|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
OP
|
$45.22
|
|
|
Service Code
|
NDC 39822120102
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna American Axle |
$29.39
|
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna Medicare |
$22.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.39
|
| Rate for Payer: BCBS Complete |
$18.09
|
| Rate for Payer: Cash Price |
$36.18
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.44
|
| Rate for Payer: PHP Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.39
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.92
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
OP
|
$27.83
|
|
|
Service Code
|
NDC 61570004701
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$25.05 |
| Rate for Payer: Aetna American Axle |
$18.09
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Medicare |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.09
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: Cash Price |
$22.26
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$23.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.26
|
| Rate for Payer: Healthscope Commercial |
$25.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.09
|
| Rate for Payer: Priority Health SBD |
$17.53
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.87
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$27.83
|
|
|
Service Code
|
NDC 61570004701
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$25.05 |
| Rate for Payer: Aetna American Axle |
$18.09
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.09
|
| Rate for Payer: Cash Price |
$22.26
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$23.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.26
|
| Rate for Payer: Healthscope Commercial |
$25.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.09
|
| Rate for Payer: Priority Health SBD |
$17.53
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.87
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
OP
|
$380.12
|
|
|
Service Code
|
NDC 39822122001
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.64 |
| Max. Negotiated Rate |
$342.11 |
| Rate for Payer: Aetna American Axle |
$247.08
|
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Medicare |
$190.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.08
|
| Rate for Payer: BCBS Complete |
$152.05
|
| Rate for Payer: Cash Price |
$304.10
|
| Rate for Payer: Cofinity Commercial |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$326.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.10
|
| Rate for Payer: Healthscope Commercial |
$342.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.10
|
| Rate for Payer: PHP Commercial |
$323.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.08
|
| Rate for Payer: Priority Health SBD |
$239.48
|
| Rate for Payer: UMR Bronson Commercial |
$140.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.09
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$45.22
|
|
|
Service Code
|
NDC 39822120101
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna American Axle |
$29.39
|
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.39
|
| Rate for Payer: Cash Price |
$36.18
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.44
|
| Rate for Payer: PHP Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.39
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.92
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$380.12
|
|
|
Service Code
|
NDC 39822122001
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.25 |
| Max. Negotiated Rate |
$342.11 |
| Rate for Payer: Aetna American Axle |
$247.08
|
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.08
|
| Rate for Payer: Cash Price |
$304.10
|
| Rate for Payer: Cofinity Commercial |
$266.08
|
| Rate for Payer: Cofinity Commercial |
$326.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.10
|
| Rate for Payer: Healthscope Commercial |
$342.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.10
|
| Rate for Payer: PHP Commercial |
$323.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.08
|
| Rate for Payer: Priority Health SBD |
$239.48
|
| Rate for Payer: UMR Bronson Commercial |
$167.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.09
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
IP
|
$45.22
|
|
|
Service Code
|
NDC 39822120102
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna American Axle |
$29.39
|
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.39
|
| Rate for Payer: Cash Price |
$36.18
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.44
|
| Rate for Payer: PHP Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.39
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.92
|
|
|
NEOMYCIN 40 MG-POLYMYXIN B 200,000 UNIT/ML GU IRRIGATION SOLUTION
|
Facility
|
OP
|
$45.22
|
|
|
Service Code
|
NDC 39822120101
|
| Hospital Charge Code |
70678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna American Axle |
$29.39
|
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna Medicare |
$22.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.39
|
| Rate for Payer: BCBS Complete |
$18.09
|
| Rate for Payer: Cash Price |
$36.18
|
| Rate for Payer: Cofinity Commercial |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$40.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.44
|
| Rate for Payer: PHP Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.39
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UMR Bronson Commercial |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.92
|
|
|
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 Commercial |
$318.19
|
| Rate for Payer: Cofinity Commercial |
$390.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$318.19
|
| 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: PHP Commercial |
$386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.46
|
| 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
|
IP
|
$348.00
|
|
|
Service Code
|
NDC 00093117701
|
| Hospital Charge Code |
5472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.12 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna American Axle |
$226.20
|
| Rate for Payer: Aetna Commercial |
$295.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$243.60
|
| Rate for Payer: Cofinity Commercial |
$299.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.40
|
| Rate for Payer: Healthscope Commercial |
$313.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.80
|
| Rate for Payer: PHP Commercial |
$295.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health SBD |
$219.24
|
| Rate for Payer: UMR Bronson Commercial |
$153.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.00
|
|
|
NEOMYCIN 500 MG TABLET
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
NDC 00093117701
|
| Hospital Charge Code |
5472
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.76 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna American Axle |
$226.20
|
| Rate for Payer: Aetna Commercial |
$295.80
|
| Rate for Payer: Aetna Medicare |
