Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 68084077611
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$3.74
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: ASR ASR	$3.63
Rate for Payer: ASR Commercial	$3.63
Rate for Payer: BCBS Trust/PPO	$3.05
Rate for Payer: BCN Commercial	$2.90
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Commercial	$3.52
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.74
Rate for Payer: Healthscope Whirlpool	$3.63
Rate for Payer: Mclaren Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.18
Rate for Payer: Nomi Health Commercial	$3.07
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.29

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 00832712301
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$149.46
Max. Negotiated Rate	$373.65
Rate for Payer: Aetna Commercial	$336.28
Rate for Payer: Aetna Medicare	$186.82
Rate for Payer: ASR ASR	$362.44
Rate for Payer: ASR Commercial	$362.44
Rate for Payer: BCBS Complete	$149.46
Rate for Payer: BCBS Trust/PPO	$305.98
Rate for Payer: BCN Commercial	$289.69
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Commercial	$351.23
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$373.65
Rate for Payer: Healthscope Whirlpool	$362.44
Rate for Payer: Mclaren Commercial	$336.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.60
Rate for Payer: Nomi Health Commercial	$306.39
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$327.39
Rate for Payer: Priority Health Narrow Network	$261.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$328.81

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 00832712389
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$3.74
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: ASR ASR	$3.63
Rate for Payer: ASR Commercial	$3.63
Rate for Payer: BCBS Trust/PPO	$3.05
Rate for Payer: BCN Commercial	$2.90
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Commercial	$3.52
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.74
Rate for Payer: Healthscope Whirlpool	$3.63
Rate for Payer: Mclaren Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.18
Rate for Payer: Nomi Health Commercial	$3.07
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.29

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$338.40

Service Code	NDC 00904686061
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$219.96
Max. Negotiated Rate	$338.40
Rate for Payer: Aetna Commercial	$304.56
Rate for Payer: ASR ASR	$328.25
Rate for Payer: ASR Commercial	$328.25
Rate for Payer: BCBS Trust/PPO	$275.76
Rate for Payer: BCN Commercial	$262.36
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Commercial	$318.10
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$338.40
Rate for Payer: Healthscope Whirlpool	$328.25
Rate for Payer: Mclaren Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: Nomi Health Commercial	$277.49
Rate for Payer: Priority Health Cigna Priority Health	$219.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$297.79

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 68084077601
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$149.46
Max. Negotiated Rate	$373.65
Rate for Payer: Aetna Commercial	$336.28
Rate for Payer: Aetna Medicare	$186.82
Rate for Payer: ASR ASR	$362.44
Rate for Payer: ASR Commercial	$362.44
Rate for Payer: BCBS Complete	$149.46
Rate for Payer: BCBS Trust/PPO	$305.98
Rate for Payer: BCN Commercial	$289.69
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Commercial	$351.23
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$373.65
Rate for Payer: Healthscope Whirlpool	$362.44
Rate for Payer: Mclaren Commercial	$336.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.60
Rate for Payer: Nomi Health Commercial	$306.39
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$327.39
Rate for Payer: Priority Health Narrow Network	$261.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$328.81

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 00832712389
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.74
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: Aetna Medicare	$1.87
Rate for Payer: ASR ASR	$3.63
Rate for Payer: ASR Commercial	$3.63
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: BCBS Trust/PPO	$3.06
Rate for Payer: BCN Commercial	$2.90
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Commercial	$3.52
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.74
Rate for Payer: Healthscope Whirlpool	$3.63
Rate for Payer: Mclaren Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.18
Rate for Payer: Nomi Health Commercial	$3.07
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.28
Rate for Payer: Priority Health Narrow Network	$2.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.29

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 68084077601
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$242.87
Max. Negotiated Rate	$373.65
Rate for Payer: Aetna Commercial	$336.28
Rate for Payer: ASR ASR	$362.44
Rate for Payer: ASR Commercial	$362.44
Rate for Payer: BCBS Trust/PPO	$304.49
Rate for Payer: BCN Commercial	$289.69
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Commercial	$351.23
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$373.65
Rate for Payer: Healthscope Whirlpool	$362.44
Rate for Payer: Mclaren Commercial	$336.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.60
Rate for Payer: Nomi Health Commercial	$306.39
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$328.81

