Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TIMOLOL MALEATE 0.25 % EYE DROPS

Facility

$25.56

Service Code	NDC 61314022610
Hospital Charge Code	11561
Hospital Revenue Code	637
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$21.73
Rate for Payer: Aetna New Business (MI Preferred)	$16.61
Rate for Payer: Cash Price	$20.45
Rate for Payer: Cofinity Commercial	$17.89
Rate for Payer: Cofinity Commercial	$21.98
Rate for Payer: Cofinity Medicare Advantage	$17.89
Rate for Payer: Encore Health Key Benefits Commercial	$20.45
Rate for Payer: Healthscope Commercial	$23.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.73
Rate for Payer: PHP Commercial	$21.73
Rate for Payer: Priority Health Cigna Priority Health	$16.61
Rate for Payer: Priority Health SBD	$16.10

TIMOLOL MALEATE 0.25 % EYE DROPS

Facility

$14.90

Service Code	NDC 61314022605
Hospital Charge Code	11561
Hospital Revenue Code	637
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$13.41
Rate for Payer: Aetna Commercial	$12.66
Rate for Payer: Aetna New Business (MI Preferred)	$9.68
Rate for Payer: Cash Price	$11.92
Rate for Payer: Cofinity Commercial	$10.43
Rate for Payer: Cofinity Commercial	$12.81
Rate for Payer: Cofinity Medicare Advantage	$10.43
Rate for Payer: Encore Health Key Benefits Commercial	$11.92
Rate for Payer: Healthscope Commercial	$13.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.66
Rate for Payer: PHP Commercial	$12.66
Rate for Payer: Priority Health Cigna Priority Health	$9.68
Rate for Payer: Priority Health SBD	$9.39

TIMOLOL MALEATE 0.25 % EYE DROPS

Facility

$14.90

Service Code	NDC 61314022605
Hospital Charge Code	11561
Hospital Revenue Code	637
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$13.41
Rate for Payer: Aetna Commercial	$12.66
Rate for Payer: Aetna Medicare	$7.45
Rate for Payer: Aetna New Business (MI Preferred)	$9.68
Rate for Payer: BCBS Complete	$5.96
Rate for Payer: Cash Price	$11.92
Rate for Payer: Cofinity Commercial	$10.43
Rate for Payer: Cofinity Commercial	$12.81
Rate for Payer: Cofinity Medicare Advantage	$10.43
Rate for Payer: Encore Health Key Benefits Commercial	$11.92
Rate for Payer: Healthscope Commercial	$13.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.66
Rate for Payer: PHP Commercial	$12.66
Rate for Payer: Priority Health Cigna Priority Health	$9.68
Rate for Payer: Priority Health SBD	$9.39

TIMOLOL MALEATE 0.25 % EYE DROPS

Facility

$25.56

Service Code	NDC 61314022610
Hospital Charge Code	11561
Hospital Revenue Code	637
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$21.73
Rate for Payer: Aetna Medicare	$12.78
Rate for Payer: Aetna New Business (MI Preferred)	$16.61
Rate for Payer: BCBS Complete	$10.22
Rate for Payer: Cash Price	$20.45
Rate for Payer: Cofinity Commercial	$17.89
Rate for Payer: Cofinity Commercial	$21.98
Rate for Payer: Cofinity Medicare Advantage	$17.89
Rate for Payer: Encore Health Key Benefits Commercial	$20.45
Rate for Payer: Healthscope Commercial	$23.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.73
Rate for Payer: PHP Commercial	$21.73
Rate for Payer: Priority Health Cigna Priority Health	$16.61
Rate for Payer: Priority Health SBD	$16.10

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$31.57

Service Code	NDC 64980051405
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$28.41
Rate for Payer: Aetna Commercial	$26.83
Rate for Payer: Aetna New Business (MI Preferred)	$20.52
Rate for Payer: Cash Price	$25.26
Rate for Payer: Cofinity Commercial	$22.10
Rate for Payer: Cofinity Commercial	$27.15
Rate for Payer: Cofinity Medicare Advantage	$22.10
Rate for Payer: Encore Health Key Benefits Commercial	$25.26
Rate for Payer: Healthscope Commercial	$28.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.83
Rate for Payer: PHP Commercial	$26.83
Rate for Payer: Priority Health Cigna Priority Health	$20.52
Rate for Payer: Priority Health SBD	$19.89

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$20.21

Service Code	NDC 61314022705
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$18.19
Rate for Payer: Aetna Commercial	$17.18
Rate for Payer: Aetna Medicare	$10.10
Rate for Payer: Aetna New Business (MI Preferred)	$13.14
Rate for Payer: BCBS Complete	$8.08
Rate for Payer: Cash Price	$16.17
Rate for Payer: Cofinity Commercial	$14.15
Rate for Payer: Cofinity Commercial	$17.38
Rate for Payer: Cofinity Medicare Advantage	$14.15
Rate for Payer: Encore Health Key Benefits Commercial	$16.17
Rate for Payer: Healthscope Commercial	$18.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.18
Rate for Payer: PHP Commercial	$17.18
Rate for Payer: Priority Health Cigna Priority Health	$13.14
Rate for Payer: Priority Health SBD	$12.73

