|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$331.63
|
|
|
Service Code
|
NDC 0065-0643-05
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.92 |
| Max. Negotiated Rate |
$298.47 |
| Rate for Payer: Aetna American Axle |
$215.56
|
| Rate for Payer: Aetna Commercial |
$281.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.56
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cofinity Commercial |
$232.14
|
| Rate for Payer: Cofinity Commercial |
$285.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.30
|
| Rate for Payer: Healthscope Commercial |
$298.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.89
|
| Rate for Payer: PHP Commercial |
$281.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.14
|
| Rate for Payer: Priority Health SBD |
$208.93
|
| Rate for Payer: UMR Bronson Commercial |
$145.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.72
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$37.84
|
|
|
Service Code
|
NDC 17478-290-10
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna American Axle |
$24.60
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.60
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cofinity Commercial |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$32.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.27
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.16
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.49
|
| Rate for Payer: Priority Health SBD |
$23.84
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.38
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$20.07
|
|
|
Service Code
|
NDC 70069-131-01
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna American Axle |
$13.05
|
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.05
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$14.05
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$18.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$8.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.05
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 24208-290-05
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna American Axle |
$25.39
|
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$27.34
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$27.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.20
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.34
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| Rate for Payer: UMR Bronson Commercial |
$17.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT
|
Facility
|
IP
|
$696.47
|
|
|
Service Code
|
NDC 0065-0644-35
|
| Hospital Charge Code |
19769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.45 |
| Max. Negotiated Rate |
$626.82 |
| Rate for Payer: Aetna American Axle |
$452.71
|
| Rate for Payer: Aetna Commercial |
$592.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.71
|
| Rate for Payer: Cash Price |
$557.18
|
| Rate for Payer: Cofinity Commercial |
$487.53
|
| Rate for Payer: Cofinity Commercial |
$598.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.18
|
| Rate for Payer: Healthscope Commercial |
$626.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$487.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.00
|
| Rate for Payer: PHP Commercial |
$592.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.53
|
| Rate for Payer: Priority Health SBD |
$438.78
|
| Rate for Payer: UMR Bronson Commercial |
$306.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.35
|
|
|
TOBRAMYCIN 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.32
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: Aetna American Axle |
$13.21
|
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.21
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$18.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.27
|
| Rate for Payer: PHP Commercial |
$17.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.24
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$167.65
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
11565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna American Axle |
$152.50
|
| Rate for Payer: Aetna American Axle |
$148.51
|
| Rate for Payer: Aetna American Axle |
$120.50
|
| Rate for Payer: Aetna American Axle |
$136.99
|
| Rate for Payer: Aetna American Axle |
$120.18
|
| Rate for Payer: Aetna Commercial |
$199.42
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Aetna Commercial |
$179.15
|
| Rate for Payer: Aetna Commercial |
$157.16
|
| Rate for Payer: Aetna Commercial |
$194.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.50
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cash Price |
$147.91
|
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Cash Price |
$168.61
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cash Price |
$187.69
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$164.23
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Cofinity Commercial |
$159.44
|
| Rate for Payer: Cofinity Commercial |
$181.25
|
| Rate for Payer: Cofinity Commercial |
$129.77
|
| Rate for Payer: Cofinity Commercial |
$196.49
|
| Rate for Payer: Cofinity Commercial |
$129.42
|
| Rate for Payer: Cofinity Commercial |
$159.01
|
| Rate for Payer: Cofinity Commercial |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.78
|
| Rate for Payer: Healthscope Commercial |
$166.85
|
| Rate for Payer: Healthscope Commercial |
$189.68
|
| Rate for Payer: Healthscope Commercial |
$211.15
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Healthscope Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$205.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.42
|
| Rate for Payer: PHP Commercial |
$179.15
|
| Rate for Payer: PHP Commercial |
$199.42
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: PHP Commercial |
$157.58
|
| Rate for Payer: PHP Commercial |
$157.16
|
| Rate for Payer: PHP Commercial |
$194.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.23
|
| Rate for Payer: Priority Health SBD |
