|
NEOMY-BACIT-POLYMYX-PRAMOXINE 3.5 MG-500 UNIT-10,000 UNIT/G TOP OINT
|
Facility
|
OP
|
$44.31
|
|
|
Service Code
|
NDC 00713062231
|
| Hospital Charge Code |
21070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$39.88 |
| Rate for Payer: Aetna American Axle |
$28.80
|
| Rate for Payer: Aetna Commercial |
$37.66
|
| Rate for Payer: Aetna Medicare |
$22.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.80
|
| Rate for Payer: BCBS Complete |
$17.72
|
| Rate for Payer: Cash Price |
$35.45
|
| Rate for Payer: Cofinity Advantage |
$31.02
|
| Rate for Payer: Cofinity Commercial |
$38.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.45
|
| Rate for Payer: Healthscope Commercial |
$39.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.23
|
| Rate for Payer: PHP Commercial |
$37.66
|
| Rate for Payer: Priority Health SBD |
$27.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.80
|
| Rate for Payer: UHC Core |
$23.09
|
| Rate for Payer: UHC Exchange |
$17.41
|
| Rate for Payer: UMR Bronson Commercial |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.23
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
OP
|
$167.13
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.84 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Aetna American Axle |
$108.63
|
| Rate for Payer: Aetna Commercial |
$142.06
|
| Rate for Payer: Aetna Medicare |
$83.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.63
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: Cofinity Advantage |
$116.99
|
| Rate for Payer: Cofinity Commercial |
$143.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.70
|
| Rate for Payer: Healthscope Commercial |
$150.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.35
|
| Rate for Payer: PHP Commercial |
$142.06
|
| Rate for Payer: Priority Health SBD |
$105.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.63
|
| Rate for Payer: UHC Core |
$87.07
|
| Rate for Payer: UHC Exchange |
$65.68
|
| Rate for Payer: UMR Bronson Commercial |
$61.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.35
|
|
|
NEOMYCIN 1.75 MG-POLYMYXIN 10,000 UNIT-GRAMICIDIN 0.025MG/ML EYE DROPS
|
Facility
|
IP
|
$167.13
|
|
|
Service Code
|
NDC 24208079062
|
| Hospital Charge Code |
5474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$150.42 |
| Rate for Payer: Aetna American Axle |
$108.63
|
| Rate for Payer: Aetna Commercial |
$142.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.63
|
| Rate for Payer: Cash Price |
$133.70
|
| Rate for Payer: Cofinity Advantage |
$116.99
|
| Rate for Payer: Cofinity Commercial |
$143.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.70
|
| Rate for Payer: Healthscope Commercial |
$150.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.35
|
| Rate for Payer: PHP Commercial |
$142.06
|
| Rate for Payer: Priority Health SBD |
$105.29
|
| Rate for Payer: UMR Bronson Commercial |
$73.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.35
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna American Axle |
$38.09
|
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna Medicare |
$29.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: BCBS Complete |
$23.44
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Advantage |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.95
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.09
|
| Rate for Payer: UHC Core |
$30.53
|
| Rate for Payer: UHC Exchange |
$23.03
|
| Rate for Payer: UMR Bronson Commercial |
$21.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$43.05
|
|
|
Service Code
|
NDC 24208079535
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna American Axle |
$27.98
|
| Rate for Payer: Aetna Commercial |
$36.59
|
| Rate for Payer: Aetna Medicare |
$21.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.98
|
| Rate for Payer: BCBS Complete |
$17.22
|
| Rate for Payer: Cash Price |
$34.44
|
| Rate for Payer: Cofinity Advantage |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$37.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.44
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.29
|
| Rate for Payer: PHP Commercial |
$36.59
|
| Rate for Payer: Priority Health SBD |
$27.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.98
|
| Rate for Payer: UHC Core |
$22.43
|
| Rate for Payer: UHC Exchange |
$16.92
|
| Rate for Payer: UMR Bronson Commercial |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.29
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$58.60
|
|
|
Service Code
|
NDC 61314063136
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.78 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna American Axle |
$38.09
|
| Rate for Payer: Aetna Commercial |
$49.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.09
|
| Rate for Payer: Cash Price |
$46.88
|
| Rate for Payer: Cofinity Advantage |
$41.02
|
| Rate for Payer: Cofinity Commercial |
$50.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$52.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.95
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: Priority Health SBD |
$36.92
|
| Rate for Payer: UMR Bronson Commercial |
