|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$427.20
|
|
|
Service Code
|
NDC 68084031001
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.06 |
| Max. Negotiated Rate |
$427.20 |
| Rate for Payer: Aetna Commercial |
$384.48
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: ASR ASR |
$414.38
|
| Rate for Payer: BCBS Complete |
$170.88
|
| Rate for Payer: BCBS Trust/PPO |
$352.23
|
| Rate for Payer: BCN Commercial |
$352.23
|
| Rate for Payer: Cash Price |
$341.76
|
| Rate for Payer: Cofinity Commercial |
$401.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.76
|
| Rate for Payer: Healthscope Commercial |
$414.38
|
| Rate for Payer: Healthscope Whirlpool |
$427.20
|
| Rate for Payer: Mclaren Commercial |
$384.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.12
|
| Rate for Payer: Nomi Health Commercial |
$350.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$374.31
|
| Rate for Payer: Priority Health Narrow Network |
$299.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.94
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$467.65 |
| Rate for Payer: Aetna Commercial |
$420.88
|
| Rate for Payer: Aetna Medicare |
$173.03
|
| Rate for Payer: ASR ASR |
$453.62
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: BCBS Trust/PPO |
$385.58
|
| Rate for Payer: BCN Commercial |
$385.58
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Commercial |
$439.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$453.62
|
| Rate for Payer: Healthscope Whirlpool |
$467.65
|
| Rate for Payer: Mclaren Commercial |
$420.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$409.75
|
| Rate for Payer: Priority Health Narrow Network |
$327.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.53
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$388.80
|
|
|
Service Code
|
NDC 904636361
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$349.92
|
| Rate for Payer: ASR ASR |
$377.14
|
| Rate for Payer: BCBS Trust/PPO |
$319.28
|
| Rate for Payer: BCN Commercial |
$319.28
|
| Rate for Payer: Cash Price |
$311.04
|
| Rate for Payer: Cofinity Commercial |
$365.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.04
|
| Rate for Payer: Healthscope Commercial |
$377.14
|
| Rate for Payer: Healthscope Whirlpool |
$388.80
|
| Rate for Payer: Mclaren Commercial |
$349.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.48
|
| Rate for Payer: Nomi Health Commercial |
$318.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.14
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
IP
|
$11,321.34
|
|
|
Service Code
|
APR-DRG 2444
|
| Min. Negotiated Rate |
$10,235.84 |
| Max. Negotiated Rate |
$11,321.34 |
| Rate for Payer: BCBS Complete |
$11,321.34
|
| Rate for Payer: Mclaren Medicaid |
$10,782.23
|
| Rate for Payer: Meridian Medicaid |
$11,321.34
|
| Rate for Payer: PHP Medicaid |
$10,235.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,782.23
|
| Rate for Payer: UHC Medicaid |
$10,782.23
|
| Rate for Payer: UHCCP Medicaid |
$10,782.23
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
IP
|
$6,750.30
|
|
|
Service Code
|
APR-DRG 2443
|
| Min. Negotiated Rate |
$6,103.07 |
| Max. Negotiated Rate |
$6,750.30 |
| Rate for Payer: BCBS Complete |
$6,750.30
|
| Rate for Payer: Mclaren Medicaid |
$6,428.85
|
| Rate for Payer: Meridian Medicaid |
$6,750.30
|
| Rate for Payer: PHP Medicaid |
$6,103.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,428.85
|
| Rate for Payer: UHC Medicaid |
$6,428.85
|
| Rate for Payer: UHCCP Medicaid |
$6,428.85
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
IP
|
$3,112.75
|
|
|
Service Code
|
APR-DRG 2441
|
| Min. Negotiated Rate |
$2,814.30 |
| Max. Negotiated Rate |
$3,112.75 |
| Rate for Payer: BCBS Complete |
$3,112.75
|
| Rate for Payer: Mclaren Medicaid |
$2,964.53
|
| Rate for Payer: Meridian Medicaid |
$3,112.75
|
| Rate for Payer: PHP Medicaid |
$2,814.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,964.53
|
| Rate for Payer: UHC Medicaid |
$2,964.53
|
| Rate for Payer: UHCCP Medicaid |
$2,964.53
|
|
|
DIVERTICULITIS AND DIVERTICULOSIS
|
Facility
|
IP
|
$4,128.00
|
|
|
Service Code
|
APR-DRG 2442
|
| Min. Negotiated Rate |
$3,732.20 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: BCBS Complete |
$4,128.00
|
| Rate for Payer: Mclaren Medicaid |
$3,931.43
|
| Rate for Payer: Meridian Medicaid |
$4,128.00
|
| Rate for Payer: PHP Medicaid |
$3,732.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,931.43
|
| Rate for Payer: UHC Medicaid |
$3,931.43
|
| Rate for Payer: UHCCP Medicaid |
