|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$35.81
|
|
|
Service Code
|
NDC 68682081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$32.23 |
| Rate for Payer: Aetna Commercial |
$30.44
|
| Rate for Payer: Aetna Medicare |
$9.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.19
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$8.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.44
|
| Rate for Payer: BCN Commercial |
$27.84
|
| Rate for Payer: BCN Medicare Advantage |
$8.95
|
| Rate for Payer: Cash Price |
$28.65
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.95
|
| Rate for Payer: Healthscope Commercial |
$32.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.44
|
| Rate for Payer: Nomi Health Commercial |
$29.36
|
| Rate for Payer: PACE Senior Care Partners |
$8.50
|
| Rate for Payer: PACE SWMI |
$8.95
|
| Rate for Payer: PHP Commercial |
$30.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.28
|
| Rate for Payer: Priority Health HMO/PPO |
$31.15
|
| Rate for Payer: Priority Health Medicare |
$9.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.99
|
| Rate for Payer: Railroad Medicare Medicare |
$8.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.51
|
| Rate for Payer: UHC Core |
$29.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.95
|
| Rate for Payer: UHC Exchange |
$8.95
|
| Rate for Payer: UHC Medicare Advantage |
$8.95
|
| Rate for Payer: VA VA |
$8.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.86
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$20.21
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: Aetna Medicare |
$5.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.32
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: BCBS MAPPO |
$5.05
|
| Rate for Payer: BCBS Trust/PPO |
$16.61
|
| Rate for Payer: BCN Commercial |
$15.71
|
| Rate for Payer: BCN Medicare Advantage |
$5.05
|
| Rate for Payer: Cash Price |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$17.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.05
|
| Rate for Payer: Healthscope Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.18
|
| Rate for Payer: Nomi Health Commercial |
$16.57
|
| Rate for Payer: PACE Senior Care Partners |
$4.80
|
| Rate for Payer: PACE SWMI |
$5.05
|
| Rate for Payer: PHP Commercial |
$17.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.14
|
| Rate for Payer: Priority Health HMO/PPO |
$17.58
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.78
|
| Rate for Payer: UHC Core |
$16.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.05
|
| Rate for Payer: UHC Exchange |
$5.05
|
| Rate for Payer: UHC Medicare Advantage |
$5.05
|
| Rate for Payer: VA VA |
$5.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.16
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.83
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: BCBS MAPPO |
$7.06
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: BCN Medicare Advantage |
$7.06
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PACE Senior Care Partners |
$6.71
|
| Rate for Payer: PACE SWMI |
$7.06
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Medicare |
$7.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| Rate for Payer: Railroad Medicare Medicare |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.06
|
| Rate for Payer: UHC Exchange |
$7.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.06
|
| Rate for Payer: VA VA |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$22.91
|
|
|
Service Code
|
NDC 60758080105
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$19.47
|
| Rate for Payer: Aetna Medicare |
$5.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.16
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS MAPPO |
$5.73
|
| Rate for Payer: BCBS Trust/PPO |
$18.83
|
| Rate for Payer: BCN Commercial |
$17.81
|
| Rate for Payer: BCN Medicare Advantage |
$5.73
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$19.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$20.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: PACE Senior Care Partners |
$5.44
|
| Rate for Payer: PACE SWMI |
$5.73
|
| Rate for Payer: PHP Commercial |
$19.47
|
| Rate for Payer: PHP Medicare Advantage |
$5.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.89
|
| Rate for Payer: Priority Health HMO/PPO |
$19.93
|
| Rate for Payer: Priority Health Medicare |
$5.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.35
|
| Rate for Payer: Railroad Medicare Medicare |
$5.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.16
|
| Rate for Payer: UHC Core |
$19.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.73
|
| Rate for Payer: UHC Exchange |
$5.73
|
| Rate for Payer: UHC Medicare Advantage |
$5.73
|
| Rate for Payer: VA VA |
$5.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.18
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$35.81
|
|
|
Service Code
|
NDC 68682081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$32.23 |
| Rate for Payer: Aetna Commercial |
$30.44
|
| Rate for Payer: BCBS Trust/PPO |
$29.23
|
| Rate for Payer: BCN Commercial |
$27.67
|
| Rate for Payer: Cash Price |
$28.65
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.65
|
| Rate for Payer: Healthscope Commercial |
$32.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.44
|
| Rate for Payer: Nomi Health Commercial |
$29.36
|
| Rate for Payer: PHP Commercial |
$30.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.28
|
| Rate for Payer: Priority Health HMO/PPO |
$31.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.51
|
