|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$22.82
|
|
|
Service Code
|
NDC 17478028810
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: ASR ASR |
$22.14
|
| Rate for Payer: BCBS Complete |
$9.13
|
| Rate for Payer: BCBS Trust/PPO |
$18.82
|
| Rate for Payer: BCN Commercial |
$18.82
|
| 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: MI Amish Medical Board Commercial |
$18.26
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.99
|
| Rate for Payer: Priority Health Narrow Network |
$16.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.08
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$4.55
|
|
|
Service Code
|
NDC 50268076011
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$4.10
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: ASR ASR |
$4.41
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.75
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$4.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$4.41
|
| Rate for Payer: Healthscope Whirlpool |
$4.55
|
| Rate for Payer: Mclaren Commercial |
$4.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Nomi Health Commercial |
$3.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.99
|
| Rate for Payer: Priority Health Narrow Network |
$3.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.00
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.24 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Aetna Commercial |
$418.95
|
| Rate for Payer: Aetna Medicare |
$172.24
|
| Rate for Payer: ASR ASR |
$451.54
|
| Rate for Payer: BCBS Complete |
$186.20
|
| Rate for Payer: BCBS Trust/PPO |
$383.80
|
| Rate for Payer: BCN Commercial |
$383.80
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$437.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$451.54
|
| Rate for Payer: Healthscope Whirlpool |
$465.50
|
| Rate for Payer: Mclaren Commercial |
$418.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Nomi Health Commercial |
$381.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$407.87
|
| Rate for Payer: Priority Health Narrow Network |
$326.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$409.64
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$227.53
|
|
|
Service Code
|
NDC 50268076015
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.18 |
| Max. Negotiated Rate |
$227.53 |
| Rate for Payer: Aetna Commercial |
$204.77
|
| Rate for Payer: Aetna Medicare |
$84.18
|
| Rate for Payer: ASR ASR |
$220.70
|
| Rate for Payer: BCBS Complete |
$91.01
|
| Rate for Payer: BCBS Trust/PPO |
$187.59
|
| Rate for Payer: BCN Commercial |
$187.59
|
| Rate for Payer: Cash Price |
$182.02
|
| Rate for Payer: Cofinity Commercial |
$213.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.02
|
| Rate for Payer: Healthscope Commercial |
$220.70
|
| Rate for Payer: Healthscope Whirlpool |
$227.53
|
| Rate for Payer: Mclaren Commercial |
$204.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.40
|
| Rate for Payer: Nomi Health Commercial |
$186.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$199.36
|
| Rate for Payer: Priority Health Narrow Network |
$159.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.22
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$227.53
|
|
|
Service Code
|
NDC 50268076015
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.64 |
| Max. Negotiated Rate |
$227.53 |
| Rate for Payer: Aetna Commercial |
$204.77
|
| Rate for Payer: ASR ASR |
$220.70
|
| Rate for Payer: BCBS Trust/PPO |
$186.84
|
| Rate for Payer: BCN Commercial |
$186.84
|
| Rate for Payer: Cash Price |
$182.02
|
| Rate for Payer: Cofinity Commercial |
$213.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.02
|
| Rate for Payer: Healthscope Commercial |
$220.70
|
| Rate for Payer: Healthscope Whirlpool |
$227.53
|
| Rate for Payer: Mclaren Commercial |
$204.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.40
|
| Rate for Payer: Nomi Health Commercial |
$186.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.22
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 68084064511
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: ASR ASR |
$2.51
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Healthscope Whirlpool |
$2.59
|
| Rate for Payer: Mclaren Commercial |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.27
|
| Rate for Payer: Priority Health Narrow Network |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.28
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$165.68
|
|
|
Service Code
|
NDC 57664050389
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$165.68 |
| Rate for Payer: Aetna Commercial |
$149.11
|
| Rate for Payer: Aetna Medicare |
$61.30
|
| Rate for Payer: ASR ASR |
$160.70
|
| Rate for Payer: BCBS Complete |
$66.27
|
| Rate for Payer: BCBS Trust/PPO |
$136.60
|
| Rate for Payer: BCN Commercial |
$136.60
|
| Rate for Payer: Cash Price |
$132.54
|
| Rate for Payer: Cofinity Commercial |
$155.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.54
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Healthscope Whirlpool |
$165.68
|
| Rate for Payer: Mclaren Commercial |
