|
TIZANIDINE 2 MG TABLET
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 50268075911
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna Commercial |
$2.72
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: BCBS MAPPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.63
|
| Rate for Payer: BCN Commercial |
$2.63
|
| Rate for Payer: BCN Medicare Advantage |
$0.80
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$2.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$2.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.40
|
| Rate for Payer: Mclaren Medicaid |
$0.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.84
|
| Rate for Payer: Meridian Medicaid |
$0.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.72
|
| Rate for Payer: Nomi Health Commercial |
$2.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.40
|
| Rate for Payer: PACE Senior Care Partners |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.80
|
| Rate for Payer: PHP Commercial |
$2.72
|
| Rate for Payer: PHP Medicare Advantage |
$0.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.78
|
| Rate for Payer: Priority Health Medicare |
$0.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.23
|
| Rate for Payer: Railroad Medicare Medicare |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.82
|
| Rate for Payer: UHC Core |
$2.67
|
| Rate for Payer: UHC Exchange |
$0.80
|
| Rate for Payer: UHC Medicaid |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: UHCCP Medicaid |
$0.56
|
| Rate for Payer: VA VA |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.40
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
IP
|
$159.84
|
|
|
Service Code
|
NDC 50268075915
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.25 |
| Max. Negotiated Rate |
$143.86 |
| Rate for Payer: Aetna Commercial |
$135.86
|
| Rate for Payer: BCBS Trust/PPO |
$132.01
|
| Rate for Payer: BCN Commercial |
$132.01
|
| Rate for Payer: Cash Price |
$127.87
|
| Rate for Payer: Cofinity Commercial |
$137.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.87
|
| Rate for Payer: Healthscope Commercial |
$143.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.86
|
| Rate for Payer: Nomi Health Commercial |
$131.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.88
|
| Rate for Payer: PHP Commercial |
$135.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.66
|
| Rate for Payer: UHC Core |
$133.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.88
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 57664050289
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$47.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.28
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$150.69
|
| Rate for Payer: BCN Medicare Advantage |
$45.83
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.83
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.83
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: PHP Medicare Advantage |
$45.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: Railroad Medicare Medicare |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicaid |
$32.32
|
| Rate for Payer: UHC Medicare Advantage |
$45.83
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$45.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 57664050289
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: BCBS Trust/PPO |
$151.39
|
| Rate for Payer: BCN Commercial |
$151.39
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 51079099801
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.82
|
| Rate for Payer: BCBS Complete |
$0.48
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Mclaren Medicaid |
$0.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: Meridian Medicaid |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Nomi Health Commercial |
$2.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.27
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.30
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicaid |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: UHCCP Medicaid |
$0.46
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 51079099801
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Nomi Health Commercial |
$2.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.30
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.99 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: BCBS Trust/PPO |
$384.46
|
| Rate for Payer: BCN Commercial |
$384.46
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Nomi Health Commercial |
$381.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$404.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.64
|
| Rate for Payer: UHC Core |
$388.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.07 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$121.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.47
|
| Rate for Payer: BCBS Complete |
$86.16
|
| Rate for Payer: BCBS MAPPO |
$116.38
|
| Rate for Payer: BCBS Trust/PPO |
$382.69
|
| Rate for Payer: BCN Commercial |
$382.69
|
| Rate for Payer: BCN Medicare Advantage |
$116.38
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.38
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Mclaren Medicaid |
