|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.21
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PACE Senior Care Partners |
$0.92
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: Railroad Medicare Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$0.97
|
| Rate for Payer: VA VA |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
THIORIDAZINE 50 MG TABLET
|
Facility
|
IP
|
$366.24
|
|
|
Service Code
|
NDC 00378061601
|
| Hospital Charge Code |
7900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.06 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: BCBS Trust/PPO |
$298.96
|
| Rate for Payer: BCN Commercial |
$283.03
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.06
|
| Rate for Payer: Priority Health HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
THIORIDAZINE 50 MG TABLET
|
Facility
|
OP
|
$366.24
|
|
|
Service Code
|
NDC 00378061601
|
| Hospital Charge Code |
7900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.98 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: Aetna Medicare |
$95.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.45
|
| Rate for Payer: BCBS Complete |
$146.50
|
| Rate for Payer: BCBS MAPPO |
$91.56
|
| Rate for Payer: BCBS Trust/PPO |
$301.09
|
| Rate for Payer: BCN Commercial |
$284.75
|
| Rate for Payer: BCN Medicare Advantage |
$91.56
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.56
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: PACE Senior Care Partners |
$86.98
|
| Rate for Payer: PACE SWMI |
$91.56
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: PHP Medicare Advantage |
$91.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.06
|
| Rate for Payer: Priority Health HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Medicare |
$92.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.38
|
| Rate for Payer: Railroad Medicare Medicare |
$91.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.56
|
| Rate for Payer: UHC Exchange |
$91.56
|
| Rate for Payer: UHC Medicare Advantage |
$91.56
|
| Rate for Payer: VA VA |
$91.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
IP
|
$854.74
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$555.58 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna Commercial |
$726.53
|
| Rate for Payer: BCBS Trust/PPO |
$697.72
|
| Rate for Payer: BCN Commercial |
$660.54
|
| Rate for Payer: Cash Price |
$683.79
|
| Rate for Payer: Cofinity Commercial |
$735.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.79
|
| Rate for Payer: Healthscope Commercial |
$769.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.53
|
| Rate for Payer: Nomi Health Commercial |
$700.89
|
| Rate for Payer: PHP Commercial |
$726.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.58
|
| Rate for Payer: Priority Health HMO/PPO |
$743.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$752.17
|
| Rate for Payer: UHC Core |
$713.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.05
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
OP
|
$854.74
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna Commercial |
$726.53
|
| Rate for Payer: Aetna Medicare |
$222.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$267.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$267.11
|
| Rate for Payer: BCBS Complete |
$341.90
|
| Rate for Payer: BCBS MAPPO |
$213.69
|
| Rate for Payer: BCBS Trust/PPO |
$702.68
|
| Rate for Payer: BCN Commercial |
$664.56
|
| Rate for Payer: BCN Medicare Advantage |
$213.69
|
| Rate for Payer: Cash Price |
$683.79
|
| Rate for Payer: Cofinity Commercial |
$735.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.69
|
| Rate for Payer: Healthscope Commercial |
$769.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.53
|
| Rate for Payer: Nomi Health Commercial |
$700.89
|
| Rate for Payer: PACE Senior Care Partners |
$203.00
|
| Rate for Payer: PACE SWMI |
$213.69
|
| Rate for Payer: PHP Commercial |
$726.53
|
| Rate for Payer: PHP Medicare Advantage |
$213.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.58
|
| Rate for Payer: Priority Health HMO/PPO |
$743.62
|
| Rate for Payer: Priority Health Medicare |
$215.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.68
|
| Rate for Payer: Railroad Medicare Medicare |
$213.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$752.17
|
| Rate for Payer: UHC Core |
$713.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.69
|
| Rate for Payer: UHC Exchange |
$213.69
|
| Rate for Payer: UHC Medicare Advantage |
$213.69
|
| Rate for Payer: VA VA |
$213.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.05
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
OP
|
$202.04
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$181.84 |
| Rate for Payer: Aetna Commercial |
$171.73
|
| Rate for Payer: Aetna Medicare |
$52.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.14
|
| Rate for Payer: BCBS Complete |
$80.82
|
| Rate for Payer: BCBS MAPPO |
$50.51
|
| Rate for Payer: BCBS Trust/PPO |
$166.10
|
| Rate for Payer: BCN Commercial |
$157.09
|
| Rate for Payer: BCN Medicare Advantage |
$50.51
|
| Rate for Payer: Cash Price |
$161.63
|
| Rate for Payer: Cofinity Commercial |
$173.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.51
|
| Rate for Payer: Healthscope Commercial |
$181.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.73
|
| Rate for Payer: Nomi Health Commercial |
$165.67
|
| Rate for Payer: PACE Senior Care Partners |
$47.98
|
| Rate for Payer: PACE SWMI |
$50.51
|
| Rate for Payer: PHP Commercial |
$171.73
|
