Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TIZANIDINE 2 MG TABLET

Facility

$157.68

Service Code	NDC 50268075915
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$99.34
Max. Negotiated Rate	$141.91
Rate for Payer: Aetna Commercial	$134.03
Rate for Payer: Aetna New Business (MI Preferred)	$102.49
Rate for Payer: Cash Price	$126.14
Rate for Payer: Cofinity Commercial	$110.38
Rate for Payer: Cofinity Commercial	$135.60
Rate for Payer: Cofinity Medicare Advantage	$110.38
Rate for Payer: Encore Health Key Benefits Commercial	$126.14
Rate for Payer: Healthscope Commercial	$141.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.03
Rate for Payer: PHP Commercial	$134.03
Rate for Payer: Priority Health Cigna Priority Health	$102.49
Rate for Payer: Priority Health SBD	$99.34

TIZANIDINE 2 MG TABLET

Facility

$157.68

Service Code	NDC 50268075915
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$63.07
Max. Negotiated Rate	$141.91
Rate for Payer: Aetna Commercial	$134.03
Rate for Payer: Aetna Medicare	$78.84
Rate for Payer: Aetna New Business (MI Preferred)	$102.49
Rate for Payer: BCBS Complete	$63.07
Rate for Payer: Cash Price	$126.14
Rate for Payer: Cofinity Commercial	$110.38
Rate for Payer: Cofinity Commercial	$135.60
Rate for Payer: Cofinity Medicare Advantage	$110.38
Rate for Payer: Encore Health Key Benefits Commercial	$126.14
Rate for Payer: Healthscope Commercial	$141.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.03
Rate for Payer: PHP Commercial	$134.03
Rate for Payer: Priority Health Cigna Priority Health	$102.49
Rate for Payer: Priority Health SBD	$99.34

TIZANIDINE 2 MG TABLET

Facility

$3.16

Service Code	NDC 50268075911
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna Medicare	$1.58
Rate for Payer: Aetna New Business (MI Preferred)	$2.05
Rate for Payer: BCBS Complete	$1.26
Rate for Payer: Cash Price	$2.53
Rate for Payer: Cofinity Commercial	$2.21
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Cofinity Medicare Advantage	$2.21
Rate for Payer: Encore Health Key Benefits Commercial	$2.53
Rate for Payer: Healthscope Commercial	$2.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.69
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health Cigna Priority Health	$2.05
Rate for Payer: Priority Health SBD	$1.99

TIZANIDINE 2 MG TABLET

Facility

$3.16

Service Code	NDC 50268075911
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.05
Rate for Payer: Cash Price	$2.53
Rate for Payer: Cofinity Commercial	$2.21
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Cofinity Medicare Advantage	$2.21
Rate for Payer: Encore Health Key Benefits Commercial	$2.53
Rate for Payer: Healthscope Commercial	$2.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.69
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health Cigna Priority Health	$2.05
Rate for Payer: Priority Health SBD	$1.99

TIZANIDINE 2 MG TABLET

Facility

$91.44

Service Code	NDC 68084077525
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$57.61
Max. Negotiated Rate	$82.30
Rate for Payer: Aetna Commercial	$77.72
Rate for Payer: Aetna New Business (MI Preferred)	$59.44
Rate for Payer: Cash Price	$73.15
Rate for Payer: Cofinity Commercial	$64.01
Rate for Payer: Cofinity Commercial	$78.64
Rate for Payer: Cofinity Medicare Advantage	$64.01
Rate for Payer: Encore Health Key Benefits Commercial	$73.15
Rate for Payer: Healthscope Commercial	$82.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.72
Rate for Payer: PHP Commercial	$77.72
Rate for Payer: Priority Health Cigna Priority Health	$59.44
Rate for Payer: Priority Health SBD	$57.61

