|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$164.61
|
|
|
Service Code
|
NDC 24208029525
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$148.15 |
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.00
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cofinity Advantage |
$115.23
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.46
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: Priority Health SBD |
$103.70
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$50.47
|
|
|
Service Code
|
NDC 61314064305
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$45.42 |
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.81
|
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Cofinity Advantage |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.38
|
| Rate for Payer: Healthscope Commercial |
$45.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.85
|
| Rate for Payer: PHP Commercial |
$42.90
|
| Rate for Payer: Priority Health SBD |
$31.80
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$25.24
|
|
|
Service Code
|
NDC 62332051805
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$21.45
|
| Rate for Payer: Aetna Medicare |
$12.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.41
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: Cash Price |
$20.19
|
| Rate for Payer: Cofinity Advantage |
$17.67
|
| Rate for Payer: Cofinity Commercial |
$21.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.19
|
| Rate for Payer: Healthscope Commercial |
$22.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.93
|
| Rate for Payer: PHP Commercial |
$21.45
|
| Rate for Payer: Priority Health SBD |
$15.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.41
|
| Rate for Payer: UHC Core |
$13.15
|
| Rate for Payer: UHC Exchange |
$9.92
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$20.93
|
|
|
Service Code
|
NDC 70069013101
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$18.84 |
| Rate for Payer: Aetna Commercial |
$17.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cofinity Advantage |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$18.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$18.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.70
|
| Rate for Payer: PHP Commercial |
$17.79
|
| Rate for Payer: Priority Health SBD |
$13.19
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$50.47
|
|
|
Service Code
|
NDC 61314064305
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.83 |
| Max. Negotiated Rate |
$45.42 |
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: Aetna Medicare |
$25.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.81
|
| Rate for Payer: BCBS Complete |
$20.19
|
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Cofinity Advantage |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.38
|
| Rate for Payer: Healthscope Commercial |
$45.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.85
|
| Rate for Payer: PHP Commercial |
$42.90
|
| Rate for Payer: Priority Health SBD |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.81
|
| Rate for Payer: UHC Core |
$26.29
|
| Rate for Payer: UHC Exchange |
$19.83
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$37.84
|
|
|
Service Code
|
NDC 17478029010
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Medicare |
$18.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.60
|
| Rate for Payer: BCBS Complete |
$15.14
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cofinity Advantage |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$32.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.27
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.38
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health SBD |
$23.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.60
|
| Rate for Payer: UHC Core |
$19.71
|
| Rate for Payer: UHC Exchange |
$14.87
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$37.84
|
|
|
Service Code
|
NDC 17478029010
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.60
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cofinity Advantage |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$32.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.27
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.38
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health SBD |
$23.84
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$20.93
|
|
|
Service Code
|
NDC 70069013101
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$18.84 |
| Rate for Payer: Aetna Commercial |
$17.79
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cofinity Advantage |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$18.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$18.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.70
|
| Rate for Payer: PHP Commercial |
$17.79
|
| Rate for Payer: Priority Health SBD |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$10.90
