|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$70.68
|
|
|
Service Code
|
NDC 29300012613
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.19 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: BCBS Trust/PPO |
$58.37
|
| Rate for Payer: BCN Commercial |
$58.37
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Healthscope Commercial |
$63.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.08
|
| Rate for Payer: Nomi Health Commercial |
$57.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.01
|
| Rate for Payer: PHP Commercial |
$60.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.20
|
| Rate for Payer: UHC Core |
$59.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.01
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$70.68
|
|
|
Service Code
|
NDC 29300012613
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: Aetna Medicare |
$18.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.09
|
| Rate for Payer: BCBS Complete |
$13.08
|
| Rate for Payer: BCBS MAPPO |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$58.11
|
| Rate for Payer: BCN Medicare Advantage |
$17.67
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.67
|
| Rate for Payer: Healthscope Commercial |
$63.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.01
|
| Rate for Payer: Mclaren Medicaid |
$12.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.55
|
| Rate for Payer: Meridian Medicaid |
$13.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.08
|
| Rate for Payer: Nomi Health Commercial |
$57.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.01
|
| Rate for Payer: PACE Senior Care Partners |
$16.79
|
| Rate for Payer: PACE SWMI |
$17.67
|
| Rate for Payer: PHP Commercial |
$60.08
|
| Rate for Payer: PHP Medicare Advantage |
$17.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.49
|
| Rate for Payer: Priority Health Medicare |
$17.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.19
|
| Rate for Payer: Railroad Medicare Medicare |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.20
|
| Rate for Payer: UHC Core |
$59.02
|
| Rate for Payer: UHC Exchange |
$17.67
|
| Rate for Payer: UHC Medicaid |
$12.46
|
| Rate for Payer: UHC Medicare Advantage |
$17.67
|
| Rate for Payer: UHCCP Medicaid |
$12.46
|
| Rate for Payer: VA VA |
$17.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.01
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$124.79
|
|
|
Service Code
|
NDC 52817027030
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$106.07
|
| Rate for Payer: Aetna Medicare |
$32.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.00
|
| Rate for Payer: BCBS Complete |
$23.10
|
| Rate for Payer: BCBS MAPPO |
$31.20
|
| Rate for Payer: BCBS Trust/PPO |
$102.59
|
| Rate for Payer: BCN Commercial |
$102.59
|
| Rate for Payer: BCN Medicare Advantage |
$31.20
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$112.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.59
|
| Rate for Payer: Mclaren Medicaid |
$22.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.76
|
| Rate for Payer: Meridian Medicaid |
$23.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.59
|
| Rate for Payer: PACE Senior Care Partners |
$29.64
|
| Rate for Payer: PACE SWMI |
$31.20
|
| Rate for Payer: PHP Commercial |
$106.07
|
| Rate for Payer: PHP Medicare Advantage |
$31.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.57
|
| Rate for Payer: Priority Health Medicare |
$31.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.85
|
| Rate for Payer: Railroad Medicare Medicare |
$31.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.20
|
| Rate for Payer: UHC Exchange |
$31.20
|
| Rate for Payer: UHC Medicaid |
$22.00
|
| Rate for Payer: UHC Medicare Advantage |
$31.20
|
| Rate for Payer: UHCCP Medicaid |
$22.00
|
| Rate for Payer: VA VA |
$31.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$124.79
|
|
|
Service Code
|
NDC 52817027030
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.85 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$106.07
|
| Rate for Payer: BCBS Trust/PPO |
$103.06
|
| Rate for Payer: BCN Commercial |
$103.06
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Healthscope Commercial |
$112.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.59
|
| Rate for Payer: PHP Commercial |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$174.10
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$156.69 |
| Rate for Payer: Aetna Commercial |
$147.99
|
| Rate for Payer: BCBS Trust/PPO |
$143.79
|
| Rate for Payer: BCN Commercial |
$143.79
|
| Rate for Payer: Cash Price |
$139.28
|
| Rate for Payer: Cofinity Commercial |
$149.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.28
|