$149.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.82
|
| Rate for Payer: Nomi Health Commercial |
$135.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$145.16
|
| Rate for Payer: Priority Health Narrow Network |
$116.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.79
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$4.55
|
|
|
Service Code
|
NDC 50268076011
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$4.10
|
| Rate for Payer: ASR ASR |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$3.74
|
| Rate for Payer: BCN Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$4.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$4.41
|
| Rate for Payer: Healthscope Whirlpool |
$4.55
|
| Rate for Payer: Mclaren Commercial |
$4.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Nomi Health Commercial |
$3.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.00
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$258.72
|
|
|
Service Code
|
NDC 68084064501
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.73 |
| Max. Negotiated Rate |
$258.72 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Aetna Medicare |
$95.73
|
| Rate for Payer: ASR ASR |
$250.96
|
| Rate for Payer: BCBS Complete |
$103.49
|
| Rate for Payer: BCBS Trust/PPO |
$213.31
|
| Rate for Payer: BCN Commercial |
$213.31
|
| Rate for Payer: Cash Price |
$206.98
|
| Rate for Payer: Cofinity Commercial |
$243.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.98
|
| Rate for Payer: Healthscope Commercial |
$250.96
|
| Rate for Payer: Healthscope Whirlpool |
$258.72
|
| Rate for Payer: Mclaren Commercial |
$232.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.91
|
| Rate for Payer: Nomi Health Commercial |
$212.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.69
|
| Rate for Payer: Priority Health Narrow Network |
$181.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.67
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 68084064511
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: ASR ASR |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Healthscope Whirlpool |
$2.59
|
| Rate for Payer: Mclaren Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.28
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 904641861
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.12 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Aetna Commercial |
$418.95
|
| Rate for Payer: ASR ASR |
$451.54
|
| Rate for Payer: BCBS Trust/PPO |
$382.27
|
| Rate for Payer: BCN Commercial |
$382.27
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$437.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$451.54
|
| Rate for Payer: Healthscope Whirlpool |
$465.50
|
| Rate for Payer: Mclaren Commercial |
$418.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Nomi Health Commercial |
$381.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$409.64
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$258.72
|
|
|
Service Code
|
NDC 68084064501
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$258.72 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: ASR ASR |
$250.96
|
| Rate for Payer: BCBS Trust/PPO |
$212.46
|
| Rate for Payer: BCN Commercial |
$212.46
|
| Rate for Payer: Cash Price |
$206.98
|
| Rate for Payer: Cofinity Commercial |
$243.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.98
|
| Rate for Payer: Healthscope Commercial |
$250.96
|
| Rate for Payer: Healthscope Whirlpool |
$258.72
|
| Rate for Payer: Mclaren Commercial |
$232.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.91
|
| Rate for Payer: Nomi Health Commercial |
$212.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.67
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$165.68
|
|
|
Service Code
|
NDC 57664050389
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.26 |
| Max. Negotiated Rate |
$165.68 |
| Rate for Payer: Aetna Commercial |
$149.11
|
| Rate for Payer: ASR ASR |
$160.70
|
| Rate for Payer: BCBS Trust/PPO |
$136.05
|
| Rate for Payer: BCN Commercial |
$136.05
|
| Rate for Payer: Cash Price |
$132.54
|
| Rate for Payer: Cofinity Commercial |
$155.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.54
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Healthscope Whirlpool |
$165.68
|
| Rate for Payer: Mclaren Commercial |
$149.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.82
|
| Rate for Payer: Nomi Health Commercial |
$135.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.79
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$25.24
|
|
|
Service Code
|
NDC 62332051805
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCN Commercial |
$20.72
|
| Rate for Payer: Cash Price |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.19
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.21
|
|
|
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 |
$37.84 |
| Rate for Payer: Aetna Commercial |
$34.05
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: ASR ASR |
$36.70
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$31.19
|
| Rate for Payer: BCN Commercial |
$31.19