| Rate for Payer: UHC Core |
$29.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.86
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
OP
|
$3.16
|
|
|
Service Code
|
NDC 50268075911
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.99
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: BCBS MAPPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.60
|
| Rate for Payer: BCN Commercial |
$2.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.79
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.79
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: Nomi Health Commercial |
$2.59
|
| Rate for Payer: PACE Senior Care Partners |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.79
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: PHP Medicare Advantage |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2.75
|
| Rate for Payer: Priority Health Medicare |
$0.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.12
|
| Rate for Payer: Railroad Medicare Medicare |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.78
|
| Rate for Payer: UHC Core |
$2.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Medicare Advantage |
$0.79
|
| Rate for Payer: VA VA |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 57664050289
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.80
|
| 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 |
$73.32
|
| Rate for Payer: BCBS MAPPO |
$45.82
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$142.52
|
| Rate for Payer: BCN Medicare Advantage |
$45.82
|
| 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 |
$45.82
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.80
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: PACE Senior Care Partners |
$43.53
|
| Rate for Payer: PACE SWMI |
$45.82
|
| Rate for Payer: PHP Commercial |
$155.80
|
| Rate for Payer: PHP Medicare Advantage |
$45.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.81
|
| Rate for Payer: Railroad Medicare Medicare |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.82
|
| Rate for Payer: UHC Exchange |
$45.82
|
| Rate for Payer: UHC Medicare Advantage |
$45.82
|
| Rate for Payer: VA VA |
$45.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.48
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
NDC 50268075911
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.44
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: Nomi Health Commercial |
$2.59
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.78
|
| Rate for Payer: UHC Core |
$2.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
IP
|
$157.68
|
|
|
Service Code
|
NDC 50268075915
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.49 |
| Max. Negotiated Rate |
$141.91 |
| Rate for Payer: Aetna Commercial |
$134.03
|
| Rate for Payer: BCBS Trust/PPO |
$128.71
|
| Rate for Payer: BCN Commercial |
$121.86
|
| Rate for Payer: Cash Price |
$126.14
|
| Rate for Payer: Cofinity Commercial |
$135.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.14
|
| Rate for Payer: Healthscope Commercial |
$141.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.03
|
| Rate for Payer: Nomi Health Commercial |
$129.30
|
| Rate for Payer: PHP Commercial |
$134.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.49
|
| Rate for Payer: Priority Health HMO/PPO |
$137.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.76
|
| Rate for Payer: UHC Core |
$131.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.26
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 57664050289
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.80
|
| Rate for Payer: BCBS Trust/PPO |
$149.63
|
| Rate for Payer: BCN Commercial |
$141.65
|
| 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 |
$137.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.80
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: PHP Commercial |
$155.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health HMO/PPO |
$159.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.81
|
| 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 |
$137.48
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
OP
|
$157.68
|
|
|
Service Code
|
NDC 50268075915
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$141.91 |
| Rate for Payer: Aetna Commercial |
$134.03
|
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.28
|
| Rate for Payer: BCBS Complete |
$63.07
|
| Rate for Payer: BCBS MAPPO |
$39.42
|
| Rate for Payer: BCBS Trust/PPO |
$129.63
|
| Rate for Payer: BCN Commercial |
$122.60
|
| Rate for Payer: BCN Medicare Advantage |
$39.42
|
| Rate for Payer: Cash Price |
$126.14
|
| Rate for Payer: Cofinity Commercial |
$135.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.42
|
| Rate for Payer: Healthscope Commercial |
$141.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.03
|
| Rate for Payer: Nomi Health Commercial |
$129.30
|
| Rate for Payer: PACE Senior Care Partners |
$37.45
|
| Rate for Payer: PACE SWMI |
$39.42
|
| Rate for Payer: PHP Commercial |
$134.03
|
| Rate for Payer: PHP Medicare Advantage |
$39.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.49
|
| Rate for Payer: Priority Health HMO/PPO |
$137.18
|
| Rate for Payer: Priority Health Medicare |
$39.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.65
|
| Rate for Payer: Railroad Medicare Medicare |
$39.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.76
|
| Rate for Payer: UHC Core |
$131.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.42
|
| Rate for Payer: UHC Exchange |
$39.42
|
| Rate for Payer: UHC Medicare Advantage |
