|
THYROID DISORDERS
|
Facility
|
IP
|
$7,376.44
|
|
|
Service Code
|
APR-DRG 4273
|
| Min. Negotiated Rate |
$6,669.19 |
| Max. Negotiated Rate |
$7,376.44 |
| Rate for Payer: BCBS Complete |
$7,376.44
|
| Rate for Payer: Mclaren Medicaid |
$7,025.18
|
| Rate for Payer: Meridian Medicaid |
$7,376.44
|
| Rate for Payer: PHP Medicaid |
$6,669.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,025.18
|
| Rate for Payer: UHC Medicaid |
$7,025.18
|
| Rate for Payer: UHCCP Medicaid |
$7,025.18
|
|
|
THYROID DISORDERS
|
Facility
|
IP
|
$3,169.43
|
|
|
Service Code
|
APR-DRG 4271
|
| Min. Negotiated Rate |
$2,865.54 |
| Max. Negotiated Rate |
$3,169.43 |
| Rate for Payer: BCBS Complete |
$3,169.43
|
| Rate for Payer: Mclaren Medicaid |
$3,018.50
|
| Rate for Payer: Meridian Medicaid |
$3,169.43
|
| Rate for Payer: PHP Medicaid |
$2,865.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,018.50
|
| Rate for Payer: UHC Medicaid |
$3,018.50
|
| Rate for Payer: UHCCP Medicaid |
$3,018.50
|
|
|
THYROID DISORDERS
|
Facility
|
IP
|
$12,946.38
|
|
|
Service Code
|
APR-DRG 4274
|
| Min. Negotiated Rate |
$11,705.07 |
| Max. Negotiated Rate |
$12,946.38 |
| Rate for Payer: BCBS Complete |
$12,946.38
|
| Rate for Payer: Mclaren Medicaid |
$12,329.88
|
| Rate for Payer: Meridian Medicaid |
$12,946.38
|
| Rate for Payer: PHP Medicaid |
$11,705.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,329.88
|
| Rate for Payer: UHC Medicaid |
$12,329.88
|
| Rate for Payer: UHCCP Medicaid |
$12,329.88
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES
|
Facility
|
IP
|
$6,908.88
|
|
|
Service Code
|
APR-DRG 4041
|
| Min. Negotiated Rate |
$6,246.45 |
| Max. Negotiated Rate |
$6,908.88 |
| Rate for Payer: BCBS Complete |
$6,908.88
|
| Rate for Payer: Mclaren Medicaid |
$6,579.88
|
| Rate for Payer: Meridian Medicaid |
$6,908.88
|
| Rate for Payer: PHP Medicaid |
$6,246.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,579.88
|
| Rate for Payer: UHC Medicaid |
$6,579.88
|
| Rate for Payer: UHCCP Medicaid |
$6,579.88
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES
|
Facility
|
IP
|
$24,093.33
|
|
|
Service Code
|
APR-DRG 4044
|
| Min. Negotiated Rate |
$21,783.25 |
| Max. Negotiated Rate |
$24,093.33 |
| Rate for Payer: BCBS Complete |
$24,093.33
|
| Rate for Payer: Mclaren Medicaid |
$22,946.03
|
| Rate for Payer: Meridian Medicaid |
$24,093.33
|
| Rate for Payer: PHP Medicaid |
$21,783.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,946.03
|
| Rate for Payer: UHC Medicaid |
$22,946.03
|
| Rate for Payer: UHCCP Medicaid |
$22,946.03
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES
|
Facility
|
IP
|
$11,880.45
|
|
|
Service Code
|
APR-DRG 4043
|
| Min. Negotiated Rate |
$10,741.35 |
| Max. Negotiated Rate |
$11,880.45 |
| Rate for Payer: BCBS Complete |
$11,880.45
|
| Rate for Payer: Mclaren Medicaid |
$11,314.72
|
| Rate for Payer: Meridian Medicaid |
$11,880.45
|
| Rate for Payer: PHP Medicaid |
$10,741.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,314.72
|
| Rate for Payer: UHC Medicaid |
$11,314.72
|
| Rate for Payer: UHCCP Medicaid |
$11,314.72
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES
|
Facility
|
IP
|
$9,993.84
|
|
|
Service Code
|
APR-DRG 4042
|
| Min. Negotiated Rate |
$9,035.63 |
| Max. Negotiated Rate |
$9,993.84 |
| Rate for Payer: BCBS Complete |
$9,993.84
|
| Rate for Payer: Mclaren Medicaid |
$9,517.94
|
| Rate for Payer: Meridian Medicaid |
$9,993.84
|
| Rate for Payer: PHP Medicaid |
$9,035.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,517.94
|
| Rate for Payer: UHC Medicaid |
$9,517.94
|
| Rate for Payer: UHCCP Medicaid |
$9,517.94
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
|
IP
|
$20,599.96
|
|
|
Service Code
|
MSDRG 626
|
| Min. Negotiated Rate |
$11,924.40 |
| Max. Negotiated Rate |
$20,599.96 |
| Rate for Payer: Aetna Medicare |
$12,552.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,690.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,690.00
|
| Rate for Payer: BCBS MAPPO |
$12,552.00
|
| Rate for Payer: BCN Medicare Advantage |
$12,552.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,552.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,552.00
|
| Rate for Payer: Mclaren Medicare |
$12,552.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,179.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,434.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,807.20
|
| Rate for Payer: PACE Medicare |
$11,924.40
|
| Rate for Payer: PACE SWMI |
$12,552.00
|
| Rate for Payer: PHP Commercial |
$13,807.20
|
| Rate for Payer: PHP Medicare Advantage |
$12,552.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,599.96
