|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$468.35
|
|
|
Service Code
|
NDC 51079056620
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.43 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna Commercial |
$421.51
|
| Rate for Payer: ASR ASR |
$454.30
|
| Rate for Payer: ASR Commercial |
$454.30
|
| Rate for Payer: BCBS Trust/PPO |
$381.66
|
| Rate for Payer: BCN Commercial |
$363.11
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$440.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.68
|
| Rate for Payer: Healthscope Commercial |
$468.35
|
| Rate for Payer: Healthscope Whirlpool |
$454.30
|
| Rate for Payer: Mclaren Commercial |
$421.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.10
|
| Rate for Payer: Nomi Health Commercial |
$384.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.15
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$299.04
|
|
|
Service Code
|
NDC 00378061401
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.38 |
| Max. Negotiated Rate |
$299.04 |
| Rate for Payer: Aetna Commercial |
$269.14
|
| Rate for Payer: ASR ASR |
$290.07
|
| Rate for Payer: ASR Commercial |
$290.07
|
| Rate for Payer: BCBS Trust/PPO |
$243.69
|
| Rate for Payer: BCN Commercial |
$231.85
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Commercial |
$281.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$299.04
|
| Rate for Payer: Healthscope Whirlpool |
$290.07
|
| Rate for Payer: Mclaren Commercial |
$269.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: Nomi Health Commercial |
$245.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.16
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$934.62
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$934.62 |
| Rate for Payer: Aetna Medicare |
$602.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$602.98
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$663.28
|
| Rate for Payer: PHP Medicaid |
$323.20
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Exchange |
$934.62
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP DNSP |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$323.20
|
| Rate for Payer: VA VA |
$602.98
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$934.62
|
|
|
Service Code
|
CPT 32554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$323.20 |
| Max. Negotiated Rate |
$934.62 |
| Rate for Payer: Aetna Medicare |
$602.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.73
|
| Rate for Payer: BCBS Complete |
$339.36
|
| Rate for Payer: BCBS MAPPO |
$602.98
|
| Rate for Payer: BCN Medicare Advantage |
$602.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$602.98
|
| Rate for Payer: Mclaren Medicaid |
$323.20
|
| Rate for Payer: Mclaren Medicare |
$602.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.13
|
| Rate for Payer: Meridian Medicaid |
$339.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.43
|
| Rate for Payer: PACE Medicare |
$572.83
|
| Rate for Payer: PACE SWMI |
$602.98
|
| Rate for Payer: PHP Commercial |
$663.28
|
| Rate for Payer: PHP Medicaid |
$323.20
|
| Rate for Payer: PHP Medicare Advantage |
$602.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.20
|
| Rate for Payer: Priority Health Medicare |
$602.98
|
| Rate for Payer: Railroad Medicare Medicare |
$602.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.98
|
| Rate for Payer: UHC Exchange |
$934.62
|
| Rate for Payer: UHC Medicare Advantage |
$602.98
|
| Rate for Payer: UHCCP DNSP |
$602.98
|
| Rate for Payer: UHCCP Medicaid |
$323.20
|
| Rate for Payer: VA VA |
$602.98
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.22 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna Commercial |
$187.25
|
| Rate for Payer: Aetna Medicare |
$104.03
|
| Rate for Payer: ASR ASR |
$201.81
|
| Rate for Payer: ASR Commercial |
$201.81
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: BCBS Trust/PPO |
$170.37
|
| Rate for Payer: BCN Commercial |
$161.30
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$195.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$208.05
|
| Rate for Payer: Healthscope Whirlpool |
$201.81
|
| Rate for Payer: Mclaren Commercial |
$187.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.29
|
| Rate for Payer: Priority Health Narrow Network |
$145.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.08
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.23 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna Commercial |
$187.25
|
| Rate for Payer: ASR ASR |
$201.81
|
| Rate for Payer: ASR Commercial |
$201.81
|
| Rate for Payer: BCBS Trust/PPO |
$169.54
|
| Rate for Payer: BCN Commercial |
$161.30
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$195.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$208.05
|
| Rate for Payer: Healthscope Whirlpool |
$201.81
|
| Rate for Payer: Mclaren Commercial |
$187.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.08
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,084.41 |
| 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: ASR Commercial |
$1,618.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,359.52
|
| Rate for Payer: BCN Commercial |
$1,293.46
|
| 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 |
$1,668.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,618.28
|
| 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: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,468.13
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$667.33 |
| Max. Negotiated Rate |
$1,668.33 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Aetna Medicare |
$834.16
|
| Rate for Payer: ASR ASR |
$1,618.28
|
| Rate for Payer: ASR Commercial |
$1,618.28
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,366.20
|
| Rate for Payer: BCN Commercial |
$1,293.46
|
| 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 |
