|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
OP
|
$12.47
|
|
|
Service Code
|
NDC 60758080205
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna American Axle |
$8.11
|
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Advantage |
$8.73
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.35
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.11
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Exchange |
$4.90
|
| Rate for Payer: UMR Bronson Commercial |
$4.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
NDC 61314022605
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna American Axle |
$11.41
|
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: Cash Price |
$14.04
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.16
|
| Rate for Payer: PHP Commercial |
$14.92
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.41
|
| Rate for Payer: UHC Core |
$9.14
|
| Rate for Payer: UHC Exchange |
$6.90
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$21.78
|
|
|
Service Code
|
NDC 64980051305
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna American Axle |
$14.16
|
| Rate for Payer: Aetna Commercial |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.16
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cofinity Advantage |
$15.25
|
| Rate for Payer: Cofinity Commercial |
$18.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$19.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.34
|
| Rate for Payer: PHP Commercial |
$18.51
|
| Rate for Payer: Priority Health SBD |
$13.72
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.34
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$688.84
|
|
|
Service Code
|
NDC 24208081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.09 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna American Axle |
$447.75
|
| Rate for Payer: Aetna Commercial |
$585.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: Cash Price |
$551.07
|
| Rate for Payer: Cofinity Advantage |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.07
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$482.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.63
|
| Rate for Payer: PHP Commercial |
$585.51
|
| Rate for Payer: Priority Health SBD |
$433.97
|
| Rate for Payer: UMR Bronson Commercial |
$303.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.63
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$20.61
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$18.55 |
| Rate for Payer: Aetna American Axle |
$13.40
|
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Advantage |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: UMR Bronson Commercial |
$9.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.46
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$31.57
|
|
|
Service Code
|
NDC 64980051405
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna American Axle |
$20.52
|
| Rate for Payer: Aetna Commercial |
$26.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.52
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Cofinity Advantage |
$22.10
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.68
|
| Rate for Payer: PHP Commercial |
$26.83
|
| Rate for Payer: Priority Health SBD |
$19.89
|
| Rate for Payer: UMR Bronson Commercial |
$13.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.68
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$688.84
|
|
|
Service Code
|
NDC 24208081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.87 |
| Max. Negotiated Rate |
$619.96 |
| Rate for Payer: Aetna American Axle |
$447.75
|
| Rate for Payer: Aetna Commercial |
$585.51
|
| Rate for Payer: Aetna Medicare |
$344.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.75
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: Cash Price |
$551.07
|
| Rate for Payer: Cofinity Advantage |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.07
|
| Rate for Payer: Healthscope Commercial |
$619.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$482.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$551.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.63
|
| Rate for Payer: PHP Commercial |
$585.51
|
| Rate for Payer: Priority Health SBD |
$433.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.75
|
| Rate for Payer: UHC Core |
$358.89
|
| Rate for Payer: UHC Exchange |
$270.71
|
| Rate for Payer: UMR Bronson Commercial |
$254.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.63
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$31.57
|
|
|
Service Code
|
NDC 64980051405
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$28.41 |
| Rate for Payer: Aetna American Axle |
$20.52
|
| Rate for Payer: Aetna Commercial |
$26.83
|
| Rate for Payer: Aetna Medicare |
$15.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.52
|
| Rate for Payer: BCBS Complete |
$12.63
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Cofinity Advantage |
$22.10
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$28.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.68
|
| Rate for Payer: PHP Commercial |
$26.83
|
| Rate for Payer: Priority Health SBD |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.52
|
| Rate for Payer: UHC Core |
$16.45
|
| Rate for Payer: UHC Exchange |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$11.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.68
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna American Axle |
$18.36
|
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Advantage |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.19
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health SBD |
$17.80
|