$25.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.95
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$41.34
|
|
|
Service Code
|
NDC 00574416035
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna American Axle |
$26.87
|
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Advantage |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.00
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health SBD |
$26.04
|
| Rate for Payer: UMR Bronson Commercial |
$18.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$733.42
|
|
|
Service Code
|
NDC 00078077101
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$660.08 |
| Rate for Payer: Aetna American Axle |
$476.72
|
| Rate for Payer: Aetna Commercial |
$623.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.72
|
| Rate for Payer: Cash Price |
$586.74
|
| Rate for Payer: Cofinity Advantage |
$513.39
|
| Rate for Payer: Cofinity Commercial |
$630.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.74
|
| Rate for Payer: Healthscope Commercial |
$660.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.07
|
| Rate for Payer: PHP Commercial |
$623.41
|
| Rate for Payer: Priority Health SBD |
$462.05
|
| Rate for Payer: UMR Bronson Commercial |
$322.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.07
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$733.42
|
|
|
Service Code
|
NDC 00078077101
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.37 |
| Max. Negotiated Rate |
$660.08 |
| Rate for Payer: Aetna American Axle |
$476.72
|
| Rate for Payer: Aetna Commercial |
$623.41
|
| Rate for Payer: Aetna Medicare |
$366.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.72
|
| Rate for Payer: BCBS Complete |
$293.37
|
| Rate for Payer: Cash Price |
$586.74
|
| Rate for Payer: Cofinity Advantage |
$513.39
|
| Rate for Payer: Cofinity Commercial |
$630.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.74
|
| Rate for Payer: Healthscope Commercial |
$660.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$586.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.07
|
| Rate for Payer: PHP Commercial |
$623.41
|
| Rate for Payer: Priority Health SBD |
$462.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.72
|
| Rate for Payer: UHC Core |
$382.11
|
| Rate for Payer: UHC Exchange |
$288.23
|
| Rate for Payer: UMR Bronson Commercial |
$271.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.07
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
OP
|
$41.34
|
|
|
Service Code
|
NDC 00574416035
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna American Axle |
$26.87
|
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare |
$20.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Advantage |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.00
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health SBD |
$26.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.87
|
| Rate for Payer: UHC Core |
$21.54
|
| Rate for Payer: UHC Exchange |
$16.25
|
| Rate for Payer: UMR Bronson Commercial |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT
|
Facility
|
IP
|
$43.05
|
|
|
Service Code
|
NDC 24208079535
|
| Hospital Charge Code |
19495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna American Axle |
$27.98
|
| Rate for Payer: Aetna Commercial |
$36.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.98
|
| Rate for Payer: Cash Price |
$34.44
|
| Rate for Payer: Cofinity Advantage |
$30.14
|
| Rate for Payer: Cofinity Commercial |
$37.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.44
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.29
|
| Rate for Payer: PHP Commercial |
$36.59
|
| Rate for Payer: Priority Health SBD |
$27.12
|
| Rate for Payer: UMR Bronson Commercial |
$18.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.29
|
|
|
NEOMYCIN 500 MG TABLET
|
Facility
|
OP
|
$474.72
|
|
|
Service Code
|
NDC 00093117701
|
| Hospital Charge Code |
5472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.65 |
| Max. Negotiated Rate |
$427.25 |
| Rate for Payer: Aetna American Axle |
$308.57
|
| Rate for Payer: Aetna Commercial |
$403.51
|
| Rate for Payer: Aetna Medicare |
$237.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.57
|
| Rate for Payer: BCBS Complete |
$189.89
|
| Rate for Payer: Cash Price |
$379.78
|
| Rate for Payer: Cofinity Advantage |
$332.30
|
| Rate for Payer: Cofinity Commercial |
$408.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.78
|
| Rate for Payer: Healthscope Commercial |
$427.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$379.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.04
|
| Rate for Payer: PHP Commercial |
$403.51
|
| Rate for Payer: Priority Health SBD |
$299.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.57
|
| Rate for Payer: UHC Core |
$247.33
|
| Rate for Payer: UHC Exchange |
$186.56
|
| Rate for Payer: UMR Bronson Commercial |
$175.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.04
|
|
|
NEOMYCIN 500 MG TABLET
|
Facility
|
IP
|
$454.56
|
|
|
Service Code
|
NDC 50383056510
|
| Hospital Charge Code |
5472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.01 |
