|
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
|
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 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
|
|
|
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 Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| 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: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| 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
|
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
|
$8.16
|
|
|
Service Code
|
NDC 48433020510
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Aetna American Axle |
$5.30
|
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$4.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$5.71
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.71
|
| 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: PHP Commercial |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| Rate for Payer: Priority Health SBD |
$5.14
|
| Rate for Payer: UMR Bronson Commercial |
$3.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.12
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 50383034911
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| 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: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| 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
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 00904727972
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: BCBS Complete |
$1.98
|
| 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 |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 09900000306
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna American Axle |
$2.78
|
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$3.64
|
| Rate for Payer: PHP Commercial |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.78
|
| Rate for Payer: Priority Health SBD |
$2.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.21
|
|
|
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 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 |
$15.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.26
|
|
|
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 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 |
$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 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 Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| 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: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| 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 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 |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$49.01
|
|
|
Service Code
|
NDC 54838011680
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$44.11 |
| Rate for Payer: Aetna American Axle |
$31.86
|
| Rate for Payer: Aetna Commercial |
$41.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.86
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Cofinity Commercial |
$34.31
|
| Rate for Payer: Cofinity Commercial |
$42.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.21
|
| Rate for Payer: Healthscope Commercial |
$44.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.66
|
| Rate for Payer: PHP Commercial |
$41.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.86
|
| Rate for Payer: Priority Health SBD |
$30.88
|
| Rate for Payer: UMR Bronson Commercial |
$21.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.76
|
|
|
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 Commercial |
$5.71
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.71
|
| 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: PHP Commercial |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.30
|
| 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
|
$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 Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| 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: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| 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
|
$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
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 00904727966
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: BCBS Complete |
$1.98
|
| 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 |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID
|
Facility
|
OP
|
$49.01
|
|
|
Service Code
|
NDC 54838011680
|
| Hospital Charge Code |
36962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$44.11 |
| Rate for Payer: Aetna American Axle |
$31.86
|
| Rate for Payer: Aetna Commercial |
$41.66
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.86
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: Cash Price |
$39.21
|
| Rate for Payer: Cofinity Commercial |
$34.31
|
| Rate for Payer: Cofinity Commercial |
$42.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.21
|
| Rate for Payer: Healthscope Commercial |
$44.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.66
|
| Rate for Payer: PHP Commercial |
$41.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.86
|
| Rate for Payer: Priority Health SBD |
$30.88
|
| Rate for Payer: UMR Bronson Commercial |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.76
|
|
|
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 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
|
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 Commercial |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$3.64
|
| Rate for Payer: PHP Commercial |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.78
|
| Rate for Payer: Priority Health SBD |
$2.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.21
|
|
|
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 Commercial |
$605.44
|
| Rate for Payer: Cofinity Commercial |
$743.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$605.44
|
| 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: PHP Commercial |
$735.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.20
|
| Rate for Payer: Priority Health SBD |
$544.90
|
| 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
|
$163.02
|
|
|
Service Code
|
NDC 72205003960
|
| Hospital Charge Code |
26965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$146.72 |
| Rate for Payer: Cofinity Commercial |
$140.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.11
|
| Rate for Payer: Aetna American Axle |
$105.96
|
| Rate for Payer: Aetna Commercial |
$138.57
|
| Rate for Payer: Aetna Medicare |
$81.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.96
|
| Rate for Payer: BCBS Complete |
$65.21
|
| Rate for Payer: Cash Price |
$130.42
|
| Rate for Payer: Cofinity Commercial |
$114.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.42
|
| Rate for Payer: Healthscope Commercial |
$146.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.57
|
| Rate for Payer: PHP Commercial |
$138.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.96
|
| Rate for Payer: Priority Health SBD |
$102.70
|
| Rate for Payer: UMR Bronson Commercial |
$60.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.26
|
|
|
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: PHP Commercial |
$1,226.75
|
| 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 Commercial |
$1,010.26
|
| Rate for Payer: Cofinity Commercial |
$1,241.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,010.26
|
| 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: Priority Health Cigna Priority Health |
$938.10
|
| 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
|
|