TIZANIDINE 4 MG TABLET

Facility

$396.15

Service Code	NDC 00904641861
Hospital Charge Code	14793
Hospital Revenue Code	637
Min. Negotiated Rate	$249.57
Max. Negotiated Rate	$356.54
Rate for Payer: Aetna Commercial	$336.73
Rate for Payer: Aetna New Business (MI Preferred)	$257.50
Rate for Payer: Cash Price	$316.92
Rate for Payer: Cofinity Commercial	$277.31
Rate for Payer: Cofinity Commercial	$340.69
Rate for Payer: Cofinity Medicare Advantage	$277.31
Rate for Payer: Encore Health Key Benefits Commercial	$316.92
Rate for Payer: Healthscope Commercial	$356.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.73
Rate for Payer: PHP Commercial	$336.73
Rate for Payer: Priority Health Cigna Priority Health	$257.50
Rate for Payer: Priority Health SBD	$249.57

TIZANIDINE 4 MG TABLET

Facility

$396.15

Service Code	NDC 00904641861
Hospital Charge Code	14793
Hospital Revenue Code	637
Min. Negotiated Rate	$158.46
Max. Negotiated Rate	$356.54
Rate for Payer: Aetna Commercial	$336.73
Rate for Payer: Aetna Medicare	$198.07
Rate for Payer: Aetna New Business (MI Preferred)	$257.50
Rate for Payer: BCBS Complete	$158.46
Rate for Payer: Cash Price	$316.92
Rate for Payer: Cofinity Commercial	$277.31
Rate for Payer: Cofinity Commercial	$340.69
Rate for Payer: Cofinity Medicare Advantage	$277.31
Rate for Payer: Encore Health Key Benefits Commercial	$316.92
Rate for Payer: Healthscope Commercial	$356.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.73
Rate for Payer: PHP Commercial	$336.73
Rate for Payer: Priority Health Cigna Priority Health	$257.50
Rate for Payer: Priority Health SBD	$249.57

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$297.40

Service Code	NDC 00078095340
Hospital Charge Code	11567
Hospital Revenue Code	637
Min. Negotiated Rate	$118.96
Max. Negotiated Rate	$267.66
Rate for Payer: Aetna Commercial	$252.79
Rate for Payer: Aetna Medicare	$148.70
Rate for Payer: Aetna New Business (MI Preferred)	$193.31
Rate for Payer: BCBS Complete	$118.96
Rate for Payer: Cash Price	$237.92
Rate for Payer: Cofinity Commercial	$208.18
Rate for Payer: Cofinity Commercial	$255.76
Rate for Payer: Cofinity Medicare Advantage	$208.18
Rate for Payer: Encore Health Key Benefits Commercial	$237.92
Rate for Payer: Healthscope Commercial	$267.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$252.79
Rate for Payer: PHP Commercial	$252.79
Rate for Payer: Priority Health Cigna Priority Health	$193.31
Rate for Payer: Priority Health SBD	$187.36

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$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 Commercial	$115.23
Rate for Payer: Cofinity Commercial	$141.56
Rate for Payer: Cofinity Medicare Advantage	$115.23
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: PHP Commercial	$139.92
Rate for Payer: Priority Health Cigna Priority Health	$107.00
Rate for Payer: Priority Health SBD	$103.70

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$164.61

Service Code	NDC 24208029525
Hospital Charge Code	11567
Hospital Revenue Code	637
Min. Negotiated Rate	$65.84
Max. Negotiated Rate	$148.15
Rate for Payer: Aetna Commercial	$139.92
Rate for Payer: Aetna Medicare	$82.31
Rate for Payer: Aetna New Business (MI Preferred)	$107.00
Rate for Payer: BCBS Complete	$65.84
Rate for Payer: Cash Price	$131.69
Rate for Payer: Cofinity Commercial	$115.23
Rate for Payer: Cofinity Commercial	$141.56
Rate for Payer: Cofinity Medicare Advantage	$115.23
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: PHP Commercial	$139.92
Rate for Payer: Priority Health Cigna Priority Health	$107.00
Rate for Payer: Priority Health SBD	$103.70