|
| Rate for Payer: Priority Health Medicare |
$12,552.00
|
| Rate for Payer: Priority Health Narrow Network |
$16,479.97
|
| Rate for Payer: Railroad Medicare Medicare |
$12,552.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,552.00
|
| Rate for Payer: UHC Exchange |
$19,455.60
|
| Rate for Payer: UHCCP DNSP |
$12,552.00
|
| Rate for Payer: VA VA |
$12,552.00
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$41,492.55
|
|
|
Service Code
|
MSDRG 625
|
| Min. Negotiated Rate |
$22,327.78 |
| Max. Negotiated Rate |
$41,492.55 |
| Rate for Payer: Aetna Medicare |
$23,502.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,378.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,378.66
|
| Rate for Payer: BCBS MAPPO |
$23,502.93
|
| Rate for Payer: BCN Medicare Advantage |
$23,502.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,502.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,502.93
|
| Rate for Payer: Mclaren Medicare |
$23,502.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,678.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,028.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,853.22
|
| Rate for Payer: PACE Medicare |
$22,327.78
|
| Rate for Payer: PACE SWMI |
$23,502.93
|
| Rate for Payer: PHP Commercial |
$25,853.22
|
| Rate for Payer: PHP Medicare Advantage |
$23,502.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41,492.55
|
| Rate for Payer: Priority Health Medicare |
$23,502.93
|
| Rate for Payer: Priority Health Narrow Network |
$33,194.04
|
| Rate for Payer: Railroad Medicare Medicare |
$23,502.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,502.93
|
| Rate for Payer: UHC Exchange |
$36,429.54
|
| Rate for Payer: UHCCP DNSP |
$23,502.93
|
| Rate for Payer: VA VA |
$23,502.93
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,249.25
|
|
|
Service Code
|
MSDRG 627
|
| Min. Negotiated Rate |
$10,753.89 |
| Max. Negotiated Rate |
$18,249.25 |
| Rate for Payer: Aetna Medicare |
$11,319.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,149.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,149.85
|
| Rate for Payer: BCBS MAPPO |
$11,319.88
|
| Rate for Payer: BCN Medicare Advantage |
$11,319.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,319.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,319.88
|
| Rate for Payer: Mclaren Medicare |
$11,319.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,885.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,017.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,451.87
|
| Rate for Payer: PACE Medicare |
$10,753.89
|
| Rate for Payer: PACE SWMI |
$11,319.88
|
| Rate for Payer: PHP Commercial |
$12,451.87
|
| Rate for Payer: PHP Medicare Advantage |
$11,319.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,249.25
|
| Rate for Payer: Priority Health Medicare |
$11,319.88
|
| Rate for Payer: Priority Health Narrow Network |
$14,599.40
|
| Rate for Payer: Railroad Medicare Medicare |
$11,319.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,319.88
|
| Rate for Payer: UHC Exchange |
$17,545.81
|
| Rate for Payer: UHCCP DNSP |
$11,319.88
|
| Rate for Payer: VA VA |
$11,319.88
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$2,780.18
|
|
|
Service Code
|
NDC 186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,085.14 |
| Max. Negotiated Rate |
$2,780.18 |
| Rate for Payer: Aetna Commercial |
$2,502.16
|
| Rate for Payer: ASR ASR |
$2,696.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,283.08
|
| Rate for Payer: BCN Commercial |
$2,283.08
|
| Rate for Payer: Cash Price |
$2,224.14
|
| Rate for Payer: Cofinity Commercial |
$2,613.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.14
|
| Rate for Payer: Healthscope Commercial |
$2,696.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,780.18
|
| Rate for Payer: Mclaren Commercial |
$2,502.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.15
|
| Rate for Payer: Nomi Health Commercial |
$2,279.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,085.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,446.56
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,251.25 |
| Max. Negotiated Rate |
$1,668.33 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: ASR ASR |
$1,618.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,370.03
|
| Rate for Payer: BCN Commercial |
$1,370.03
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,568.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,618.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,668.33
|
| Rate for Payer: Mclaren Commercial |
$1,501.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Nomi Health Commercial |
