|
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 |
$49.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.27
|
| 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 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 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
|
$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
|
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
|
$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
|
$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
|
$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
|
OP
|
$123.45
|
|
|
Service Code
|
NDC 69238137302
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.32 |
| 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 |
$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 |
$111.11
|
| 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
|
$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
|
$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
|
$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
|
OP
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.32 |
| 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 |
$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 |
$111.11
|
| 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
|
IP
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$111.11 |
| 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 |
$111.11
|
| 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: 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
|
IP
|
$123.45
|
|
|
Service Code
|
NDC 69238137302
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$111.11 |
| 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 |
$111.11
|
| 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: 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 % EYE DROPS
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 24208029005
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.28 |
| 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 |
$15.62
|
| Rate for Payer: BCBS MAPPO |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| Rate for Payer: BCN Commercial |
$30.37
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$32.03
|
| 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 Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Medicare |
$9.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.17
|
| 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 Dual Complete DSNP |
$9.77
|
| Rate for Payer: UHC Exchange |
$9.77
|
| Rate for Payer: UHC Medicare Advantage |
$9.77
|
| 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 |
$25.39 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.88
|
| Rate for Payer: BCN Commercial |
$30.19
|
| 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: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health HMO/PPO |
$33.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.17
|
| 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 |
$7.13 |
| 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 |
$9.14
|
| Rate for Payer: BCBS Trust/PPO |
$8.95
|
| Rate for Payer: BCBS Trust/PPO |
$15.30
|
| Rate for Payer: BCN Commercial |
$8.66
|
| Rate for Payer: BCN Commercial |
$8.48
|
| Rate for Payer: BCN Commercial |
$14.48
|
| 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: PHP Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health HMO/PPO |
$16.30
|
| Rate for Payer: Priority Health HMO/PPO |
$9.74
|
| Rate for Payer: Priority Health HMO/PPO |
$9.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.35
|
| 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 |
$2.61 |
| 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 |
$3.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.86
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$7.50
|
| 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 |
$9.21
|
| Rate for Payer: BCBS Trust/PPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$15.41
|
| Rate for Payer: BCN Commercial |
$8.71
|
| Rate for Payer: BCN Commercial |
$14.57
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: BCN Medicare Advantage |
$2.74
|
| Rate for Payer: BCN Medicare Advantage |
$2.80
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| 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 |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| 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: 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: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Nomi Health Commercial |
$15.37
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Nomi Health Commercial |
$9.18
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE Senior Care Partners |
$2.61
|
| Rate for Payer: PACE Senior Care Partners |
$2.66
|
| Rate for Payer: PACE SWMI |
$2.80
|
| Rate for Payer: PACE SWMI |
$2.74
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Medicare Advantage |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: PHP Medicare Advantage |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health HMO/PPO |
$16.30
|
| Rate for Payer: Priority Health HMO/PPO |
$9.54
|
| Rate for Payer: Priority Health HMO/PPO |
$9.74
|
| Rate for Payer: Priority Health Medicare |
$2.77
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Medicare |
$2.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.35
|
| 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 |
$15.65
|
| Rate for Payer: UHC Core |
$9.35
|
| Rate for Payer: UHC Core |
$9.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.80
|
| Rate for Payer: UHC Exchange |
$2.80
|
| Rate for Payer: UHC Exchange |
$2.74
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$2.74
|
| Rate for Payer: UHC Medicare Advantage |
$2.80
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$2.80
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: VA VA |
$2.74
|
| 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
|
|
|
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 |
$4.13 |
| 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 |
$4.34
|
| Rate for Payer: BCBS MAPPO |
$1,035.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,406.03
|
| Rate for Payer: BCN Commercial |
$3,221.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,035.77
|
| Rate for Payer: Cash Price |
$3,314.46
|
| 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 |
$4.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,087.56
|
| Rate for Payer: Meridian Medicaid |
$4.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,191.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,521.62
|
| Rate for Payer: Nomi Health Commercial |
$3,397.33
|
| 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 |
$4.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,693.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,604.48
|
| Rate for Payer: Priority Health Medicare |
$1,046.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,775.86
|
| 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 Dual Complete DSNP |
$1,035.77
|
| Rate for Payer: UHC Exchange |
$1,035.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,035.77
|
| Rate for Payer: UHCCP Medicaid |
$4.13
|
| Rate for Payer: VA VA |
$1,035.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,107.31
|
|
|
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 |
$2,693.00 |
| Max. Negotiated Rate |
$3,728.77 |
| Rate for Payer: Aetna Commercial |
$3,521.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,382.00
|
| Rate for Payer: BCN Commercial |
$3,201.77
|
| 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: PHP Commercial |
$3,521.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,693.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,604.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,775.86
|
| 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 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 |
$4,376.12 |
| Max. Negotiated Rate |
$6,059.25 |
| Rate for Payer: Aetna Commercial |
$5,722.62
|
| Rate for Payer: BCBS Trust/PPO |
$5,495.74
|
| Rate for Payer: BCN Commercial |
$5,202.88
|
| 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: PHP Commercial |
$5,722.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,376.12
|
| Rate for Payer: Priority Health HMO/PPO |
$5,857.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,510.77
|
| 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
|
|
|
TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,732.50
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$6,059.25 |
| Rate for Payer: Aetna Commercial |
$5,722.62
|
| Rate for Payer: Aetna Medicare |
$1,750.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,103.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,103.91
|
| Rate for Payer: BCBS Complete |
$4.34
|
| Rate for Payer: BCBS MAPPO |
$1,683.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,534.79
|
| Rate for Payer: BCN Commercial |
$5,234.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,683.12
|
| Rate for Payer: Cash Price |
$5,386.00
|
| 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: Health Alliance Plan Medicare Advantage |
$1,683.12
|
| Rate for Payer: Healthscope Commercial |
$6,059.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,049.38
|
| Rate for Payer: Mclaren Medicaid |
$4.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,767.28
|
| Rate for Payer: Meridian Medicaid |
$4.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,935.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,722.62
|
| Rate for Payer: Nomi Health Commercial |
$5,520.65
|
| Rate for Payer: PACE Senior Care Partners |
$1,598.97
|
| Rate for Payer: PACE SWMI |
$1,683.12
|
| Rate for Payer: PHP Commercial |
$5,722.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,683.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,376.12
|
| Rate for Payer: Priority Health HMO/PPO |
$5,857.27
|
| Rate for Payer: Priority Health Medicare |
$1,699.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,510.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,683.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,924.60
|
| Rate for Payer: UHC Core |
$5,621.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,683.12
|
| Rate for Payer: UHC Exchange |
$1,683.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,683.12
|
| Rate for Payer: UHCCP Medicaid |
$4.13
|
| Rate for Payer: VA VA |
$1,683.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,049.38
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,657.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,077.19 |
| Max. Negotiated Rate |
$1,491.50 |
| Rate for Payer: Aetna Commercial |
$1,408.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,352.79
|
| Rate for Payer: BCN Commercial |
$1,280.70
|
| Rate for Payer: Cash Price |
$1,325.78
|
| Rate for Payer: Cofinity Commercial |
$1,425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.78
|
| Rate for Payer: Healthscope Commercial |
$1,491.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.64
|
| Rate for Payer: Nomi Health Commercial |
$1,358.92
|
| Rate for Payer: PHP Commercial |
$1,408.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.19
|
| Rate for Payer: Priority Health HMO/PPO |
$1,441.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.35
|
| Rate for Payer: UHC Core |
$1,383.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.91
|
|
