|
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
|
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
|
|
|
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
|
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 |
$82.30
|
| 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
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$111.10 |
| 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 |
$111.10
|
| 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
|
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
|
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
|
OP
|
$123.45
|
|
|
Service Code
|
NDC 61314064725
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.68 |
| Max. Negotiated Rate |
$111.10 |
| Rate for Payer: Aetna American Axle |
$80.24
|
| Rate for Payer: Aetna Commercial |
$104.93
|
| Rate for Payer: Aetna Medicare |
$61.72
|
| 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 |
$111.10
|
| 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
|
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
|
$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
|
$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
|
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 |
$25.24
|
| 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
|
$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
|
$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
|
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
|
$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 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 |
$165.82
|
| 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 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
|
OP
|
$20.32
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.11 |
| 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: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: Cash Price |
$16.26
|
| 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
|
|
|
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 1.2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$210.76
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
11565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.73 |
| Max. Negotiated Rate |
$189.68 |
| Rate for Payer: Aetna American Axle |
$136.99
|
| Rate for Payer: Aetna American Axle |
$124.47
|
| Rate for Payer: Aetna American Axle |
$120.50
|
| Rate for Payer: Aetna American Axle |
$116.37
|
| Rate for Payer: Aetna American Axle |
$92.20
|
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna American Axle |
$120.18
|
| Rate for Payer: Aetna American Axle |
$138.06
|
| Rate for Payer: Aetna Commercial |
$180.54
|
| Rate for Payer: Aetna Commercial |
$179.15
|
| Rate for Payer: Aetna Commercial |
$152.18
|
| Rate for Payer: Aetna Commercial |
$157.16
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Commercial |
$120.57
|
| Rate for Payer: Aetna Commercial |
$162.77
|
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.50
|
| Rate for Payer: Cash Price |
$147.91
|
| Rate for Payer: Cash Price |
$168.61
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cash Price |
$169.92
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cash Price |
$143.22
|
| Rate for Payer: Cash Price |
$113.48
|
| Rate for Payer: Cash Price |
$153.19
|
| Rate for Payer: Cofinity Commercial |
$159.01
|
| Rate for Payer: Cofinity Commercial |
$121.99
|
| Rate for Payer: Cofinity Commercial |
$129.42
|
| Rate for Payer: Cofinity Commercial |
$125.32
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Cofinity Commercial |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$99.30
|
| Rate for Payer: Cofinity Commercial |
$129.77
|
| Rate for Payer: Cofinity Commercial |
$159.44
|
| Rate for Payer: Cofinity Commercial |
$134.04
|
| Rate for Payer: Cofinity Commercial |
$164.68
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Cofinity Commercial |
$181.25
|
| Rate for Payer: Cofinity Commercial |
$148.68
|
| Rate for Payer: Cofinity Commercial |
$182.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.22
|
| Rate for Payer: Healthscope Commercial |
$127.66
|
| Rate for Payer: Healthscope Commercial |
$191.16
|
| Rate for Payer: Healthscope Commercial |
$189.68
|
| Rate for Payer: Healthscope Commercial |
$166.85
|
| Rate for Payer: Healthscope Commercial |
$172.34
|
| Rate for Payer: Healthscope Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$161.13
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.18
|
| Rate for Payer: PHP Commercial |
$179.15
|
| Rate for Payer: PHP Commercial |
$152.18
|
| Rate for Payer: PHP Commercial |
$162.77
|
| Rate for Payer: PHP Commercial |
$157.16
|
| Rate for Payer: PHP Commercial |
$180.54
|
| Rate for Payer: PHP Commercial |
$120.57
|
| Rate for Payer: PHP Commercial |
$157.58
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.37
|
| Rate for Payer: Priority Health SBD |
$112.79
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: Priority Health SBD |
$89.37
|
| Rate for Payer: Priority Health SBD |
$116.48
|
| Rate for Payer: Priority Health SBD |
$120.64
|
| Rate for Payer: Priority Health SBD |
$116.80
|
| Rate for Payer: Priority Health SBD |
$133.81
|
| Rate for Payer: Priority Health SBD |
$132.78
|
| Rate for Payer: UMR Bronson Commercial |
$78.77
|
| Rate for Payer: UMR Bronson Commercial |
$81.35
|
| Rate for Payer: UMR Bronson Commercial |
$84.26
|
| Rate for Payer: UMR Bronson Commercial |
$92.73
|
| Rate for Payer: UMR Bronson Commercial |
$73.77
|
| Rate for Payer: UMR Bronson Commercial |
$93.46
|
| Rate for Payer: UMR Bronson Commercial |
$81.57
|
| Rate for Payer: UMR Bronson Commercial |
$62.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.04
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$212.40
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