|
| Rate for Payer: UHC Exchange |
$8.23
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$25.24
|
|
|
Service Code
|
NDC 62332051805
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$21.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.41
|
| Rate for Payer: Cash Price |
$20.19
|
| Rate for Payer: Cofinity Advantage |
$17.67
|
| Rate for Payer: Cofinity Commercial |
$21.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.19
|
| Rate for Payer: Healthscope Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.93
|
| Rate for Payer: PHP Commercial |
$21.45
|
| Rate for Payer: Priority Health SBD |
$15.90
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT
|
Facility
|
IP
|
$1,001.64
|
|
|
Service Code
|
NDC 00078081301
|
| Hospital Charge Code |
19769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$631.03 |
| Max. Negotiated Rate |
$901.48 |
| Rate for Payer: Aetna Commercial |
$851.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.07
|
| Rate for Payer: Cash Price |
$801.31
|
| Rate for Payer: Cofinity Advantage |
$701.15
|
| Rate for Payer: Cofinity Commercial |
$861.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.31
|
| Rate for Payer: Healthscope Commercial |
$901.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$751.23
|
| Rate for Payer: PHP Commercial |
$851.39
|
| Rate for Payer: Priority Health SBD |
$631.03
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT
|
Facility
|
OP
|
$1,001.64
|
|
|
Service Code
|
NDC 00078081301
|
| Hospital Charge Code |
19769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.64 |
| Max. Negotiated Rate |
$901.48 |
| Rate for Payer: Aetna Commercial |
$851.39
|
| Rate for Payer: Aetna Medicare |
$500.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.07
|
| Rate for Payer: BCBS Complete |
$400.66
|
| Rate for Payer: Cash Price |
$801.31
|
| Rate for Payer: Cofinity Advantage |
$701.15
|
| Rate for Payer: Cofinity Commercial |
$861.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.31
|
| Rate for Payer: Healthscope Commercial |
$901.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$801.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$751.23
|
| Rate for Payer: PHP Commercial |
$851.39
|
| Rate for Payer: Priority Health SBD |
$631.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.07
|
| Rate for Payer: UHC Core |
$521.85
|
| Rate for Payer: UHC Exchange |
$393.64
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$247.42
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
11565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.87 |
| Max. Negotiated Rate |
$222.68 |
| Rate for Payer: Aetna Commercial |
$210.31
|
| Rate for Payer: Aetna Commercial |
$180.54
|
| Rate for Payer: Aetna Commercial |
$157.16
|
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.82
|
| Rate for Payer: Cash Price |
$147.91
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cash Price |
$169.92
|
| Rate for Payer: Cash Price |
$197.94
|
| Rate for Payer: Cofinity Advantage |
$129.77
|
| Rate for Payer: Cofinity Advantage |
$148.68
|
| Rate for Payer: Cofinity Advantage |
$173.19
|
| Rate for Payer: Cofinity Advantage |
$129.42
|
| Rate for Payer: Cofinity Commercial |
$182.66
|
| Rate for Payer: Cofinity Commercial |
$159.44
|
| Rate for Payer: Cofinity Commercial |
$212.78
|
| Rate for Payer: Cofinity Commercial |
$159.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.94
|
| Rate for Payer: Healthscope Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$191.16
|
| Rate for Payer: Healthscope Commercial |
$166.85
|
| Rate for Payer: Healthscope Commercial |
$222.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.56
|
| Rate for Payer: PHP Commercial |
$157.58
|
| Rate for Payer: PHP Commercial |
$157.16
|
| Rate for Payer: PHP Commercial |
$210.31
|
| Rate for Payer: PHP Commercial |
$180.54
|
| Rate for Payer: Priority Health SBD |
$133.81
|
| Rate for Payer: Priority Health SBD |
$116.80
|
| Rate for Payer: Priority Health SBD |
$155.87
|
| Rate for Payer: Priority Health SBD |
$116.48
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$185.39
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
11565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$166.85 |
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Aetna Commercial |
$210.31
|
| Rate for Payer: Aetna Commercial |
$180.54
|
| Rate for Payer: Aetna Commercial |
$157.16
|
| Rate for Payer: Aetna Medicare |
$92.69
|
| Rate for Payer: Aetna Medicare |
$123.71
|
| Rate for Payer: Aetna Medicare |
$106.20
|
| Rate for Payer: Aetna Medicare |
$92.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.50
|
| Rate for Payer: BCBS Complete |
$98.97
|
| Rate for Payer: BCBS Complete |
$74.16
|
| Rate for Payer: BCBS Complete |
$73.96
|
| Rate for Payer: BCBS Complete |
$84.96
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cash Price |
$169.92
|
| Rate for Payer: Cash Price |
$197.94