| Max. Negotiated Rate |
$409.10 |
| Rate for Payer: Aetna American Axle |
$295.46
|
| Rate for Payer: Aetna Commercial |
$386.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.46
|
| Rate for Payer: Cash Price |
$363.65
|
| Rate for Payer: Cofinity Advantage |
$318.19
|
| Rate for Payer: Cofinity Commercial |
$390.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.65
|
| Rate for Payer: Healthscope Commercial |
$409.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.92
|
| Rate for Payer: PHP Commercial |
$386.38
|
| Rate for Payer: Priority Health SBD |
$286.37
|
| Rate for Payer: UMR Bronson Commercial |
$200.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.92
|
|
|
NEOMYCIN 500 MG TABLET
|
Facility
|
OP
|
$454.56
|
|
|
Service Code
|
NDC 50383056510
|
| Hospital Charge Code |
5472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.19 |
| Max. Negotiated Rate |
$409.10 |
| Rate for Payer: Aetna American Axle |
$295.46
|
| Rate for Payer: Aetna Commercial |
$386.38
|
| Rate for Payer: Aetna Medicare |
$227.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.46
|
| Rate for Payer: BCBS Complete |
$181.82
|
| Rate for Payer: Cash Price |
$363.65
|
| Rate for Payer: Cofinity Advantage |
$318.19
|
| Rate for Payer: Cofinity Commercial |
$390.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.65
|
| Rate for Payer: Healthscope Commercial |
$409.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.92
|
| Rate for Payer: PHP Commercial |
$386.38
|
| Rate for Payer: Priority Health SBD |
$286.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.46
|
| Rate for Payer: UHC Core |
$236.83
|
| Rate for Payer: UHC Exchange |
$178.64
|
| Rate for Payer: UMR Bronson Commercial |
$168.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.92
|
|
|
NEOMYCIN 500 MG TABLET
|
Facility
|
IP
|
$474.72
|
|
|
Service Code
|
NDC 00093117701
|
| Hospital Charge Code |
5472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.88 |
| Max. Negotiated Rate |
$427.25 |
| Rate for Payer: Aetna American Axle |
$308.57
|
| Rate for Payer: Aetna Commercial |
$403.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.57
|
| Rate for Payer: Cash Price |
$379.78
|
| Rate for Payer: Cofinity Advantage |
$332.30
|
| Rate for Payer: Cofinity Commercial |
$408.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.78
|
| Rate for Payer: Healthscope Commercial |
$427.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.04
|
| Rate for Payer: PHP Commercial |
$403.51
|
| Rate for Payer: Priority Health SBD |
$299.07
|
| Rate for Payer: UMR Bronson Commercial |
$208.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.04
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
OP
|
$56.22
|
|
|
Service Code
|
NDC 16571075453
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna American Axle |
$36.54
|
| Rate for Payer: Aetna Commercial |
$47.79
|
| Rate for Payer: Aetna Medicare |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: BCBS Complete |
$22.49
|
| Rate for Payer: Cash Price |
$44.98
|
| Rate for Payer: Cofinity Advantage |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.98
|
| Rate for Payer: Healthscope Commercial |
$50.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.16
|
| Rate for Payer: PHP Commercial |
$47.79
|
| Rate for Payer: Priority Health SBD |
$35.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.54
|
| Rate for Payer: UHC Core |
$29.29
|
| Rate for Payer: UHC Exchange |
$22.09
|
| Rate for Payer: UMR Bronson Commercial |
$20.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.16
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
OP
|
$67.42
|
|
|
Service Code
|
NDC 24208078055
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$60.68 |
| Rate for Payer: Aetna American Axle |
$43.82
|
| Rate for Payer: Aetna Commercial |
$57.31
|
| Rate for Payer: Aetna Medicare |
$33.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.82
|
| Rate for Payer: BCBS Complete |
$26.97
|
| Rate for Payer: Cash Price |
$53.94
|
| Rate for Payer: Cofinity Advantage |
$47.19
|
| Rate for Payer: Cofinity Commercial |
$57.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.94
|
| Rate for Payer: Healthscope Commercial |
$60.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.56
|
| Rate for Payer: PHP Commercial |
$57.31
|
| Rate for Payer: Priority Health SBD |
$42.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.82
|
| Rate for Payer: UHC Core |
$35.13
|
| Rate for Payer: UHC Exchange |
$26.50
|
| Rate for Payer: UMR Bronson Commercial |
$24.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.56
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
IP
|
$56.22
|
|
|
Service Code
|
NDC 16571075453
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna American Axle |
$36.54
|
| Rate for Payer: Aetna Commercial |
$47.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.54
|
| Rate for Payer: Cash Price |
$44.98
|
| Rate for Payer: Cofinity Advantage |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.98
|
| Rate for Payer: Healthscope Commercial |
$50.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.16