$82.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.19
|
| Rate for Payer: Meridian Medicaid |
$86.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Nomi Health Commercial |
$381.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PACE Senior Care Partners |
$110.56
|
| Rate for Payer: PACE SWMI |
$116.38
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: PHP Medicare Advantage |
$116.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$404.99
|
| Rate for Payer: Priority Health Medicare |
$117.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.99
|
| Rate for Payer: Railroad Medicare Medicare |
$116.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.64
|
| Rate for Payer: UHC Core |
$388.69
|
| Rate for Payer: UHC Exchange |
$116.38
|
| Rate for Payer: UHC Medicaid |
$82.07
|
| Rate for Payer: UHC Medicare Advantage |
$116.38
|
| Rate for Payer: UHCCP Medicaid |
$82.07
|
| Rate for Payer: VA VA |
$116.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$260.64
|
|
|
Service Code
|
NDC 51079099820
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Medicare |
$67.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.45
|
| Rate for Payer: BCBS Complete |
$48.24
|
| Rate for Payer: BCBS MAPPO |
$65.16
|
| Rate for Payer: BCBS Trust/PPO |
$214.27
|
| Rate for Payer: BCN Commercial |
$214.27
|
| Rate for Payer: BCN Medicare Advantage |
$65.16
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.16
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Mclaren Medicaid |
$45.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.42
|
| Rate for Payer: Meridian Medicaid |
$48.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Nomi Health Commercial |
$213.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.48
|
| Rate for Payer: PACE Senior Care Partners |
$61.90
|
| Rate for Payer: PACE SWMI |
$65.16
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: PHP Medicare Advantage |
$65.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.76
|
| Rate for Payer: Priority Health Medicare |
$65.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.41
|
| Rate for Payer: Railroad Medicare Medicare |
$65.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.36
|
| Rate for Payer: UHC Core |
$217.63
|
| Rate for Payer: UHC Exchange |
$65.16
|
| Rate for Payer: UHC Medicaid |
$45.95
|
| Rate for Payer: UHC Medicare Advantage |
$65.16
|
| Rate for Payer: UHCCP Medicaid |
$45.95
|
| Rate for Payer: VA VA |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$260.64
|
|
|
Service Code
|
NDC 51079099820
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.41 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: BCBS Trust/PPO |
$215.26
|
| Rate for Payer: BCN Commercial |
$215.26
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Nomi Health Commercial |
$213.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.48
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.36
|
| Rate for Payer: UHC Core |
$217.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$101.96
|
| Rate for Payer: Cash Price |
$98.76
|
| Rate for Payer: Cofinity Commercial |
$106.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.76
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$101.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.59
|
| Rate for Payer: PHP Commercial |
$104.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.64
|
| Rate for Payer: UHC Core |
$103.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.59
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$79.42
|
|
|
Service Code
|
NDC 00574403125
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.28 |
| Max. Negotiated Rate |
$71.48 |
| Rate for Payer: Aetna Commercial |
$67.51
|
| Rate for Payer: BCBS Trust/PPO |
$65.59
|
| Rate for Payer: BCN Commercial |
$65.59
|
| Rate for Payer: Cash Price |
$63.54
|
| Rate for Payer: Cofinity Commercial |
$68.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.54
|
| Rate for Payer: Healthscope Commercial |
$71.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.51
|
| Rate for Payer: Nomi Health Commercial |
$65.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.56
|
| Rate for Payer: PHP Commercial |
$67.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.89
|
| Rate for Payer: UHC Core |
$66.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.56
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$164.61
|
|
|
Service Code
|
NDC 24208029525
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.57 |
| Max. Negotiated Rate |
$148.15 |
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: BCBS Trust/PPO |
$135.95
|
| Rate for Payer: BCN Commercial |
$135.95
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Nomi Health Commercial |
$134.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.46
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.86
|
| Rate for Payer: UHC Core |
$137.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.46
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$164.61
|
|
|
Service Code
|
NDC 24208029525
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$148.15 |
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna Medicare |