$3,931.43
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
9892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Commercial |
$30.20
|
| Rate for Payer: ASR ASR |
$32.55
|
| Rate for Payer: ASR ASR |
$20.37
|
| Rate for Payer: BCBS Trust/PPO |
$27.55
|
| Rate for Payer: BCBS Trust/PPO |
$17.25
|
| Rate for Payer: BCN Commercial |
$27.55
|
| Rate for Payer: BCN Commercial |
$17.25
|
| Rate for Payer: Cash Price |
$26.84
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$31.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$20.37
|
| Rate for Payer: Healthscope Commercial |
$32.55
|
| Rate for Payer: Healthscope Whirlpool |
$33.55
|
| Rate for Payer: Healthscope Whirlpool |
$21.00
|
| Rate for Payer: Mclaren Commercial |
$30.20
|
| Rate for Payer: Mclaren Commercial |
$18.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.85
|
| Rate for Payer: Nomi Health Commercial |
$27.51
|
| Rate for Payer: Nomi Health Commercial |
$17.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.53
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.55
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
9892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$33.55 |
| Rate for Payer: Aetna Commercial |
$30.20
|
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna Medicare |
$12.41
|
| Rate for Payer: ASR ASR |
$32.55
|
| Rate for Payer: ASR ASR |
$20.37
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS Trust/PPO |
$27.66
|
| Rate for Payer: BCBS Trust/PPO |
$17.32
|
| Rate for Payer: BCN Commercial |
$17.32
|
| Rate for Payer: BCN Commercial |
$27.66
|
| Rate for Payer: Cash Price |
$26.84
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$26.84
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$31.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$32.55
|
| Rate for Payer: Healthscope Commercial |
$20.37
|
| Rate for Payer: Healthscope Whirlpool |
$33.55
|
| Rate for Payer: Healthscope Whirlpool |
$21.00
|
| Rate for Payer: Mclaren Commercial |
$30.20
|
| Rate for Payer: Mclaren Commercial |
$18.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.52
|
| Rate for Payer: Nomi Health Commercial |
$17.22
|
| Rate for Payer: Nomi Health Commercial |
$27.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.33
|
| Rate for Payer: Priority Health Narrow Network |
$6.66
|
| Rate for Payer: Priority Health Narrow Network |
$6.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.53
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$91.71
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$91.71 |
| Rate for Payer: Aetna Commercial |
$82.54
|
| Rate for Payer: Aetna Commercial |
$125.09
|
| Rate for Payer: Aetna Medicare |
$51.43
|
| Rate for Payer: Aetna Medicare |
$33.93
|
| Rate for Payer: ASR ASR |
$88.96
|
| Rate for Payer: ASR ASR |
$134.82
|
| Rate for Payer: BCBS Complete |
$55.60
|
| Rate for Payer: BCBS Complete |
$36.69
|
| Rate for Payer: BCBS Trust/PPO |
$75.62
|
| Rate for Payer: BCBS Trust/PPO |
$114.60
|
| Rate for Payer: BCN Commercial |
$114.60
|
| Rate for Payer: BCN Commercial |
$75.62
|
| Rate for Payer: Cash Price |
$73.37
|
| Rate for Payer: Cash Price |
$111.19
|
| Rate for Payer: Cash Price |
$73.37
|
| Rate for Payer: Cash Price |
$111.19
|
| Rate for Payer: Cofinity Commercial |
$130.65
|
| Rate for Payer: Cofinity Commercial |
$86.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.19
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Healthscope Commercial |
$134.82
|
| Rate for Payer: Healthscope Whirlpool |
$91.71
|
| Rate for Payer: Healthscope Whirlpool |
$138.99
|
| Rate for Payer: Mclaren Commercial |
$82.54
|
| Rate for Payer: Mclaren Commercial |
$125.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Nomi Health Commercial |
$113.97
|
| Rate for Payer: Nomi Health Commercial |
$75.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.33
|
| Rate for Payer: Priority Health Narrow Network |
$6.66
|
| Rate for Payer: Priority Health Narrow Network |
$6.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.71
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$138.99
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.24 |
| Max. Negotiated Rate |
$138.99 |
| Rate for Payer: Aetna Commercial |
$125.09
|
| Rate for Payer: Aetna Commercial |
$82.54
|
| Rate for Payer: ASR ASR |
$88.96
|
| Rate for Payer: ASR ASR |
$134.82
|
| Rate for Payer: BCBS Trust/PPO |
$75.31
|
| Rate for Payer: BCBS Trust/PPO |
$114.14
|
| Rate for Payer: BCN Commercial |
$75.31
|
| Rate for Payer: BCN Commercial |
