|
| Rate for Payer: BCBS Complete |
$138.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$277.16
|
| Rate for Payer: Cash Price |
$716.03
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$277.16
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$716.03
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Cofinity Commercial |
$297.95
|
| Rate for Payer: Cofinity Commercial |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$505.05
|
| Rate for Payer: Cofinity Commercial |
$620.49
|
| Rate for Payer: Cofinity Commercial |
$626.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$242.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$805.54
|
| Rate for Payer: Healthscope Commercial |
$649.35
|
| Rate for Payer: Healthscope Commercial |
$311.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: PHP Commercial |
$294.48
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$613.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.98
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: Priority Health SBD |
$454.54
|
| Rate for Payer: Priority Health SBD |
$218.26
|
| Rate for Payer: Priority Health SBD |
$563.88
|
| Rate for Payer: UMR Bronson Commercial |
$711.00
|
| Rate for Payer: UMR Bronson Commercial |
$266.96
|
| Rate for Payer: UMR Bronson Commercial |
$331.16
|
| Rate for Payer: UMR Bronson Commercial |
$128.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.28
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,921.63
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
161671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$845.52 |
| Max. Negotiated Rate |
$1,729.47 |
| Rate for Payer: Aetna American Axle |
$1,249.06
|
| Rate for Payer: Aetna American Axle |
$581.78
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.78
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$716.03
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Cofinity Commercial |
$626.53
|
| Rate for Payer: Cofinity Commercial |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.03
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$805.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.78
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: Priority Health SBD |
$563.88
|
| Rate for Payer: UMR Bronson Commercial |
$845.52
|
| Rate for Payer: UMR Bronson Commercial |
$393.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.28
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$352.40
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
106443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$317.16 |
| Rate for Payer: Aetna American Axle |
$229.06
|
| Rate for Payer: Aetna Commercial |
$299.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.06
|
| Rate for Payer: Cash Price |
$281.92
|
| Rate for Payer: Cofinity Commercial |
$246.68
|
| Rate for Payer: Cofinity Commercial |
$303.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.92
|
| Rate for Payer: Healthscope Commercial |
$317.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.54
|
| Rate for Payer: PHP Commercial |
$299.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.06
|
| Rate for Payer: Priority Health SBD |
$222.01
|
| Rate for Payer: UMR Bronson Commercial |
$155.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.30
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$352.40
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
106443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$317.16 |
| Rate for Payer: Aetna American Axle |
$229.06
|
| Rate for Payer: Aetna American Axle |
$182.42
|
| Rate for Payer: Aetna Commercial |
$238.55
|
| Rate for Payer: Aetna Commercial |
$299.54
|
| Rate for Payer: Aetna Medicare |
$176.20
|
| Rate for Payer: Aetna Medicare |
$140.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.06
|
| Rate for Payer: BCBS Complete |
$140.96
|
| Rate for Payer: BCBS Complete |
$112.26
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$224.52
|
| Rate for Payer: Cash Price |
$224.52
|
| Rate for Payer: Cash Price |
$281.92
|
| Rate for Payer: Cash Price |
$281.92
|
| Rate for Payer: Cofinity Commercial |
$196.46
|
| Rate for Payer: Cofinity Commercial |
$241.36
|
| Rate for Payer: Cofinity Commercial |
$303.06
|
| Rate for Payer: Cofinity Commercial |
$246.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.52
|
| Rate for Payer: Healthscope Commercial |
$252.58
|
| Rate for Payer: Healthscope Commercial |
$317.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.55
|
| Rate for Payer: PHP Commercial |
$299.54
|
| Rate for Payer: PHP Commercial |
$238.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.06
|
| Rate for Payer: Priority Health SBD |
$222.01
|
| Rate for Payer: Priority Health SBD |
$176.81
|
| Rate for Payer: UMR Bronson Commercial |
$103.84
|
| Rate for Payer: UMR Bronson Commercial |
$130.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.30
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$499.25
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
120029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.67 |
| Max. Negotiated Rate |
$449.32 |
| Rate for Payer: Aetna American Axle |
$324.51
|
| Rate for Payer: Aetna American Axle |
$1,249.06
|
| Rate for Payer: Aetna American Axle |
$538.19
|
| Rate for Payer: Aetna Commercial |
$424.36
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Commercial |
$703.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: Cash Price |
$662.39
|
| Rate for Payer: Cash Price |
$399.40
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Commercial |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$349.48
|
| Rate for Payer: Cofinity Commercial |
$429.36
|
| Rate for Payer: Cofinity Commercial |
$579.59
|
| Rate for Payer: Cofinity Commercial |
$712.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Healthscope Commercial |
$745.19
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$449.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.79
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$703.79
|
| Rate for Payer: PHP Commercial |
$424.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.19
|
| Rate for Payer: Priority Health SBD |
$314.53
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: Priority Health SBD |
