Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$277.30
Rate for Payer: Cofinity Commercial	$340.69
Rate for Payer: Cofinity Medicare Advantage	$277.30
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	$198.08
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	$277.30
Rate for Payer: Cofinity Commercial	$340.69
Rate for Payer: Cofinity Medicare Advantage	$277.30
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

$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	$82.30
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	$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 %-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	$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	$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 % 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

$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

$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	$165.82
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 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

$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	$25.24
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

$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

$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 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

TOBRAMYCIN 0.3 % EYE OINTMENT

Facility

$829.33

Service Code	NDC 00078081301
Hospital Charge Code	19769
Hospital Revenue Code	637
Min. Negotiated Rate	$522.48
Max. Negotiated Rate	$746.40
Rate for Payer: Aetna Commercial	$704.93
Rate for Payer: Aetna New Business (MI Preferred)	$539.06
Rate for Payer: Cash Price	$663.46
Rate for Payer: Cofinity Commercial	$580.53
Rate for Payer: Cofinity Commercial	$713.22
Rate for Payer: Cofinity Medicare Advantage	$580.53
Rate for Payer: Encore Health Key Benefits Commercial	$663.46
Rate for Payer: Healthscope Commercial	$746.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$704.93
Rate for Payer: PHP Commercial	$704.93
Rate for Payer: Priority Health Cigna Priority Health	$539.06
Rate for Payer: Priority Health SBD	$522.48

TOBRAMYCIN 0.3 % EYE OINTMENT

Facility

$829.33

Service Code	NDC 00078081301
Hospital Charge Code	19769
Hospital Revenue Code	637
Min. Negotiated Rate	$331.73
Max. Negotiated Rate	$746.40
Rate for Payer: Aetna Commercial	$704.93
Rate for Payer: Aetna Medicare	$414.66
Rate for Payer: Aetna New Business (MI Preferred)	$539.06
Rate for Payer: BCBS Complete	$331.73
Rate for Payer: Cash Price	$663.46
Rate for Payer: Cofinity Commercial	$580.53
Rate for Payer: Cofinity Commercial	$713.22
Rate for Payer: Cofinity Medicare Advantage	$580.53
Rate for Payer: Encore Health Key Benefits Commercial	$663.46
Rate for Payer: Healthscope Commercial	$746.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$704.93
Rate for Payer: PHP Commercial	$704.93
Rate for Payer: Priority Health Cigna Priority Health	$539.06
Rate for Payer: Priority Health SBD	$522.48

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 1.2 GRAM SOLUTION FOR INJECTION

Facility

$212.40

Service Code	HCPCS J3260
Hospital Charge Code	11565
Hospital Revenue Code	636
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$191.16
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 Medicare	$92.44
Rate for Payer: Aetna Medicare	$92.70
Rate for Payer: Aetna Medicare	$106.20
Rate for Payer: Aetna New Business (MI Preferred)	$120.50
Rate for Payer: Aetna New Business (MI Preferred)	$120.18
Rate for Payer: Aetna New Business (MI Preferred)	$138.06
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	$6.40
Rate for Payer: BCBS Trust/PPO	$6.40
Rate for Payer: BCBS Trust/PPO	$6.40
Rate for Payer: BCN Commercial	$6.40
Rate for Payer: BCN Commercial	$6.40
Rate for Payer: BCN Commercial	$6.40
Rate for Payer: Cash Price	$148.31
Rate for Payer: Cash Price	$147.91
Rate for Payer: Cash Price	$169.92
Rate for Payer: Cash Price	$148.31
Rate for Payer: Cash Price	$147.91
Rate for Payer: Cash Price	$169.92
Rate for Payer: Cofinity Commercial	$129.77
Rate for Payer: Cofinity Commercial	$129.42
Rate for Payer: Cofinity Commercial	$159.01
Rate for Payer: Cofinity Commercial	$159.44
Rate for Payer: Cofinity Commercial	$148.68
Rate for Payer: Cofinity Commercial	$182.66
Rate for Payer: Cofinity Medicare Advantage	$148.68
Rate for Payer: Cofinity Medicare Advantage	$129.77
Rate for Payer: Cofinity Medicare Advantage	$129.42
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: Healthscope Commercial	$166.85
Rate for Payer: Healthscope Commercial	$166.40
Rate for Payer: Healthscope Commercial	$191.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.54
Rate for Payer: PHP Commercial	$157.58
Rate for Payer: PHP Commercial	$180.54
Rate for Payer: PHP Commercial	$157.16
Rate for Payer: Priority Health Cigna Priority Health	$120.50
Rate for Payer: Priority Health Cigna Priority Health	$138.06
Rate for Payer: Priority Health Cigna Priority Health	$120.18
Rate for Payer: Priority Health SBD	$116.48
Rate for Payer: Priority Health SBD	$133.81
Rate for Payer: Priority Health SBD	$116.80

TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION

Facility

$185.39

Service Code	HCPCS J3260
Hospital Charge Code	11565
Hospital Revenue Code	636
Min. Negotiated Rate	$116.80
Max. Negotiated Rate	$166.85
Rate for Payer: Aetna Commercial	$157.58
Rate for Payer: Aetna Commercial	$157.16
Rate for Payer: Aetna Commercial	$180.54
Rate for Payer: Aetna New Business (MI Preferred)	$138.06
Rate for Payer: Aetna New Business (MI Preferred)	$120.18
Rate for Payer: Aetna New Business (MI Preferred)	$120.50
Rate for Payer: Cash Price	$148.31
Rate for Payer: Cash Price	$147.91
Rate for Payer: Cash Price	$169.92
Rate for Payer: Cofinity Commercial	$148.68
Rate for Payer: Cofinity Commercial	$182.66
Rate for Payer: Cofinity Commercial	$159.44
Rate for Payer: Cofinity Commercial	$159.01
Rate for Payer: Cofinity Commercial	$129.42
Rate for Payer: Cofinity Commercial	$129.77
Rate for Payer: Cofinity Medicare Advantage	$129.42
Rate for Payer: Cofinity Medicare Advantage	$129.77
Rate for Payer: Cofinity Medicare Advantage	$148.68
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: Healthscope Commercial	$166.40
Rate for Payer: Healthscope Commercial	$166.85
Rate for Payer: Healthscope Commercial	$191.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.54
Rate for Payer: PHP Commercial	$157.16
Rate for Payer: PHP Commercial	$157.58
Rate for Payer: PHP Commercial	$180.54
Rate for Payer: Priority Health Cigna Priority Health	$120.18
Rate for Payer: Priority Health Cigna Priority Health	$120.50
Rate for Payer: Priority Health Cigna Priority Health	$138.06
Rate for Payer: Priority Health SBD	$133.81
Rate for Payer: Priority Health SBD	$116.48
Rate for Payer: Priority Health SBD	$116.80

TOBRAMYCIN 300 MG/5 ML NEBULIZATION CUSTOM

Facility

$50.66

Service Code	HCPCS J7682
Hospital Charge Code	168920
Hospital Revenue Code	250
Min. Negotiated Rate	$12.80
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 Commercial	$35.46
Rate for Payer: Cofinity Commercial	$43.57
Rate for Payer: Cofinity Medicare Advantage	$35.46
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: PHP Commercial	$43.06
Rate for Payer: Priority Health Cigna Priority Health	$32.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.00
Rate for Payer: Priority Health Narrow Network	$12.80
Rate for Payer: Priority Health SBD	$31.92

Know your out-of-pocket cost for care.

All Charges