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$373.65

Service Code	NDC 00832712301
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$242.87
Max. Negotiated Rate	$373.65
Rate for Payer: Aetna Commercial	$336.28
Rate for Payer: ASR ASR	$362.44
Rate for Payer: ASR Commercial	$362.44
Rate for Payer: BCBS Trust/PPO	$304.49
Rate for Payer: BCN Commercial	$289.69
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Commercial	$351.23
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$373.65
Rate for Payer: Healthscope Whirlpool	$362.44
Rate for Payer: Mclaren Commercial	$336.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.60
Rate for Payer: Nomi Health Commercial	$306.39
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$328.81

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$338.40

Service Code	NDC 00904686061
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$135.36
Max. Negotiated Rate	$338.40
Rate for Payer: Aetna Commercial	$304.56
Rate for Payer: Aetna Medicare	$169.20
Rate for Payer: ASR ASR	$328.25
Rate for Payer: ASR Commercial	$328.25
Rate for Payer: BCBS Complete	$135.36
Rate for Payer: BCBS Trust/PPO	$277.12
Rate for Payer: BCN Commercial	$262.36
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Commercial	$318.10
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$338.40
Rate for Payer: Healthscope Whirlpool	$328.25
Rate for Payer: Mclaren Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: Nomi Health Commercial	$277.49
Rate for Payer: Priority Health Cigna Priority Health	$219.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$296.51
Rate for Payer: Priority Health Narrow Network	$237.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$297.79

DIVALPROEX 250 MG TABLET,DELAYED RELEASE

Facility

$3.74

Service Code	NDC 68084077611
Hospital Charge Code	2552
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.74
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: Aetna Medicare	$1.87
Rate for Payer: ASR ASR	$3.63
Rate for Payer: ASR Commercial	$3.63
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: BCBS Trust/PPO	$3.06
Rate for Payer: BCN Commercial	$2.90
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Commercial	$3.52
Rate for Payer: Encore Health Key Benefits Commercial	$2.99
Rate for Payer: Healthscope Commercial	$3.74
Rate for Payer: Healthscope Whirlpool	$3.63
Rate for Payer: Mclaren Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.18
Rate for Payer: Nomi Health Commercial	$3.07
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.28
Rate for Payer: Priority Health Narrow Network	$2.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.29

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$396.48

Service Code	NDC 00904636361
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$257.71
Max. Negotiated Rate	$396.48
Rate for Payer: Aetna Commercial	$356.83
Rate for Payer: ASR ASR	$384.59
Rate for Payer: ASR Commercial	$384.59
Rate for Payer: BCBS Trust/PPO	$323.09
Rate for Payer: BCN Commercial	$307.39
Rate for Payer: Cash Price	$317.18
Rate for Payer: Cofinity Commercial	$372.69
Rate for Payer: Encore Health Key Benefits Commercial	$317.18
Rate for Payer: Healthscope Commercial	$396.48
Rate for Payer: Healthscope Whirlpool	$384.59
Rate for Payer: Mclaren Commercial	$356.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.01
Rate for Payer: Nomi Health Commercial	$325.11
Rate for Payer: Priority Health Cigna Priority Health	$257.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$348.90

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$228.95

Service Code	NDC 65162075510
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$91.58
Max. Negotiated Rate	$228.95
Rate for Payer: Aetna Commercial	$206.06
Rate for Payer: Aetna Medicare	$114.48
Rate for Payer: ASR ASR	$222.08
Rate for Payer: ASR Commercial	$222.08
Rate for Payer: BCBS Complete	$91.58
Rate for Payer: BCBS Trust/PPO	$187.49
Rate for Payer: BCN Commercial	$177.50
Rate for Payer: Cash Price	$183.16
Rate for Payer: Cofinity Commercial	$215.21
Rate for Payer: Encore Health Key Benefits Commercial	$183.16
Rate for Payer: Healthscope Commercial	$228.95
Rate for Payer: Healthscope Whirlpool	$222.08
Rate for Payer: Mclaren Commercial	$206.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$194.61
Rate for Payer: Nomi Health Commercial	$187.74
Rate for Payer: Priority Health Cigna Priority Health	$148.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$200.61
Rate for Payer: Priority Health Narrow Network	$160.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$201.48

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$4.36

Service Code	NDC 68084031011
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: ASR ASR	$4.23
Rate for Payer: ASR Commercial	$4.23
Rate for Payer: BCBS Trust/PPO	$3.55
Rate for Payer: BCN Commercial	$3.38
Rate for Payer: Cash Price	$3.49
Rate for Payer: Cofinity Commercial	$4.10
Rate for Payer: Encore Health Key Benefits Commercial	$3.49
Rate for Payer: Healthscope Commercial	$4.36
Rate for Payer: Healthscope Whirlpool	$4.23
Rate for Payer: Mclaren Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.71
Rate for Payer: Nomi Health Commercial	$3.58
Rate for Payer: Priority Health Cigna Priority Health	$2.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.84