$39.42
|
| Rate for Payer: VA VA |
$39.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.26
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 51079099801
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.02
|
| 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: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health HMO/PPO |
$2.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.75
|
| 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
|
$396.15
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.50 |
| Max. Negotiated Rate |
$356.54 |
| Rate for Payer: Aetna Commercial |
$336.73
|
| Rate for Payer: BCBS Trust/PPO |
$323.38
|
| Rate for Payer: BCN Commercial |
$306.14
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$340.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Healthscope Commercial |
$356.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.73
|
| Rate for Payer: Nomi Health Commercial |
$324.84
|
| Rate for Payer: PHP Commercial |
$336.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.50
|
| Rate for Payer: Priority Health HMO/PPO |
$344.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.61
|
| Rate for Payer: UHC Core |
$330.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.11
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$260.64
|
|
|
Service Code
|
NDC 51079099820
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.42 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: BCBS Trust/PPO |
$212.76
|
| Rate for Payer: BCN Commercial |
$201.42
|
| 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: PHP Commercial |
$221.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.42
|
| Rate for Payer: Priority Health HMO/PPO |
$226.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.63
|
| 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
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$260.64
|
|
|
Service Code
|
NDC 51079099820
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.90 |
| 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 |
$104.26
|
| Rate for Payer: BCBS MAPPO |
$65.16
|
| Rate for Payer: BCBS Trust/PPO |
$214.27
|
| Rate for Payer: BCN Commercial |
$202.65
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Nomi Health Commercial |
$213.72
|
| 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 Cigna Priority Health |
$169.42
|
| Rate for Payer: Priority Health HMO/PPO |
$226.76
|
| Rate for Payer: Priority Health Medicare |
$65.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.63
|
| 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 Dual Complete DSNP |
$65.16
|
| Rate for Payer: UHC Exchange |
$65.16
|
| Rate for Payer: UHC Medicare Advantage |
$65.16
|
| Rate for Payer: VA VA |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 51079099801
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| 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 |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.03
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Nomi Health Commercial |
$2.14
|
| 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 Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health HMO/PPO |
$2.27
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.75
|
| 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 Dual Complete DSNP |
$0.65
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$396.15
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$356.54 |
| Rate for Payer: Aetna Commercial |
$336.73
|
| Rate for Payer: Aetna Medicare |
$103.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.80
|
| Rate for Payer: BCBS Complete |
$158.46
|
| Rate for Payer: BCBS MAPPO |
$99.04
|
| Rate for Payer: BCBS Trust/PPO |
$325.67
|
| Rate for Payer: BCN Commercial |
$308.01
|
| Rate for Payer: BCN Medicare Advantage |
$99.04
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$340.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.04
|
| Rate for Payer: Healthscope Commercial |
$356.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.73
|
| Rate for Payer: Nomi Health Commercial |
$324.84
|
| Rate for Payer: PACE Senior Care Partners |
$94.09
|
| Rate for Payer: PACE SWMI |
$99.04
|
| Rate for Payer: PHP Commercial |
$336.73
|
| Rate for Payer: PHP Medicare Advantage |
$99.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.50
|
| Rate for Payer: Priority Health HMO/PPO |
$344.65
|
| Rate for Payer: Priority Health Medicare |
$100.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.42
|
| Rate for Payer: Railroad Medicare Medicare |
$99.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.61
|
| Rate for Payer: UHC Core |
$330.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.04
|
| Rate for Payer: UHC Exchange |
$99.04
|
| Rate for Payer: UHC Medicare Advantage |
$99.04
|
| Rate for Payer: VA VA |
$99.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.11
|
|
|
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 |
$80.24 |
| Max. Negotiated Rate |
$111.10 |
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: BCBS Trust/PPO |
$100.77
|
| Rate for Payer: BCN Commercial |
$95.40
|
| 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 |
$111.10
|
| 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: PHP Commercial |
$104.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.24
|
| Rate for Payer: Priority Health HMO/PPO |
$107.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.71
|
| 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
|
$164.61
|
|
|
Service Code
|
NDC 24208029525
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.09 |