$1,668.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,618.28
|
| 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: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: 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
|
IP
|
$2,780.18
|
|
|
Service Code
|
NDC 00186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,807.12 |
| 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: ASR Commercial |
$2,696.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,265.57
|
| Rate for Payer: BCN Commercial |
$2,155.47
|
| 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 |
$2,780.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,696.77
|
| 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: Priority Health Cigna Priority Health |
$1,807.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,446.56
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$2,780.18
|
|
|
Service Code
|
NDC 00186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,112.07 |
| Max. Negotiated Rate |
$2,780.18 |
| Rate for Payer: Aetna Commercial |
$2,502.16
|
| Rate for Payer: Aetna Medicare |
$1,390.09
|
| Rate for Payer: ASR ASR |
$2,696.77
|
| Rate for Payer: ASR Commercial |
$2,696.77
|
| Rate for Payer: BCBS Complete |
$1,112.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.69
|
| Rate for Payer: BCN Commercial |
$2,155.47
|
| 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 |
$2,780.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,696.77
|
| 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: Priority Health Cigna Priority Health |
$1,807.12
|
| Rate for Payer: 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
|
$372.00
|
|
|
Service Code
|
NDC 00378005501
|
| Hospital Charge Code |
7969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$334.80
|
| Rate for Payer: ASR ASR |
$360.84
|
| Rate for Payer: ASR Commercial |
$360.84
|
| Rate for Payer: BCBS Trust/PPO |
$303.14
|
| Rate for Payer: BCN Commercial |
$288.41
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.60
|
| Rate for Payer: Healthscope Commercial |
$372.00
|
| Rate for Payer: Healthscope Whirlpool |
$360.84
|
| Rate for Payer: Mclaren Commercial |
$334.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.20
|
| Rate for Payer: Nomi Health Commercial |
$305.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.36
|
|
|
TIMOLOL 5 MG TABLET
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
NDC 00378005501
|
| Hospital Charge Code |
7969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$334.80
|
| Rate for Payer: Aetna Medicare |
$186.00
|
| Rate for Payer: ASR ASR |
$360.84
|
| Rate for Payer: ASR Commercial |
$360.84
|
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: BCBS Trust/PPO |
$304.63
|
| Rate for Payer: BCN Commercial |
$288.41
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.60
|
| Rate for Payer: Healthscope Commercial |
$372.00
|
| Rate for Payer: Healthscope Whirlpool |
$360.84
|
| Rate for Payer: Mclaren Commercial |
$334.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.20
|
| Rate for Payer: Nomi Health Commercial |
$305.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.95
|
| Rate for Payer: Priority Health Narrow Network |
$260.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.36
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$20.20
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.13 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: ASR ASR |
$19.59
|
| Rate for Payer: ASR Commercial |
$19.59
|
| Rate for Payer: BCBS Trust/PPO |
$16.46
|
| Rate for Payer: BCN Commercial |
$15.66
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.16
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Healthscope Whirlpool |
$19.59
|
| Rate for Payer: Mclaren Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.17
|
| Rate for Payer: Nomi Health Commercial |
$16.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.78
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$35.80
|
|
|
Service Code
|
NDC 68682081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: ASR ASR |
$34.73
|
| Rate for Payer: ASR Commercial |
$34.73
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$29.32
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.64
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Healthscope Whirlpool |
$34.73
|
| 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: Priority Health Cigna Priority Health |
$23.27
|
| Rate for Payer: 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 |
$31.50
|
|
|
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 |
$9.16 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$20.62
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: ASR ASR |
$22.22
|
| Rate for Payer: ASR Commercial |
$22.22
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$18.76
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Healthscope Whirlpool |
$22.22
|
| Rate for Payer: Mclaren Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.89
|
| Rate for Payer: 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
|
|
|
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 |
$14.89 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$20.62
|
| Rate for Payer: ASR ASR |
$22.22
|
| Rate for Payer: ASR Commercial |
$22.22
|
| Rate for Payer: BCBS Trust/PPO |
$18.67
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Healthscope Whirlpool |
$22.22
|
| Rate for Payer: Mclaren Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.16
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$20.20
|
|
|
Service Code
|
NDC 61314022705
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: ASR ASR |
$19.59
|
| Rate for Payer: ASR Commercial |
$19.59
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: BCBS Trust/PPO |
$16.54
|
| Rate for Payer: BCN Commercial |
$15.66
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.16