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$228.95

Service Code	NDC 65162075510
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$148.82
Max. Negotiated Rate	$228.95
Rate for Payer: Aetna Commercial	$206.06
Rate for Payer: ASR ASR	$222.08
Rate for Payer: ASR Commercial	$222.08
Rate for Payer: BCBS Trust/PPO	$186.57
Rate for Payer: BCN Commercial	$177.50
Rate for Payer: Cash Price	$183.16
Rate for Payer: Cofinity Commercial	$215.21
Rate for Payer: Encore Health Key Benefits Commercial	$183.16
Rate for Payer: Healthscope Commercial	$228.95
Rate for Payer: Healthscope Whirlpool	$222.08
Rate for Payer: Mclaren Commercial	$206.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$194.61
Rate for Payer: Nomi Health Commercial	$187.74
Rate for Payer: Priority Health Cigna Priority Health	$148.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$201.48

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$435.84

Service Code	NDC 68084031001
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$174.34
Max. Negotiated Rate	$435.84
Rate for Payer: Aetna Commercial	$392.26
Rate for Payer: Aetna Medicare	$217.92
Rate for Payer: ASR ASR	$422.76
Rate for Payer: ASR Commercial	$422.76
Rate for Payer: BCBS Complete	$174.34
Rate for Payer: BCBS Trust/PPO	$356.91
Rate for Payer: BCN Commercial	$337.91
Rate for Payer: Cash Price	$348.67
Rate for Payer: Cofinity Commercial	$409.69
Rate for Payer: Encore Health Key Benefits Commercial	$348.67
Rate for Payer: Healthscope Commercial	$435.84
Rate for Payer: Healthscope Whirlpool	$422.76
Rate for Payer: Mclaren Commercial	$392.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$370.46
Rate for Payer: Nomi Health Commercial	$357.39
Rate for Payer: Priority Health Cigna Priority Health	$283.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$381.88
Rate for Payer: Priority Health Narrow Network	$305.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$383.54

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$435.84

Service Code	NDC 68084031001
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$283.30
Max. Negotiated Rate	$435.84
Rate for Payer: Aetna Commercial	$392.26
Rate for Payer: ASR ASR	$422.76
Rate for Payer: ASR Commercial	$422.76
Rate for Payer: BCBS Trust/PPO	$355.17
Rate for Payer: BCN Commercial	$337.91
Rate for Payer: Cash Price	$348.67
Rate for Payer: Cofinity Commercial	$409.69
Rate for Payer: Encore Health Key Benefits Commercial	$348.67
Rate for Payer: Healthscope Commercial	$435.84
Rate for Payer: Healthscope Whirlpool	$422.76
Rate for Payer: Mclaren Commercial	$392.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$370.46
Rate for Payer: Nomi Health Commercial	$357.39
Rate for Payer: Priority Health Cigna Priority Health	$283.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$383.54

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$396.48

Service Code	NDC 00904636361
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$158.59
Max. Negotiated Rate	$396.48
Rate for Payer: Aetna Commercial	$356.83
Rate for Payer: Aetna Medicare	$198.24
Rate for Payer: ASR ASR	$384.59
Rate for Payer: ASR Commercial	$384.59
Rate for Payer: BCBS Complete	$158.59
Rate for Payer: BCBS Trust/PPO	$324.68
Rate for Payer: BCN Commercial	$307.39
Rate for Payer: Cash Price	$317.18
Rate for Payer: Cofinity Commercial	$372.69
Rate for Payer: Encore Health Key Benefits Commercial	$317.18
Rate for Payer: Healthscope Commercial	$396.48
Rate for Payer: Healthscope Whirlpool	$384.59
Rate for Payer: Mclaren Commercial	$356.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.01
Rate for Payer: Nomi Health Commercial	$325.11
Rate for Payer: Priority Health Cigna Priority Health	$257.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$347.40
Rate for Payer: Priority Health Narrow Network	$277.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$348.90