| 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 |
$65.84
|
| Rate for Payer: BCBS MAPPO |
$41.15
|
| Rate for Payer: BCBS Trust/PPO |
$135.33
|
| Rate for Payer: BCN Commercial |
$127.98
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Nomi Health Commercial |
$134.98
|
| 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 Cigna Priority Health |
$107.00
|
| Rate for Payer: Priority Health HMO/PPO |
$143.21
|
| Rate for Payer: Priority Health Medicare |
$41.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.29
|
| 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 Dual Complete DSNP |
$41.15
|
| Rate for Payer: UHC Exchange |
$41.15
|
| Rate for Payer: UHC Medicare Advantage |
$41.15
|
| 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
|
IP
|
$78.44
|
|
|
Service Code
|
NDC 00574403125
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.99 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.67
|
| Rate for Payer: BCBS Trust/PPO |
$64.03
|
| Rate for Payer: BCN Commercial |
$60.62
|
| Rate for Payer: Cash Price |
$62.75
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.75
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.67
|
| Rate for Payer: Nomi Health Commercial |
$64.32
|
| Rate for Payer: PHP Commercial |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health HMO/PPO |
$68.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.03
|
| Rate for Payer: UHC Core |
$65.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.83
|
|
|
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 |
$80.24 |
| Max. Negotiated Rate |
$111.10 |
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: BCBS Trust/PPO |
$100.77
|
| Rate for Payer: BCN Commercial |
$95.40
|
| 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 |
$111.10
|
| 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: PHP Commercial |
$104.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.24
|
| Rate for Payer: Priority Health HMO/PPO |
$107.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.71
|
| 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
|
$78.44
|
|
|
Service Code
|
NDC 00574403125
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.67
|
| Rate for Payer: Aetna Medicare |
$20.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.51
|
| Rate for Payer: BCBS Complete |
$31.38
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$64.49
|
| Rate for Payer: BCN Commercial |
$60.99
|
| Rate for Payer: BCN Medicare Advantage |
$19.61
|
| Rate for Payer: Cash Price |
$62.75
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.67
|
| Rate for Payer: Nomi Health Commercial |
$64.32
|
| Rate for Payer: PACE Senior Care Partners |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$66.67
|
| Rate for Payer: PHP Medicare Advantage |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health HMO/PPO |
$68.24
|
| Rate for Payer: Priority Health Medicare |
$19.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.55
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.03
|
| Rate for Payer: UHC Core |
$65.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.61
|
| Rate for Payer: UHC Exchange |
$19.61
|
| Rate for Payer: UHC Medicare Advantage |
$19.61
|
| Rate for Payer: VA VA |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.83
|
|
|
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 |
$107.00 |
| Max. Negotiated Rate |
$148.15 |
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: BCBS Trust/PPO |
$134.37
|
| Rate for Payer: BCN Commercial |
$127.21
|
| 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: PHP Commercial |
$139.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.00
|
| Rate for Payer: Priority Health HMO/PPO |
$143.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.29
|
| 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
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$111.10 |
| 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 |
$49.38
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$101.49
|
| Rate for Payer: BCN Commercial |
$95.98
|
| 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 |
$111.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$101.23
|
| 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 Cigna Priority Health |
$80.24
|
| Rate for Payer: Priority Health HMO/PPO |
$107.40
|
| Rate for Payer: Priority Health Medicare |
$31.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.71
|
| 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 Dual Complete DSNP |
$30.86
|
| Rate for Payer: UHC Exchange |
$30.86
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| 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 69238137302
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$111.10 |
| 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 |
$49.38
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$101.49
|
| Rate for Payer: BCN Commercial |
$95.98
|
| 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 |
$111.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$101.23
|
| 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 Cigna Priority Health |
$80.24
|
| Rate for Payer: Priority Health HMO/PPO |
$107.40
|
| Rate for Payer: Priority Health Medicare |
$31.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.71
|
| 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 Dual Complete DSNP |
$30.86
|
| Rate for Payer: UHC Exchange |
$30.86
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: VA VA |
$30.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.59
|
|
