|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$65.84
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$59.26 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$32.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Advantage |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$65.84
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$59.26 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Advantage |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: Priority Health SBD |
$267.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.12 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Commercial |
$151.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Advantage |
$124.36
|
| Rate for Payer: Cofinity Advantage |
$61.23
|
| Rate for Payer: Cofinity Advantage |
$296.80
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$152.79
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: PHP Commercial |
$151.01
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: Priority Health SBD |
$111.93
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$55.11
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Commercial |
$151.01
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$88.83
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$32.92
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna Medicare |
$43.73
|
| Rate for Payer: Aetna Medicare |
$33.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: BCBS Complete |
$34.99
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS Complete |
$26.49
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cash Price |
$59.46
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Advantage |
$124.36
|
| Rate for Payer: Cofinity Advantage |
$52.02
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Advantage |
$61.23
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Advantage |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$152.79
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$63.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.46
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Healthscope Commercial |
$66.89
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.60
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: PHP Commercial |
$151.01
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: PHP Commercial |
$63.17
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$55.11
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: Priority Health SBD |
$111.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$87.47
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.11 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Advantage |
$61.23
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.60
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: Priority Health SBD |
$55.11
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$87.47
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Medicare |
$32.92
|
| Rate for Payer: Aetna Medicare |
$43.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: BCBS Complete |
$34.99
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cofinity Advantage |
$61.23
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: Priority Health SBD |
$55.11
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
|
|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
OP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$4,095.60 |
| Rate for Payer: Aetna Commercial |
$3,868.07
|
| Rate for Payer: Aetna Medicare |
$2,275.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,957.94
|
| Rate for Payer: BCBS Complete |
$1,820.27
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCN Commercial |
$22.97
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Advantage |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,640.54
|
| Rate for Payer: Healthscope Commercial |
$4,095.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,640.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,868.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,413.00
|
| Rate for Payer: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
|
|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
IP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,866.92 |
| Max. Negotiated Rate |
$4,095.60 |
| Rate for Payer: Aetna Commercial |
$3,868.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,957.94
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Advantage |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,640.54
|
| Rate for Payer: Healthscope Commercial |
$4,095.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,868.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,413.00
|
| Rate for Payer: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$692.76
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.25 |
| Max. Negotiated Rate |
$623.48 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Medicare |
$346.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.29
|
| Rate for Payer: BCBS Complete |
$277.10
|
| Rate for Payer: Cash Price |
$554.21
|
| Rate for Payer: Cofinity Advantage |
$484.93
|
| Rate for Payer: Cofinity Commercial |
$595.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.21
|
| Rate for Payer: Healthscope Commercial |
$623.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$554.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.57
|
| Rate for Payer: PHP Commercial |
$588.85
|
| Rate for Payer: Priority Health SBD |
$436.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.29
|
| Rate for Payer: UHC Core |
$360.93
|
| Rate for Payer: UHC Exchange |
$272.25
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$514.93
|
|
|
Service Code
|
NDC 52536018003
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$463.44 |
| Rate for Payer: Aetna Commercial |
$437.69
|
| Rate for Payer: Aetna Medicare |
$257.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.70
|
| Rate for Payer: BCBS Complete |
$205.97
|
| Rate for Payer: Cash Price |
$411.94
|
| Rate for Payer: Cofinity Advantage |
$360.45
|
| Rate for Payer: Cofinity Commercial |
$442.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.94
|
| Rate for Payer: Healthscope Commercial |
$463.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$411.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$437.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$386.20
|
| Rate for Payer: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health SBD |
$324.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.70
|
| Rate for Payer: UHC Core |
$268.28
|
| Rate for Payer: UHC Exchange |
$202.37
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$531.69
|
|
|
Service Code
|
NDC 24338012203
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.96 |
| Max. Negotiated Rate |
$478.52 |
| Rate for Payer: Aetna Commercial |
$451.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.60
|
| Rate for Payer: Cash Price |
$425.35
|
| Rate for Payer: Cofinity Advantage |
$372.18
|
| Rate for Payer: Cofinity Commercial |