| Rate for Payer: UMR Bronson Commercial |
$12.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna American Axle |
$18.36
|
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Advantage |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$25.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.19
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health SBD |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$14.72
|
| Rate for Payer: UHC Exchange |
$11.10
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.19
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$20.61
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$18.55 |
| Rate for Payer: Aetna American Axle |
$13.40
|
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Advantage |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.40
|
| Rate for Payer: UHC Core |
$10.74
|
| Rate for Payer: UHC Exchange |
$8.10
|
| Rate for Payer: UMR Bronson Commercial |
$7.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.46
|
|
|
TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION
|
Facility
|
OP
|
$479.75
|
|
|
Service Code
|
NDC 43598074811
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.51 |
| Max. Negotiated Rate |
$431.77 |
| Rate for Payer: Aetna American Axle |
$311.84
|
| Rate for Payer: Aetna Commercial |
$407.79
|
| Rate for Payer: Aetna Medicare |
$239.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.84
|
| Rate for Payer: BCBS Complete |
$191.90
|
| Rate for Payer: Cash Price |
$383.80
|
| Rate for Payer: Cofinity Advantage |
$335.82
|
| Rate for Payer: Cofinity Commercial |
$412.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.80
|
| Rate for Payer: Healthscope Commercial |
$431.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.81
|
| Rate for Payer: PHP Commercial |
$407.79
|
| Rate for Payer: Priority Health SBD |
$302.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.84
|
| Rate for Payer: UHC Core |
$249.95
|
| Rate for Payer: UHC Exchange |
$188.54
|
| Rate for Payer: UMR Bronson Commercial |
$177.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.81
|
|
|
TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION
|
Facility
|
IP
|
$479.75
|
|
|
Service Code
|
NDC 43598074811
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.09 |
| Max. Negotiated Rate |
$431.77 |
| Rate for Payer: Aetna American Axle |
$311.84
|
| Rate for Payer: Aetna Commercial |
$407.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.84
|
| Rate for Payer: Cash Price |
$383.80
|
| Rate for Payer: Cofinity Advantage |
$335.82
|
| Rate for Payer: Cofinity Commercial |
$412.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.80
|
| Rate for Payer: Healthscope Commercial |
$431.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.81
|
| Rate for Payer: PHP Commercial |
$407.79
|
| Rate for Payer: Priority Health SBD |
$302.24
|
| Rate for Payer: UMR Bronson Commercial |
$211.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.81
|
|
|
TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION
|
Facility
|
IP
|
$590.56
|
|
|
Service Code
|
NDC 82260081905
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.85 |
| Max. Negotiated Rate |
$531.50 |
| Rate for Payer: Aetna American Axle |
$383.86
|
| Rate for Payer: Aetna Commercial |
$501.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.86
|
| Rate for Payer: Cash Price |
$472.45
|
| Rate for Payer: Cofinity Advantage |
$413.39
|
| Rate for Payer: Cofinity Commercial |
$507.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.45
|
| Rate for Payer: Healthscope Commercial |
$531.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$442.92
|
| Rate for Payer: PHP Commercial |
$501.98
|
| Rate for Payer: Priority Health SBD |
$372.05
|
| Rate for Payer: UMR Bronson Commercial |
$259.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.92
|
|
|
TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION
|
Facility
|
OP
|
$590.56
|
|
|
Service Code
|
NDC 82260081905
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.51 |
| Max. Negotiated Rate |
$531.50 |
| Rate for Payer: Aetna American Axle |
$383.86
|
| Rate for Payer: Aetna Commercial |
$501.98
|
| Rate for Payer: Aetna Medicare |
$295.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.86
|
| Rate for Payer: BCBS Complete |
$236.22
|
| Rate for Payer: Cash Price |
$472.45
|
| Rate for Payer: Cofinity Advantage |
$413.39
|
| Rate for Payer: Cofinity Commercial |
$507.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$472.45
|
| Rate for Payer: Healthscope Commercial |
$531.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$413.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$472.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$442.92
|
| Rate for Payer: PHP Commercial |
$501.98
|
| Rate for Payer: Priority Health SBD |
$372.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.86
|
| Rate for Payer: UHC Core |
$307.68
|
| Rate for Payer: UHC Exchange |
$232.09
|
| Rate for Payer: UMR Bronson Commercial |
$218.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.92
|
|
|
TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION
|
Facility
|
IP
|
$399.53
|
|
|
Service Code
|
NDC 24208081905
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.79 |
| Max. Negotiated Rate |
$359.58 |
| Rate for Payer: Aetna American Axle |
$259.69
|
| Rate for Payer: Aetna Commercial |
$339.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.69
|
| Rate for Payer: Cash Price |
$319.62
|
| Rate for Payer: Cofinity Advantage |
$279.67
|
| Rate for Payer: Cofinity Commercial |
$343.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.62
|
| Rate for Payer: Healthscope Commercial |
