|
BREXPIPRAZOLE 0.25 MG TABLET
|
Facility
|
IP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003513
|
| Hospital Charge Code |
174663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,294.80 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna American Axle |
$3,390.04
|
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,650.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,911.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
| Rate for Payer: UMR Bronson Commercial |
$2,294.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,911.59
|
|
|
BREXPIPRAZOLE 0.25 MG TABLET
|
Facility
|
OP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003513
|
| Hospital Charge Code |
174663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,929.72 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna American Axle |
$3,390.04
|
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna Medicare |
$2,607.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: BCBS Complete |
$2,086.18
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,650.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,911.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,929.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,911.59
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
OP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003713
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,929.72 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna American Axle |
$3,390.04
|
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna Medicare |
$2,607.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: BCBS Complete |
$2,086.18
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,650.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,911.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,929.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,911.59
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
IP
|
$5,215.45
|
|
|
Service Code
|
NDC 59148003713
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,294.80 |
| Max. Negotiated Rate |
$4,693.90 |
| Rate for Payer: Aetna American Axle |
$3,390.04
|
| Rate for Payer: Aetna Commercial |
$4,433.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,390.04
|
| Rate for Payer: Cash Price |
$4,172.36
|
| Rate for Payer: Cofinity Commercial |
$3,650.82
|
| Rate for Payer: Cofinity Commercial |
$4,485.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,650.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,172.36
|
| Rate for Payer: Healthscope Commercial |
$4,693.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,650.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,911.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,433.13
|
| Rate for Payer: PHP Commercial |
$4,433.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,390.04
|
| Rate for Payer: Priority Health SBD |
$3,285.73
|
| Rate for Payer: UMR Bronson Commercial |
$2,294.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,911.59
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$674.73
|
|
|
Service Code
|
NDC 00023917705
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.65 |
| Max. Negotiated Rate |
$607.26 |
| Rate for Payer: Aetna American Axle |
$438.57
|
| Rate for Payer: Aetna Commercial |
$573.52
|
| Rate for Payer: Aetna Medicare |
$337.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.57
|
| Rate for Payer: BCBS Complete |
$269.89
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cofinity Commercial |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$472.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.78
|
| Rate for Payer: Healthscope Commercial |
$607.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.52
|
| Rate for Payer: PHP Commercial |
$573.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.57
|
| Rate for Payer: Priority Health SBD |
$425.08
|
| Rate for Payer: UMR Bronson Commercial |
$249.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.05
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.63 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna American Axle |
$324.46
|
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.46
|
| Rate for Payer: Priority Health SBD |
$314.48
|
| Rate for Payer: UMR Bronson Commercial |
$219.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.38
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.69 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna American Axle |
$324.46
|
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna Medicare |
$249.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: BCBS Complete |
$199.67
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.46
|
| Rate for Payer: Priority Health SBD |
$314.48
|
| Rate for Payer: UMR Bronson Commercial |
$184.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.38
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$674.73
|
|
|
Service Code
|
NDC 00023917705
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.88 |
| Max. Negotiated Rate |
$607.26 |
| Rate for Payer: Aetna American Axle |
$438.57
|
| Rate for Payer: Aetna Commercial |
$573.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.57
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cofinity Commercial |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$472.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.78
|
| Rate for Payer: Healthscope Commercial |
$607.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.52
|
| Rate for Payer: PHP Commercial |
$573.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.57
|
| Rate for Payer: Priority Health SBD |
$425.08
|
| Rate for Payer: UMR Bronson Commercial |
$296.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.05
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$404.01
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.48 |
| Max. Negotiated Rate |
$363.61 |
| Rate for Payer: Aetna American Axle |
$262.61
|
| Rate for Payer: Aetna Commercial |
$343.41
|
| Rate for Payer: Aetna Medicare |
$202.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.61
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: Cash Price |
$323.21
|
| Rate for Payer: Cofinity Commercial |
$282.81
|
| Rate for Payer: Cofinity Commercial |
$347.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.21
|
| Rate for Payer: Healthscope Commercial |
$363.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.41
|
| Rate for Payer: PHP Commercial |
$343.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.61
|
| Rate for Payer: Priority Health SBD |
$254.53
|
| Rate for Payer: UMR Bronson Commercial |
$149.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.01
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.34 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna American Axle |
$411.18
|
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.18
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$442.81
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: Priority Health SBD |
$398.53
|
| Rate for Payer: UMR Bronson Commercial |
$278.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$404.01
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.76 |
| Max. Negotiated Rate |
$363.61 |
| Rate for Payer: Aetna American Axle |
$262.61
|
| Rate for Payer: Aetna Commercial |
$343.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.61
|
| Rate for Payer: Cash Price |
$323.21
|
| Rate for Payer: Cofinity Commercial |
$282.81
|
| Rate for Payer: Cofinity Commercial |
$347.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.21
|
| Rate for Payer: Healthscope Commercial |
$363.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.41
|
| Rate for Payer: PHP Commercial |
$343.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.61
|
| Rate for Payer: Priority Health SBD |
$254.53
|
| Rate for Payer: UMR Bronson Commercial |
$177.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.01
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.06 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna American Axle |
$411.18
|
