|
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 Commercial |
$413.39
|
| Rate for Payer: Cofinity Commercial |
$507.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.39
|
| 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: PHP Commercial |
$501.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.86
|
| 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
|
IP
|
$471.21
|
|
|
Service Code
|
NDC 43598074811
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.33 |
| Max. Negotiated Rate |
$424.09 |
| Rate for Payer: Aetna American Axle |
$306.29
|
| Rate for Payer: Aetna Commercial |
$400.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.29
|
| Rate for Payer: Cash Price |
$376.97
|
| Rate for Payer: Cofinity Commercial |
$329.85
|
| Rate for Payer: Cofinity Commercial |
$405.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.97
|
| Rate for Payer: Healthscope Commercial |
$424.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.53
|
| Rate for Payer: PHP Commercial |
$400.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.29
|
| Rate for Payer: Priority Health SBD |
$296.86
|
| Rate for Payer: UMR Bronson Commercial |
$207.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.41
|
|
|
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 Commercial |
$279.67
|
| Rate for Payer: Cofinity Commercial |
$343.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.67
|
| 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: PHP Commercial |
$339.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.69
|
| Rate for Payer: Priority Health SBD |
$251.70
|
| 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
|
$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 Commercial |
$279.67
|
| Rate for Payer: Cofinity Commercial |
$343.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.67
|
| 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: PHP Commercial |
$339.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.69
|
| 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
|
$471.21
|
|
|
Service Code
|
NDC 43598074811
|
| Hospital Charge Code |
24576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.35 |
| Max. Negotiated Rate |
$424.09 |
| Rate for Payer: Aetna American Axle |
$306.29
|
| Rate for Payer: Aetna Commercial |
$400.53
|
| Rate for Payer: Aetna Medicare |
$235.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.29
|
| Rate for Payer: BCBS Complete |
$188.48
|
| Rate for Payer: Cash Price |
$376.97
|
| Rate for Payer: Cofinity Commercial |
$329.85
|
| Rate for Payer: Cofinity Commercial |
$405.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.97
|
| Rate for Payer: Healthscope Commercial |
$424.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.53
|
| Rate for Payer: PHP Commercial |
$400.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.29
|
| Rate for Payer: Priority Health SBD |
$296.86
|
| Rate for Payer: UMR Bronson Commercial |
$174.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.41
|
|
|
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 Commercial |
$413.39
|
| Rate for Payer: Cofinity Commercial |
$507.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$413.39
|
| 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: PHP Commercial |
$501.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.86
|
| Rate for Payer: Priority Health SBD |
$372.05
|
| 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
|
$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 Commercial |
$348.78
|
| Rate for Payer: Cofinity Commercial |
$428.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.78
|
| 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: PHP Commercial |
$423.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.87
|
| 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
|
|
|
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 Commercial |
$348.78
|
| Rate for Payer: Cofinity Commercial |
$428.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.78
|
| 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: PHP Commercial |
$423.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.87
|
| Rate for Payer: Priority Health SBD |
$313.90
|
| Rate for Payer: UMR Bronson Commercial |
$184.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.69
|
|
|
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 Commercial |
$1,033.44
|
| Rate for Payer: Cofinity Commercial |
$841.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$841.17
|
| 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: PHP Commercial |
$1,021.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.09
|
| 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 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 Commercial |
$1,033.44
|
| Rate for Payer: Cofinity Commercial |
$841.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$841.17
|
| 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: PHP Commercial |
$1,021.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.09
|
| Rate for Payer: Priority Health SBD |
$757.05
|
| Rate for Payer: UMR Bronson Commercial |
$444.62
|
| 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 Commercial |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.06
|
| 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: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.20
|
| 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 Commercial |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.06
|
| 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: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.20
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| 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
|
$31,982.27
|
|
|
Service Code
|
HCPCS J9273
|
| Hospital Charge Code |
198323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$28,784.04 |
| Rate for Payer: Aetna American Axle |
$20,788.48
|
| Rate for Payer: Aetna Commercial |
$27,184.93
|
| Rate for Payer: Aetna Medicare |
$196.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,788.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$235.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$235.95
|
| Rate for Payer: BCBS Complete |
$106.23
|
| Rate for Payer: BCBS MAPPO |
$188.76
|
| Rate for Payer: BCN Medicare Advantage |
$188.76
|
| Rate for Payer: Cash Price |
$25,585.82
|
| Rate for Payer: Cash Price |
$25,585.82
|
| Rate for Payer: Cofinity Commercial |
$22,387.59
|
| Rate for Payer: Cofinity Commercial |
$27,504.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$22,387.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,585.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.76
|
| Rate for Payer: Healthscope Commercial |
$28,784.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22,387.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,986.70
|
| Rate for Payer: Mclaren Medicaid |
$101.18
|
| Rate for Payer: Mclaren Medicare |
$188.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.20
|
| Rate for Payer: Meridian Medicaid |
$106.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,184.93
|
| Rate for Payer: PACE Medicare |
$179.32
|
| Rate for Payer: PACE SWMI |