$457.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.35
|
| Rate for Payer: Healthscope Commercial |
$478.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.77
|
| Rate for Payer: PHP Commercial |
$451.94
|
| Rate for Payer: Priority Health SBD |
$334.96
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$531.69
|
|
|
Service Code
|
NDC 24338012203
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.95 |
| Max. Negotiated Rate |
$478.52 |
| Rate for Payer: Aetna Commercial |
$451.94
|
| Rate for Payer: Aetna Medicare |
$265.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.60
|
| Rate for Payer: BCBS Complete |
$212.68
|
| Rate for Payer: Cash Price |
$425.35
|
| Rate for Payer: Cofinity Advantage |
$372.18
|
| Rate for Payer: Cofinity Commercial |
$457.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.35
|
| Rate for Payer: Healthscope Commercial |
$478.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.77
|
| Rate for Payer: PHP Commercial |
$451.94
|
| Rate for Payer: Priority Health SBD |
$334.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.60
|
| Rate for Payer: UHC Core |
$277.01
|
| Rate for Payer: UHC Exchange |
$208.95
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$514.93
|
|
|
Service Code
|
NDC 52536018003
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.41 |
| Max. Negotiated Rate |
$463.44 |
| Rate for Payer: Aetna Commercial |
$437.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.70
|
| Rate for Payer: Cash Price |
$411.94
|
| Rate for Payer: Cofinity Advantage |
$360.45
|
| Rate for Payer: Cofinity Commercial |
$442.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.94
|
| Rate for Payer: Healthscope Commercial |
$463.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$437.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$386.20
|
| Rate for Payer: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health SBD |
$324.41
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$692.76
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$436.44 |
| Max. Negotiated Rate |
$623.48 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.29
|
| Rate for Payer: Cash Price |
$554.21
|
| Rate for Payer: Cofinity Advantage |
$484.93
|
| Rate for Payer: Cofinity Commercial |
$595.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.21
|
| Rate for Payer: Healthscope Commercial |
$623.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.57
|
| Rate for Payer: PHP Commercial |
$588.85
|
| Rate for Payer: Priority Health SBD |
$436.44
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$24.45
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Aetna Commercial |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.89
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cofinity Advantage |
$17.11
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.34
|
| Rate for Payer: PHP Commercial |
$20.78
|
| Rate for Payer: Priority Health SBD |
$15.40
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 00574402450
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Exchange |
$9.27
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$17.91
|
|
|
Service Code
|
NDC 17478007031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Aetna Commercial |
$15.22
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.64
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: Cash Price |
$14.33
|
| Rate for Payer: Cofinity Advantage |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.33
|
| Rate for Payer: Healthscope Commercial |
$16.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.43
|
| Rate for Payer: PHP Commercial |
$15.22
|
| Rate for Payer: Priority Health SBD |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.64
|
| Rate for Payer: UHC Core |
$9.33
|
| Rate for Payer: UHC Exchange |
$7.04
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$17.91
|
|
|
Service Code
|
NDC 17478007031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Aetna Commercial |
$15.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.64
|
| Rate for Payer: Cash Price |
$14.33
|
| Rate for Payer: Cofinity Advantage |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.33
|
| Rate for Payer: Healthscope Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.43
|
| Rate for Payer: PHP Commercial |
$15.22
|
| Rate for Payer: Priority Health SBD |
$11.28
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$22.26
|
|
|
Service Code
|
NDC 72485067031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$20.03 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Advantage |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: Priority Health SBD |
$14.02
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$22.26
|
|
|
Service Code
|
NDC 72485067031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$20.03 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Advantage |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.47
|
| Rate for Payer: UHC Core |
$11.60
|
| Rate for Payer: UHC Exchange |
$8.75
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$34.30
|
|
|
Service Code
|
NDC 48102005711
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$30.87 |
| Rate for Payer: Aetna Commercial |
$29.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.30
|
| Rate for Payer: Cash Price |
$27.44
|
| Rate for Payer: Cofinity Advantage |
$24.01
|
| Rate for Payer: Cofinity Commercial |
$29.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.44
|
| Rate for Payer: Healthscope Commercial |
$30.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.73
|
| Rate for Payer: PHP Commercial |
$29.16
|
| Rate for Payer: Priority Health SBD |
$21.61
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 00574402411
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health SBD |
$14.86
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$34.30
|
|
|
Service Code
|
NDC 48102005711
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$30.87 |
| Rate for Payer: Aetna Commercial |
$29.16
|
| Rate for Payer: Aetna Medicare |
$17.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.30
|
| Rate for Payer: BCBS Complete |
$13.72
|
| Rate for Payer: Cash Price |
$27.44
|
| Rate for Payer: Cofinity Advantage |
$24.01
|
| Rate for Payer: Cofinity Commercial |
$29.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.44
|
| Rate for Payer: Healthscope Commercial |
$30.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.73
|
| Rate for Payer: PHP Commercial |
$29.16
|
| Rate for Payer: Priority Health SBD |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.30
|
| Rate for Payer: UHC Core |
$17.87
|
| Rate for Payer: UHC Exchange |
$13.48
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 00574402411
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.33
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Exchange |
$9.27
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 00574402450
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health SBD |
$14.86
|
|
