|
TICAGRELOR 60 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077660
|
| Hospital Charge Code |
175597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$617.28 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna American Axle |
$1,084.41
|
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna Medicare |
$834.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,167.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
| Rate for Payer: UMR Bronson Commercial |
$617.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TICAGRELOR 60 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077660
|
| Hospital Charge Code |
175597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$734.07 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna American Axle |
$1,084.41
|
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,167.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
| Rate for Payer: UMR Bronson Commercial |
$734.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$617.28 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna American Axle |
$1,084.41
|
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna Medicare |
$834.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,167.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
| Rate for Payer: UMR Bronson Commercial |
$617.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$2,780.18
|
|
|
Service Code
|
NDC 00186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,223.28 |
| Max. Negotiated Rate |
$2,502.16 |
| Rate for Payer: Aetna American Axle |
$1,807.12
|
| Rate for Payer: Aetna Commercial |
$2,363.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.12
|
| Rate for Payer: Cash Price |
$2,224.14
|
| Rate for Payer: Cofinity Commercial |
$1,946.13
|
| Rate for Payer: Cofinity Commercial |
$2,390.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,946.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.14
|
| Rate for Payer: Healthscope Commercial |
$2,502.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,946.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,085.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.15
|
| Rate for Payer: PHP Commercial |
$2,363.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.12
|
| Rate for Payer: Priority Health SBD |
$1,751.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,223.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,085.14
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$734.07 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna American Axle |
$1,084.41
|
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,167.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
| Rate for Payer: UMR Bronson Commercial |
$734.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$2,780.18
|
|
|
Service Code
|
NDC 00186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,028.67 |
| Max. Negotiated Rate |
$2,502.16 |
| Rate for Payer: Aetna American Axle |
$1,807.12
|
| Rate for Payer: Aetna Commercial |
$2,363.15
|
| Rate for Payer: Aetna Medicare |
$1,390.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.12
|
| Rate for Payer: BCBS Complete |
$1,112.07
|
| Rate for Payer: Cash Price |
$2,224.14
|
| Rate for Payer: Cofinity Commercial |
$1,946.13
|
| Rate for Payer: Cofinity Commercial |
$2,390.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,946.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.14
|
| Rate for Payer: Healthscope Commercial |
$2,502.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,946.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,085.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.15
|
| Rate for Payer: PHP Commercial |
$2,363.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.12
|
| Rate for Payer: Priority Health SBD |
$1,751.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,028.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,085.14
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$84.74
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
301711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna American Axle |
$55.08
|
| Rate for Payer: Aetna Commercial |
$72.03
|
| Rate for Payer: Aetna Medicare |
$42.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.08
|
| Rate for Payer: BCBS Complete |
$33.90
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Healthscope Commercial |
$76.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.03
|
| Rate for Payer: PHP Commercial |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.08
|
| Rate for Payer: Priority Health SBD |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$31.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.55
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$84.74
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
301711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna American Axle |
$55.08
|
| Rate for Payer: Aetna Commercial |
$72.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.08
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Healthscope Commercial |
$76.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.03
|
| Rate for Payer: PHP Commercial |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.08
|
| Rate for Payer: Priority Health SBD |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$37.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.55
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$84.74
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
41652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna American Axle |
$55.08
|
| Rate for Payer: Aetna Commercial |
$72.03
|
| Rate for Payer: Aetna Medicare |
$42.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.08
|
| Rate for Payer: BCBS Complete |
$33.90
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Healthscope Commercial |
$76.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.03
|
| Rate for Payer: PHP Commercial |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.08
|
| Rate for Payer: Priority Health SBD |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$31.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.55
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$84.74
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
41652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Aetna American Axle |
$55.08
|
| Rate for Payer: Aetna Commercial |
$72.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.08
|
| Rate for Payer: Cash Price |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$59.32
|
| Rate for Payer: Cofinity Commercial |
$72.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.79
|
| Rate for Payer: Healthscope Commercial |
$76.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.03
|
| Rate for Payer: PHP Commercial |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.08
|
| Rate for Payer: Priority Health SBD |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$37.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.55
|
|
|
TILDRAKIZUMAB-ASMN 100 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$34,626.28
|
|
|
Service Code
|
HCPCS J3245
|
| Hospital Charge Code |
188045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.31 |
| Max. Negotiated Rate |
$31,163.65 |
| Rate for Payer: Aetna American Axle |
$22,507.08
|
| Rate for Payer: Aetna Commercial |
$29,432.34
|
| Rate for Payer: Aetna Medicare |
$132.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,507.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.31
|
| Rate for Payer: BCBS Complete |
$71.73
|
| Rate for Payer: BCBS MAPPO |
$127.45
|
| Rate for Payer: BCN Medicare Advantage |
$127.45
|
| Rate for Payer: Cash Price |
$27,701.02
|
| Rate for Payer: Cash Price |
$27,701.02
|
| Rate for Payer: Cofinity Commercial |
$24,238.40
|
| Rate for Payer: Cofinity Commercial |
$29,778.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$24,238.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,701.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.45
|
| Rate for Payer: Healthscope Commercial |
$31,163.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24,238.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25,969.71
|
| Rate for Payer: Mclaren Medicaid |
$68.31
|
| Rate for Payer: Mclaren Medicare |
$127.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.82
|
| Rate for Payer: Meridian Medicaid |
$71.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,432.34
|
| Rate for Payer: PACE Medicare |
$121.08
|
| Rate for Payer: PACE SWMI |
$127.45