$174.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.20
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$243.60
|
| Rate for Payer: Cofinity Commercial |
$299.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.40
|
| Rate for Payer: Healthscope Commercial |
$313.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.80
|
| Rate for Payer: PHP Commercial |
$295.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health SBD |
$219.24
|
| Rate for Payer: UMR Bronson Commercial |
$128.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.00
|
|
|
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 Commercial |
$318.19
|
| Rate for Payer: Cofinity Commercial |
$390.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$318.19
|
| 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: PHP Commercial |
$386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.46
|
| Rate for Payer: Priority Health SBD |
$286.37
|
| Rate for Payer: UMR Bronson Commercial |
$168.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.92
|
|
|
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 Commercial |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.35
|
| 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: PHP Commercial |
$47.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.54
|
| Rate for Payer: Priority Health SBD |
$35.42
|
| 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
|
IP
|
$56.22
|
|
|
Service Code
|
NDC 24208078055
|
| 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 Commercial |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.35
|
| 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: PHP Commercial |
$47.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.54
|
| 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
|
$56.22
|
|
|
Service Code
|
NDC 24208078055
|
| 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 Commercial |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.35
|
| 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: PHP Commercial |
$47.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.54
|
| Rate for Payer: Priority Health SBD |
$35.42
|
| 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
|
$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 Commercial |
$100.30
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.30
|
| 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: PHP Commercial |
$121.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| Rate for Payer: Priority Health SBD |
$90.27
|
| 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
|
$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 Commercial |
$100.30
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.30
|
| 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: PHP Commercial |
$121.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| 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-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 Commercial |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$48.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.35
|
| 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: PHP Commercial |
$47.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.54
|
| 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-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.58
|
|
|
Service Code
|
NDC 45802014301
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.62 |
| Rate for Payer: Aetna American Axle |
$6.23
|
| Rate for Payer: Aetna Commercial |
$8.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.23
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$6.71
|
| Rate for Payer: Cofinity Commercial |
$8.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.71
|
| 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: Multiplan/Beech St/PHCS Commercial |
$8.14
|
| Rate for Payer: PHP Commercial |
$8.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.23
|
| Rate for Payer: Priority Health SBD |
$6.04
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| 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
|
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 Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| 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 |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| 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 |
$15.92
|
|
|
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 Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| 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 |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
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 |
$5.98
|
| 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 Commercial |
$10.29
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.38
|
| 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: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: PHP Commercial |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.78
|
| Rate for Payer: Priority Health SBD |
$7.54
|
| Rate for Payer: UMR Bronson Commercial |
$4.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.98
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$11.97
|
|
|
Service Code
|
NDC 59390002714
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna American Axle |
$7.78
|
| Rate for Payer: Aetna Commercial |
$10.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.78
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cofinity Commercial |
$10.29
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.38
|
| 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: Multiplan/Beech St/PHCS Commercial |
$10.17
|
| Rate for Payer: PHP Commercial |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.78
|
| Rate for Payer: Priority Health SBD |
$7.54
|
| Rate for Payer: UMR Bronson Commercial |
$5.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.98
|
|
|
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 Commercial |
$6.71
|
| Rate for Payer: Cofinity Commercial |
$8.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.71
|
| 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: Multiplan/Beech St/PHCS Commercial |
$8.14
|
| Rate for Payer: PHP Commercial |
$8.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.23
|
| Rate for Payer: Priority Health SBD |
$6.04
|
| 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
|
$7.98
|
|
|
Service Code
|
NDC 61269017934
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Aetna American Axle |
$5.19
|
| Rate for Payer: Aetna Commercial |
$6.78
|
| Rate for Payer: Aetna Medicare |
$3.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.19
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$6.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$7.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.78
|
| Rate for Payer: PHP Commercial |
$6.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.19
|
| Rate for Payer: Priority Health SBD |
$5.03
|
| Rate for Payer: UMR Bronson Commercial |
$2.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.98
|
|