$521.63
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
| Rate for Payer: UMR Bronson Commercial |
$219.67
|
| Rate for Payer: UMR Bronson Commercial |
$845.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.44
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$333.66
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
120029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$300.29 |
| Rate for Payer: Aetna American Axle |
$216.88
|
| Rate for Payer: Aetna American Axle |
$414.14
|
| Rate for Payer: Aetna American Axle |
$324.51
|
| Rate for Payer: Aetna American Axle |
$1,249.06
|
| Rate for Payer: Aetna American Axle |
$538.19
|
| Rate for Payer: Aetna Commercial |
$283.61
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Commercial |
$703.79
|
| Rate for Payer: Aetna Commercial |
$424.36
|
| Rate for Payer: Aetna Commercial |
$541.57
|
| Rate for Payer: Aetna Medicare |
$249.62
|
| Rate for Payer: Aetna Medicare |
$318.57
|
| Rate for Payer: Aetna Medicare |
$166.83
|
| Rate for Payer: Aetna Medicare |
$960.82
|
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.51
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$768.65
|
| Rate for Payer: BCBS Complete |
$254.86
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: BCBS Complete |
$199.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$266.93
|
| Rate for Payer: Cash Price |
$399.40
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$266.93
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$399.40
|
| Rate for Payer: Cash Price |
$662.39
|
| Rate for Payer: Cash Price |
$662.39
|
| Rate for Payer: Cash Price |
$509.71
|
| Rate for Payer: Cash Price |
$509.71
|
| Rate for Payer: Cofinity Commercial |
$233.56
|
| Rate for Payer: Cofinity Commercial |
$712.07
|
| Rate for Payer: Cofinity Commercial |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$429.36
|
| Rate for Payer: Cofinity Commercial |
$349.48
|
| Rate for Payer: Cofinity Commercial |
$579.59
|
| Rate for Payer: Cofinity Commercial |
$547.94
|
| Rate for Payer: Cofinity Commercial |
$446.00
|
| Rate for Payer: Cofinity Commercial |
$286.95
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$446.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.71
|
| Rate for Payer: Healthscope Commercial |
$573.43
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$300.29
|
| Rate for Payer: Healthscope Commercial |
$449.32
|
| Rate for Payer: Healthscope Commercial |
$745.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$446.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$703.79
|
| Rate for Payer: PHP Commercial |
$541.57
|
| Rate for Payer: PHP Commercial |
$283.61
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$424.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.88
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: Priority Health SBD |
$521.63
|
| Rate for Payer: Priority Health SBD |
$401.40
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: Priority Health SBD |
$314.53
|
| Rate for Payer: UMR Bronson Commercial |
$711.00
|
| Rate for Payer: UMR Bronson Commercial |
$184.72
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$235.74
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.22
|
|
|
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
|
|
|
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 |
$0.03 |
| 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 |
$54.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.26
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: BCBS MAPPO |
$52.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Medicare Advantage |
$52.21
|
| 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 |
$52.21
|
| 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 |
$27.98
|
| Rate for Payer: Mclaren Medicare |
$52.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.82
|
| Rate for Payer: Meridian Medicaid |
$29.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.46
|
| Rate for Payer: Nomi Health Commercial |
$156.63
|
| Rate for Payer: PACE Medicare |
$49.60
|
| Rate for Payer: PACE SWMI |
$52.21
|
| Rate for Payer: PHP Commercial |
$393.46
|
| Rate for Payer: PHP Medicare Advantage |
$52.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.74
|
| Rate for Payer: Priority Health Medicare |
$52.21
|
| Rate for Payer: Priority Health Narrow Network |
$117.39
|
| Rate for Payer: Priority Health SBD |
$291.62
|
| Rate for Payer: Railroad Medicare Medicare |
$52.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.21
|
| Rate for Payer: UHC Exchange |
$99.78
|
| Rate for Payer: UHC Medicare Advantage |
$52.21
|
| Rate for Payer: UHCCP Medicaid |
$27.98
|
| Rate for Payer: UMR Bronson Commercial |
$171.27
|
| Rate for Payer: VA VA |
$52.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.17
|
|
|
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: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.32
|
| 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: 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
|
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
|
$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
|
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
|
$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: PHP Commercial |
$128.52
|
| 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: 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
|
$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
|
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
|
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
|
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
|
$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
|
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
|
$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 |
$122.26
|
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.26
|
| 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 |
$141.08
|
| 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 |
$122.26
|
| 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 |
$141.08
|
|
|
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
|
$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
|
$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
|
|