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Healthscope Whirlpool |
$19.59
|
| Rate for Payer: Mclaren Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.17
|
| Rate for Payer: Nomi Health Commercial |
$16.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.70
|
| Rate for Payer: Priority Health Narrow Network |
$14.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.78
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$35.80
|
|
|
Service Code
|
NDC 68682081305
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: ASR ASR |
$34.73
|
| Rate for Payer: ASR Commercial |
$34.73
|
| Rate for Payer: BCBS Trust/PPO |
$29.17
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.64
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Healthscope Whirlpool |
$34.73
|
| 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: Priority Health Cigna Priority Health |
$23.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.50
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
OP
|
$30.76
|
|
|
Service Code
|
NDC 61314022710
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$30.76 |
| Rate for Payer: Aetna Commercial |
$27.68
|
| Rate for Payer: Aetna Medicare |
$15.38
|
| Rate for Payer: ASR ASR |
$29.84
|
| Rate for Payer: ASR Commercial |
$29.84
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS Trust/PPO |
$25.19
|
| Rate for Payer: BCN Commercial |
$23.85
|
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Cofinity Commercial |
$28.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.61
|
| Rate for Payer: Healthscope Commercial |
$30.76
|
| Rate for Payer: Healthscope Whirlpool |
$29.84
|
| Rate for Payer: Mclaren Commercial |
$27.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.95
|
| Rate for Payer: Priority Health Narrow Network |
$21.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.07
|
|
|
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 |
$9.13 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare |
$11.41
|
| Rate for Payer: ASR ASR |
$22.14
|
| Rate for Payer: ASR Commercial |
$22.14
|
| Rate for Payer: BCBS Complete |
$9.13
|
| Rate for Payer: BCBS Trust/PPO |
$18.69
|
| Rate for Payer: BCN Commercial |
$17.69
|
| 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 |
$22.82
|
| Rate for Payer: Healthscope Whirlpool |
$22.14
|
| 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: Priority Health Cigna Priority Health |
$14.83
|
| Rate for Payer: 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
|
|
|
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 |
$14.83 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: ASR ASR |
$22.14
|
| Rate for Payer: ASR Commercial |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$18.60
|
| Rate for Payer: BCN Commercial |
$17.69
|
| 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 |
$22.82
|
| Rate for Payer: Healthscope Whirlpool |
$22.14
|
| 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: Priority Health Cigna Priority Health |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.08
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
|
IP
|
$30.76
|
|
|
Service Code
|
NDC 61314022710
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$30.76 |
| Rate for Payer: Aetna Commercial |
$27.68
|
| Rate for Payer: ASR ASR |
$29.84
|
| Rate for Payer: ASR Commercial |
$29.84
|
| Rate for Payer: BCBS Trust/PPO |
$25.07
|
| Rate for Payer: BCN Commercial |
$23.85
|
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Cofinity Commercial |
$28.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.61
|
| Rate for Payer: Healthscope Commercial |
$30.76
|
| Rate for Payer: Healthscope Whirlpool |
$29.84
|
| Rate for Payer: Mclaren Commercial |
$27.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.15
|
| Rate for Payer: Nomi Health Commercial |
$25.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.07
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 68084064501
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.49 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: ASR ASR |
$415.60
|
| Rate for Payer: ASR Commercial |
$415.60
|
| Rate for Payer: BCBS Trust/PPO |
$349.14
|
| Rate for Payer: BCN Commercial |
$332.18
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$402.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$428.45
|
| Rate for Payer: Healthscope Whirlpool |
$415.60
|
| Rate for Payer: Mclaren Commercial |
$385.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.04
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 68084064501
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$385.61
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: ASR ASR |
$415.60
|
| Rate for Payer: ASR Commercial |
$415.60
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: BCBS Trust/PPO |
$350.86
|
| Rate for Payer: BCN Commercial |
$332.18
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$402.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$428.45
|
| Rate for Payer: Healthscope Whirlpool |
$415.60
|
| Rate for Payer: Mclaren Commercial |
$385.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: Nomi Health Commercial |
$351.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.41
|
| Rate for Payer: Priority Health Narrow Network |
$300.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$377.04
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 68084064511
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: ASR ASR |
$4.15
|
| Rate for Payer: ASR Commercial |
$4.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$3.43
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Healthscope Whirlpool |
$4.15
|
| Rate for Payer: Mclaren Commercial |
$3.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.64
|
| Rate for Payer: Nomi Health Commercial |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.77
|
|