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cofinity Commercial |
$35.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.27
|
| Rate for Payer: Healthscope Commercial |
$36.70
|
| Rate for Payer: Healthscope Whirlpool |
$37.84
|
| Rate for Payer: Mclaren Commercial |
$34.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Nomi Health Commercial |
$31.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Narrow Network |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.29
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$25.24
|
|
|
Service Code
|
NDC 62332051805
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: ASR ASR |
$24.48
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.81
|
| Rate for Payer: BCN Commercial |
$20.81
|
| Rate for Payer: Cash Price |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.19
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.11
|
| Rate for Payer: Priority Health Narrow Network |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.21
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$20.93
|
|
|
Service Code
|
NDC 70069013101
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: ASR ASR |
$20.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.18
|
| Rate for Payer: BCN Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Healthscope Whirlpool |
$20.93
|
| Rate for Payer: Mclaren Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.79
|
| Rate for Payer: Nomi Health Commercial |
$17.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.41
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$37.84
|
|
|
Service Code
|
NDC 17478029010
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$34.05
|
| Rate for Payer: ASR ASR |
$36.70
|
| Rate for Payer: BCBS Trust/PPO |
$31.07
|
| Rate for Payer: BCN Commercial |
$31.07
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cofinity Commercial |
$35.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.27
|
| Rate for Payer: Healthscope Commercial |
$36.70
|
| Rate for Payer: Healthscope Whirlpool |
$37.84
|
| Rate for Payer: Mclaren Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Nomi Health Commercial |
$31.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.29
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$20.93
|
|
|
Service Code
|
NDC 70069013101
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$20.93 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Medicare |
$7.74
|
| Rate for Payer: ASR ASR |
$20.30
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS Trust/PPO |
$17.25
|
| Rate for Payer: BCN Commercial |
$17.25
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$20.30
|
| Rate for Payer: Healthscope Whirlpool |
$20.93
|
| Rate for Payer: Mclaren Commercial |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.79
|
| Rate for Payer: Nomi Health Commercial |
$17.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.33
|
| Rate for Payer: Priority Health Narrow Network |
$14.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.41
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT
|
Facility
|
OP
|
$1,001.63
|
|
|
Service Code
|
NDC 78081301
|
| Hospital Charge Code |
19769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$370.60 |
| Max. Negotiated Rate |
$1,001.63 |
| Rate for Payer: Aetna Commercial |
$901.47
|
| Rate for Payer: Aetna Medicare |
$370.60
|
| Rate for Payer: ASR ASR |
$971.58
|
| Rate for Payer: BCBS Complete |
$400.65
|
| Rate for Payer: BCBS Trust/PPO |
$825.85
|
| Rate for Payer: BCN Commercial |
$825.85
|
| Rate for Payer: Cash Price |
$801.31
|
| Rate for Payer: Cofinity Commercial |
$941.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.31
|
| Rate for Payer: Healthscope Commercial |
$971.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,001.63
|
| Rate for Payer: Mclaren Commercial |
$901.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$801.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.39
|
| Rate for Payer: Nomi Health Commercial |
$821.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$751.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$877.63
|
| Rate for Payer: Priority Health Narrow Network |
$702.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$881.44
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT
|
Facility
|
IP
|
$1,001.63
|
|
|
Service Code
|
NDC 78081301
|
| Hospital Charge Code |
19769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$751.23 |
| Max. Negotiated Rate |
$1,001.63 |
| Rate for Payer: Aetna Commercial |
$901.47
|
| Rate for Payer: ASR ASR |
$971.58
|
| Rate for Payer: BCBS Trust/PPO |
$822.54
|
| Rate for Payer: BCN Commercial |
$822.54
|
| Rate for Payer: Cash Price |
$801.31
|
| Rate for Payer: Cofinity Commercial |
$941.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.31
|
| Rate for Payer: Healthscope Commercial |
$971.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,001.63
|
| Rate for Payer: Mclaren Commercial |
$901.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$851.39
|
| Rate for Payer: Nomi Health Commercial |