$188.76
|
| Rate for Payer: PHP Commercial |
$27,184.93
|
| Rate for Payer: PHP Medicare Advantage |
$188.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,788.48
|
| Rate for Payer: Priority Health Medicare |
$188.76
|
| Rate for Payer: Priority Health SBD |
$20,148.83
|
| Rate for Payer: Railroad Medicare Medicare |
$188.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.76
|
| Rate for Payer: UHC Exchange |
$360.74
|
| Rate for Payer: UHC Medicare Advantage |
$188.76
|
| Rate for Payer: UHCCP Medicaid |
$101.18
|
| Rate for Payer: UMR Bronson Commercial |
$11,833.44
|
| Rate for Payer: VA VA |
$188.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,986.70
|
|
|
TISSUE EXPANDER PLACEMENT IN BREAST RECONSTRUCTION, INCLUDING SUBSEQUENT EXPANSION(S)
|
Facility
|
OP
|
$47,763.96
|
|
|
Service Code
|
CPT 19357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,094.99 |
| Max. Negotiated Rate |
$47,763.96 |
| Rate for Payer: Aetna Medicare |
$17,646.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,210.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,210.33
|
| Rate for Payer: BCBS Complete |
$9,549.74
|
| Rate for Payer: BCBS MAPPO |
$16,968.26
|
| Rate for Payer: BCN Medicare Advantage |
$16,968.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,968.26
|
| Rate for Payer: Mclaren Medicaid |
$9,094.99
|
| Rate for Payer: Mclaren Medicare |
$16,968.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,816.67
|
| Rate for Payer: Meridian Medicaid |
$9,549.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,513.50
|
| Rate for Payer: PACE Medicare |
$16,119.85
|
| Rate for Payer: PACE SWMI |
$16,968.26
|
| Rate for Payer: PHP Medicare Advantage |
$16,968.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,094.99
|
| Rate for Payer: Priority Health Medicare |
$16,968.26
|
| Rate for Payer: Railroad Medicare Medicare |
$16,968.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,763.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,968.26
|
| Rate for Payer: UHC Exchange |
$32,428.04
|
| Rate for Payer: UHC Medicare Advantage |
$16,968.26
|
| Rate for Payer: UHCCP Medicaid |
$9,094.99
|
| Rate for Payer: VA VA |
$16,968.26
|
|
|
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 Commercial |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.31
|
| 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: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health SBD |
$115.48
|
| Rate for Payer: UMR Bronson Commercial |
$67.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.47
|
|
|
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 Commercial |
$128.31
|
| Rate for Payer: Cofinity Commercial |
$157.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.31
|
| 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: PHP Commercial |
$155.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| 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 4 MG TABLET
|
Facility
|
IP
|
$396.15
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.31 |
| Max. Negotiated Rate |
$356.54 |
| Rate for Payer: Aetna American Axle |
$257.50
|
| Rate for Payer: Aetna Commercial |
$336.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.50
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$277.31
|
| Rate for Payer: Cofinity Commercial |
$340.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Healthscope Commercial |
$356.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.73
|
| Rate for Payer: PHP Commercial |
$336.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.50
|
| Rate for Payer: Priority Health SBD |
$249.57
|
| Rate for Payer: UMR Bronson Commercial |
$174.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.11
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$396.15
|
|
|
Service Code
|
NDC 00904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.58 |
| Max. Negotiated Rate |
$356.54 |
| Rate for Payer: Aetna American Axle |
$257.50
|
| Rate for Payer: Aetna Commercial |
$336.73
|
| Rate for Payer: Aetna Medicare |
$198.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.50
|
| Rate for Payer: BCBS Complete |
$158.46
|
| Rate for Payer: Cash Price |
$316.92
|
| Rate for Payer: Cofinity Commercial |
$277.31
|
| Rate for Payer: Cofinity Commercial |
$340.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.92
|
| Rate for Payer: Healthscope Commercial |
$356.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.73
|
| Rate for Payer: PHP Commercial |
$336.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.50
|
| Rate for Payer: Priority Health SBD |
$249.57
|
| Rate for Payer: UMR Bronson Commercial |
$146.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.11
|
|
|
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 Commercial |
$234.42
|
| Rate for Payer: Cofinity Commercial |
$288.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.42
|
| 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: PHP Commercial |
$284.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.67
|
| Rate for Payer: Priority Health SBD |
$210.97
|
| 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 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 Commercial |
$234.42
|
| Rate for Payer: Cofinity Commercial |
$288.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$234.42
|
| 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: PHP Commercial |
$284.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.67
|
| 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
|
$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 Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.83
|
| 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: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
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 Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.83
|
| 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: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| 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
|
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 Commercial |
$182.45
|
| Rate for Payer: Cofinity Commercial |
$224.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.45
|
| 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: PHP Commercial |
$221.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.42
|
| 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
|
IP
|
$4.14
|
|
|
Service Code
|
NDC 50268076011
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.69
|
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.69
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.52
|
| Rate for Payer: PHP Commercial |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.69
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$4.14
|
|
|
Service Code
|
NDC 50268076011
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.69
|
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna Medicare |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.69
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.52
|
| Rate for Payer: PHP Commercial |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.69
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