$143.94
|
| Rate for Payer: Priority Health SBD |
$116.80
|
| Rate for Payer: Priority Health SBD |
$116.48
|
| Rate for Payer: Priority Health SBD |
$147.80
|
| Rate for Payer: Priority Health SBD |
$132.78
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: UMR Bronson Commercial |
$100.53
|
| Rate for Payer: UMR Bronson Commercial |
$92.73
|
| Rate for Payer: UMR Bronson Commercial |
$81.57
|
| Rate for Payer: UMR Bronson Commercial |
$81.35
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: UMR Bronson Commercial |
$103.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.96
|
|
|
TOBRAMYCIN 14 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$174.41
|
|
|
Service Code
|
NDC 9900-0000-90
|
| Hospital Charge Code |
500595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.74 |
| Max. Negotiated Rate |
$156.97 |
| Rate for Payer: Aetna American Axle |
$113.37
|
| Rate for Payer: Aetna Commercial |
$148.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.37
|
| Rate for Payer: Cash Price |
$139.53
|
| Rate for Payer: Cofinity Commercial |
$122.09
|
| Rate for Payer: Cofinity Commercial |
$149.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.53
|
| Rate for Payer: Healthscope Commercial |
$156.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.25
|
| Rate for Payer: PHP Commercial |
$148.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.09
|
| Rate for Payer: Priority Health SBD |
$109.88
|
| Rate for Payer: UMR Bronson Commercial |
$76.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.81
|
|
|
TOBRAMYCIN 300 MG/5 ML NEBULIZATION CUSTOM
|
Facility
|
IP
|
$50.66
|
|
|
Service Code
|
HCPCS J7682
|
| Hospital Charge Code |
168920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Aetna American Axle |
$32.93
|
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.93
|
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Cofinity Commercial |
$35.46
|
| Rate for Payer: Cofinity Commercial |
$43.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.53
|
| Rate for Payer: Healthscope Commercial |
$45.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.06
|
| Rate for Payer: PHP Commercial |
$43.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.46
|
| Rate for Payer: Priority Health SBD |
$31.92
|
| Rate for Payer: UMR Bronson Commercial |
$22.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.00
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna American Axle |
$123.08
|
| Rate for Payer: Aetna American Axle |
$58.49
|
| Rate for Payer: Aetna Commercial |
$76.48
|
| Rate for Payer: Aetna Commercial |
$160.95
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Cofinity Commercial |
$162.84
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$62.99
|
| Rate for Payer: Cofinity Commercial |
$77.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$80.98
|
| Rate for Payer: Healthscope Commercial |
$170.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$160.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$76.48
|
| Rate for Payer: PHP Commercial |
$160.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.99
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Priority Health SBD |
$119.29
|
| Rate for Payer: Priority Health SBD |
$56.69
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: UMR Bronson Commercial |
$39.59
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.48
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.74
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$16.87 |
| Rate for Payer: Aetna American Axle |
$12.18
|
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Complete |
$7.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.60
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$17.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$17.92
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.92
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: UMR Bronson Commercial |
$6.93
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
|
|
TOBRAMYCIN 9 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$130.81
|
|
|
Service Code
|
NDC 9900-0000-89
|
| Hospital Charge Code |
500594
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$117.73 |
| Rate for Payer: Aetna American Axle |
$85.03
|
| Rate for Payer: Aetna Commercial |
$111.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.03
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cofinity Commercial |
$112.50
|
| Rate for Payer: Cofinity Commercial |
$91.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.65
|
| Rate for Payer: Healthscope Commercial |
$117.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.19
|
| Rate for Payer: PHP Commercial |
$111.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.57
|
| Rate for Payer: Priority Health SBD |
$82.41
|
| Rate for Payer: UMR Bronson Commercial |
$57.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.11
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT
|
Facility
|
IP
|
$736.40
|
|
|
Service Code
|
NDC 0065-0648-35
|
| Hospital Charge Code |
11566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.02 |
| Max. Negotiated Rate |
$662.76 |
| Rate for Payer: Aetna American Axle |
$478.66
|
| Rate for Payer: Aetna Commercial |
$625.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.66
|
| Rate for Payer: Cash Price |
$589.12
|
| Rate for Payer: Cofinity Commercial |
$515.48
|
| Rate for Payer: Cofinity Commercial |
$633.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.12
|
| Rate for Payer: Healthscope Commercial |
$662.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.94
|
| Rate for Payer: PHP Commercial |
$625.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.48
|
| Rate for Payer: Priority Health SBD |
$463.93
|
| Rate for Payer: UMR Bronson Commercial |
$324.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.30
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,597.06
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$3,237.35 |