|
| Rate for Payer: Cash Price |
$169.92
|
| Rate for Payer: Cash Price |
$147.91
|
| Rate for Payer: Cash Price |
$147.91
|
| Rate for Payer: Cash Price |
$197.94
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cofinity Advantage |
$173.19
|
| Rate for Payer: Cofinity Advantage |
$129.42
|
| Rate for Payer: Cofinity Advantage |
$148.68
|
| Rate for Payer: Cofinity Advantage |
$129.77
|
| Rate for Payer: Cofinity Commercial |
$159.01
|
| Rate for Payer: Cofinity Commercial |
$212.78
|
| Rate for Payer: Cofinity Commercial |
$159.44
|
| Rate for Payer: Cofinity Commercial |
$182.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.31
|
| Rate for Payer: Healthscope Commercial |
$191.16
|
| Rate for Payer: Healthscope Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$166.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.56
|
| Rate for Payer: PHP Commercial |
$180.54
|
| Rate for Payer: PHP Commercial |
$157.58
|
| Rate for Payer: PHP Commercial |
$210.31
|
| Rate for Payer: PHP Commercial |
$157.16
|
| Rate for Payer: Priority Health SBD |
$116.48
|
| Rate for Payer: Priority Health SBD |
$133.81
|
| Rate for Payer: Priority Health SBD |
$155.87
|
| Rate for Payer: Priority Health SBD |
$116.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
|
|
TOBRAMYCIN 300 MG/5 ML NEBULIZATION CUSTOM
|
Facility
|
IP
|
$50.66
|
|
|
Service Code
|
HCPCS J7682
|
| Hospital Charge Code |
168920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.93
|
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cofinity Advantage |
$35.46
|
| Rate for Payer: Cofinity Commercial |
$43.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.53
|
| Rate for Payer: Healthscope Commercial |
$45.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.99
|
| Rate for Payer: PHP Commercial |
$43.06
|
| Rate for Payer: Priority Health SBD |
$31.92
|
|
|
TOBRAMYCIN 300 MG/5 ML NEBULIZATION CUSTOM
|
Facility
|
OP
|
$50.66
|
|
|
Service Code
|
HCPCS J7682
|
| Hospital Charge Code |
168920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Medicare |
$25.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.93
|
| Rate for Payer: BCBS Complete |
$20.26
|
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cofinity Advantage |
$35.46
|
| Rate for Payer: Cofinity Commercial |
$43.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.53
|
| Rate for Payer: Healthscope Commercial |
$45.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.99
|
| Rate for Payer: PHP Commercial |
$43.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.47
|
| Rate for Payer: Priority Health SBD |
$31.92
|
| Rate for Payer: Priority Health Tiered Network |
$9.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.93
|
| Rate for Payer: UHC Core |
$26.39
|
| Rate for Payer: UHC Exchange |
$19.91
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$95.46
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$85.91 |
| Rate for Payer: Aetna Commercial |
$81.14
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Commercial |
$76.48
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna Medicare |
$9.37
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna Medicare |
$47.73
|
| Rate for Payer: Aetna Medicare |
$44.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: BCBS Complete |
$38.18
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: BCBS Complete |
$35.99
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: BCN Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cash Price |
$76.37
|
| Rate for Payer: Cash Price |
$76.37
|
| Rate for Payer: Cofinity Advantage |
$66.82
|
| Rate for Payer: Cofinity Advantage |
$62.99
|
| Rate for Payer: Cofinity Advantage |
$13.12
|
| Rate for Payer: Cofinity Advantage |
$7.84
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$77.38
|
| Rate for Payer: Cofinity Commercial |
$82.10
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$85.91
|
| Rate for Payer: Healthscope Commercial |
$80.98
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.48
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$81.14
|
| Rate for Payer: PHP Commercial |
$76.48
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Priority Health SBD |
$56.69
|
| Rate for Payer: Priority Health SBD |
$60.14
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$89.98
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$80.98 |
| Rate for Payer: Cofinity Commercial |
$77.38
|
| Rate for Payer: Aetna Commercial |
$76.48
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Commercial |
$81.14
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.49
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$76.37
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cofinity Advantage |
$62.99
|
| Rate for Payer: Cofinity Advantage |
$66.82
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Advantage |
$13.12
|