|
| Rate for Payer: PHP Commercial |
$47.79
|
| Rate for Payer: Priority Health SBD |
$35.42
|
| Rate for Payer: UMR Bronson Commercial |
$24.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.16
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
OP
|
$143.29
|
|
|
Service Code
|
NDC 00574425035
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.02 |
| Max. Negotiated Rate |
$128.96 |
| Rate for Payer: Aetna American Axle |
$93.14
|
| Rate for Payer: Aetna Commercial |
$121.80
|
| Rate for Payer: Aetna Medicare |
$71.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.14
|
| Rate for Payer: BCBS Complete |
$57.32
|
| Rate for Payer: Cash Price |
$114.63
|
| Rate for Payer: Cofinity Advantage |
$100.30
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.63
|
| Rate for Payer: Healthscope Commercial |
$128.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.47
|
| Rate for Payer: PHP Commercial |
$121.80
|
| Rate for Payer: Priority Health SBD |
$90.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.14
|
| Rate for Payer: UHC Core |
$74.65
|
| Rate for Payer: UHC Exchange |
$56.31
|
| Rate for Payer: UMR Bronson Commercial |
$53.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.47
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
IP
|
$67.42
|
|
|
Service Code
|
NDC 24208078055
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$60.68 |
| Rate for Payer: Aetna American Axle |
$43.82
|
| Rate for Payer: Aetna Commercial |
$57.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.82
|
| Rate for Payer: Cash Price |
$53.94
|
| Rate for Payer: Cofinity Advantage |
$47.19
|
| Rate for Payer: Cofinity Commercial |
$57.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.94
|
| Rate for Payer: Healthscope Commercial |
$60.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.56
|
| Rate for Payer: PHP Commercial |
$57.31
|
| Rate for Payer: Priority Health SBD |
$42.47
|
| Rate for Payer: UMR Bronson Commercial |
$29.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.56
|
|
|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
IP
|
$143.29
|
|
|
Service Code
|
NDC 00574425035
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$128.96 |
| Rate for Payer: Aetna American Axle |
$93.14
|
| Rate for Payer: Aetna Commercial |
$121.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.14
|
| Rate for Payer: Cash Price |
$114.63
|
| Rate for Payer: Cofinity Advantage |
$100.30
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.63
|
| Rate for Payer: Healthscope Commercial |
$128.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.47
|
| Rate for Payer: PHP Commercial |
$121.80
|
| Rate for Payer: Priority Health SBD |
$90.27
|
| Rate for Payer: UMR Bronson Commercial |
$63.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.47
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
NDC 00810073088
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna American Axle |
$13.79
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.91
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.79
|
| Rate for Payer: UHC Core |
$11.06
|
| Rate for Payer: UHC Exchange |
$8.34
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.91
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
NDC 00810073088
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna American Axle |
$13.79
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.91
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.91
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$9.58
|
|
|
Service Code
|
NDC 45802014301
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna American Axle |
$6.23
|
| Rate for Payer: Aetna Commercial |
$8.14
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.23
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Advantage |
$6.71
|
| Rate for Payer: Cofinity Commercial |
$8.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$8.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.18
|
| Rate for Payer: PHP Commercial |
$8.14
|
| Rate for Payer: Priority Health SBD |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.23
|
| Rate for Payer: UHC Core |
$4.99
|
| Rate for Payer: UHC Exchange |
$3.76
|
| Rate for Payer: UMR Bronson Commercial |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.18
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
OP
|
$11.97
|
|
|
Service Code
|
NDC 59390002714
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna American Axle |
$7.78
|
| Rate for Payer: Aetna Commercial |
$10.17
|
| Rate for Payer: Aetna Medicare |
$5.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cofinity Advantage |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$10.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$10.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.98
|
| Rate for Payer: PHP Commercial |
$10.17
|
| Rate for Payer: Priority Health SBD |
$7.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.78
|
| Rate for Payer: UHC Core |
$6.24
|
| Rate for Payer: UHC Exchange |
$4.70
|
| Rate for Payer: UMR Bronson Commercial |
$4.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.98
|
|