| Rate for Payer: Aetna American Axle |
$2,338.09
|
| Rate for Payer: Aetna Commercial |
$3,057.50
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,338.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$20.65
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: Cash Price |
$2,877.65
|
| Rate for Payer: Cash Price |
$2,877.65
|
| Rate for Payer: Cofinity Commercial |
$3,093.47
|
| Rate for Payer: Cofinity Commercial |
$2,517.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,877.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$3,237.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,517.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,697.80
|
| Rate for Payer: Mclaren Medicaid |
$3.35
|
| Rate for Payer: Mclaren Medicare |
$6.12
|
| Rate for Payer: Meridian Medicaid |
$3.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,057.50
|
| Rate for Payer: PACE Medicare |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PHP Commercial |
$3,057.50
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,517.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.17
|
| Rate for Payer: Priority Health Medicare |
$6.12
|
| Rate for Payer: Priority Health Narrow Network |
$14.54
|
| Rate for Payer: Priority Health SBD |
$2,266.15
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,330.91
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,697.80
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,597.06
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,582.71 |
| Max. Negotiated Rate |
$3,237.35 |
| Rate for Payer: Aetna American Axle |
$2,338.09
|
| Rate for Payer: Aetna Commercial |
$3,057.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,338.09
|
| Rate for Payer: Cash Price |
$2,877.65
|
| Rate for Payer: Cofinity Commercial |
$2,517.94
|
| Rate for Payer: Cofinity Commercial |
$3,093.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,877.65
|
| Rate for Payer: Healthscope Commercial |
$3,237.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,517.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,697.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,057.50
|
| Rate for Payer: PHP Commercial |
$3,057.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,517.94
|
| Rate for Payer: Priority Health SBD |
$2,266.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,582.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,697.80
|
|
|
TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,845.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$5,260.70 |
| Rate for Payer: Aetna American Axle |
$3,799.39
|
| Rate for Payer: Aetna Commercial |
$4,968.44
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,799.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$20.65
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: Cash Price |
$4,676.18
|
| Rate for Payer: Cash Price |
$4,676.18
|
| Rate for Payer: Cofinity Commercial |
$4,091.65
|
| Rate for Payer: Cofinity Commercial |
$5,026.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,676.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$5,260.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,091.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,383.92
|
| Rate for Payer: Mclaren Medicaid |
$3.35
|
| Rate for Payer: Mclaren Medicare |
$6.12
|
| Rate for Payer: Meridian Medicaid |
$3.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,968.44
|
| Rate for Payer: PACE Medicare |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PHP Commercial |
$4,968.44
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,091.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.17
|
| Rate for Payer: Priority Health Medicare |
$6.12
|
| Rate for Payer: Priority Health Narrow Network |
$14.54
|
| Rate for Payer: Priority Health SBD |
$3,682.49
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,162.73
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,383.92
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,532.36
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$1,379.12 |
| Rate for Payer: Aetna American Axle |
$996.03
|
| Rate for Payer: Aetna Commercial |
$1,302.51
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$20.65
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: Cash Price |
$1,225.89
|
| Rate for Payer: Cash Price |
$1,225.89
|
| Rate for Payer: Cofinity Commercial |
$1,317.83
|
| Rate for Payer: Cofinity Commercial |
$1,072.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,225.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$1,379.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,072.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,149.27
|
| Rate for Payer: Mclaren Medicaid |
$3.35
|
| Rate for Payer: Mclaren Medicare |
$6.12
|
| Rate for Payer: Meridian Medicaid |
$3.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,302.51
|
| Rate for Payer: PACE Medicare |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PHP Commercial |
$1,302.51
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.17
|
| Rate for Payer: Priority Health Medicare |
$6.12
|
| Rate for Payer: Priority Health Narrow Network |
$14.54
|
| Rate for Payer: Priority Health SBD |
$965.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$566.97
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,149.27
|
|
|
TOLTERODINE 1 MG TABLET
|
Facility
|
IP
|
$546.57
|
|
|
Service Code
|
NDC 0093-0010-06
|
| Hospital Charge Code |
22782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.49 |
| Max. Negotiated Rate |
$491.91 |
| Rate for Payer: Aetna American Axle |
$355.27
|
| Rate for Payer: Aetna Commercial |
$464.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.27
|
| Rate for Payer: Cash Price |
$437.26
|
| Rate for Payer: Cofinity Commercial |
$382.60
|
| Rate for Payer: Cofinity Commercial |
$470.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.26
|
| Rate for Payer: Healthscope Commercial |