| Rate for Payer: Cofinity Advantage |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$82.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.37
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$80.98
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$85.91
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.48
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$76.48
|
| Rate for Payer: PHP Commercial |
$81.14
|
| Rate for Payer: Priority Health SBD |
$56.69
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: Priority Health SBD |
$60.14
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT
|
Facility
|
IP
|
$1,066.36
|
|
|
Service Code
|
NDC 00078087601
|
| Hospital Charge Code |
11566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$671.81 |
| Max. Negotiated Rate |
$959.72 |
| Rate for Payer: Aetna Commercial |
$906.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.13
|
| Rate for Payer: Cash Price |
$853.09
|
| Rate for Payer: Cofinity Advantage |
$746.45
|
| Rate for Payer: Cofinity Commercial |
$917.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.09
|
| Rate for Payer: Healthscope Commercial |
$959.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$799.77
|
| Rate for Payer: PHP Commercial |
$906.41
|
| Rate for Payer: Priority Health SBD |
$671.81
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT
|
Facility
|
OP
|
$1,066.36
|
|
|
Service Code
|
NDC 00078087601
|
| Hospital Charge Code |
11566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$419.08 |
| Max. Negotiated Rate |
$959.72 |
| Rate for Payer: Aetna Commercial |
$906.41
|
| Rate for Payer: Aetna Medicare |
$533.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.13
|
| Rate for Payer: BCBS Complete |
$426.54
|
| Rate for Payer: Cash Price |
$853.09
|
| Rate for Payer: Cofinity Advantage |
$746.45
|
| Rate for Payer: Cofinity Commercial |
$917.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.09
|
| Rate for Payer: Healthscope Commercial |
$959.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$853.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$799.77
|
| Rate for Payer: PHP Commercial |
$906.41
|
| Rate for Payer: Priority Health SBD |
$671.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.13
|
| Rate for Payer: UHC Core |
$555.57
|
| Rate for Payer: UHC Exchange |
$419.08
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,143.08
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,610.14 |
| Max. Negotiated Rate |
$3,728.77 |
| Rate for Payer: Aetna Commercial |
$3,521.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,693.00
|
| Rate for Payer: Cash Price |
$3,314.46
|
| Rate for Payer: Cofinity Advantage |
$2,900.16
|
| Rate for Payer: Cofinity Commercial |
$3,563.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,314.46
|
| Rate for Payer: Healthscope Commercial |
$3,728.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,521.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,107.31
|
| Rate for Payer: PHP Commercial |
$3,521.62
|
| Rate for Payer: Priority Health SBD |
$2,610.14
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,143.08
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$3,728.77 |
| Rate for Payer: Aetna Commercial |
$3,521.62
|
| Rate for Payer: Aetna Medicare |
$5.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,693.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.91
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$5.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.53
|
| Rate for Payer: Cash Price |
$3,314.46
|
| Rate for Payer: Cash Price |
$3,314.46
|
| Rate for Payer: Cofinity Advantage |
$2,900.16
|
| Rate for Payer: Cofinity Commercial |
$3,563.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,314.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.53
|
| Rate for Payer: Healthscope Commercial |
$3,728.77
|
| Rate for Payer: Mclaren Medicaid |
$2.89
|
| Rate for Payer: Mclaren Medicare |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.81
|
| Rate for Payer: Meridian Medicaid |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,521.62
|
| Rate for Payer: Nomi Health Commercial |
$16.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,107.31
|
| Rate for Payer: PACE Medicare |
$5.25
|
| Rate for Payer: PACE SWMI |
$5.53
|
| Rate for Payer: PHP Commercial |
$3,521.62
|
| Rate for Payer: PHP Medicare Advantage |
$5.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.99
|
| Rate for Payer: Priority Health Medicare |
$5.53
|
| Rate for Payer: Priority Health SBD |
$2,610.14
|
| Rate for Payer: Priority Health Tiered Network |
$14.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.26
|
| Rate for Payer: UHC Core |
$9.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.53
|
| Rate for Payer: UHC Exchange |
$9.26
|
| Rate for Payer: UHC Medicaid |
$2.89
|
| Rate for Payer: UHCCP Medicaid |
$2.89
|
| Rate for Payer: VA VA |
$5.53
|
|
|
TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,732.50