$42.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.44
|
| Rate for Payer: BCBS Complete |
$30.47
|
| Rate for Payer: BCBS MAPPO |
$41.15
|
| Rate for Payer: BCBS Trust/PPO |
$135.33
|
| Rate for Payer: BCN Commercial |
$135.33
|
| Rate for Payer: BCN Medicare Advantage |
$41.15
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.15
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.46
|
| Rate for Payer: Mclaren Medicaid |
$29.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.21
|
| Rate for Payer: Meridian Medicaid |
$30.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Nomi Health Commercial |
$134.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.46
|
| Rate for Payer: PACE Senior Care Partners |
$39.09
|
| Rate for Payer: PACE SWMI |
$41.15
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: PHP Medicare Advantage |
$41.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.21
|
| Rate for Payer: Priority Health Medicare |
$41.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.57
|
| Rate for Payer: Railroad Medicare Medicare |
$41.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.86
|
| Rate for Payer: UHC Core |
$137.45
|
| Rate for Payer: UHC Exchange |
$41.15
|
| Rate for Payer: UHC Medicaid |
$29.02
|
| Rate for Payer: UHC Medicare Advantage |
$41.15
|
| Rate for Payer: UHCCP Medicaid |
$29.02
|
| Rate for Payer: VA VA |
$41.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.46
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$123.45
|
|
|
Service Code
|
NDC 69238137302
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: Aetna Medicare |
$32.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: BCBS Complete |
$22.85
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$101.49
|
| Rate for Payer: BCN Commercial |
$101.49
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$98.76
|
| Rate for Payer: Cofinity Commercial |
$106.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.59
|
| Rate for Payer: Mclaren Medicaid |
$21.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.41
|
| Rate for Payer: Meridian Medicaid |
$22.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$101.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.59
|
| Rate for Payer: PACE Senior Care Partners |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$104.93
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.40
|
| Rate for Payer: Priority Health Medicare |
$31.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.92
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.64
|
| Rate for Payer: UHC Core |
$103.08
|
| Rate for Payer: UHC Exchange |
$30.86
|
| Rate for Payer: UHC Medicaid |
$21.76
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$21.76
|
| Rate for Payer: VA VA |
$30.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.59
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: Aetna Medicare |
$32.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: BCBS Complete |
$22.85
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$101.49
|
| Rate for Payer: BCN Commercial |
$101.49
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$98.76
|
| Rate for Payer: Cofinity Commercial |
$106.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.59
|
| Rate for Payer: Mclaren Medicaid |
$21.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.41
|
| Rate for Payer: Meridian Medicaid |
$22.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$101.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.59
|
| Rate for Payer: PACE Senior Care Partners |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$104.93
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.40
|
| Rate for Payer: Priority Health Medicare |
$31.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.92
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.64
|
| Rate for Payer: UHC Core |
$103.08
|
| Rate for Payer: UHC Exchange |
$30.86
|
| Rate for Payer: UHC Medicaid |
$21.76
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$21.76
|
| Rate for Payer: VA VA |
$30.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.59
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$123.45
|
|
|
Service Code
|
NDC 69238137302
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.92 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$101.96
|
| Rate for Payer: Cash Price |
$98.76
|
| Rate for Payer: Cofinity Commercial |
$106.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.76
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$101.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.59
|
| Rate for Payer: PHP Commercial |
$104.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.64
|
| Rate for Payer: UHC Core |
$103.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.59
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$79.42
|
|
|
Service Code
|
NDC 00574403125
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$71.48 |
| Rate for Payer: Aetna Commercial |
$67.51
|
| Rate for Payer: Aetna Medicare |
$20.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.82
|
| Rate for Payer: BCBS Complete |
$14.70
|
| Rate for Payer: BCBS MAPPO |
$19.86
|
| Rate for Payer: BCBS Trust/PPO |
$65.29
|