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$20.21

Service Code	NDC 61314022705
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$18.19
Rate for Payer: Aetna Commercial	$17.18
Rate for Payer: Aetna New Business (MI Preferred)	$13.14
Rate for Payer: Cash Price	$16.17
Rate for Payer: Cofinity Commercial	$14.15
Rate for Payer: Cofinity Commercial	$17.38
Rate for Payer: Cofinity Medicare Advantage	$14.15
Rate for Payer: Encore Health Key Benefits Commercial	$16.17
Rate for Payer: Healthscope Commercial	$18.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.18
Rate for Payer: PHP Commercial	$17.18
Rate for Payer: Priority Health Cigna Priority Health	$13.14
Rate for Payer: Priority Health SBD	$12.73

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$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 Commercial	$482.19
Rate for Payer: Cofinity Commercial	$592.40
Rate for Payer: Cofinity Medicare Advantage	$482.19
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: PHP Commercial	$585.51
Rate for Payer: Priority Health Cigna Priority Health	$447.75
Rate for Payer: Priority Health SBD	$433.97

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$28.25

Service Code	NDC 17478028810
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$25.42
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 Commercial	$19.78
Rate for Payer: Cofinity Commercial	$24.30
Rate for Payer: Cofinity Medicare Advantage	$19.78
Rate for Payer: Encore Health Key Benefits Commercial	$22.60
Rate for Payer: Healthscope Commercial	$25.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.01
Rate for Payer: PHP Commercial	$24.01
Rate for Payer: Priority Health Cigna Priority Health	$18.36
Rate for Payer: Priority Health SBD	$17.80

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$22.91

Service Code	NDC 60758080105
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$19.47
Rate for Payer: Aetna New Business (MI Preferred)	$14.89
Rate for Payer: Cash Price	$18.33
Rate for Payer: Cofinity Commercial	$16.04
Rate for Payer: Cofinity Commercial	$19.70
Rate for Payer: Cofinity Medicare Advantage	$16.04
Rate for Payer: Encore Health Key Benefits Commercial	$18.33
Rate for Payer: Healthscope Commercial	$20.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.47
Rate for Payer: PHP Commercial	$19.47
Rate for Payer: Priority Health Cigna Priority Health	$14.89
Rate for Payer: Priority Health SBD	$14.43

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$22.91

Service Code	NDC 60758080105
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$9.16
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 Commercial	$16.04
Rate for Payer: Cofinity Commercial	$19.70
Rate for Payer: Cofinity Medicare Advantage	$16.04
Rate for Payer: Encore Health Key Benefits Commercial	$18.33
Rate for Payer: Healthscope Commercial	$20.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.47
Rate for Payer: PHP Commercial	$19.47
Rate for Payer: Priority Health Cigna Priority Health	$14.89
Rate for Payer: Priority Health SBD	$14.43

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$31.57

Service Code	NDC 64980051405
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$12.63
Max. Negotiated Rate	$28.41
Rate for Payer: Aetna Commercial	$26.83
Rate for Payer: Aetna Medicare	$15.78
Rate for Payer: Aetna New Business (MI Preferred)	$20.52
Rate for Payer: BCBS Complete	$12.63
Rate for Payer: Cash Price	$25.26
Rate for Payer: Cofinity Commercial	$22.10
Rate for Payer: Cofinity Commercial	$27.15
Rate for Payer: Cofinity Medicare Advantage	$22.10
Rate for Payer: Encore Health Key Benefits Commercial	$25.26
Rate for Payer: Healthscope Commercial	$28.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.83
Rate for Payer: PHP Commercial	$26.83
Rate for Payer: Priority Health Cigna Priority Health	$20.52
Rate for Payer: Priority Health SBD	$19.89

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$28.25

Service Code	NDC 17478028810
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$25.42
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 Commercial	$19.78
Rate for Payer: Cofinity Commercial	$24.30
Rate for Payer: Cofinity Medicare Advantage	$19.78
Rate for Payer: Encore Health Key Benefits Commercial	$22.60
Rate for Payer: Healthscope Commercial	$25.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.01
Rate for Payer: PHP Commercial	$24.01
Rate for Payer: Priority Health Cigna Priority Health	$18.36
Rate for Payer: Priority Health SBD	$17.80

TIMOLOL MALEATE 0.5 % EYE DROPS

Facility

$688.84

Service Code	NDC 24208081305
Hospital Charge Code	11562
Hospital Revenue Code	637
Min. Negotiated Rate	$275.54
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 Commercial	$482.19
Rate for Payer: Cofinity Commercial	$592.40
Rate for Payer: Cofinity Medicare Advantage	$482.19
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: PHP Commercial	$585.51
Rate for Payer: Priority Health Cigna Priority Health	$447.75
Rate for Payer: Priority Health SBD	$433.97

TISSUE EXPANDER PLACEMENT IN BREAST RECONSTRUCTION, INCLUDING SUBSEQUENT EXPANSION(S)

