|
TIZANIDINE 2 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 57664050289
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.65 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UMR Bronson Commercial |
$80.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 57664050289
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.82 |
| Max. Negotiated Rate |
$164.97 |
| Rate for Payer: Aetna American Axle |
$119.14
|
| Rate for Payer: Aetna Commercial |
$155.81
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Advantage |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$164.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.47
|
| Rate for Payer: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.14
|
| Rate for Payer: UHC Core |
$95.50
|
| Rate for Payer: UHC Exchange |
$72.04
|
| Rate for Payer: UMR Bronson Commercial |
$67.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 64980065815
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.51 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$130.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Advantage |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.55
|
| Rate for Payer: UHC Core |
$135.90
|
| Rate for Payer: UHC Exchange |
$102.51
|
| Rate for Payer: UMR Bronson Commercial |
$96.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
TIZANIDINE 2 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 64980065815
|
| Hospital Charge Code |
14792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Advantage |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$334.88
|
|
|
Service Code
|
NDC 29300016915
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.91 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna American Axle |
$217.67
|
| Rate for Payer: Aetna Commercial |
$284.65
|
| Rate for Payer: Aetna Medicare |
$167.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.67
|
| Rate for Payer: BCBS Complete |
$133.95
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cofinity Advantage |
$234.42
|
| Rate for Payer: Cofinity Commercial |
$288.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.90
|
| Rate for Payer: Healthscope Commercial |
$301.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.16
|
| Rate for Payer: PHP Commercial |
$284.65
|
| Rate for Payer: Priority Health SBD |
$210.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.67
|
| Rate for Payer: UHC Core |
$174.47
|
| Rate for Payer: UHC Exchange |
$131.61
|
| Rate for Payer: UMR Bronson Commercial |
$123.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.16
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$334.88
|
|
|
Service Code
|
NDC 55111018015
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna American Axle |
$217.67
|
| Rate for Payer: Aetna Commercial |
$284.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.67
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cofinity Advantage |
$234.42
|
| Rate for Payer: Cofinity Commercial |
$288.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.90
|
| Rate for Payer: Healthscope Commercial |
$301.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.16
|
| Rate for Payer: PHP Commercial |
$284.65
|
| Rate for Payer: Priority Health SBD |
$210.97
|
| Rate for Payer: UMR Bronson Commercial |
$147.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.16
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.24 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna American Axle |
$302.57
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$232.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.57
|
| Rate for Payer: BCBS Complete |
$186.20
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Advantage |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.57
|
| Rate for Payer: UHC Core |
$242.53
|
| Rate for Payer: UHC Exchange |
$182.94
|
| Rate for Payer: UMR Bronson Commercial |
$172.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
NDC 51079099801
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna American Axle |
$1.70
|
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Advantage |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.70
|
| Rate for Payer: UHC Core |
$1.36
|
| Rate for Payer: UHC Exchange |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$227.53
|
|
|
Service Code
|
NDC 50268076015
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.19 |
| Max. Negotiated Rate |
$204.78 |
| Rate for Payer: Aetna American Axle |
$147.89
|
| Rate for Payer: Aetna Commercial |
$193.40
|
| Rate for Payer: Aetna Medicare |
$113.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.89
|
| Rate for Payer: BCBS Complete |
$91.01
|
| Rate for Payer: Cash Price |
$182.02
|
| Rate for Payer: Cofinity Advantage |
$159.27
|
| Rate for Payer: Cofinity Commercial |
$195.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.02
|
| Rate for Payer: Healthscope Commercial |
$204.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.65
|
| Rate for Payer: PHP Commercial |
$193.40
|
| Rate for Payer: Priority Health SBD |
$143.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.89
|
| Rate for Payer: UHC Core |
$118.54
|
| Rate for Payer: UHC Exchange |
$89.42
|
| Rate for Payer: UMR Bronson Commercial |
$84.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.65
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$4.56
|
|
|
Service Code
|
NDC 50268076011
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna American Axle |