| Rate for Payer: BCN Commercial |
$65.29
|
| Rate for Payer: BCN Medicare Advantage |
$19.86
|
| Rate for Payer: Cash Price |
$63.54
|
| Rate for Payer: Cofinity Commercial |
$68.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.86
|
| Rate for Payer: Healthscope Commercial |
$71.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.56
|
| Rate for Payer: Mclaren Medicaid |
$14.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.85
|
| Rate for Payer: Meridian Medicaid |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.51
|
| Rate for Payer: Nomi Health Commercial |
$65.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.56
|
| Rate for Payer: PACE Senior Care Partners |
$18.86
|
| Rate for Payer: PACE SWMI |
$19.86
|
| Rate for Payer: PHP Commercial |
$67.51
|
| Rate for Payer: PHP Medicare Advantage |
$19.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.10
|
| Rate for Payer: Priority Health Medicare |
$20.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.89
|
| Rate for Payer: UHC Core |
$66.32
|
| Rate for Payer: UHC Exchange |
$19.86
|
| Rate for Payer: UHC Medicaid |
$14.00
|
| Rate for Payer: UHC Medicare Advantage |
$19.86
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: VA VA |
$19.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.56
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 24208029005
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.21
|
| Rate for Payer: BCBS Complete |
$7.23
|
| Rate for Payer: BCBS MAPPO |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| Rate for Payer: BCN Commercial |
$32.11
|
| Rate for Payer: BCN Medicare Advantage |
$9.77
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.25
|
| Rate for Payer: Meridian Medicaid |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.30
|
| Rate for Payer: PACE Senior Care Partners |
$9.28
|
| Rate for Payer: PACE SWMI |
$9.77
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Medicare |
$9.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.19
|
| Rate for Payer: Railroad Medicare Medicare |
$9.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: UHC Exchange |
$9.77
|
| Rate for Payer: UHC Medicaid |
$6.89
|
| Rate for Payer: UHC Medicare Advantage |
$9.77
|
| Rate for Payer: UHCCP Medicaid |
$6.89
|
| Rate for Payer: VA VA |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 24208029005
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$32.26
|
| Rate for Payer: BCN Commercial |
$32.26
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$35.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.30
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$32.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.97
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.25
|
| Rate for Payer: BCBS Trust/PPO |
$9.06
|
| Rate for Payer: BCBS Trust/PPO |
$15.48
|
| Rate for Payer: BCN Commercial |
$9.25
|
| Rate for Payer: BCN Commercial |
$9.06
|
| Rate for Payer: BCN Commercial |
$15.48
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Nomi Health Commercial |
$9.18
|
| Rate for Payer: Nomi Health Commercial |
$15.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.05
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.65
|
| Rate for Payer: UHC Core |
$9.16
|
| Rate for Payer: UHC Core |
$15.65
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.97
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna Medicare |
$2.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.86
|
| Rate for Payer: BCBS Complete |
$2.07
|
| Rate for Payer: BCBS Complete |
$2.03
|
| Rate for Payer: BCBS Complete |
$3.47
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS MAPPO |
$2.74
|
| Rate for Payer: BCBS MAPPO |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$9.21
|
| Rate for Payer: BCBS Trust/PPO |
$15.41
|
| Rate for Payer: BCN Commercial |
$9.21
|
| Rate for Payer: BCN Commercial |
$15.41
|
| Rate for Payer: BCN Commercial |
$9.02
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: BCN Medicare Advantage |
$2.80
|
| Rate for Payer: BCN Medicare Advantage |
$2.74
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Mclaren Medicaid |
$1.93
|
| Rate for Payer: Mclaren Medicaid |
$3.30
|
| Rate for Payer: Mclaren Medicaid |
$1.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.92
|
| Rate for Payer: Meridian Medicaid |
$3.47
|
| Rate for Payer: Meridian Medicaid |
$2.03
|
| Rate for Payer: Meridian Medicaid |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Nomi Health Commercial |
$15.37
|
| Rate for Payer: Nomi Health Commercial |
$9.18
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: PACE Senior Care Partners |
$2.66
|
| Rate for Payer: PACE Senior Care Partners |
$2.61
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PACE SWMI |
$2.80
|
| Rate for Payer: PACE SWMI |
$2.74
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: PHP Medicare Advantage |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$2.74
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.30
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Medicare |
$2.83
|
| Rate for Payer: Priority Health Medicare |
$2.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.64
|
| Rate for Payer: Railroad Medicare Medicare |