| Rate for Payer: Healthscope Commercial |
$156.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.99
|
| Rate for Payer: Nomi Health Commercial |
$142.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: PHP Commercial |
$147.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$151.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.21
|
| Rate for Payer: UHC Core |
$145.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$7,015.76
|
|
|
Service Code
|
APR-DRG 1323
|
| Min. Negotiated Rate |
$6,681.67 |
| Max. Negotiated Rate |
$7,015.76 |
| Rate for Payer: BCBS Complete |
$7,015.76
|
| Rate for Payer: Mclaren Medicaid |
$6,681.67
|
| Rate for Payer: Meridian Medicaid |
$7,015.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,681.67
|
| Rate for Payer: UHC Medicaid |
$6,681.67
|
| Rate for Payer: UHCCP Medicaid |
$6,681.67
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$3,033.05
|
|
|
Service Code
|
APR-DRG 1321
|
| Min. Negotiated Rate |
$2,888.61 |
| Max. Negotiated Rate |
$3,033.05 |
| Rate for Payer: BCBS Complete |
$3,033.05
|
| Rate for Payer: Mclaren Medicaid |
$2,888.61
|
| Rate for Payer: Meridian Medicaid |
$3,033.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,888.61
|
| Rate for Payer: UHC Medicaid |
$2,888.61
|
| Rate for Payer: UHCCP Medicaid |
$2,888.61
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$4,191.47
|
|
|
Service Code
|
APR-DRG 1322
|
| Min. Negotiated Rate |
$3,991.88 |
| Max. Negotiated Rate |
$4,191.47 |
| Rate for Payer: BCBS Complete |
$4,191.47
|
| Rate for Payer: Mclaren Medicaid |
$3,991.88
|
| Rate for Payer: Meridian Medicaid |
$4,191.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,991.88
|
| Rate for Payer: UHC Medicaid |
$3,991.88
|
| Rate for Payer: UHCCP Medicaid |
$3,991.88
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$8,736.83
|
|
|
Service Code
|
APR-DRG 1324
|
| Min. Negotiated Rate |
$8,320.79 |
| Max. Negotiated Rate |
$8,736.83 |
| Rate for Payer: BCBS Complete |
$8,736.83
|
| Rate for Payer: Mclaren Medicaid |
$8,320.79
|
| Rate for Payer: Meridian Medicaid |
$8,736.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,320.79
|
| Rate for Payer: UHC Medicaid |
$8,320.79
|
| Rate for Payer: UHCCP Medicaid |
$8,320.79
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$15,906.66
|
|
|
Service Code
|
APR-DRG 3633
|
| Min. Negotiated Rate |
$15,149.20 |
| Max. Negotiated Rate |
$15,906.66 |
| Rate for Payer: BCBS Complete |
$15,906.66
|
| Rate for Payer: Mclaren Medicaid |
$15,149.20
|
| Rate for Payer: Meridian Medicaid |
$15,906.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,149.20
|
| Rate for Payer: UHC Medicaid |
$15,149.20
|
| Rate for Payer: UHCCP Medicaid |
$15,149.20
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$16,899.45
|
|
|
Service Code
|
APR-DRG 3634
|
| Min. Negotiated Rate |
$16,094.71 |
| Max. Negotiated Rate |
$16,899.45 |
| Rate for Payer: BCBS Complete |
$16,899.45
|
| Rate for Payer: Mclaren Medicaid |
$16,094.71
|
| Rate for Payer: Meridian Medicaid |
$16,899.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,094.71
|
| Rate for Payer: UHC Medicaid |
$16,094.71
|
| Rate for Payer: UHCCP Medicaid |
$16,094.71
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$11,002.15
|
|
|
Service Code
|
APR-DRG 3632
|
| Min. Negotiated Rate |
$10,478.24 |
| Max. Negotiated Rate |
$11,002.15 |
| Rate for Payer: BCBS Complete |
$11,002.15
|
| Rate for Payer: Mclaren Medicaid |
$10,478.24
|
| Rate for Payer: Meridian Medicaid |
$11,002.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,478.24
|
| Rate for Payer: UHC Medicaid |
$10,478.24
|
| Rate for Payer: UHCCP Medicaid |
$10,478.24
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$7,693.57
|
|
|
Service Code
|
APR-DRG 3631
|
| Min. Negotiated Rate |
$7,327.20 |
| Max. Negotiated Rate |
$7,693.57 |
| Rate for Payer: BCBS Complete |
$7,693.57
|
| Rate for Payer: Mclaren Medicaid |
$7,327.20
|
| Rate for Payer: Meridian Medicaid |
$7,693.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,327.20
|
| Rate for Payer: UHC Medicaid |
$7,327.20
|
| Rate for Payer: UHCCP Medicaid |
$7,327.20
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$262.78
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.33 |
| Max. Negotiated Rate |
$236.50 |
| Rate for Payer: Aetna Commercial |
$223.36
|
| Rate for Payer: Aetna Medicare |
$68.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.12
|
| Rate for Payer: BCBS Complete |
$48.64
|
| Rate for Payer: BCBS MAPPO |
$65.69
|
| Rate for Payer: BCBS Trust/PPO |
$216.03
|
| Rate for Payer: BCN Commercial |
$216.03
|
| Rate for Payer: BCN Medicare Advantage |
$65.69
|
| Rate for Payer: Cash Price |
$210.22
|
| Rate for Payer: Cofinity Commercial |