$1,368.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,468.13
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$617.28 |
| Max. Negotiated Rate |
$1,668.33 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Aetna Medicare |
$617.28
|
| Rate for Payer: ASR ASR |
$1,618.28
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,375.54
|
| Rate for Payer: BCN Commercial |
$1,375.54
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,568.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,618.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,668.33
|
| Rate for Payer: Mclaren Commercial |
$1,501.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,334.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Nomi Health Commercial |
$1,368.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,251.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,461.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,169.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,468.13
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$2,780.18
|
|
|
Service Code
|
NDC 186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,028.67 |
| Max. Negotiated Rate |
$2,780.18 |
| Rate for Payer: Aetna Commercial |
$2,502.16
|
| Rate for Payer: Aetna Medicare |
$1,028.67
|
| Rate for Payer: ASR ASR |
$2,696.77
|
| Rate for Payer: BCBS Complete |
$1,112.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,292.26
|
| Rate for Payer: BCN Commercial |
$2,292.26
|
| Rate for Payer: Cash Price |
$2,224.14
|
| Rate for Payer: Cofinity Commercial |
$2,613.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.14
|
| Rate for Payer: Healthscope Commercial |
$2,696.77
|
| Rate for Payer: Healthscope Whirlpool |
$2,780.18
|
| Rate for Payer: Mclaren Commercial |
$2,502.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,224.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.15
|
| Rate for Payer: Nomi Health Commercial |
$2,279.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,085.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,435.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,948.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,446.56
|
|
|
TIMOLOL 5 MG TABLET
|
Facility
|
IP
|
$491.52
|
|
|
Service Code
|
NDC 378005501
|
| Hospital Charge Code |
7969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.64 |
| Max. Negotiated Rate |
$491.52 |
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: ASR ASR |
$476.77
|
| Rate for Payer: BCBS Trust/PPO |
$403.64
|
| Rate for Payer: BCN Commercial |
$403.64
|
| Rate for Payer: Cash Price |
$393.22
|
| Rate for Payer: Cofinity Commercial |
$462.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.22
|
| Rate for Payer: Healthscope Commercial |
$476.77
|
| Rate for Payer: Healthscope Whirlpool |
$491.52
|
| Rate for Payer: Mclaren Commercial |
$442.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.79
|
| Rate for Payer: Nomi Health Commercial |
$403.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.54
|
|
|
TIMOLOL 5 MG TABLET
|
Facility
|
OP
|
$491.52
|
|
|
Service Code
|
NDC 378005501
|
| Hospital Charge Code |
7969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$491.52 |
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: Aetna Medicare |
$181.86
|
| Rate for Payer: ASR ASR |
$476.77
|
| Rate for Payer: BCBS Complete |
$196.61
|
| Rate for Payer: BCBS Trust/PPO |
$405.26
|
| Rate for Payer: BCN Commercial |
$405.26
|
| Rate for Payer: Cash Price |
$393.22
|
| Rate for Payer: Cofinity Commercial |
$462.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.22
|
| Rate for Payer: Healthscope Commercial |
$476.77
|
| Rate for Payer: Healthscope Whirlpool |
$491.52
|
| Rate for Payer: Mclaren Commercial |
$442.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.79
|
| Rate for Payer: Nomi Health Commercial |
$403.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$430.67
|
| Rate for Payer: Priority Health Narrow Network |
$344.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.54
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$35.81
|
|
|
Service Code
|
NDC 68682081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: ASR ASR |
$34.73
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.52
|
| Rate for Payer: BCN Commercial |
$29.52
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.64
|
| Rate for Payer: Healthscope Commercial |
$34.73
|
| Rate for Payer: Healthscope Whirlpool |
$35.80
|
| Rate for Payer: Mclaren Commercial |
$32.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.43
|
| Rate for Payer: Nomi Health Commercial |
$29.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.37
|