|
| Rate for Payer: PHP Commercial |
$29,432.34
|
| Rate for Payer: PHP Medicare Advantage |
$127.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22,507.08
|
| Rate for Payer: Priority Health Medicare |
$127.45
|
| Rate for Payer: Priority Health SBD |
$21,814.56
|
| Rate for Payer: Railroad Medicare Medicare |
$127.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.45
|
| Rate for Payer: UHC Exchange |
$243.57
|
| Rate for Payer: UHC Medicare Advantage |
$127.45
|
| Rate for Payer: UHCCP Medicaid |
$68.31
|
| Rate for Payer: UMR Bronson Commercial |
$12,811.72
|
| Rate for Payer: VA VA |
$127.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25,969.71
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
OP
|
$13.01
|
|
|
Service Code
|
NDC 60758080205
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Aetna American Axle |
$8.46
|
| Rate for Payer: Aetna Commercial |
$11.06
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.46
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$11.19
|
| Rate for Payer: Cofinity Commercial |
$9.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.41
|
| Rate for Payer: Healthscope Commercial |
$11.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.06
|
| Rate for Payer: PHP Commercial |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.46
|
| Rate for Payer: Priority Health SBD |
$8.20
|
| Rate for Payer: UMR Bronson Commercial |
$4.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.76
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$14.90
|
|
|
Service Code
|
NDC 61314022605
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$13.41 |
| Rate for Payer: Aetna American Axle |
$9.69
|
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.69
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$10.43
|
| Rate for Payer: Cofinity Commercial |
$12.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.92
|
| Rate for Payer: Healthscope Commercial |
$13.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.66
|
| Rate for Payer: PHP Commercial |
$12.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.69
|
| Rate for Payer: Priority Health SBD |
$9.39
|
| Rate for Payer: UMR Bronson Commercial |
$6.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.18
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$13.01
|
|
|
Service Code
|
NDC 60758080205
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Aetna American Axle |
$8.46
|
| Rate for Payer: Aetna Commercial |
$11.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.46
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$11.19
|
| Rate for Payer: Cofinity Commercial |
$9.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.41
|
| Rate for Payer: Healthscope Commercial |
$11.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.06
|
| Rate for Payer: PHP Commercial |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.46
|
| Rate for Payer: Priority Health SBD |
$8.20
|
| Rate for Payer: UMR Bronson Commercial |
$5.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.76
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
OP
|
$21.78
|
|
|
Service Code
|
NDC 64980051305
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna American Axle |
$14.16
|
| Rate for Payer: Aetna Commercial |
$18.51
|
| Rate for Payer: Aetna Medicare |
$10.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.16
|
| Rate for Payer: BCBS Complete |
$8.71
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$15.25
|
| Rate for Payer: Cofinity Commercial |
$18.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.25
|
| 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: PHP Commercial |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.16
|
| Rate for Payer: Priority Health SBD |
$13.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.34
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
OP
|
$14.90
|
|
|
Service Code
|
NDC 61314022605
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$13.41 |
| Rate for Payer: Aetna American Axle |
$9.69
|
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.69
|
| Rate for Payer: BCBS Complete |
$5.96
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Cofinity Commercial |
$10.43
|
| Rate for Payer: Cofinity Commercial |
$12.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.92
|
| Rate for Payer: Healthscope Commercial |
$13.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.66
|
| Rate for Payer: PHP Commercial |
$12.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.69
|
| Rate for Payer: Priority Health SBD |
$9.39
|
| Rate for Payer: UMR Bronson Commercial |
$5.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.18
|
|
|
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 Commercial |
$15.25
|
| Rate for Payer: Cofinity Commercial |
$18.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.25
|
| 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: PHP Commercial |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.16
|
| 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 Commercial |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$482.19
|
| 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: PHP Commercial |
$585.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| 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
|
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 Commercial |
$482.19
|
| Rate for Payer: Cofinity Commercial |
$592.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$482.19
|
| 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: PHP Commercial |
$585.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.75
|
| Rate for Payer: Priority Health SBD |
$433.97
|
| 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
|
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 Commercial |
$22.10
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.10
|
| 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: PHP Commercial |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.52
|
| 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
|
IP
|
$20.21
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Aetna American Axle |
$13.14
|
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.14
|
| Rate for Payer: Cash Price |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$14.15
|
| Rate for Payer: Cofinity Commercial |
$17.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.17
|
| Rate for Payer: Healthscope Commercial |
$18.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.18
|
| Rate for Payer: PHP Commercial |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.14
|
| Rate for Payer: Priority Health SBD |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.16
|
|
|
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 Commercial |
$22.10
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.10
|
| 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: PHP Commercial |
$26.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.52
|
| Rate for Payer: Priority Health SBD |
$19.89
|
| 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
|
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 Commercial |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.77
|
| 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: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health SBD |
$17.80
|
| 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
|
$20.21
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Aetna American Axle |
$13.14
|
| Rate for Payer: Aetna Commercial |
$17.18
|
| Rate for Payer: Aetna Medicare |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.14
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: Cash Price |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$14.15
|
| Rate for Payer: Cofinity Commercial |
$17.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.17
|
| Rate for Payer: Healthscope Commercial |
$18.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.18
|
| Rate for Payer: PHP Commercial |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.14
|
| Rate for Payer: Priority Health SBD |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$7.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.16
|
|
|
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 Commercial |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.77
|
| 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: PHP Commercial |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| 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
|
|