$225.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.69
|
| Rate for Payer: Healthscope Commercial |
$236.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.09
|
| Rate for Payer: Mclaren Medicaid |
$46.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.98
|
| Rate for Payer: Meridian Medicaid |
$48.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.36
|
| Rate for Payer: Nomi Health Commercial |
$215.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.09
|
| Rate for Payer: PACE Senior Care Partners |
$62.41
|
| Rate for Payer: PACE SWMI |
$65.69
|
| Rate for Payer: PHP Commercial |
$223.36
|
| Rate for Payer: PHP Medicare Advantage |
$65.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.62
|
| Rate for Payer: Priority Health Medicare |
$66.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.89
|
| Rate for Payer: Railroad Medicare Medicare |
$65.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.25
|
| Rate for Payer: UHC Core |
$219.42
|
| Rate for Payer: UHC Exchange |
$65.69
|
| Rate for Payer: UHC Medicaid |
$46.33
|
| Rate for Payer: UHC Medicare Advantage |
$65.69
|
| Rate for Payer: UHCCP Medicaid |
$46.33
|
| Rate for Payer: VA VA |
$65.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.09
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$262.78
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.89 |
| Max. Negotiated Rate |
$236.50 |
| Rate for Payer: Aetna Commercial |
$223.36
|
| Rate for Payer: BCBS Trust/PPO |
$217.03
|
| Rate for Payer: BCN Commercial |
$217.03
|
| Rate for Payer: Cash Price |
$210.22
|
| Rate for Payer: Cofinity Commercial |
$225.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.22
|
| Rate for Payer: Healthscope Commercial |
$236.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.36
|
| Rate for Payer: Nomi Health Commercial |
$215.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.09
|
| Rate for Payer: PHP Commercial |
$223.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$228.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.25
|
| Rate for Payer: UHC Core |
$219.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.09
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.53 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna Medicare |
$164.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$197.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$197.68
|
| Rate for Payer: BCBS Complete |
$117.09
|
| Rate for Payer: BCBS MAPPO |
$158.15
|
| Rate for Payer: BCBS Trust/PPO |
$520.05
|
| Rate for Payer: BCN Commercial |
$520.05
|
| Rate for Payer: BCN Medicare Advantage |
$158.15
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.15
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Mclaren Medicaid |
$111.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.05
|
| Rate for Payer: Meridian Medicaid |
$117.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$173.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.44
|
| Rate for Payer: PACE Senior Care Partners |
$150.24
|
| Rate for Payer: PACE SWMI |
$158.15
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: PHP Medicare Advantage |
$158.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$550.35
|
| Rate for Payer: Priority Health Medicare |
$159.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$440.28
|
| Rate for Payer: Railroad Medicare Medicare |
$158.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.68
|
| Rate for Payer: UHC Core |
$528.21
|
| Rate for Payer: UHC Exchange |
$158.15
|
| Rate for Payer: UHC Medicaid |
$111.53
|
| Rate for Payer: UHC Medicare Advantage |
$158.15
|
| Rate for Payer: UHCCP Medicaid |
$111.53
|
| Rate for Payer: VA VA |
$158.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$440.28 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: BCBS Trust/PPO |
$522.46
|
| Rate for Payer: BCN Commercial |
$522.46
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.44
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$550.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$440.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.68
|
| Rate for Payer: UHC Core |
$528.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$41.46
|
|
|
Service Code
|
NDC 61314014315
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$37.31 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: BCBS Trust/PPO |
$34.24
|
| Rate for Payer: BCN Commercial |
$34.24
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.17
|
| Rate for Payer: Healthscope Commercial |
$37.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.24
|
| Rate for Payer: Nomi Health Commercial |
$34.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.09
|
| Rate for Payer: PHP Commercial |