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$4.36

Service Code	NDC 68084031011
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: Aetna Medicare	$2.18
Rate for Payer: ASR ASR	$4.23
Rate for Payer: ASR Commercial	$4.23
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: BCBS Trust/PPO	$3.57
Rate for Payer: BCN Commercial	$3.38
Rate for Payer: Cash Price	$3.49
Rate for Payer: Cofinity Commercial	$4.10
Rate for Payer: Encore Health Key Benefits Commercial	$3.49
Rate for Payer: Healthscope Commercial	$4.36
Rate for Payer: Healthscope Whirlpool	$4.23
Rate for Payer: Mclaren Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.71
Rate for Payer: Nomi Health Commercial	$3.58
Rate for Payer: Priority Health Cigna Priority Health	$2.83
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.82
Rate for Payer: Priority Health Narrow Network	$3.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.84

DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION

Facility

$27.06

Service Code	HCPCS J1250
Hospital Charge Code	9892
Hospital Revenue Code	636
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$27.06
Rate for Payer: Aetna Commercial	$24.35
Rate for Payer: Aetna Commercial	$19.45
Rate for Payer: Aetna Medicare	$10.80
Rate for Payer: Aetna Medicare	$13.53
Rate for Payer: ASR ASR	$26.25
Rate for Payer: ASR ASR	$20.96
Rate for Payer: ASR Commercial	$20.96
Rate for Payer: ASR Commercial	$26.25
Rate for Payer: BCBS Complete	$10.82
Rate for Payer: BCBS Complete	$8.64
Rate for Payer: BCBS Trust/PPO	$22.16
Rate for Payer: BCBS Trust/PPO	$17.70
Rate for Payer: BCN Commercial	$16.75
Rate for Payer: BCN Commercial	$20.98
Rate for Payer: Cash Price	$17.29
Rate for Payer: Cash Price	$17.29
Rate for Payer: Cash Price	$21.64
Rate for Payer: Cash Price	$21.64
Rate for Payer: Cofinity Commercial	$20.31
Rate for Payer: Cofinity Commercial	$25.44
Rate for Payer: Encore Health Key Benefits Commercial	$21.65
Rate for Payer: Encore Health Key Benefits Commercial	$17.29
Rate for Payer: Healthscope Commercial	$27.06
Rate for Payer: Healthscope Commercial	$21.61
Rate for Payer: Healthscope Whirlpool	$26.25
Rate for Payer: Healthscope Whirlpool	$20.96
Rate for Payer: Mclaren Commercial	$19.45
Rate for Payer: Mclaren Commercial	$24.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.37
Rate for Payer: Nomi Health Commercial	$22.19
Rate for Payer: Nomi Health Commercial	$17.72
Rate for Payer: Priority Health Cigna Priority Health	$17.59
Rate for Payer: Priority Health Cigna Priority Health	$14.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.45
Rate for Payer: Priority Health Narrow Network	$6.76
Rate for Payer: Priority Health Narrow Network	$6.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.81

DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION

Facility

$27.06

Service Code	HCPCS J1250
Hospital Charge Code	9892
Hospital Revenue Code	636
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$27.06
Rate for Payer: Aetna Commercial	$24.35
Rate for Payer: Aetna Commercial	$19.45
Rate for Payer: ASR ASR	$26.25
Rate for Payer: ASR ASR	$20.96
Rate for Payer: ASR Commercial	$20.96
Rate for Payer: ASR Commercial	$26.25
Rate for Payer: BCBS Trust/PPO	$17.61
Rate for Payer: BCBS Trust/PPO	$22.05
Rate for Payer: BCN Commercial	$20.98
Rate for Payer: BCN Commercial	$16.75
Rate for Payer: Cash Price	$21.64
Rate for Payer: Cash Price	$17.29
Rate for Payer: Cofinity Commercial	$20.31
Rate for Payer: Cofinity Commercial	$25.44
Rate for Payer: Encore Health Key Benefits Commercial	$17.29
Rate for Payer: Encore Health Key Benefits Commercial	$21.65
Rate for Payer: Healthscope Commercial	$21.61
Rate for Payer: Healthscope Commercial	$27.06
Rate for Payer: Healthscope Whirlpool	$20.96
Rate for Payer: Healthscope Whirlpool	$26.25
Rate for Payer: Mclaren Commercial	$19.45
Rate for Payer: Mclaren Commercial	$24.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.00
Rate for Payer: Nomi Health Commercial	$17.72
Rate for Payer: Nomi Health Commercial	$22.19
Rate for Payer: Priority Health Cigna Priority Health	$17.59
Rate for Payer: Priority Health Cigna Priority Health	$14.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.81

DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV

Facility

$80.33

Service Code	HCPCS J1250
Hospital Charge Code	18315
Hospital Revenue Code	636
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$80.33
Rate for Payer: Aetna Commercial	$72.30
Rate for Payer: ASR ASR	$77.92
Rate for Payer: ASR Commercial	$77.92
Rate for Payer: BCBS Trust/PPO	$65.46
Rate for Payer: BCN Commercial	$62.28
Rate for Payer: Cash Price	$64.26
Rate for Payer: Cofinity Commercial	$75.51
Rate for Payer: Encore Health Key Benefits Commercial	$64.26
Rate for Payer: Healthscope Commercial	$80.33
Rate for Payer: Healthscope Whirlpool	$77.92
Rate for Payer: Mclaren Commercial	$72.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.28
Rate for Payer: Nomi Health Commercial	$65.87
Rate for Payer: Priority Health Cigna Priority Health	$52.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.69

DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV

Facility

$80.33

Service Code	HCPCS J1250
Hospital Charge Code	18315
Hospital Revenue Code	636
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$80.33
Rate for Payer: Aetna Commercial	$72.30
Rate for Payer: Aetna Medicare	$40.16
Rate for Payer: ASR ASR	$77.92
Rate for Payer: ASR Commercial	$77.92
Rate for Payer: BCBS Complete	$32.13
Rate for Payer: BCBS Trust/PPO	$65.78
Rate for Payer: BCN Commercial	$62.28
Rate for Payer: Cash Price	$64.26
Rate for Payer: Cash Price	$64.26
Rate for Payer: Cofinity Commercial	$75.51
Rate for Payer: Encore Health Key Benefits Commercial	$64.26
Rate for Payer: Healthscope Commercial	$80.33
Rate for Payer: Healthscope Whirlpool	$77.92
Rate for Payer: Mclaren Commercial	$72.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.28
Rate for Payer: Nomi Health Commercial	$65.87
Rate for Payer: Priority Health Cigna Priority Health	$52.21
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.45
Rate for Payer: Priority Health Narrow Network	$6.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.69

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$88.20

Service Code	NDC 00904699860
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$88.20
Rate for Payer: Aetna Commercial	$79.38
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: ASR ASR	$85.55
Rate for Payer: ASR Commercial	$85.55
Rate for Payer: BCBS Complete	$35.28
Rate for Payer: BCBS Trust/PPO	$72.23
Rate for Payer: BCN Commercial	$68.38
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$82.91
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$88.20
Rate for Payer: Healthscope Whirlpool	$85.55
Rate for Payer: Mclaren Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: Nomi Health Commercial	$72.32
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$77.28
Rate for Payer: Priority Health Narrow Network	$61.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$77.62

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$188.10

Service Code	NDC 60687012901
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$122.26
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$169.29
Rate for Payer: ASR ASR	$182.46
Rate for Payer: ASR Commercial	$182.46
Rate for Payer: BCBS Trust/PPO	$153.28
Rate for Payer: BCN Commercial	$145.83
Rate for Payer: Cash Price	$150.48
Rate for Payer: Cofinity Commercial	$176.81
Rate for Payer: Encore Health Key Benefits Commercial	$150.48
Rate for Payer: Healthscope Commercial	$188.10
Rate for Payer: Healthscope Whirlpool	$182.46
Rate for Payer: Mclaren Commercial	$169.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.88
Rate for Payer: Nomi Health Commercial	$154.24
Rate for Payer: Priority Health Cigna Priority Health	$122.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$165.53

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$188.10

Service Code	NDC 60687012901
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$75.24
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$169.29
Rate for Payer: Aetna Medicare	$94.05
Rate for Payer: ASR ASR	$182.46
Rate for Payer: ASR Commercial	$182.46
Rate for Payer: BCBS Complete	$75.24
Rate for Payer: BCBS Trust/PPO	$154.04
Rate for Payer: BCN Commercial	$145.83
Rate for Payer: Cash Price	$150.48
Rate for Payer: Cofinity Commercial	$176.81
Rate for Payer: Encore Health Key Benefits Commercial	$150.48
Rate for Payer: Healthscope Commercial	$188.10
Rate for Payer: Healthscope Whirlpool	$182.46
Rate for Payer: Mclaren Commercial	$169.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.88
Rate for Payer: Nomi Health Commercial	$154.24
Rate for Payer: Priority Health Cigna Priority Health	$122.26
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$164.81
Rate for Payer: Priority Health Narrow Network	$131.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$165.53

Know your out-of-pocket cost for care.

All Charges