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$270.80

Service Code	NDC 00065064725
Hospital Charge Code	11567
Hospital Revenue Code	637
Min. Negotiated Rate	$108.32
Max. Negotiated Rate	$243.72
Rate for Payer: Aetna Commercial	$230.18
Rate for Payer: Aetna Medicare	$135.40
Rate for Payer: Aetna New Business (MI Preferred)	$176.02
Rate for Payer: BCBS Complete	$108.32
Rate for Payer: Cash Price	$216.64
Rate for Payer: Cofinity Commercial	$189.56
Rate for Payer: Cofinity Commercial	$232.89
Rate for Payer: Cofinity Medicare Advantage	$189.56
Rate for Payer: Encore Health Key Benefits Commercial	$216.64
Rate for Payer: Healthscope Commercial	$243.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.18
Rate for Payer: PHP Commercial	$230.18
Rate for Payer: Priority Health Cigna Priority Health	$176.02
Rate for Payer: Priority Health SBD	$170.60

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$297.40

Service Code	NDC 00078095340
Hospital Charge Code	11567
Hospital Revenue Code	637
Min. Negotiated Rate	$187.36
Max. Negotiated Rate	$267.66
Rate for Payer: Aetna Commercial	$252.79
Rate for Payer: Aetna New Business (MI Preferred)	$193.31
Rate for Payer: Cash Price	$237.92
Rate for Payer: Cofinity Commercial	$208.18
Rate for Payer: Cofinity Commercial	$255.76
Rate for Payer: Cofinity Medicare Advantage	$208.18
Rate for Payer: Encore Health Key Benefits Commercial	$237.92
Rate for Payer: Healthscope Commercial	$267.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$252.79
Rate for Payer: PHP Commercial	$252.79
Rate for Payer: Priority Health Cigna Priority Health	$193.31
Rate for Payer: Priority Health SBD	$187.36

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$270.80

Service Code	NDC 00065064725
Hospital Charge Code	11567
Hospital Revenue Code	637
Min. Negotiated Rate	$170.60
Max. Negotiated Rate	$243.72
Rate for Payer: Aetna Commercial	$230.18
Rate for Payer: Aetna New Business (MI Preferred)	$176.02
Rate for Payer: Cash Price	$216.64
Rate for Payer: Cofinity Commercial	$189.56
Rate for Payer: Cofinity Commercial	$232.89
Rate for Payer: Cofinity Medicare Advantage	$189.56
Rate for Payer: Encore Health Key Benefits Commercial	$216.64
Rate for Payer: Healthscope Commercial	$243.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.18
Rate for Payer: PHP Commercial	$230.18
Rate for Payer: Priority Health Cigna Priority Health	$176.02
Rate for Payer: Priority Health SBD	$170.60

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$37.84

Service Code	NDC 17478029010
Hospital Charge Code	7995
Hospital Revenue Code	637
Min. Negotiated Rate	$15.14
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 Commercial	$26.49
Rate for Payer: Cofinity Commercial	$32.54
Rate for Payer: Cofinity Medicare Advantage	$26.49
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: PHP Commercial	$32.16
Rate for Payer: Priority Health Cigna Priority Health	$24.60
Rate for Payer: Priority Health SBD	$23.84

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$20.07

Service Code	NDC 70069013101
Hospital Charge Code	7995
Hospital Revenue Code	637
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$18.06
Rate for Payer: Aetna Commercial	$17.06
Rate for Payer: Aetna Medicare	$10.04
Rate for Payer: Aetna New Business (MI Preferred)	$13.05
Rate for Payer: BCBS Complete	$8.03
Rate for Payer: Cash Price	$16.06
Rate for Payer: Cofinity Commercial	$14.05
Rate for Payer: Cofinity Commercial	$17.26
Rate for Payer: Cofinity Medicare Advantage	$14.05
Rate for Payer: Encore Health Key Benefits Commercial	$16.06
Rate for Payer: Healthscope Commercial	$18.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.06
Rate for Payer: PHP Commercial	$17.06
Rate for Payer: Priority Health Cigna Priority Health	$13.05
Rate for Payer: Priority Health SBD	$12.64