$2.96
|
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cofinity Advantage |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.65
|
| Rate for Payer: Healthscope Commercial |
$4.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.42
|
| Rate for Payer: PHP Commercial |
$3.88
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: UMR Bronson Commercial |
$2.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.42
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$227.53
|
|
|
Service Code
|
NDC 50268076015
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$204.78 |
| Rate for Payer: Aetna American Axle |
$147.89
|
| Rate for Payer: Aetna Commercial |
$193.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.89
|
| Rate for Payer: Cash Price |
$182.02
|
| Rate for Payer: Cofinity Advantage |
$159.27
|
| Rate for Payer: Cofinity Commercial |
$195.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.02
|
| Rate for Payer: Healthscope Commercial |
$204.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.65
|
| Rate for Payer: PHP Commercial |
$193.40
|
| Rate for Payer: Priority Health SBD |
$143.34
|
| Rate for Payer: UMR Bronson Commercial |
$100.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.65
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$334.88
|
|
|
Service Code
|
NDC 29300016915
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna American Axle |
$217.67
|
| Rate for Payer: Aetna Commercial |
$284.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.67
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cofinity Advantage |
$234.42
|
| Rate for Payer: Cofinity Commercial |
$288.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.90
|
| Rate for Payer: Healthscope Commercial |
$301.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.16
|
| Rate for Payer: PHP Commercial |
$284.65
|
| Rate for Payer: Priority Health SBD |
$210.97
|
| Rate for Payer: UMR Bronson Commercial |
$147.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.16
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.82 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna American Axle |
$302.57
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.57
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Advantage |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UMR Bronson Commercial |
$204.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 51079099801
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna American Axle |
$1.70
|
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Advantage |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.96
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$334.88
|
|
|
Service Code
|
NDC 55111018015
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.91 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna American Axle |
$217.67
|
| Rate for Payer: Aetna Commercial |
$284.65
|
| Rate for Payer: Aetna Medicare |
$167.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.67
|
| Rate for Payer: BCBS Complete |
$133.95
|
| Rate for Payer: Cash Price |
$267.90
|
| Rate for Payer: Cofinity Advantage |
$234.42
|
| Rate for Payer: Cofinity Commercial |
$288.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.90
|
| Rate for Payer: Healthscope Commercial |
$301.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.16
|
| Rate for Payer: PHP Commercial |
$284.65
|
| Rate for Payer: Priority Health SBD |
$210.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.67
|
| Rate for Payer: UHC Core |
$174.47
|
| Rate for Payer: UHC Exchange |
$131.61
|
| Rate for Payer: UMR Bronson Commercial |
$123.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.16
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$260.64
|
|
|
Service Code
|
NDC 51079099820
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.68 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cofinity Advantage |
$182.45
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.48
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: UMR Bronson Commercial |
$114.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$4.56
|
|
|
Service Code
|
NDC 50268076011
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna American Axle |
$2.96
|
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Aetna Medicare |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cofinity Advantage |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.65
|
| Rate for Payer: Healthscope Commercial |
$4.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.42
|
| Rate for Payer: PHP Commercial |
$3.88
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: UHC Exchange |
$1.79
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.42
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$260.64
|
|
|
Service Code
|
NDC 51079099820
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.44 |
| Max. Negotiated Rate |
$234.58 |
| Rate for Payer: Aetna American Axle |
$169.42
|
| Rate for Payer: Aetna Commercial |
$221.54
|
| Rate for Payer: Aetna Medicare |
$130.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.42
|
| Rate for Payer: BCBS Complete |
$104.26
|
| Rate for Payer: Cash Price |
$208.51
|
| Rate for Payer: Cofinity Advantage |
$182.45
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.51
|
| Rate for Payer: Healthscope Commercial |
$234.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.48
|
| Rate for Payer: PHP Commercial |
$221.54
|