| Rate for Payer: Priority Health Narrow Network |
$25.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.51
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$22.91
|
|
|
Service Code
|
NDC 60758080105
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: ASR ASR |
$22.22
|
| Rate for Payer: BCBS Trust/PPO |
$18.81
|
| Rate for Payer: BCN Commercial |
$18.81
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$22.22
|
| Rate for Payer: Healthscope Whirlpool |
$22.91
|
| Rate for Payer: Mclaren Commercial |
$20.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Nomi Health Commercial |
$18.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.16
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$31.33
|
|
|
Service Code
|
NDC 61314022710
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$31.32 |
| Rate for Payer: Aetna Commercial |
$28.19
|
| Rate for Payer: Aetna Medicare |
$11.59
|
| Rate for Payer: ASR ASR |
$30.39
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.83
|
| Rate for Payer: BCN Commercial |
$25.83
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cofinity Commercial |
$29.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$30.39
|
| Rate for Payer: Healthscope Whirlpool |
$31.32
|
| Rate for Payer: Mclaren Commercial |
$28.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.63
|
| Rate for Payer: Nomi Health Commercial |
$25.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.45
|
| Rate for Payer: Priority Health Narrow Network |
$21.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.57
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$35.81
|
|
|
Service Code
|
NDC 68682081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.85 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: ASR ASR |
$34.73
|
| Rate for Payer: BCBS Trust/PPO |
$29.40
|
| Rate for Payer: BCN Commercial |
$29.40
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.64
|
| Rate for Payer: Healthscope Commercial |
$34.73
|
| Rate for Payer: Healthscope Whirlpool |
$35.80
|
| Rate for Payer: Mclaren Commercial |
$32.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.43
|
| Rate for Payer: Nomi Health Commercial |
$29.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.51
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$31.33
|
|
|
Service Code
|
NDC 61314022710
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$31.32 |
| Rate for Payer: Aetna Commercial |
$28.19
|
| Rate for Payer: ASR ASR |
$30.39
|
| Rate for Payer: BCBS Trust/PPO |
$25.72
|
| Rate for Payer: BCN Commercial |
$25.72
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cofinity Commercial |
$29.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$30.39
|
| Rate for Payer: Healthscope Whirlpool |
$31.32
|
| Rate for Payer: Mclaren Commercial |
$28.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.63
|
| Rate for Payer: Nomi Health Commercial |
$25.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.57
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$22.82
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.11 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: ASR ASR |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$18.74
|
| Rate for Payer: BCN Commercial |
$18.74
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$22.14
|
| Rate for Payer: Healthscope Whirlpool |
$22.82
|
| Rate for Payer: Mclaren Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.40
|
| Rate for Payer: Nomi Health Commercial |
$18.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.08
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$20.61
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$20.61
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$20.61
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$20.61
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.06
|
| Rate for Payer: Priority Health Narrow Network |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$22.91
|
|
|
Service Code
|
NDC 60758080105
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$20.61
|
| Rate for Payer: Aetna Medicare |
$8.47
|
| Rate for Payer: ASR ASR |
$22.22
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$18.89
|
| Rate for Payer: BCN Commercial |
$18.89
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.32
|
| Rate for Payer: Healthscope Commercial |
$22.22
|
| Rate for Payer: Healthscope Whirlpool |
$22.91
|
| Rate for Payer: Mclaren Commercial |
$20.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Nomi Health Commercial |
$18.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.07
|
| Rate for Payer: Priority Health Narrow Network |
$16.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.16
|
|