Facility

$53,577.07

Service Code	CPT 19357
Hospital Revenue Code	360
Min. Negotiated Rate	$1,219.40
Max. Negotiated Rate	$53,577.07
Rate for Payer: Aetna Medicare	$17,728.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,308.20
Rate for Payer: Amish Plain Church Group Commercial	$21,308.20
Rate for Payer: BCBS Complete	$9,593.80
Rate for Payer: BCBS MAPPO	$17,046.56
Rate for Payer: BCBS Trust/PPO	$5,436.78
Rate for Payer: BCN Commercial	$5,436.78
Rate for Payer: BCN Medicare Advantage	$17,046.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,046.56
Rate for Payer: Mclaren Medicaid	$9,136.96
Rate for Payer: Mclaren Medicare	$17,046.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17,898.89
Rate for Payer: Meridian Medicaid	$9,593.80
Rate for Payer: MI Amish Medical Board Commercial	$19,603.54
Rate for Payer: Nomi Health Commercial	$35,797.78
Rate for Payer: PACE Medicare	$16,194.23
Rate for Payer: PACE SWMI	$17,046.56
Rate for Payer: PHP Medicare Advantage	$17,046.56
Rate for Payer: Priority Health Choice Medicaid	$9,136.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$53,577.07
Rate for Payer: Priority Health Medicare	$17,046.56
Rate for Payer: Priority Health Narrow Network	$42,861.66
Rate for Payer: Railroad Medicare Medicare	$17,046.56
Rate for Payer: UHC All Payor (Choice/PPO)	$1,219.40
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$17,046.56
Rate for Payer: UHC Exchange	$8,174.00
Rate for Payer: UHC Medicare Advantage	$17,046.56
Rate for Payer: UHCCP Medicaid	$9,597.21
Rate for Payer: VA VA	$17,046.56

TIZANIDINE 2 MG TABLET

Facility

$91.44

Service Code	NDC 68084077525
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$36.58
Max. Negotiated Rate	$82.30
Rate for Payer: Aetna Commercial	$77.72
Rate for Payer: Aetna Medicare	$45.72
Rate for Payer: Aetna New Business (MI Preferred)	$59.44
Rate for Payer: BCBS Complete	$36.58
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 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 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

$3.05

Service Code	NDC 68084077595
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna New Business (MI Preferred)	$1.98
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cofinity Commercial	$2.14
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Medicare Advantage	$2.14
Rate for Payer: Encore Health Key Benefits Commercial	$2.44
Rate for Payer: Healthscope Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.59
Rate for Payer: PHP Commercial	$2.59
Rate for Payer: Priority Health Cigna Priority Health	$1.98
Rate for Payer: Priority Health SBD	$1.92

TIZANIDINE 2 MG TABLET

Facility

$183.30

Service Code	NDC 57664050289
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$115.48
Max. Negotiated Rate	$164.97
Rate for Payer: Aetna Commercial	$155.80
Rate for Payer: Aetna New Business (MI Preferred)	$119.14
Rate for Payer: Cash Price	$146.64
Rate for Payer: Cofinity Commercial	$128.31
Rate for Payer: Cofinity Commercial	$157.64
Rate for Payer: Cofinity Medicare Advantage	$128.31
Rate for Payer: Encore Health Key Benefits Commercial	$146.64
Rate for Payer: Healthscope Commercial	$164.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$155.80
Rate for Payer: PHP Commercial	$155.80
Rate for Payer: Priority Health Cigna Priority Health	$119.14
Rate for Payer: Priority Health SBD	$115.48

TIZANIDINE 2 MG TABLET

Facility

$3.05

Service Code	NDC 68084077595
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna Medicare	$1.52
Rate for Payer: Aetna New Business (MI Preferred)	$1.98
Rate for Payer: BCBS Complete	$1.22
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cofinity Commercial	$2.14
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Medicare Advantage	$2.14
Rate for Payer: Encore Health Key Benefits Commercial	$2.44
Rate for Payer: Healthscope Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.59
Rate for Payer: PHP Commercial	$2.59
Rate for Payer: Priority Health Cigna Priority Health	$1.98
Rate for Payer: Priority Health SBD	$1.92

TIZANIDINE 2 MG TABLET

Facility

$183.30

Service Code	NDC 57664050289
Hospital Charge Code	14792
Hospital Revenue Code	637
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$164.97
Rate for Payer: Aetna Commercial	$155.80
Rate for Payer: Aetna Medicare	$91.65
Rate for Payer: Aetna New Business (MI Preferred)	$119.14
Rate for Payer: BCBS Complete	$73.32
Rate for Payer: Cash Price	$146.64
Rate for Payer: Cofinity Commercial	$128.31
Rate for Payer: Cofinity Commercial	$157.64
Rate for Payer: Cofinity Medicare Advantage	$128.31
Rate for Payer: Encore Health Key Benefits Commercial	$146.64
Rate for Payer: Healthscope Commercial	$164.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$155.80
Rate for Payer: PHP Commercial	$155.80
Rate for Payer: Priority Health Cigna Priority Health	$119.14
Rate for Payer: Priority Health SBD	$115.48

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

Know your out-of-pocket cost for care.

All Charges