|
THYROID (PORK) 30 MG TABLET
|
Facility
|
OP
|
$496.80
|
|
|
Service Code
|
NDC 00456045801
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.24 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$422.28
|
| Rate for Payer: Aetna Medicare |
$248.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.92
|
| Rate for Payer: BCBS Complete |
$198.72
|
| Rate for Payer: Cash Price |
$397.44
|
| Rate for Payer: Cofinity Advantage |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$427.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.44
|
| Rate for Payer: Healthscope Commercial |
$447.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$397.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.60
|
| Rate for Payer: PHP Commercial |
$422.28
|
| Rate for Payer: Priority Health SBD |
$312.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.92
|
| Rate for Payer: UHC Core |
$258.83
|
| Rate for Payer: UHC Exchange |
$195.24
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
IP
|
$496.80
|
|
|
Service Code
|
NDC 00456045801
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.98 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$422.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.92
|
| Rate for Payer: Cash Price |
$397.44
|
| Rate for Payer: Cofinity Advantage |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$427.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.44
|
| Rate for Payer: Healthscope Commercial |
$447.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.60
|
| Rate for Payer: PHP Commercial |
$422.28
|
| Rate for Payer: Priority Health SBD |
$312.98
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
OP
|
$307.20
|
|
|
Service Code
|
NDC 42192032901
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.73 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$261.12
|
| Rate for Payer: Aetna Medicare |
$153.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.68
|
| Rate for Payer: BCBS Complete |
$122.88
|
| Rate for Payer: Cash Price |
$245.76
|
| Rate for Payer: Cofinity Advantage |
$215.04
|
| Rate for Payer: Cofinity Commercial |
$264.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.76
|
| Rate for Payer: Healthscope Commercial |
$276.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.40
|
| Rate for Payer: PHP Commercial |
$261.12
|
| Rate for Payer: Priority Health SBD |
$193.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.68
|
| Rate for Payer: UHC Core |
$160.05
|
| Rate for Payer: UHC Exchange |
$120.73
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
NDC 00456045901
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.94 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$469.20
|
| Rate for Payer: Aetna Medicare |
$276.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.80
|
| Rate for Payer: BCBS Complete |
$220.80
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cofinity Advantage |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$474.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.60
|
| Rate for Payer: Healthscope Commercial |
$496.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.00
|
| Rate for Payer: PHP Commercial |
$469.20
|
| Rate for Payer: Priority Health SBD |
$347.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.80
|
| Rate for Payer: UHC Core |
$287.59
|
| Rate for Payer: UHC Exchange |
$216.94
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
NDC 00456045901
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.76 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$469.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.80
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cofinity Advantage |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$474.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.60
|
| Rate for Payer: Healthscope Commercial |
$496.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.00
|
| Rate for Payer: PHP Commercial |
$469.20
|
| Rate for Payer: Priority Health SBD |
$347.76
|
|
|
THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$5,362.69
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
196901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,111.55 |
| Max. Negotiated Rate |
$6,674.81 |
| Rate for Payer: Aetna Commercial |
$4,558.29
|
| Rate for Payer: Aetna Medicare |
$2,210.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,485.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,656.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,656.68
|
| Rate for Payer: BCBS Complete |
$1,167.24
|
| Rate for Payer: BCBS MAPPO |
$2,125.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,332.92
|
| Rate for Payer: BCN Commercial |
$5,332.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,125.34
|
| Rate for Payer: Cash Price |
$4,290.15
|
| Rate for Payer: Cash Price |
$4,290.15
|
| Rate for Payer: Cofinity Advantage |
$3,753.88
|
| Rate for Payer: Cofinity Commercial |
$4,611.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,290.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,125.34
|
| Rate for Payer: Healthscope Commercial |
$4,826.42
|
| Rate for Payer: Mclaren Medicaid |
$1,111.55
|
| Rate for Payer: Mclaren Medicare |
$2,125.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,231.61
|
| Rate for Payer: Meridian Medicaid |
$2,231.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,444.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,337.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,558.29
|
| Rate for Payer: Nomi Health Commercial |
$6,376.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,022.02
|
| Rate for Payer: PACE Medicare |
$2,019.07
|
| Rate for Payer: PACE SWMI |
$2,125.34
|
| Rate for Payer: PHP Commercial |
$4,558.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,125.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,111.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,674.81
|
| Rate for Payer: Priority Health Medicare |
$2,125.34
|