$114.14
|
| Rate for Payer: Cash Price |
$73.37
|
| Rate for Payer: Cash Price |
$111.19
|
| Rate for Payer: Cofinity Commercial |
$130.65
|
| Rate for Payer: Cofinity Commercial |
$86.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.19
|
| Rate for Payer: Healthscope Commercial |
$134.82
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Healthscope Whirlpool |
$91.71
|
| Rate for Payer: Healthscope Whirlpool |
$138.99
|
| Rate for Payer: Mclaren Commercial |
$82.54
|
| Rate for Payer: Mclaren Commercial |
$125.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.14
|
| Rate for Payer: Nomi Health Commercial |
$75.20
|
| Rate for Payer: Nomi Health Commercial |
$113.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.71
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$74.36
|
| Rate for Payer: Aetna Medicare |
$30.57
|
| Rate for Payer: ASR ASR |
$80.14
|
| Rate for Payer: BCBS Complete |
$33.05
|
| Rate for Payer: BCBS Trust/PPO |
$68.12
|
| Rate for Payer: BCN Commercial |
$68.12
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$77.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$80.14
|
| Rate for Payer: Healthscope Whirlpool |
$82.62
|
| Rate for Payer: Mclaren Commercial |
$74.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.23
|
| Rate for Payer: Nomi Health Commercial |
$67.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.33
|
| Rate for Payer: Priority Health Narrow Network |
$6.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.97 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$74.36
|
| Rate for Payer: ASR ASR |
$80.14
|
| Rate for Payer: BCBS Trust/PPO |
$67.85
|
| Rate for Payer: BCN Commercial |
$67.85
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$77.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$80.14
|
| Rate for Payer: Healthscope Whirlpool |
$82.62
|
| Rate for Payer: Mclaren Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.23
|
| Rate for Payer: Nomi Health Commercial |
$67.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.71
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: ASR ASR |
$1.71
|
| Rate for Payer: BCBS Trust/PPO |
$1.45
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Healthscope Whirlpool |
$1.76
|
| Rate for Payer: Mclaren Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.55
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 60687012911
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna Medicare |
$0.65
|
| Rate for Payer: ASR ASR |
$1.71
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$1.45
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Healthscope Whirlpool |
$1.76
|
| Rate for Payer: Mclaren Commercial |
$1.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.50
|
| Rate for Payer: Nomi Health Commercial |
$1.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.54
|
| Rate for Payer: Priority Health Narrow Network |
$1.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.55
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$158.40
|
| Rate for Payer: ASR ASR |
$170.72
|
| Rate for Payer: BCBS Trust/PPO |
$144.53
|
| Rate for Payer: BCN Commercial |
$144.53
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$165.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$170.72
|
| Rate for Payer: Healthscope Whirlpool |
$176.00
|
| Rate for Payer: Mclaren Commercial |
$158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: Nomi Health Commercial |
$144.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.88
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
NDC 60687012901
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$158.40
|
| Rate for Payer: Aetna Medicare |
$65.12
|
| Rate for Payer: ASR ASR |
$170.72
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$145.11
|
| Rate for Payer: BCN Commercial |
$145.11
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$165.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$170.72
|
| Rate for Payer: Healthscope Whirlpool |
$176.00
|
| Rate for Payer: Mclaren Commercial |
$158.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.60
|
| Rate for Payer: Nomi Health Commercial |
$144.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$154.21
|
| Rate for Payer: Priority Health Narrow Network |
$123.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.88
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Medicare |
$69.93
|
| Rate for Payer: ASR ASR |
$183.33
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: BCBS Trust/PPO |
$155.83
|