$359.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.65
|
| Rate for Payer: PHP Commercial |
$339.60
|
| Rate for Payer: Priority Health SBD |
$251.70
|
| Rate for Payer: UMR Bronson Commercial |
$175.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.65
|
|
|
TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION
|
Facility
|
OP
|
$498.26
|
|
|
Service Code
|
NDC 61314022505
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.36 |
| Max. Negotiated Rate |
$448.43 |
| Rate for Payer: Aetna American Axle |
$323.87
|
| Rate for Payer: Aetna Commercial |
$423.52
|
| Rate for Payer: Aetna Medicare |
$249.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.87
|
| Rate for Payer: BCBS Complete |
$199.30
|
| Rate for Payer: Cash Price |
$398.61
|
| Rate for Payer: Cofinity Advantage |
$348.78
|
| Rate for Payer: Cofinity Commercial |
$428.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.61
|
| Rate for Payer: Healthscope Commercial |
$448.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.69
|
| Rate for Payer: PHP Commercial |
$423.52
|
| Rate for Payer: Priority Health SBD |
$313.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.87
|
| Rate for Payer: UHC Core |
$259.59
|
| Rate for Payer: UHC Exchange |
$195.82
|
| Rate for Payer: UMR Bronson Commercial |
$184.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.69
|
|
|
TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION
|
Facility
|
OP
|
$399.53
|
|
|
Service Code
|
NDC 24208081905
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.83 |
| Max. Negotiated Rate |
$359.58 |
| Rate for Payer: Aetna American Axle |
$259.69
|
| Rate for Payer: Aetna Commercial |
$339.60
|
| Rate for Payer: Aetna Medicare |
$199.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.69
|
| Rate for Payer: BCBS Complete |
$159.81
|
| Rate for Payer: Cash Price |
$319.62
|
| Rate for Payer: Cofinity Advantage |
$279.67
|
| Rate for Payer: Cofinity Commercial |
$343.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.62
|
| Rate for Payer: Healthscope Commercial |
$359.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.65
|
| Rate for Payer: PHP Commercial |
$339.60
|
| Rate for Payer: Priority Health SBD |
$251.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.69
|
| Rate for Payer: UHC Core |
$208.16
|
| Rate for Payer: UHC Exchange |
$157.02
|
| Rate for Payer: UMR Bronson Commercial |
$147.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.65
|
|
|
TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION
|
Facility
|
IP
|
$498.26
|
|
|
Service Code
|
NDC 61314022505
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.23 |
| Max. Negotiated Rate |
$448.43 |
| Rate for Payer: Aetna American Axle |
$323.87
|
| Rate for Payer: Aetna Commercial |
$423.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.87
|
| Rate for Payer: Cash Price |
$398.61
|
| Rate for Payer: Cofinity Advantage |
$348.78
|
| Rate for Payer: Cofinity Commercial |
$428.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.61
|
| Rate for Payer: Healthscope Commercial |
$448.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.69
|
| Rate for Payer: PHP Commercial |
$423.52
|
| Rate for Payer: Priority Health SBD |
$313.90
|
| Rate for Payer: UMR Bronson Commercial |
$219.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.69
|
|
|
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION MIST FOR INHALATION
|
Facility
|
OP
|
$1,201.67
|
|
|
Service Code
|
NDC 00597016061
|
| Hospital Charge Code |
175691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.62 |
| Max. Negotiated Rate |
$1,081.50 |
| Rate for Payer: Aetna American Axle |
$781.09
|
| Rate for Payer: Aetna Commercial |
$1,021.42
|
| Rate for Payer: Aetna Medicare |
$600.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.09
|
| Rate for Payer: BCBS Complete |
$480.67
|
| Rate for Payer: Cash Price |
$961.34
|
| Rate for Payer: Cofinity Advantage |
$841.17
|
| Rate for Payer: Cofinity Commercial |
$1,033.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.34
|
| Rate for Payer: Healthscope Commercial |
$1,081.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$841.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$961.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.25
|
| Rate for Payer: PHP Commercial |
$1,021.42
|
| Rate for Payer: Priority Health SBD |
$757.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$781.09
|
| Rate for Payer: UHC Core |
$626.07
|
| Rate for Payer: UHC Exchange |
$472.26
|
| Rate for Payer: UMR Bronson Commercial |
$444.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.25
|
|
|
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION MIST FOR INHALATION
|
Facility
|
IP
|
$1,201.67
|
|
|
Service Code
|
NDC 00597016061
|
| Hospital Charge Code |
175691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.73 |
| Max. Negotiated Rate |
$1,081.50 |
| Rate for Payer: Aetna American Axle |
$781.09
|
| Rate for Payer: Aetna Commercial |
$1,021.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.09
|
| Rate for Payer: Cash Price |
$961.34
|
| Rate for Payer: Cofinity Advantage |
$841.17
|
| Rate for Payer: Cofinity Commercial |
$1,033.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.34
|
| Rate for Payer: Healthscope Commercial |
$1,081.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$841.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.25
|
| Rate for Payer: PHP Commercial |
$1,021.42
|
| Rate for Payer: Priority Health SBD |
$757.05
|
| Rate for Payer: UMR Bronson Commercial |
$528.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.25
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE
|
Facility
|
IP
|
$177.23