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$20.07

Service Code	NDC 70069013101
Hospital Charge Code	7995
Hospital Revenue Code	637
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$18.06
Rate for Payer: Aetna Commercial	$17.06
Rate for Payer: Aetna New Business (MI Preferred)	$13.05
Rate for Payer: Cash Price	$16.06
Rate for Payer: Cofinity Commercial	$14.05
Rate for Payer: Cofinity Commercial	$17.26
Rate for Payer: Cofinity Medicare Advantage	$14.05
Rate for Payer: Encore Health Key Benefits Commercial	$16.06
Rate for Payer: Healthscope Commercial	$18.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.06
Rate for Payer: PHP Commercial	$17.06
Rate for Payer: Priority Health Cigna Priority Health	$13.05
Rate for Payer: Priority Health SBD	$12.64

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$24.92

Service Code	NDC 62332051805
Hospital Charge Code	7995
Hospital Revenue Code	637
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$22.43
Rate for Payer: Aetna Commercial	$21.18
Rate for Payer: Aetna New Business (MI Preferred)	$16.20
Rate for Payer: Cash Price	$19.94
Rate for Payer: Cofinity Commercial	$17.44
Rate for Payer: Cofinity Commercial	$21.43
Rate for Payer: Cofinity Medicare Advantage	$17.44
Rate for Payer: Encore Health Key Benefits Commercial	$19.94
Rate for Payer: Healthscope Commercial	$22.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.18
Rate for Payer: PHP Commercial	$21.18
Rate for Payer: Priority Health Cigna Priority Health	$16.20
Rate for Payer: Priority Health SBD	$15.70

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$50.47

Service Code	NDC 61314064305
Hospital Charge Code	7995
Hospital Revenue Code	637
Min. Negotiated Rate	$20.19
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 Commercial	$35.33
Rate for Payer: Cofinity Commercial	$43.40
Rate for Payer: Cofinity Medicare Advantage	$35.33
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: PHP Commercial	$42.90
Rate for Payer: Priority Health Cigna Priority Health	$32.81
Rate for Payer: Priority Health SBD	$31.80

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$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 Commercial	$35.33
Rate for Payer: Cofinity Commercial	$43.40
Rate for Payer: Cofinity Medicare Advantage	$35.33
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: PHP Commercial	$42.90
Rate for Payer: Priority Health Cigna Priority Health	$32.81
Rate for Payer: Priority Health SBD	$31.80

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$24.92

Service Code	NDC 62332051805
Hospital Charge Code	7995
Hospital Revenue Code	637
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$22.43
Rate for Payer: Aetna Commercial	$21.18
Rate for Payer: Aetna Medicare	$12.46
Rate for Payer: Aetna New Business (MI Preferred)	$16.20
Rate for Payer: BCBS Complete	$9.97
Rate for Payer: Cash Price	$19.94
Rate for Payer: Cofinity Commercial	$17.44
Rate for Payer: Cofinity Commercial	$21.43
Rate for Payer: Cofinity Medicare Advantage	$17.44
Rate for Payer: Encore Health Key Benefits Commercial	$19.94
Rate for Payer: Healthscope Commercial	$22.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.18
Rate for Payer: PHP Commercial	$21.18
Rate for Payer: Priority Health Cigna Priority Health	$16.20
Rate for Payer: Priority Health SBD	$15.70

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$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 Commercial	$26.49
Rate for Payer: Cofinity Commercial	$32.54
Rate for Payer: Cofinity Medicare Advantage	$26.49
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: PHP Commercial	$32.16
Rate for Payer: Priority Health Cigna Priority Health	$24.60
Rate for Payer: Priority Health SBD	$23.84