$2.80
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.65
|
| Rate for Payer: UHC Core |
$9.16
|
| Rate for Payer: UHC Core |
$15.65
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Exchange |
$2.80
|
| Rate for Payer: UHC Exchange |
$2.74
|
| Rate for Payer: UHC Medicaid |
$1.93
|
| Rate for Payer: UHC Medicaid |
$3.30
|
| Rate for Payer: UHC Medicaid |
$1.97
|
| Rate for Payer: UHC Medicare Advantage |
$2.80
|
| Rate for Payer: UHC Medicare Advantage |
$2.74
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: UHCCP Medicaid |
$1.97
|
| Rate for Payer: UHCCP Medicaid |
$1.93
|
| Rate for Payer: UHCCP Medicaid |
$3.30
|
| Rate for Payer: VA VA |
$2.74
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: VA VA |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.05
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,143.08
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,883.58 |
| Max. Negotiated Rate |
$3,728.77 |
| Rate for Payer: Aetna Commercial |
$3,521.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,421.77
|
| Rate for Payer: BCN Commercial |
$3,421.77
|
| Rate for Payer: Cash Price |
$3,314.46
|
| Rate for Payer: Cofinity Commercial |
$3,563.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,314.46
|
| Rate for Payer: Healthscope Commercial |
$3,728.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,107.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,521.62
|
| Rate for Payer: Nomi Health Commercial |
$3,397.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,107.31
|
| Rate for Payer: PHP Commercial |
$3,521.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,604.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,883.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,645.91
|
| Rate for Payer: UHC Core |
$3,459.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,107.31
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,143.08
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$730.43 |
| Max. Negotiated Rate |
$3,728.77 |
| Rate for Payer: Aetna Commercial |
$3,521.62
|
| Rate for Payer: Aetna Medicare |
$1,077.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,294.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,294.71
|
| Rate for Payer: BCBS Complete |
$766.88
|
| Rate for Payer: BCBS MAPPO |
$1,035.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,406.03
|
| Rate for Payer: BCN Commercial |
$3,406.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,035.77
|
| Rate for Payer: Cash Price |
$3,314.46
|
| Rate for Payer: Cofinity Commercial |
$3,563.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,314.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,035.77
|
| Rate for Payer: Healthscope Commercial |
$3,728.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,107.31
|
| Rate for Payer: Mclaren Medicaid |
$730.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,087.56
|
| Rate for Payer: Meridian Medicaid |
$766.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,191.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,139.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,521.62
|
| Rate for Payer: Nomi Health Commercial |
$3,397.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,107.31
|
| Rate for Payer: PACE Senior Care Partners |
$983.98
|
| Rate for Payer: PACE SWMI |
$1,035.77
|
| Rate for Payer: PHP Commercial |
$3,521.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,035.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$730.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,604.48
|
| Rate for Payer: Priority Health Medicare |
$1,046.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,883.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,035.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,645.91
|
| Rate for Payer: UHC Core |
$3,459.47
|
| Rate for Payer: UHC Exchange |
$1,035.77
|
| Rate for Payer: UHC Medicaid |
$730.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,035.77
|
| Rate for Payer: UHCCP Medicaid |
$730.43
|
| Rate for Payer: VA VA |
$1,035.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,107.31
|
|
|
TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,732.50
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,685.82 |
| Max. Negotiated Rate |
$6,059.25 |
| Rate for Payer: Aetna Commercial |
$5,722.62
|
| Rate for Payer: BCBS Trust/PPO |
$5,560.37
|
| Rate for Payer: BCN Commercial |
$5,560.37
|
| Rate for Payer: Cash Price |
$5,386.00
|
| Rate for Payer: Cofinity Commercial |
$5,789.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,386.00
|
| Rate for Payer: Healthscope Commercial |
$6,059.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,049.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,722.62
|
| Rate for Payer: Nomi Health Commercial |
$5,520.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,049.38
|
| Rate for Payer: PHP Commercial |
$5,722.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,857.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,685.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,924.60
|
| Rate for Payer: UHC Core |
$5,621.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,049.38
|
|