| Rate for Payer: Priority Health SBD |
$3,378.49
|
| Rate for Payer: Priority Health Tiered Network |
$5,339.85
|
| Rate for Payer: Railroad Medicare Medicare |
$2,125.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,507.31
|
| Rate for Payer: UHC Core |
$3,507.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,125.34
|
| Rate for Payer: UHC Exchange |
$3,507.31
|
| Rate for Payer: UHC Medicaid |
$1,111.55
|
| Rate for Payer: UHCCP Medicaid |
$1,111.55
|
| Rate for Payer: VA VA |
$2,125.34
|
|
|
TICAGRELOR 60 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077660
|
| Hospital Charge Code |
175597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,051.05 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Advantage |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.25
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
|
|
TICAGRELOR 60 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077660
|
| Hospital Charge Code |
175597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$655.65 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna Medicare |
$834.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Advantage |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,334.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.25
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,084.41
|
| Rate for Payer: UHC Core |
$869.20
|
| Rate for Payer: UHC Exchange |
$655.65
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,051.05 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Advantage |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.25
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$2,780.18
|
|
|
Service Code
|
NDC 00186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,751.51 |
| Max. Negotiated Rate |
$2,502.16 |
| Rate for Payer: Aetna Commercial |
$2,363.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.12
|
| Rate for Payer: Cash Price |
$2,224.14
|
| Rate for Payer: Cofinity Advantage |
$1,946.13
|
| Rate for Payer: Cofinity Commercial |
$2,390.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.14
|
| Rate for Payer: Healthscope Commercial |
$2,502.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,085.14
|
| Rate for Payer: PHP Commercial |
$2,363.15
|
| Rate for Payer: Priority Health SBD |
$1,751.51
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$655.65 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna Medicare |
$834.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Advantage |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,334.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.25
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,084.41
|
| Rate for Payer: UHC Core |
$869.20
|
| Rate for Payer: UHC Exchange |
$655.65
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$2,780.18
|
|
|
Service Code
|
NDC 00186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,092.61 |
| Max. Negotiated Rate |
$2,502.16 |
| Rate for Payer: Aetna Commercial |
$2,363.15
|
| Rate for Payer: Aetna Medicare |
$1,390.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.12
|
| Rate for Payer: BCBS Complete |
$1,112.07
|
| Rate for Payer: Cash Price |
$2,224.14
|
| Rate for Payer: Cofinity Advantage |
$1,946.13
|
| Rate for Payer: Cofinity Commercial |
$2,390.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.14
|
| Rate for Payer: Healthscope Commercial |
$2,502.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,224.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,085.14
|
| Rate for Payer: PHP Commercial |
$2,363.15
|
| Rate for Payer: Priority Health SBD |
$1,751.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,807.12
|
| Rate for Payer: UHC Core |
$1,448.47
|
| Rate for Payer: UHC Exchange |
$1,092.61
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$43.83
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
301711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$39.45 |
| Rate for Payer: Aetna Commercial |
$37.26
|
| Rate for Payer: Aetna Medicare |
$21.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.49
|
| Rate for Payer: BCBS Complete |
$17.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cofinity Advantage |
$30.68
|
| Rate for Payer: Cofinity Commercial |
$37.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.06
|
| Rate for Payer: Healthscope Commercial |
$39.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.87
|
| Rate for Payer: PHP Commercial |
$37.26
|
| Rate for Payer: Priority Health SBD |
$27.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC Core |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$43.83
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
301711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.61 |
| Max. Negotiated Rate |
$39.45 |
| Rate for Payer: Aetna Commercial |
$37.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.49
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cofinity Advantage |
$30.68
|
| Rate for Payer: Cofinity Commercial |
$37.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.06
|
| Rate for Payer: Healthscope Commercial |
$39.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.87
|
| Rate for Payer: PHP Commercial |
$37.26
|
| Rate for Payer: Priority Health SBD |
$27.61
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.14
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
41652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: Aetna Commercial |
$37.26
|
| Rate for Payer: Aetna Commercial |
$48.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.49
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cofinity Advantage |
$30.68
|
| Rate for Payer: Cofinity Advantage |
$40.25
|
| Rate for Payer: Cofinity Advantage |
$26.70
|
| Rate for Payer: Cofinity Advantage |
$161.78
|
| Rate for Payer: Cofinity Commercial |
$49.45
|
| Rate for Payer: Cofinity Commercial |
$37.69
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.00
|
| Rate for Payer: Healthscope Commercial |
$39.45
