|
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
|
$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
|
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
|
|
|
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
|
$206.63
|
|
|
Service Code
|
NDC 50268076015
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$185.97 |
| Rate for Payer: Aetna American Axle |
$134.31
|
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: Aetna Medicare |
$103.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.31
|
| Rate for Payer: BCBS Complete |
$82.65
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cofinity Commercial |
$144.64
|
| Rate for Payer: Cofinity Commercial |
$177.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.30
|
| Rate for Payer: Healthscope Commercial |
$185.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.64
|
| Rate for Payer: PHP Commercial |
$175.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.31
|
| Rate for Payer: Priority Health SBD |
$130.18
|
| Rate for Payer: UMR Bronson Commercial |
$76.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.97
|
|
|
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 Commercial |
$115.23
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.23
|
| 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: PHP Commercial |
$139.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.00
|
| Rate for Payer: Priority Health SBD |
$103.70
|
| 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
|
$270.80
|
|
|
Service Code
|
NDC 00065064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.15 |
| Max. Negotiated Rate |
$243.72 |
| Rate for Payer: Aetna American Axle |
$176.02
|
| Rate for Payer: Aetna Commercial |
$230.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.02
|
| Rate for Payer: Cash Price |
$216.64
|
| Rate for Payer: Cofinity Commercial |
$189.56
|
| Rate for Payer: Cofinity Commercial |
$232.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.64
|
| Rate for Payer: Healthscope Commercial |
$243.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.18
|
| Rate for Payer: PHP Commercial |
$230.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.02
|
| Rate for Payer: Priority Health SBD |
$170.60
|
| Rate for Payer: UMR Bronson Commercial |
$119.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.10
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$270.80
|
|
|
Service Code
|
NDC 00065064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$243.72 |
| Rate for Payer: Aetna American Axle |
$176.02
|
| Rate for Payer: Aetna Commercial |
$230.18
|
| Rate for Payer: Aetna Medicare |
$135.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.02
|
| Rate for Payer: BCBS Complete |
$108.32
|
| Rate for Payer: Cash Price |
$216.64
|
| Rate for Payer: Cofinity Commercial |
$189.56
|
| Rate for Payer: Cofinity Commercial |
$232.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.64
|
| Rate for Payer: Healthscope Commercial |
$243.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.18
|
| Rate for Payer: PHP Commercial |
$230.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.02
|
| Rate for Payer: Priority Health SBD |
$170.60
|
| Rate for Payer: UMR Bronson Commercial |
$100.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.10
|
|
|
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 Commercial |
$115.23
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.23
|
| 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: PHP Commercial |
$139.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.00
|
| 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 %-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 Commercial |
$106.17
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.42
|
| 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: PHP Commercial |
$104.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.24
|
| 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 Commercial |
$106.17
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.42
|
| 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: PHP Commercial |
$104.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.24
|
| Rate for Payer: Priority Health SBD |
$77.77
|
| Rate for Payer: UMR Bronson Commercial |
$45.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.59
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$37.84
|
|
|
Service Code
|
NDC 17478029010
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna American Axle |
$24.60
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Medicare |
$18.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.60
|
| Rate for Payer: BCBS Complete |
$15.14
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cofinity Commercial |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$32.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.27
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.60
|
| Rate for Payer: Priority Health SBD |
$23.84
|
| Rate for Payer: UMR Bronson Commercial |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.38
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$331.63
|
|
|
Service Code
|
NDC 00065064305
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.92 |
| Max. Negotiated Rate |
$298.47 |
| Rate for Payer: Aetna American Axle |
$215.56
|
| Rate for Payer: Aetna Commercial |
$281.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.56
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cofinity Commercial |
$232.14
|
| Rate for Payer: Cofinity Commercial |
$285.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.30
|
| Rate for Payer: Healthscope Commercial |
$298.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.89
|
| Rate for Payer: PHP Commercial |
$281.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.56
|
| Rate for Payer: Priority Health SBD |
$208.93
|
| Rate for Payer: UMR Bronson Commercial |
$145.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.72
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$331.63
|
|
|
Service Code
|
NDC 00065064305
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.70 |
| Max. Negotiated Rate |
$298.47 |
| Rate for Payer: Aetna American Axle |
$215.56
|
| Rate for Payer: Aetna Commercial |
$281.89
|
| Rate for Payer: Aetna Medicare |
$165.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.56
|
| Rate for Payer: BCBS Complete |
$132.65
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cofinity Commercial |
$232.14
|
| Rate for Payer: Cofinity Commercial |
$285.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.30
|
| Rate for Payer: Healthscope Commercial |
$298.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.89
|
| Rate for Payer: PHP Commercial |
$281.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.56
|
| Rate for Payer: Priority Health SBD |
$208.93
|
| Rate for Payer: UMR Bronson Commercial |
$122.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.72
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$20.07
|
|
|
Service Code
|
NDC 70069013101
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna American Axle |
$13.05
|
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Aetna Medicare |