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna Medicare |
$316.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.18
|
| Rate for Payer: BCBS Complete |
$253.04
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$442.81
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: Priority Health SBD |
$398.53
|
| Rate for Payer: UMR Bronson Commercial |
$234.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$50.99
|
|
|
Service Code
|
NDC 24208041105
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.34
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$20.65
|
|
|
Service Code
|
NDC 61314014305
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$7.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$8.77
|
|
|
Service Code
|
NDC 17478071510
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$5.70
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: BCBS Complete |
$3.51
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health SBD |
$5.53
|
| Rate for Payer: UMR Bronson Commercial |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$50.99
|
|
|
Service Code
|
NDC 24208041105
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.34
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
NDC 61314014305
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.42
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$10.29
|
|
|
Service Code
|
NDC 70069023101
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna American Axle |
$6.69
|
| Rate for Payer: Aetna Commercial |
$8.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.69
|
| Rate for Payer: Cash Price |
$8.23
|
| Rate for Payer: Cofinity Commercial |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$9.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.75
|
| Rate for Payer: PHP Commercial |
$8.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.69
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.72
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
NDC 17478071510
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna American Axle |
$5.70
|
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health SBD |
$5.53
|
| Rate for Payer: UMR Bronson Commercial |
$3.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$10.29
|
|
|
Service Code
|
NDC 70069023101
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$9.26 |
| Rate for Payer: Aetna American Axle |
$6.69
|
| Rate for Payer: Aetna Commercial |
$8.75
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.69
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: Cash Price |
$8.23
|
| Rate for Payer: Cofinity Commercial |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$9.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.75
|
| Rate for Payer: PHP Commercial |
$8.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.69
|
| Rate for Payer: Priority Health SBD |
$6.48
|
| Rate for Payer: UMR Bronson Commercial |
$3.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.72
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$1,114.61
|
|
|
Service Code
|
NDC 00065027510
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.41 |
| Max. Negotiated Rate |
$1,003.15 |
| Rate for Payer: Aetna Medicare |
$557.30
|
| Rate for Payer: Aetna American Axle |
$724.50
|
| Rate for Payer: Aetna Commercial |
$947.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.50
|
| Rate for Payer: BCBS Complete |
$445.84
|
| Rate for Payer: Cash Price |
$891.69
|
| Rate for Payer: Cofinity Commercial |
$780.23
|
| Rate for Payer: Cofinity Commercial |
$958.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.69
|
| Rate for Payer: Healthscope Commercial |
$1,003.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.42
|
| Rate for Payer: PHP Commercial |
$947.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health SBD |
$702.20
|
| Rate for Payer: UMR Bronson Commercial |
$412.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.96
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,114.61
|
|
|
Service Code
|
NDC 00065027510
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$490.43 |
| Max. Negotiated Rate |
$1,003.15 |
| Rate for Payer: Aetna American Axle |
$724.50
|
| Rate for Payer: Aetna Commercial |
$947.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.50
|
| Rate for Payer: Cash Price |
$891.69
|
| Rate for Payer: Cofinity Commercial |
$780.23
|
| Rate for Payer: Cofinity Commercial |
$958.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.69
|
| Rate for Payer: Healthscope Commercial |
$1,003.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$835.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.42
|
| Rate for Payer: PHP Commercial |
$947.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health SBD |
$702.20
|
| Rate for Payer: UMR Bronson Commercial |
$490.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$835.96
|
|
|
BRIVARACETAM 100 MG TABLET
|
Facility
|
IP
|
$5,068.49
|
|
|
Service Code
|
NDC 50474077066
|
| Hospital Charge Code |
178919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,230.14 |
| Max. Negotiated Rate |
$4,561.64 |
| Rate for Payer: Aetna American Axle |
$3,294.52
|
| Rate for Payer: Aetna Commercial |
$4,308.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,294.52
|
| Rate for Payer: Cash Price |
$4,054.79
|
| Rate for Payer: Cofinity Commercial |
$3,547.94
|
| Rate for Payer: Cofinity Commercial |
$4,358.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,547.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,054.79
|
| Rate for Payer: Healthscope Commercial |
$4,561.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,547.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,801.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,308.22
|
| Rate for Payer: PHP Commercial |
$4,308.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,294.52
|
| Rate for Payer: Priority Health SBD |
$3,193.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,230.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,801.37
|
|
|
BRIVARACETAM 100 MG TABLET
|
Facility
|
OP
|
$5,068.49
|
|
|
Service Code
|
NDC 50474077066
|
| Hospital Charge Code |
178919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,875.34 |
| Max. Negotiated Rate |
$4,561.64 |
| Rate for Payer: Aetna American Axle |
$3,294.52
|
| Rate for Payer: Aetna Commercial |
$4,308.22
|
| Rate for Payer: Aetna Medicare |
$2,534.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,294.52
|
| Rate for Payer: BCBS Complete |
$2,027.40
|
| Rate for Payer: Cash Price |
$4,054.79
|
| Rate for Payer: Cofinity Commercial |
$3,547.94
|
| Rate for Payer: Cofinity Commercial |
$4,358.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,547.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,054.79
|
| Rate for Payer: Healthscope Commercial |
$4,561.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,547.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,801.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,308.22
|
| Rate for Payer: PHP Commercial |
$4,308.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,294.52
|
| Rate for Payer: Priority Health SBD |
$3,193.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,875.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,801.37
|
|
|
BROMOCRIPTINE 2.5 MG TABLET
|
Facility
|
OP
|
$202.76
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
9297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$182.48 |
| Rate for Payer: Aetna American Axle |
$131.79
|
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Medicare |
$101.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.79
|
| Rate for Payer: BCBS Complete |
$81.10
|
| Rate for Payer: Cash Price |
$162.21
|
| Rate for Payer: Cofinity Commercial |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$174.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.21
|
| Rate for Payer: Healthscope Commercial |
$182.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.79
|
| Rate for Payer: Priority Health SBD |
$127.74
|
| Rate for Payer: UMR Bronson Commercial |
$75.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.07
|
|