| Rate for Payer: Priority Health SBD |
$164.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.42
|
| Rate for Payer: UHC Core |
$135.79
|
| Rate for Payer: UHC Exchange |
$102.43
|
| Rate for Payer: UMR Bronson Commercial |
$96.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.48
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$164.61
|
|
|
Service Code
|
NDC 24208029525
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$148.15 |
| Rate for Payer: Aetna American Axle |
$107.00
|
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna Medicare |
$82.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.00
|
| Rate for Payer: BCBS Complete |
$65.84
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cofinity Advantage |
$115.23
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.46
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: Priority Health SBD |
$103.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.00
|
| Rate for Payer: UHC Core |
$85.76
|
| Rate for Payer: UHC Exchange |
$64.69
|
| Rate for Payer: UMR Bronson Commercial |
$60.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.46
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna American Axle |
$80.24
|
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.24
|
| Rate for Payer: Cash Price |
$98.76
|
| Rate for Payer: Cofinity Advantage |
$86.42
|
| Rate for Payer: Cofinity Commercial |
$106.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.76
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.59
|
| Rate for Payer: PHP Commercial |
$104.93
|
| Rate for Payer: Priority Health SBD |
$77.77
|
| Rate for Payer: UMR Bronson Commercial |
$54.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.59
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.68 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna American Axle |
$80.24
|
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: Aetna Medicare |
$61.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.24
|
| Rate for Payer: BCBS Complete |
$49.38
|
| Rate for Payer: Cash Price |
$98.76
|
| Rate for Payer: Cofinity Advantage |
$86.42
|
| Rate for Payer: Cofinity Commercial |
$106.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.76
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.59
|
| Rate for Payer: PHP Commercial |
$104.93
|
| Rate for Payer: Priority Health SBD |
$77.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.24
|
| Rate for Payer: UHC Core |
$64.32
|
| Rate for Payer: UHC Exchange |
$48.52
|
| Rate for Payer: UMR Bronson Commercial |
$45.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.59
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$164.61
|
|
|
Service Code
|
NDC 24208029525
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.43 |
| Max. Negotiated Rate |
$148.15 |
| Rate for Payer: Aetna American Axle |
$107.00
|
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.00
|
| Rate for Payer: Cash Price |
$131.69
|
| Rate for Payer: Cofinity Advantage |
$115.23
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.69
|
| Rate for Payer: Healthscope Commercial |
$148.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.46
|
| Rate for Payer: PHP Commercial |
$139.92
|
| Rate for Payer: Priority Health SBD |
$103.70
|
| Rate for Payer: UMR Bronson Commercial |
$72.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.46
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$39.06
|
|
|
Service Code
|
NDC 24208029005
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna American Axle |
$25.39
|
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| Rate for Payer: BCBS Complete |
$15.62
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$31.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.30
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.39
|
| Rate for Payer: UHC Core |
$20.35
|
| Rate for Payer: UHC Exchange |
$15.35
|
| Rate for Payer: UMR Bronson Commercial |
$14.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$20.93
|
|
|
Service Code
|
NDC 70069013101
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$18.84 |
| Rate for Payer: Aetna American Axle |
$13.60
|
| Rate for Payer: Aetna Commercial |
$17.79
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.60
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cofinity Advantage |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$18.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$18.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.70
|
| Rate for Payer: PHP Commercial |
$17.79
|
| Rate for Payer: Priority Health SBD |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$10.90
|
| Rate for Payer: UHC Exchange |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.70
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$50.47
|
|
|
Service Code
|
NDC 61314064305
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.21 |
| Max. Negotiated Rate |
$45.42 |
| Rate for Payer: Aetna American Axle |
$32.81
|
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.81
|
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Cofinity Advantage |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.38
|
| Rate for Payer: Healthscope Commercial |
$45.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.85
|
| Rate for Payer: PHP Commercial |
$42.90
|
| Rate for Payer: Priority Health SBD |
$31.80
|
| Rate for Payer: UMR Bronson Commercial |
$22.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.85
|
|