| Rate for Payer: PHP Medicare Advantage |
$50.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.33
|
| Rate for Payer: Priority Health HMO/PPO |
$175.77
|
| Rate for Payer: Priority Health Medicare |
$51.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.37
|
| Rate for Payer: Railroad Medicare Medicare |
$50.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.80
|
| Rate for Payer: UHC Core |
$168.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.51
|
| Rate for Payer: UHC Exchange |
$50.51
|
| Rate for Payer: UHC Medicare Advantage |
$50.51
|
| Rate for Payer: VA VA |
$50.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.53
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
IP
|
$202.04
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$181.84 |
| Rate for Payer: Aetna Commercial |
$171.73
|
| Rate for Payer: BCBS Trust/PPO |
$164.93
|
| Rate for Payer: BCN Commercial |
$156.14
|
| Rate for Payer: Cash Price |
$161.63
|
| Rate for Payer: Cofinity Commercial |
$173.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.63
|
| Rate for Payer: Healthscope Commercial |
$181.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.73
|
| Rate for Payer: Nomi Health Commercial |
$165.67
|
| Rate for Payer: PHP Commercial |
$171.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.33
|
| Rate for Payer: Priority Health HMO/PPO |
$175.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.80
|
| Rate for Payer: UHC Core |
$168.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.53
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
IP
|
$366.72
|
|
|
Service Code
|
NDC 42192033001
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.37 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna Commercial |
$311.71
|
| Rate for Payer: BCBS Trust/PPO |
$299.35
|
| Rate for Payer: BCN Commercial |
$283.40
|
| Rate for Payer: Cash Price |
$293.38
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.38
|
| Rate for Payer: Healthscope Commercial |
$330.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.71
|
| Rate for Payer: Nomi Health Commercial |
$300.71
|
| Rate for Payer: PHP Commercial |
$311.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.37
|
| Rate for Payer: Priority Health HMO/PPO |
$319.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.71
|
| Rate for Payer: UHC Core |
$306.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.04
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
OP
|
$366.72
|
|
|
Service Code
|
NDC 42192033001
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna Commercial |
$311.71
|
| Rate for Payer: Aetna Medicare |
$95.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.60
|
| Rate for Payer: BCBS Complete |
$146.69
|
| Rate for Payer: BCBS MAPPO |
$91.68
|
| Rate for Payer: BCBS Trust/PPO |
$301.48
|
| Rate for Payer: BCN Commercial |
$285.12
|
| Rate for Payer: BCN Medicare Advantage |
$91.68
|
| Rate for Payer: Cash Price |
$293.38
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.68
|
| Rate for Payer: Healthscope Commercial |
$330.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.71
|
| Rate for Payer: Nomi Health Commercial |
$300.71
|
| Rate for Payer: PACE Senior Care Partners |
$87.10
|
| Rate for Payer: PACE SWMI |
$91.68
|
| Rate for Payer: PHP Commercial |
$311.71
|
| Rate for Payer: PHP Medicare Advantage |
$91.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.37
|
| Rate for Payer: Priority Health HMO/PPO |
$319.05
|
| Rate for Payer: Priority Health Medicare |
$92.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.70
|
| Rate for Payer: Railroad Medicare Medicare |
$91.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.71
|
| Rate for Payer: UHC Core |
$306.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.68
|
| Rate for Payer: UHC Exchange |
$91.68
|
| Rate for Payer: UHC Medicare Advantage |
$91.68
|
| Rate for Payer: VA VA |
$91.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.04
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,084.41 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,361.86
|
| Rate for Payer: BCN Commercial |
$1,289.29
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Nomi Health Commercial |
$1,368.03
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,451.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,117.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,468.13
|
| Rate for Payer: UHC Core |
$1,393.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$396.23 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna Medicare |
$433.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$521.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$521.35
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: BCBS MAPPO |
$417.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,371.53
|
| Rate for Payer: BCN Commercial |
$1,297.13
|
| Rate for Payer: BCN Medicare Advantage |
$417.08
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.08
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Nomi Health Commercial |
$1,368.03
|
| Rate for Payer: PACE Senior Care Partners |
$396.23
|
| Rate for Payer: PACE SWMI |
$417.08
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: PHP Medicare Advantage |
$417.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,451.45
|
| Rate for Payer: Priority Health Medicare |
$421.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,117.78
|
| Rate for Payer: Railroad Medicare Medicare |
$417.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,468.13
|
| Rate for Payer: UHC Core |