$35.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.48
|
| Rate for Payer: UHC Core |
$34.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.09
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
NDC 70069023301
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.46
|
| Rate for Payer: BCN Commercial |
$16.46
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.94
|
| Rate for Payer: Nomi Health Commercial |
$16.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.95
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.54
|
| Rate for Payer: UHC Core |
$16.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.95
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
NDC 70069023301
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.23
|
| Rate for Payer: BCBS Complete |
$3.69
|
| Rate for Payer: BCBS MAPPO |
$4.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCN Commercial |
$16.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.98
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.98
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.95
|
| Rate for Payer: Mclaren Medicaid |
$3.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.23
|
| Rate for Payer: Meridian Medicaid |
$3.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.94
|
| Rate for Payer: Nomi Health Commercial |
$16.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.95
|
| Rate for Payer: PACE Senior Care Partners |
$4.73
|
| Rate for Payer: PACE SWMI |
$4.98
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.34
|
| Rate for Payer: Priority Health Medicare |
$5.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.87
|
| Rate for Payer: Railroad Medicare Medicare |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.54
|
| Rate for Payer: UHC Core |
$16.64
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$3.51
|
| Rate for Payer: UHC Medicare Advantage |
$4.98
|
| Rate for Payer: UHCCP Medicaid |
$3.51
|
| Rate for Payer: VA VA |
$4.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.95
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$41.46
|
|
|
Service Code
|
NDC 61314014315
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$37.31 |
| Rate for Payer: Aetna Commercial |
$35.24
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.96
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS MAPPO |
$10.37
|
| Rate for Payer: BCBS Trust/PPO |
$34.08
|
| Rate for Payer: BCN Commercial |
$34.08
|
| Rate for Payer: BCN Medicare Advantage |
$10.37
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.37
|
| Rate for Payer: Healthscope Commercial |
$37.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.09
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.88
|
| Rate for Payer: Meridian Medicaid |
$7.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.24
|
| Rate for Payer: Nomi Health Commercial |
$34.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.09
|
| Rate for Payer: PACE Senior Care Partners |
$9.85
|
| Rate for Payer: PACE SWMI |
$10.37
|
| Rate for Payer: PHP Commercial |
$35.24
|
| Rate for Payer: PHP Medicare Advantage |
$10.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.07
|
| Rate for Payer: Priority Health Medicare |
$10.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.48
|
| Rate for Payer: UHC Core |
$34.62
|
| Rate for Payer: UHC Exchange |
$10.37
|
| Rate for Payer: UHC Medicaid |
$7.31
|
| Rate for Payer: UHC Medicare Advantage |
$10.37
|
| Rate for Payer: UHCCP Medicaid |
$7.31
|
| Rate for Payer: VA VA |
$10.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.09
|
|
|
BRIMONIDINE-TIMOLOL 0.2 %-0.5 % EYE DROPS
|
Facility
|
IP
|
$664.13
|
|
|
Service Code
|
NDC 00023921105
|
| Hospital Charge Code |
87834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$462.23 |
| Max. Negotiated Rate |
$597.72 |
| Rate for Payer: Aetna Commercial |
$564.51
|
| Rate for Payer: BCBS Trust/PPO |
$548.50
|
| Rate for Payer: BCN Commercial |
$548.50
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cofinity Commercial |
$571.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.30
|
| Rate for Payer: Healthscope Commercial |
$597.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.51
|
| Rate for Payer: Nomi Health Commercial |
$544.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.10
|
| Rate for Payer: PHP Commercial |
$564.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$577.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.43
|
| Rate for Payer: UHC Core |
$554.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.10
|
|
|
BRIMONIDINE-TIMOLOL 0.2 %-0.5 % EYE DROPS
|
Facility
|
OP
|
$664.13
|
|
|
Service Code
|
NDC 00023921105
|
| Hospital Charge Code |