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$331.63

Service Code	NDC 00065064305
Hospital Charge Code	7995
Hospital Revenue Code	637
Min. Negotiated Rate	$208.93
Max. Negotiated Rate	$298.47
Rate for Payer: Aetna Commercial	$281.89
Rate for Payer: Aetna New Business (MI Preferred)	$215.56
Rate for Payer: Cash Price	$265.30
Rate for Payer: Cofinity Commercial	$232.14
Rate for Payer: Cofinity Commercial	$285.20
Rate for Payer: Cofinity Medicare Advantage	$232.14
Rate for Payer: Encore Health Key Benefits Commercial	$265.30
Rate for Payer: Healthscope Commercial	$298.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.89
Rate for Payer: PHP Commercial	$281.89
Rate for Payer: Priority Health Cigna Priority Health	$215.56
Rate for Payer: Priority Health SBD	$208.93

TOBRAMYCIN 0.3 % EYE DROPS

Facility

$331.63

Service Code	NDC 00065064305
Hospital Charge Code	7995
Hospital Revenue Code	637
Min. Negotiated Rate	$132.65
Max. Negotiated Rate	$298.47
Rate for Payer: Aetna Commercial	$281.89
Rate for Payer: Aetna Medicare	$165.81
Rate for Payer: Aetna New Business (MI Preferred)	$215.56
Rate for Payer: BCBS Complete	$132.65
Rate for Payer: Cash Price	$265.30
Rate for Payer: Cofinity Commercial	$232.14
Rate for Payer: Cofinity Commercial	$285.20
Rate for Payer: Cofinity Medicare Advantage	$232.14
Rate for Payer: Encore Health Key Benefits Commercial	$265.30
Rate for Payer: Healthscope Commercial	$298.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.89
Rate for Payer: PHP Commercial	$281.89
Rate for Payer: Priority Health Cigna Priority Health	$215.56
Rate for Payer: Priority Health SBD	$208.93

TOBRAMYCIN 0.3 % EYE OINTMENT

Facility

$696.47

Service Code	NDC 00065064435
Hospital Charge Code	19769
Hospital Revenue Code	637
Min. Negotiated Rate	$438.78
Max. Negotiated Rate	$626.82
Rate for Payer: Aetna Commercial	$592.00
Rate for Payer: Aetna New Business (MI Preferred)	$452.71
Rate for Payer: Cash Price	$557.18
Rate for Payer: Cofinity Commercial	$487.53
Rate for Payer: Cofinity Commercial	$598.96
Rate for Payer: Cofinity Medicare Advantage	$487.53
Rate for Payer: Encore Health Key Benefits Commercial	$557.18
Rate for Payer: Healthscope Commercial	$626.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$592.00
Rate for Payer: PHP Commercial	$592.00
Rate for Payer: Priority Health Cigna Priority Health	$452.71
Rate for Payer: Priority Health SBD	$438.78

TOBRAMYCIN 0.3 % EYE OINTMENT

Facility

$696.47

Service Code	NDC 00065064435
Hospital Charge Code	19769
Hospital Revenue Code	637
Min. Negotiated Rate	$278.59
Max. Negotiated Rate	$626.82
Rate for Payer: Aetna Commercial	$592.00
Rate for Payer: Aetna Medicare	$348.24
Rate for Payer: Aetna New Business (MI Preferred)	$452.71
Rate for Payer: BCBS Complete	$278.59
Rate for Payer: Cash Price	$557.18
Rate for Payer: Cofinity Commercial	$487.53
Rate for Payer: Cofinity Commercial	$598.96
Rate for Payer: Cofinity Medicare Advantage	$487.53
Rate for Payer: Encore Health Key Benefits Commercial	$557.18
Rate for Payer: Healthscope Commercial	$626.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$592.00
Rate for Payer: PHP Commercial	$592.00
Rate for Payer: Priority Health Cigna Priority Health	$452.71
Rate for Payer: Priority Health SBD	$438.78

Know your out-of-pocket cost for care.

All Charges