$1,393.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$417.08
|
| Rate for Payer: UHC Exchange |
$417.08
|
| Rate for Payer: UHC Medicare Advantage |
$417.08
|
| Rate for Payer: VA VA |
$417.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$30.77
|
|
|
Service Code
|
NDC 61314022710
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Aetna Commercial |
$26.15
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.62
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS MAPPO |
$7.69
|
| Rate for Payer: BCBS Trust/PPO |
$25.30
|
| Rate for Payer: BCN Commercial |
$23.92
|
| Rate for Payer: BCN Medicare Advantage |
$7.69
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$26.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.69
|
| Rate for Payer: Healthscope Commercial |
$27.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: PACE Senior Care Partners |
$7.31
|
| Rate for Payer: PACE SWMI |
$7.69
|
| Rate for Payer: PHP Commercial |
$26.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.00
|
| Rate for Payer: Priority Health HMO/PPO |
$26.77
|
| Rate for Payer: Priority Health Medicare |
$7.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.08
|
| Rate for Payer: UHC Core |
$25.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.69
|
| Rate for Payer: UHC Exchange |
$7.69
|
| Rate for Payer: UHC Medicare Advantage |
$7.69
|
| Rate for Payer: VA VA |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.08
|
|
|
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
|
IP
|
$20.21
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.50
|
| Rate for Payer: BCN Commercial |
$15.62
|
| 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: Healthscope Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.18
|
| Rate for Payer: Nomi Health Commercial |
$16.57
|
| Rate for Payer: PHP Commercial |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.14
|
| Rate for Payer: Priority Health HMO/PPO |
$17.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.78
|
| Rate for Payer: UHC Core |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.16
|
|
|
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
|
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
|
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
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.06
|
| Rate for Payer: BCN Commercial |
$21.83
|
| 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: Healthscope Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Nomi Health Commercial |
$23.16
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health HMO/PPO |
$24.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.86
|
| Rate for Payer: UHC Core |
$23.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
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 |
$25.43 |
| 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 |
$25.43
|
| 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
|
IP
|
$22.91
|
|
|
Service Code
|
NDC 60758080105
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$19.47
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCN Commercial |
$17.70
|
| 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: Healthscope Commercial |
$20.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: PHP Commercial |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.89
|
| Rate for Payer: Priority Health HMO/PPO |
$19.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.16
|
| Rate for Payer: UHC Core |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.18
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$30.77
|
|
|
Service Code
|
NDC 61314022710
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Aetna Commercial |
$26.15
|
| Rate for Payer: BCBS Trust/PPO |
$25.12
|
| Rate for Payer: BCN Commercial |
$23.78
|
| Rate for Payer: Cash Price |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$26.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$27.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.23
|
| Rate for Payer: PHP Commercial |
$26.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.00
|
| Rate for Payer: Priority Health HMO/PPO |
$26.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.08
|
| Rate for Payer: UHC Core |
$25.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.08
|
|
|
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
|
$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
|
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 |
$155.81
|
| 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 |
$73.32
|
| Rate for Payer: BCBS MAPPO |
$45.83
|
| Rate for Payer: BCBS Trust/PPO |
$150.69
|
| Rate for Payer: BCN Commercial |
$142.52
|
| 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: 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 |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| 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 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 |
$45.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.30
|
| Rate for Payer: UHC Core |
$153.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.83
|
| Rate for Payer: UHC Exchange |
$45.83
|
| Rate for Payer: UHC Medicare Advantage |
$45.83
|
| 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 |
$119.14 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna Commercial |
$155.81
|
| 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 |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: PHP Commercial |
$155.81
|
| 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 |
$137.47
|
|