$10.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.05
|
| Rate for Payer: BCBS Complete |
$8.03
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$14.05
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$18.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.05
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$7.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.05
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$37.84
|
|
|
Service Code
|
NDC 17478029010
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$34.06 |
| Rate for Payer: Aetna American Axle |
$24.60
|
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.60
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cofinity Commercial |
$26.49
|
| Rate for Payer: Cofinity Commercial |
$32.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.27
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.60
|
| Rate for Payer: Priority Health SBD |
$23.84
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.38
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$50.47
|
|
|
Service Code
|
NDC 61314064305
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$45.42 |
| Rate for Payer: Aetna American Axle |
$32.81
|
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: Aetna Medicare |
$25.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.81
|
| Rate for Payer: BCBS Complete |
$20.19
|
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Cofinity Commercial |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.33
|
| 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: PHP Commercial |
$42.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.81
|
| Rate for Payer: Priority Health SBD |
$31.80
|
| Rate for Payer: UMR Bronson Commercial |
$18.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.85
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$20.07
|
|
|
Service Code
|
NDC 70069013101
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna American Axle |
$13.05
|
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.05
|
| Rate for Payer: Cash Price |
$16.06
|
| Rate for Payer: Cofinity Commercial |
$14.05
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$18.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.05
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$8.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.05
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$39.06
|
|
|
Service Code
|
NDC 24208029005
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna American Axle |
$25.39
|
| Rate for Payer: Aetna Commercial |
$33.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.39
|
| Rate for Payer: Cash Price |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.34
|
| 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: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| Rate for Payer: UMR Bronson Commercial |
$17.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.30
|
|
|
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 Commercial |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$33.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.34
|
| 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: Multiplan/Beech St/PHCS Commercial |
$33.20
|
| Rate for Payer: PHP Commercial |
$33.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.39
|
| Rate for Payer: Priority Health SBD |
$24.61
|
| 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
|
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 Commercial |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.33
|
| 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: PHP Commercial |
$42.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.81
|
| 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
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT
|
Facility
|
IP
|
$696.47
|
|
|
Service Code
|
NDC 00065064435
|
| Hospital Charge Code |
19769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.45 |
| Max. Negotiated Rate |
$626.82 |
| Rate for Payer: Aetna American Axle |
$452.71
|
| Rate for Payer: Aetna Commercial |
$592.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.71
|
| Rate for Payer: Cash Price |
$557.18
|
| Rate for Payer: Cofinity Commercial |
$487.53
|
| Rate for Payer: Cofinity Commercial |
$598.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$487.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.18
|
| Rate for Payer: Healthscope Commercial |
$626.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$487.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.00
|
| Rate for Payer: PHP Commercial |
$592.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.71
|
| Rate for Payer: Priority Health SBD |
$438.78
|
| Rate for Payer: UMR Bronson Commercial |
$306.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.35
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT
|
Facility
|
OP
|
$696.47
|
|
|
Service Code
|
NDC 00065064435
|
| Hospital Charge Code |
19769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.69 |
| Max. Negotiated Rate |
$626.82 |
| Rate for Payer: Aetna American Axle |
$452.71
|
| Rate for Payer: Aetna Commercial |
$592.00
|
| Rate for Payer: Aetna Medicare |
$348.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.71
|
| Rate for Payer: BCBS Complete |
$278.59
|
| Rate for Payer: Cash Price |
$557.18
|
| Rate for Payer: Cofinity Commercial |
$487.53
|
| Rate for Payer: Cofinity Commercial |
$598.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$487.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.18
|
| Rate for Payer: Healthscope Commercial |
$626.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$487.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.00
|
| Rate for Payer: PHP Commercial |
$592.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.71
|
| Rate for Payer: Priority Health SBD |
$438.78
|
| Rate for Payer: UMR Bronson Commercial |
$257.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.35
|
|
|
TOBRAMYCIN 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.32
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: Aetna American Axle |
$13.21
|
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.21
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$18.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.27
|
| Rate for Payer: PHP Commercial |
$17.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.21
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.24
|
|
|
TOBRAMYCIN 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.32
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: Aetna American Axle |
$13.21
|
| Rate for Payer: Aetna Commercial |
$17.27
|
| Rate for Payer: Aetna Medicare |
$10.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.21
|
| Rate for Payer: BCBS Complete |
$8.13
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$18.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.27
|
| Rate for Payer: PHP Commercial |
$17.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.21
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: UMR Bronson Commercial |
$7.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.24
|
|