| Rate for Payer: BCN Commercial |
$155.83
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$183.33
|
| Rate for Payer: Healthscope Whirlpool |
$189.00
|
| Rate for Payer: Mclaren Commercial |
$170.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$165.60
|
| Rate for Payer: Priority Health Narrow Network |
$132.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.32
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
NDC 904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$32.63
|
| Rate for Payer: ASR ASR |
$85.55
|
| Rate for Payer: BCBS Complete |
$35.28
|
| Rate for Payer: BCBS Trust/PPO |
$72.72
|
| Rate for Payer: BCN Commercial |
$72.72
|
| 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 |
$85.55
|
| Rate for Payer: Healthscope Whirlpool |
$88.20
|
| Rate for Payer: Mclaren Commercial |
$79.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.15
|
| Rate for Payer: Priority Health Cigna 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
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 63739047810
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: ASR ASR |
$183.33
|
| Rate for Payer: BCBS Trust/PPO |
$155.21
|
| Rate for Payer: BCN Commercial |
$155.21
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$177.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$183.33
|
| Rate for Payer: Healthscope Whirlpool |
$189.00
|
| Rate for Payer: Mclaren Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: Nomi Health Commercial |
$154.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$166.32
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
NDC 904699860
|
| Hospital Charge Code |
2566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: ASR ASR |
$85.55
|
| Rate for Payer: BCBS Trust/PPO |
$72.43
|
| Rate for Payer: BCN Commercial |
$72.43
|
| 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 |
$85.55
|
| Rate for Payer: Healthscope Whirlpool |
$88.20
|
| 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: Opus (Opus Packaging Group) HMA |
$66.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.62
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 904647861
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$265.55 |
| Rate for Payer: Aetna Commercial |
$239.00
|
| Rate for Payer: ASR ASR |
$257.58
|
| Rate for Payer: BCBS Trust/PPO |
$218.07
|
| Rate for Payer: BCN Commercial |
$218.07
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$249.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$257.58
|
| Rate for Payer: Healthscope Whirlpool |
$265.55
|
| Rate for Payer: Mclaren Commercial |
$239.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.68
|
|
|
DONEPEZIL 10 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 904647861
|
| Hospital Charge Code |
18787
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$265.55 |
| Rate for Payer: Aetna Commercial |
$239.00
|
| Rate for Payer: Aetna Medicare |
$98.25
|
| Rate for Payer: ASR ASR |
$257.58
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: BCBS Trust/PPO |
$218.95
|
| Rate for Payer: BCN Commercial |
$218.95
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$249.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$257.58
|
| Rate for Payer: Healthscope Whirlpool |
$265.55
|
| Rate for Payer: Mclaren Commercial |
$239.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$232.67
|
| Rate for Payer: Priority Health Narrow Network |
$186.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.68
|
|
|
DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
HCPCS J1265
|
| Hospital Charge Code |
14845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: BCBS Trust/PPO |
$60.31
|
| Rate for Payer: BCN Commercial |
$60.31
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$71.24
|
| Rate for Payer: Healthscope Whirlpool |
$73.44
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
|
DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
HCPCS J1265
|
| Hospital Charge Code |
14845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$66.10
|
| Rate for Payer: Aetna Medicare |
$27.17
|
| Rate for Payer: ASR ASR |
$71.24
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$60.55
|
| Rate for Payer: BCN Commercial |
$60.55
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$71.24
|
| Rate for Payer: Healthscope Whirlpool |
$73.44
|
| Rate for Payer: Mclaren Commercial |
$66.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.83
|
| Rate for Payer: Priority Health Narrow Network |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.63
|
|