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$6,059.25 |
| Rate for Payer: Aetna Commercial |
$5,722.62
|
| Rate for Payer: Aetna Medicare |
$5.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,376.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.91
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$5.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.53
|
| Rate for Payer: Cash Price |
$5,386.00
|
| Rate for Payer: Cash Price |
$5,386.00
|
| Rate for Payer: Cofinity Advantage |
$4,712.75
|
| Rate for Payer: Cofinity Commercial |
$5,789.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,386.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.53
|
| Rate for Payer: Healthscope Commercial |
$6,059.25
|
| Rate for Payer: Mclaren Medicaid |
$2.89
|
| Rate for Payer: Mclaren Medicare |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.81
|
| Rate for Payer: Meridian Medicaid |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,722.62
|
| Rate for Payer: Nomi Health Commercial |
$16.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,049.38
|
| Rate for Payer: PACE Medicare |
$5.25
|
| Rate for Payer: PACE SWMI |
$5.53
|
| Rate for Payer: PHP Commercial |
$5,722.62
|
| Rate for Payer: PHP Medicare Advantage |
$5.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.99
|
| Rate for Payer: Priority Health Medicare |
$5.53
|
| Rate for Payer: Priority Health SBD |
$4,241.48
|
| Rate for Payer: Priority Health Tiered Network |
$14.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.26
|
| Rate for Payer: UHC Core |
$9.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.53
|
| Rate for Payer: UHC Exchange |
$9.26
|
| Rate for Payer: UHC Medicaid |
$2.89
|
| Rate for Payer: UHCCP Medicaid |
$2.89
|
| Rate for Payer: VA VA |
$5.53
|
|
|
TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,732.50
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,241.48 |
| Max. Negotiated Rate |
$6,059.25 |
| Rate for Payer: Aetna Commercial |
$5,722.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,376.12
|
| Rate for Payer: Cash Price |
$5,386.00
|
| Rate for Payer: Cofinity Advantage |
$4,712.75
|
| Rate for Payer: Cofinity Commercial |
$5,789.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,386.00
|
| Rate for Payer: Healthscope Commercial |
$6,059.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,722.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,049.38
|
| Rate for Payer: PHP Commercial |
$5,722.62
|
| Rate for Payer: Priority Health SBD |
$4,241.48
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,657.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$1,491.50 |
| Rate for Payer: Aetna Commercial |
$1,408.64
|
| Rate for Payer: Aetna Medicare |
$5.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.91
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$5.53
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.53
|
| Rate for Payer: Cash Price |
$1,325.78
|
| Rate for Payer: Cash Price |
$1,325.78
|
| Rate for Payer: Cofinity Advantage |
$1,160.05
|
| Rate for Payer: Cofinity Commercial |
$1,425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.53
|
| Rate for Payer: Healthscope Commercial |
$1,491.50
|
| Rate for Payer: Mclaren Medicaid |
$2.89
|
| Rate for Payer: Mclaren Medicare |
$5.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.81
|
| Rate for Payer: Meridian Medicaid |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.64
|
| Rate for Payer: Nomi Health Commercial |
$16.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,242.91
|
| Rate for Payer: PACE Medicare |
$5.25
|
| Rate for Payer: PACE SWMI |
$5.53
|
| Rate for Payer: PHP Commercial |
$1,408.64
|
| Rate for Payer: PHP Medicare Advantage |
$5.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.99
|
| Rate for Payer: Priority Health Medicare |
$5.53
|
| Rate for Payer: Priority Health SBD |
$1,044.05
|
| Rate for Payer: Priority Health Tiered Network |
$14.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.26
|
| Rate for Payer: UHC Core |
$9.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.53
|
| Rate for Payer: UHC Exchange |
$9.26
|
| Rate for Payer: UHC Medicaid |
$2.89
|
| Rate for Payer: UHCCP Medicaid |
$2.89
|
| Rate for Payer: VA VA |
$5.53
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,657.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,044.05 |
| Max. Negotiated Rate |
$1,491.50 |
| Rate for Payer: Aetna Commercial |
$1,408.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.19
|
| Rate for Payer: Cash Price |
$1,325.78
|
| Rate for Payer: Cofinity Advantage |
$1,160.05
|
| Rate for Payer: Cofinity Commercial |
$1,425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.78
|
| Rate for Payer: Healthscope Commercial |
$1,491.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,242.91
|
| Rate for Payer: PHP Commercial |
$1,408.64
|
| Rate for Payer: Priority Health SBD |
$1,044.05
|
|