$821.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$751.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$881.44
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$141.84
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
11565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.38 |
| Max. Negotiated Rate |
$141.84 |
| Rate for Payer: Aetna Commercial |
$127.66
|
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: ASR ASR |
$60.22
|
| Rate for Payer: ASR ASR |
$137.59
|
| Rate for Payer: BCBS Trust/PPO |
$50.98
|
| Rate for Payer: BCBS Trust/PPO |
$116.48
|
| Rate for Payer: BCN Commercial |
$50.98
|
| Rate for Payer: BCN Commercial |
$116.48
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$113.48
|
| Rate for Payer: Cofinity Commercial |
$133.33
|
| Rate for Payer: Cofinity Commercial |
$58.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.48
|
| Rate for Payer: Healthscope Commercial |
$137.59
|
| Rate for Payer: Healthscope Commercial |
$60.22
|
| Rate for Payer: Healthscope Whirlpool |
$62.08
|
| Rate for Payer: Healthscope Whirlpool |
$141.84
|
| Rate for Payer: Mclaren Commercial |
$55.87
|
| Rate for Payer: Mclaren Commercial |
$127.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.57
|
| Rate for Payer: Nomi Health Commercial |
$50.90
|
| Rate for Payer: Nomi Health Commercial |
$116.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.63
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$62.08
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
11565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Aetna Commercial |
$55.87
|
| Rate for Payer: Aetna Commercial |
$127.66
|
| Rate for Payer: Aetna Medicare |
$52.48
|
| Rate for Payer: Aetna Medicare |
$22.97
|
| Rate for Payer: ASR ASR |
$60.22
|
| Rate for Payer: ASR ASR |
$137.59
|
| Rate for Payer: BCBS Complete |
$56.74
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Trust/PPO |
$51.18
|
| Rate for Payer: BCBS Trust/PPO |
$116.95
|
| Rate for Payer: BCN Commercial |
$116.95
|
| Rate for Payer: BCN Commercial |
$51.18
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$113.48
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$113.48
|
| Rate for Payer: Cofinity Commercial |
$133.33
|
| Rate for Payer: Cofinity Commercial |
$58.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.48
|
| Rate for Payer: Healthscope Commercial |
$60.22
|
| Rate for Payer: Healthscope Commercial |
$137.59
|
| Rate for Payer: Healthscope Whirlpool |
$62.08
|
| Rate for Payer: Healthscope Whirlpool |
$141.84
|
| Rate for Payer: Mclaren Commercial |
$55.87
|
| Rate for Payer: Mclaren Commercial |
$127.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Nomi Health Commercial |
$116.31
|
| Rate for Payer: Nomi Health Commercial |
$50.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.15
|
| Rate for Payer: Priority Health Narrow Network |
$1.72
|
| Rate for Payer: Priority Health Narrow Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.63
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT
|
Facility
|
OP
|
$1,066.35
|
|
|
Service Code
|
NDC 78087601
|
| Hospital Charge Code |
11566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.55 |
| Max. Negotiated Rate |
$1,066.35 |
| Rate for Payer: Aetna Commercial |
$959.72
|
| Rate for Payer: Aetna Medicare |
$394.55
|
| Rate for Payer: ASR ASR |
$1,034.36
|
| Rate for Payer: BCBS Complete |
$426.54
|
| Rate for Payer: BCBS Trust/PPO |
$879.21
|
| Rate for Payer: BCN Commercial |
$879.21
|
| Rate for Payer: Cash Price |
$853.08
|
| Rate for Payer: Cofinity Commercial |
$1,002.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.08
|
| Rate for Payer: Healthscope Commercial |
$1,034.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,066.35
|
| Rate for Payer: Mclaren Commercial |
$959.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$853.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.40
|
| Rate for Payer: Nomi Health Commercial |
$874.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$799.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$934.34
|
| Rate for Payer: Priority Health Narrow Network |
$747.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$938.39
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT
|
Facility
|
IP
|
$1,066.35
|
|
|
Service Code
|
NDC 78087601
|
| Hospital Charge Code |
11566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$799.76 |
| Max. Negotiated Rate |
$1,066.35 |
| Rate for Payer: Aetna Commercial |
$959.72
|
| Rate for Payer: ASR ASR |
$1,034.36
|
| Rate for Payer: BCBS Trust/PPO |
$875.69
|
| Rate for Payer: BCN Commercial |
$875.69
|
| Rate for Payer: Cash Price |
$853.08
|
| Rate for Payer: Cofinity Commercial |
$1,002.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.08
|
| Rate for Payer: Healthscope Commercial |
$1,034.36
|
| Rate for Payer: Healthscope Whirlpool |
$1,066.35
|
| Rate for Payer: Mclaren Commercial |
$959.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.40
|
| Rate for Payer: Nomi Health Commercial |
$874.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$799.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$938.39
|
|