87834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.09 |
| Max. Negotiated Rate |
$597.72 |
| Rate for Payer: Aetna Commercial |
$564.51
|
| Rate for Payer: Aetna Medicare |
$172.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.54
|
| Rate for Payer: BCBS Complete |
$122.93
|
| Rate for Payer: BCBS MAPPO |
$166.03
|
| Rate for Payer: BCBS Trust/PPO |
$545.98
|
| Rate for Payer: BCN Commercial |
$545.98
|
| Rate for Payer: BCN Medicare Advantage |
$166.03
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cofinity Commercial |
$571.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.03
|
| Rate for Payer: Healthscope Commercial |
$597.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$498.10
|
| Rate for Payer: Mclaren Medicaid |
$117.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.33
|
| Rate for Payer: Meridian Medicaid |
$122.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$182.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.51
|
| Rate for Payer: Nomi Health Commercial |
$544.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.10
|
| Rate for Payer: PACE Senior Care Partners |
$157.73
|
| Rate for Payer: PACE SWMI |
$166.03
|
| Rate for Payer: PHP Commercial |
$564.51
|
| Rate for Payer: PHP Medicare Advantage |
$166.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$577.79
|
| Rate for Payer: Priority Health Medicare |
$167.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.23
|
| Rate for Payer: Railroad Medicare Medicare |
$166.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.43
|
| Rate for Payer: UHC Core |
$554.55
|
| Rate for Payer: UHC Exchange |
$166.03
|
| Rate for Payer: UHC Medicaid |
$117.09
|
| Rate for Payer: UHC Medicare Advantage |
$166.03
|
| Rate for Payer: UHCCP Medicaid |
$117.09
|
| Rate for Payer: VA VA |
$166.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$498.10
|
|
|
BRIMONIDINE-TIMOLOL 0.2 %-0.5 % EYE DROPS
|
Facility
|
OP
|
$416.61
|
|
|
Service Code
|
NDC 00832142505
|
| Hospital Charge Code |
87834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.45 |
| Max. Negotiated Rate |
$374.95 |
| Rate for Payer: Aetna Commercial |
$354.12
|
| Rate for Payer: Aetna Medicare |
$108.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.19
|
| Rate for Payer: BCBS Complete |
$77.11
|
| Rate for Payer: BCBS MAPPO |
$104.15
|
| Rate for Payer: BCBS Trust/PPO |
$342.50
|
| Rate for Payer: BCN Commercial |
$342.50
|
| Rate for Payer: BCN Medicare Advantage |
$104.15
|
| Rate for Payer: Cash Price |
$333.29
|
| Rate for Payer: Cofinity Commercial |
$358.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.15
|
| Rate for Payer: Healthscope Commercial |
$374.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.46
|
| Rate for Payer: Mclaren Medicaid |
$73.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.36
|
| Rate for Payer: Meridian Medicaid |
$77.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.12
|
| Rate for Payer: Nomi Health Commercial |
$341.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.46
|
| Rate for Payer: PACE Senior Care Partners |
$98.94
|
| Rate for Payer: PACE SWMI |
$104.15
|
| Rate for Payer: PHP Commercial |
$354.12
|
| Rate for Payer: PHP Medicare Advantage |
$104.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.45
|
| Rate for Payer: Priority Health Medicare |
$105.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.96
|
| Rate for Payer: Railroad Medicare Medicare |
$104.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.62
|
| Rate for Payer: UHC Core |
$347.87
|
| Rate for Payer: UHC Exchange |
$104.15
|
| Rate for Payer: UHC Medicaid |
$73.45
|
| Rate for Payer: UHC Medicare Advantage |
$104.15
|
| Rate for Payer: UHCCP Medicaid |
$73.45
|
| Rate for Payer: VA VA |
$104.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.46
|
|
|
BRIMONIDINE-TIMOLOL 0.2 %-0.5 % EYE DROPS
|
Facility
|
IP
|
$416.61
|
|
|
Service Code
|
NDC 00832142505
|
| Hospital Charge Code |
87834
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.96 |
| Max. Negotiated Rate |
$374.95 |
| Rate for Payer: Aetna Commercial |
$354.12
|
| Rate for Payer: BCBS Trust/PPO |
$344.08
|
| Rate for Payer: BCN Commercial |
$344.08
|
| Rate for Payer: Cash Price |
$333.29
|
| Rate for Payer: Cofinity Commercial |
$358.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.29
|
| Rate for Payer: Healthscope Commercial |
$374.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.12
|
| Rate for Payer: Nomi Health Commercial |
$341.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.46
|
| Rate for Payer: PHP Commercial |
$354.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.62
|
| Rate for Payer: UHC Core |
$347.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.46
|
|