$491.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$382.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$464.58
|
| Rate for Payer: PHP Commercial |
$464.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.60
|
| Rate for Payer: Priority Health SBD |
$344.34
|
| Rate for Payer: UMR Bronson Commercial |
$240.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.93
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$2,064.60
|
|
|
Service Code
|
NDC 49884-768-54
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$908.42 |
| Max. Negotiated Rate |
$1,858.14 |
| Rate for Payer: Aetna American Axle |
$1,341.99
|
| Rate for Payer: Aetna Commercial |
$1,754.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.99
|
| Rate for Payer: Cash Price |
$1,651.68
|
| Rate for Payer: Cofinity Commercial |
$1,445.22
|
| Rate for Payer: Cofinity Commercial |
$1,775.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,651.68
|
| Rate for Payer: Healthscope Commercial |
$1,858.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,445.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,754.91
|
| Rate for Payer: PHP Commercial |
$1,754.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,445.22
|
| Rate for Payer: Priority Health SBD |
$1,300.70
|
| Rate for Payer: UMR Bronson Commercial |
$908.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,548.45
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 49884-768-52
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.52
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$19,151.06
|
|
|
Service Code
|
NDC 59148-020-50
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,426.47 |
| Max. Negotiated Rate |
$17,235.95 |
| Rate for Payer: Aetna American Axle |
$12,448.19
|
| Rate for Payer: Aetna Commercial |
$16,278.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,448.19
|
| Rate for Payer: Cash Price |
$15,320.85
|
| Rate for Payer: Cofinity Commercial |
$13,405.74
|
| Rate for Payer: Cofinity Commercial |
$16,469.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,320.85
|
| Rate for Payer: Healthscope Commercial |
$17,235.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,405.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,363.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,278.40
|
| Rate for Payer: PHP Commercial |
$16,278.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,405.74
|
| Rate for Payer: Priority Health SBD |
$12,065.17
|
| Rate for Payer: UMR Bronson Commercial |
$8,426.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,363.30
|
|
|
TOLVAPTAN 30 MG TABLET
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
NDC 31722-869-01
|
| Hospital Charge Code |
97894
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.36 |
| Max. Negotiated Rate |
$399.60 |
| Rate for Payer: Aetna American Axle |
$288.60
|
| Rate for Payer: Aetna Commercial |
$377.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.60
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cofinity Commercial |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$381.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.20
|
| Rate for Payer: Healthscope Commercial |
$399.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$377.40
|
| Rate for Payer: PHP Commercial |
$377.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.80
|
| Rate for Payer: Priority Health SBD |
$279.72
|
| Rate for Payer: UMR Bronson Commercial |
$195.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.00
|
|
|
TOLVAPTAN 30 MG TABLET
|
Facility
|
IP
|
$19,866.97
|
|
|
Service Code
|
NDC 59148-021-50
|
| Hospital Charge Code |
97894
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,741.47 |
| Max. Negotiated Rate |
$17,880.27 |
| Rate for Payer: Aetna American Axle |
$12,913.53
|
| Rate for Payer: Aetna Commercial |
$16,886.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,913.53
|
| Rate for Payer: Cash Price |
$15,893.58
|
| Rate for Payer: Cofinity Commercial |
$13,906.88
|
| Rate for Payer: Cofinity Commercial |
$17,085.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,893.58
|
| Rate for Payer: Healthscope Commercial |
$17,880.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,906.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,900.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,886.92
|
| Rate for Payer: PHP Commercial |
$16,886.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,906.88
|
| Rate for Payer: Priority Health SBD |
$12,516.19
|
| Rate for Payer: UMR Bronson Commercial |
$8,741.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,900.23
|
|
|
TOLVAPTAN 30 MG TABLET
|
Facility
|
IP
|
$4,439.97
|
|
|
Service Code
|
NDC 31722-869-03
|
| Hospital Charge Code |
97894
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,953.59 |
| Max. Negotiated Rate |
$3,995.97 |
| Rate for Payer: Aetna American Axle |
$2,885.98
|
| Rate for Payer: Aetna Commercial |
$3,773.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,885.98
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cofinity Commercial |
$3,107.98
|
| Rate for Payer: Cofinity Commercial |
$3,818.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,551.98
|
| Rate for Payer: Healthscope Commercial |
$3,995.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,107.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,329.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,773.97
|
| Rate for Payer: PHP Commercial |
$3,773.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,107.98
|
| Rate for Payer: Priority Health SBD |
$2,797.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,953.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,329.98
|
|
|
TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 42821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$302.56 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,803.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.82
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$302.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