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.33
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$48.88
|
| Rate for Payer: PHP Commercial |
$37.26
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: Priority Health SBD |
$27.61
|
| Rate for Payer: Priority Health SBD |
$36.23
|
| Rate for Payer: Priority Health SBD |
$145.60
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.14
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
41652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$48.88
|
| Rate for Payer: Aetna Commercial |
$37.26
|
| Rate for Payer: Aetna Commercial |
$196.44
|
| Rate for Payer: Aetna Medicare |
$19.07
|
| Rate for Payer: Aetna Medicare |
$28.75
|
| Rate for Payer: Aetna Medicare |
$21.91
|
| Rate for Payer: Aetna Medicare |
$115.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: BCBS Complete |
$23.00
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: BCBS Complete |
$92.44
|
| Rate for Payer: BCBS Complete |
$17.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cash Price |
$184.89
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cofinity Advantage |
$40.25
|
| Rate for Payer: Cofinity Advantage |
$161.78
|
| Rate for Payer: Cofinity Advantage |
$30.68
|
| Rate for Payer: Cofinity Advantage |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$198.75
|
| Rate for Payer: Cofinity Commercial |
$49.45
|
| Rate for Payer: Cofinity Commercial |
$37.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$39.45
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$51.75
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.12
|
| Rate for Payer: PHP Commercial |
$37.26
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$48.88
|
| Rate for Payer: PHP Commercial |
$196.44
|
| Rate for Payer: Priority Health SBD |
$145.60
|
| Rate for Payer: Priority Health SBD |
$27.61
|
| Rate for Payer: Priority Health SBD |
$36.23
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC Core |
$0.92
|
| Rate for Payer: UHC Core |
$0.92
|
| Rate for Payer: UHC Core |
$0.92
|
| Rate for Payer: UHC Core |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
NDC 61314022605
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.16
|
| Rate for Payer: PHP Commercial |
$14.92
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.41
|
| Rate for Payer: UHC Core |
$9.14
|
| Rate for Payer: UHC Exchange |
$6.90
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
NDC 61314022605
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.16
|
| Rate for Payer: PHP Commercial |
$14.92
|
| Rate for Payer: Priority Health SBD |
$11.06
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$23.52
|
|
|
Service Code
|
NDC 61314022610
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.29
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Advantage |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.64
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: Priority Health SBD |
$14.82
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
OP
|
$23.52
|
|
|
Service Code
|
NDC 61314022610
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna Medicare |
$11.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.29
|
| Rate for Payer: BCBS Complete |
$9.41
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cofinity Advantage |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.64
|
| Rate for Payer: PHP Commercial |
$19.99
|
| Rate for Payer: Priority Health SBD |
$14.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.29
|
| Rate for Payer: UHC Core |
$12.25
|
| Rate for Payer: UHC Exchange |
$9.24
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$688.84
|
|
|
Service Code
|
NDC 24208081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.71 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.51
|
| Rate for Payer: Aetna Medicare |
$344.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: Cash Price |
$551.07
|
| Rate for Payer: Cofinity Advantage |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.07
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$551.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.63
|
| Rate for Payer: PHP Commercial |
$585.51
|
| Rate for Payer: Priority Health SBD |
$433.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.75
|
| Rate for Payer: UHC Core |
$358.89
|
| Rate for Payer: UHC Exchange |
$270.71
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Advantage |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.19
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health SBD |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$14.72
|
| Rate for Payer: UHC Exchange |
$11.10
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$688.84
|
|
|
Service Code
|
NDC 24208081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$433.97 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna Commercial |
$585.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: Cash Price |
$551.07
|
| Rate for Payer: Cofinity Advantage |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.07
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.63
|
| Rate for Payer: PHP Commercial |
$585.51
|
| Rate for Payer: Priority Health SBD |
$433.97
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Advantage |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.19
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health SBD |
$17.80
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$22.91
|
|
|
Service Code
|
NDC 60758080105
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$19.47
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.89
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Advantage |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$20.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.18
|
| Rate for Payer: PHP Commercial |
$19.47
|
| Rate for Payer: Priority Health SBD |
$14.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.89
|
| Rate for Payer: UHC Core |
$11.94
|
| Rate for Payer: UHC Exchange |
$9.00
|
|