|
|
|
Service Code
|
NDC 00597007575
|
| Hospital Charge Code |
38315
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$159.51 |
| Rate for Payer: Aetna American Axle |
$115.20
|
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.20
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Advantage |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$159.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.92
|
| Rate for Payer: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| Rate for Payer: UMR Bronson Commercial |
$77.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.92
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE
|
Facility
|
OP
|
$177.23
|
|
|
Service Code
|
NDC 00597007575
|
| Hospital Charge Code |
38315
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$159.51 |
| Rate for Payer: Aetna American Axle |
$115.20
|
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$88.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.20
|
| Rate for Payer: BCBS Complete |
$70.89
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Advantage |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$159.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.92
|
| Rate for Payer: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.20
|
| Rate for Payer: UHC Core |
$92.34
|
| Rate for Payer: UHC Exchange |
$69.65
|
| Rate for Payer: UMR Bronson Commercial |
$65.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.92
|
|
|
TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33,229.60
|
|
|
Service Code
|
HCPCS J9273
|
| Hospital Charge Code |
198323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$29,906.64 |
| Rate for Payer: Aetna American Axle |
$21,599.24
|
| Rate for Payer: Aetna Commercial |
$28,245.16
|
| Rate for Payer: Aetna Medicare |
$203.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,599.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.15
|
| Rate for Payer: BCBS Complete |
$107.71
|
| Rate for Payer: BCBS MAPPO |
$196.12
|
| Rate for Payer: BCBS Trust/PPO |
$635.76
|
| Rate for Payer: BCN Commercial |
$635.76
|
| Rate for Payer: BCN Medicare Advantage |
$196.12
|
| Rate for Payer: Cash Price |
$26,583.68
|
| Rate for Payer: Cash Price |
$26,583.68
|
| Rate for Payer: Cofinity Advantage |
$23,260.72
|
| Rate for Payer: Cofinity Commercial |
$28,577.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,583.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.12
|
| Rate for Payer: Healthscope Commercial |
$29,906.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,260.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,922.20
|
| Rate for Payer: Mclaren Medicaid |
$196.12
|
| Rate for Payer: Mclaren Medicare |
$196.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.93
|
| Rate for Payer: Meridian Medicaid |
$205.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$215.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,245.16
|
| Rate for Payer: Nomi Health Commercial |
$588.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24,922.20
|
| Rate for Payer: PACE Medicare |
$186.31
|
| Rate for Payer: PACE SWMI |
$196.12
|
| Rate for Payer: PHP Commercial |
$28,245.16
|
| Rate for Payer: PHP Medicare Advantage |
$196.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$595.35
|
| Rate for Payer: Priority Health Medicare |
$196.12
|
| Rate for Payer: Priority Health SBD |
$20,934.65
|
| Rate for Payer: Priority Health Tiered Network |
$476.28
|
| Rate for Payer: Railroad Medicare Medicare |
$196.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.52
|
| Rate for Payer: UHC Core |
$323.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$196.12
|
| Rate for Payer: UHC Exchange |
$323.52
|
| Rate for Payer: UHC Medicaid |
$102.57
|
| Rate for Payer: UHCCP Medicaid |
$102.57
|
| Rate for Payer: UMR Bronson Commercial |
$12,294.95
|
| Rate for Payer: VA VA |
$196.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,922.20
|
|
|
TISSUE EXPANDER PLACEMENT IN BREAST RECONSTRUCTION, INCLUDING SUBSEQUENT EXPANSION(S)
|
Facility
|
OP
|
$44,406.09
|
|
|
Service Code
|
CPT 19357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,181.52 |
| Max. Negotiated Rate |
$44,406.09 |
| Rate for Payer: Aetna Medicare |
$14,280.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,164.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,164.25
|
| Rate for Payer: BCBS Complete |
$7,541.28
|
| Rate for Payer: BCBS MAPPO |
$13,731.40
|
| Rate for Payer: BCBS Trust/PPO |
$11,444.52
|
| Rate for Payer: BCN Commercial |
$11,444.52
|
| Rate for Payer: BCN Medicare Advantage |
$13,731.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,731.40
|
| Rate for Payer: Mclaren Medicaid |
$13,731.40
|
| Rate for Payer: Mclaren Medicare |
$13,731.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,417.97
|
| Rate for Payer: Meridian Medicaid |
$14,417.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,791.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,104.54
|
| Rate for Payer: Nomi Health Commercial |
$41,194.20
|
| Rate for Payer: PACE Medicare |
$13,044.83
|
| Rate for Payer: PACE SWMI |
$13,731.40
|
| Rate for Payer: PHP Medicare Advantage |
$13,731.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,181.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44,406.09
|
| Rate for Payer: Priority Health Medicare |
$13,731.40
|
| Rate for Payer: Priority Health Tiered Network |
$35,524.87
|
| Rate for Payer: Railroad Medicare Medicare |
$13,731.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,731.40
|
| Rate for Payer: UHC Medicaid |
$7,181.52
|
| Rate for Payer: UHCCP Medicaid |
$7,181.52
|
| Rate for Payer: VA VA |
$13,731.40
|
|