11565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$191.16 |
| Rate for Payer: Aetna American Axle |
$138.06
|
| Rate for Payer: Aetna American Axle |
$136.99
|
| Rate for Payer: Aetna American Axle |
$120.50
|
| Rate for Payer: Aetna American Axle |
$120.18
|
| Rate for Payer: Aetna American Axle |
$124.47
|
| Rate for Payer: Aetna American Axle |
$92.20
|
| Rate for Payer: Aetna American Axle |
$116.37
|
| Rate for Payer: Aetna American Axle |
$108.97
|
| Rate for Payer: Aetna Commercial |
$152.18
|
| Rate for Payer: Aetna Commercial |
$120.57
|
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Commercial |
$157.58
|
| Rate for Payer: Aetna Commercial |
$157.16
|
| Rate for Payer: Aetna Commercial |
$162.77
|
| Rate for Payer: Aetna Commercial |
$179.15
|
| Rate for Payer: Aetna Commercial |
$180.54
|
| Rate for Payer: Aetna Medicare |
$92.44
|
| Rate for Payer: Aetna Medicare |
$83.82
|
| Rate for Payer: Aetna Medicare |
$105.38
|
| Rate for Payer: Aetna Medicare |
$89.52
|
| Rate for Payer: Aetna Medicare |
$106.20
|
| Rate for Payer: Aetna Medicare |
$92.70
|
| Rate for Payer: Aetna Medicare |
$70.92
|
| Rate for Payer: Aetna Medicare |
$95.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.50
|
| Rate for Payer: BCBS Complete |
$84.96
|
| Rate for Payer: BCBS Complete |
$76.60
|
| Rate for Payer: BCBS Complete |
$73.96
|
| Rate for Payer: BCBS Complete |
$67.06
|
| Rate for Payer: BCBS Complete |
$56.74
|
| Rate for Payer: BCBS Complete |
$71.61
|
| Rate for Payer: BCBS Complete |
$84.30
|
| Rate for Payer: BCBS Complete |
$74.16
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: Cash Price |
$143.22
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cash Price |
$113.48
|
| Rate for Payer: Cash Price |
$134.12
|
| Rate for Payer: Cash Price |
$113.48
|
| Rate for Payer: Cash Price |
$143.22
|
| Rate for Payer: Cash Price |
$147.91
|
| Rate for Payer: Cash Price |
$147.91
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cash Price |
$153.19
|
| Rate for Payer: Cash Price |
$153.19
|
| Rate for Payer: Cash Price |
$168.61
|
| Rate for Payer: Cash Price |
$168.61
|
| Rate for Payer: Cash Price |
$169.92
|
| Rate for Payer: Cash Price |
$169.92
|
| Rate for Payer: Cofinity Commercial |
$129.42
|
| Rate for Payer: Cofinity Commercial |
$164.68
|
| Rate for Payer: Cofinity Commercial |
$134.04
|
| Rate for Payer: Cofinity Commercial |
$121.99
|
| Rate for Payer: Cofinity Commercial |
$144.18
|
| Rate for Payer: Cofinity Commercial |
$148.68
|
| Rate for Payer: Cofinity Commercial |
$159.01
|
| Rate for Payer: Cofinity Commercial |
$159.44
|
| Rate for Payer: Cofinity Commercial |
$125.32
|
| Rate for Payer: Cofinity Commercial |
$117.36
|
| Rate for Payer: Cofinity Commercial |
$99.30
|
| Rate for Payer: Cofinity Commercial |
$153.97
|
| Rate for Payer: Cofinity Commercial |
$129.77
|
| Rate for Payer: Cofinity Commercial |
$181.25
|
| Rate for Payer: Cofinity Commercial |
$147.53
|
| Rate for Payer: Cofinity Commercial |
$182.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.48
|
| Rate for Payer: Healthscope Commercial |
$161.13
|
| Rate for Payer: Healthscope Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$189.68
|
| Rate for Payer: Healthscope Commercial |
$191.16
|
| Rate for Payer: Healthscope Commercial |
$172.34
|
| Rate for Payer: Healthscope Commercial |
$127.66
|
| Rate for Payer: Healthscope Commercial |
$150.88
|
| Rate for Payer: Healthscope Commercial |
$166.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.16
|
| Rate for Payer: PHP Commercial |
$162.77
|
| Rate for Payer: PHP Commercial |
$142.50
|
| Rate for Payer: PHP Commercial |
$180.54
|
| Rate for Payer: PHP Commercial |
$157.58
|
| Rate for Payer: PHP Commercial |
$120.57
|
| Rate for Payer: PHP Commercial |
$152.18
|
| Rate for Payer: PHP Commercial |
$179.15
|
| Rate for Payer: PHP Commercial |
$157.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.99
|
| Rate for Payer: Priority Health SBD |
$89.37
|
| Rate for Payer: Priority Health SBD |
$133.81
|
| Rate for Payer: Priority Health SBD |
$116.48
|
| Rate for Payer: Priority Health SBD |
$116.80
|
| Rate for Payer: Priority Health SBD |
$105.62
|
| Rate for Payer: Priority Health SBD |
$112.79
|
| Rate for Payer: Priority Health SBD |
$132.78
|
| Rate for Payer: Priority Health SBD |
$120.64
|
| Rate for Payer: UMR Bronson Commercial |
$77.98
|
| Rate for Payer: UMR Bronson Commercial |
$78.59
|
| Rate for Payer: UMR Bronson Commercial |
$70.85
|
| Rate for Payer: UMR Bronson Commercial |
$68.59
|
| Rate for Payer: UMR Bronson Commercial |
$68.41
|
| Rate for Payer: UMR Bronson Commercial |
$62.03
|
| Rate for Payer: UMR Bronson Commercial |
$52.48
|
| Rate for Payer: UMR Bronson Commercial |
$66.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.39
|
|
|
TOBRAMYCIN 14 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
OP
|
$170.74
|
|
|
Service Code
|
NDC 09900000090
|
| Hospital Charge Code |
500595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$153.67 |
| Rate for Payer: Aetna American Axle |
$110.98
|
| Rate for Payer: Aetna Commercial |
$145.13
|
| Rate for Payer: Aetna Medicare |
$85.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.98
|
| Rate for Payer: BCBS Complete |
$68.30
|
| Rate for Payer: Cash Price |
$136.59
|
| Rate for Payer: Cofinity Commercial |
$119.52
|
| Rate for Payer: Cofinity Commercial |
$146.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.59
|
| Rate for Payer: Healthscope Commercial |
$153.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.13
|
| Rate for Payer: PHP Commercial |
$145.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.98
|
| Rate for Payer: Priority Health SBD |
$107.57
|
| Rate for Payer: UMR Bronson Commercial |
$63.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.06
|
|
