|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 60687050011
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.80
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health SBD |
$2.71
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$429.60
|
|
|
Service Code
|
NDC 60687050001
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.84 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna Medicare |
$214.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: BCBS Complete |
$171.84
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.16
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.24
|
| Rate for Payer: Priority Health SBD |
$270.65
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,330.90
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
106773
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.46 |
| Max. Negotiated Rate |
$5,697.81 |
| Rate for Payer: Aetna Commercial |
$5,381.26
|
| Rate for Payer: Aetna Medicare |
$138.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,115.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.65
|
| Rate for Payer: BCBS Complete |
$75.03
|
| Rate for Payer: BCBS MAPPO |
$133.32
|
| Rate for Payer: BCBS Trust/PPO |
$376.45
|
| Rate for Payer: BCN Commercial |
$376.45
|
| Rate for Payer: BCN Medicare Advantage |
$133.32
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cofinity Commercial |
$4,431.63
|
| Rate for Payer: Cofinity Commercial |
$5,444.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,431.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,064.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.32
|
| Rate for Payer: Healthscope Commercial |
$5,697.81
|
| Rate for Payer: Mclaren Medicaid |
$71.46
|
| Rate for Payer: Mclaren Medicare |
$133.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.99
|
| Rate for Payer: Meridian Medicaid |
$75.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,381.26
|
| Rate for Payer: Nomi Health Commercial |
$399.96
|
| Rate for Payer: PACE Medicare |
$126.65
|
| Rate for Payer: PACE SWMI |
$133.32
|
| Rate for Payer: PHP Commercial |
$5,381.26
|
| Rate for Payer: PHP Medicare Advantage |
$133.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,115.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.80
|
| Rate for Payer: Priority Health Medicare |
$133.32
|
| Rate for Payer: Priority Health Narrow Network |
$312.64
|
| Rate for Payer: Priority Health SBD |
$3,988.47
|
| Rate for Payer: Railroad Medicare Medicare |
$133.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.32
|
| Rate for Payer: UHC Medicare Advantage |
$133.32
|
| Rate for Payer: UHCCP Medicaid |
$75.06
|
| Rate for Payer: VA VA |
$133.32
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.11 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$67.11
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$53.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$67.11
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.40
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$93.90
|
| Rate for Payer: Aetna Commercial |
$114.49
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$107.75
|
| Rate for Payer: Cash Price |
$88.38
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$94.28
|
| Rate for Payer: Cofinity Commercial |
$115.83
|
| Rate for Payer: Cofinity Commercial |
$77.33
|
| Rate for Payer: Cofinity Commercial |
$95.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$99.42
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$121.22
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$114.49
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$93.90
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.55
|
| Rate for Payer: Priority Health SBD |
$84.85
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$69.60
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$267.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$110.47
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$99.42 |
| Rate for Payer: Aetna Commercial |
$93.90
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$114.49
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$67.34
|
| Rate for Payer: Aetna Medicare |
$55.24
|
| Rate for Payer: Aetna Medicare |
$50.70
|
| Rate for Payer: Aetna Medicare |
$53.26
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.81
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$44.19
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: Cash Price |
$107.75
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$88.38
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$88.38
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$107.75
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$77.33
|
| Rate for Payer: Cofinity Commercial |
$95.00
|
| Rate for Payer: Cofinity Commercial |
$115.83
|
| Rate for Payer: Cofinity Commercial |
$94.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.75
|
| Rate for Payer: Healthscope Commercial |
$99.42
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$121.22
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.49
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$93.90
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$114.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$69.60
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$84.85
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$53.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Trust/PPO |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.11 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
|
|
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 Commercial |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,185.47
|
| 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: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,957.94
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
|
|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
OP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.42 |
| 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 |
$29.42
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Commercial |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,185.47
|
| 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: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,957.94
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$561.22
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.57 |
| Max. Negotiated Rate |
$505.10 |
| Rate for Payer: Aetna Commercial |
$477.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.79
|
| Rate for Payer: Cash Price |
$448.98
|
| Rate for Payer: Cofinity Commercial |
$392.85
|
| Rate for Payer: Cofinity Commercial |
$482.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.98
|
| Rate for Payer: Healthscope Commercial |
$505.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.04
|
| Rate for Payer: PHP Commercial |
$477.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.79
|
| Rate for Payer: Priority Health SBD |
$353.57
|
|
|
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 Commercial |
$372.18
|
| Rate for Payer: Cofinity Commercial |
$457.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.18
|
| 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: PHP Commercial |
$451.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.60
|
| Rate for Payer: Priority Health SBD |
$334.96
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$561.22
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.49 |
| Max. Negotiated Rate |
$505.10 |
| Rate for Payer: Aetna Commercial |
$477.04
|
| Rate for Payer: Aetna Medicare |
$280.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.79
|
| Rate for Payer: BCBS Complete |
$224.49
|
| Rate for Payer: Cash Price |
$448.98
|
| Rate for Payer: Cofinity Commercial |
$392.85
|
| Rate for Payer: Cofinity Commercial |
$482.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.98
|
| Rate for Payer: Healthscope Commercial |
$505.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.04
|
| Rate for Payer: PHP Commercial |
$477.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.79
|
| Rate for Payer: Priority Health SBD |
$353.57
|
|
|
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 |
$205.97 |
| 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 Commercial |
$360.45
|
| Rate for Payer: Cofinity Commercial |
$442.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$360.45
|
| 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: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.70
|
| Rate for Payer: Priority Health SBD |
$324.41
|
|
|
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 |
$212.68 |
| Max. Negotiated Rate |
$478.52 |
| Rate for Payer: Aetna Commercial |
$451.94
|
| Rate for Payer: Aetna Medicare |
$265.84
|
| 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 Commercial |
$372.18
|
| Rate for Payer: Cofinity Commercial |
$457.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.18
|
| 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: PHP Commercial |
$451.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.60
|
| Rate for Payer: Priority Health SBD |
$334.96
|
|
|
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 Commercial |
$360.45
|
| Rate for Payer: Cofinity Commercial |
$442.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$360.45
|
| 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: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.70
|
| Rate for Payer: Priority Health SBD |
$324.41
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$22.23
|
|
|
Service Code
|
NDC 72485067031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: BCBS Complete |
$8.89
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$15.56
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.45
|
| Rate for Payer: Priority Health SBD |
$14.00
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$22.23
|
|
|
Service Code
|
NDC 72485067031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$15.56
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.45
|
| Rate for Payer: Priority Health SBD |
$14.00
|
|
|
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 |
$9.44 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| 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 Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| 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: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
|
|
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 |
$9.44 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| 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 Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| 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: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$26.03
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.92
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: Priority Health SBD |
$16.40
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$26.03
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.92
|
| Rate for Payer: BCBS Complete |
$10.41
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: Priority Health SBD |
$16.40
|
|
|
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 |
$7.16 |
| 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 Commercial |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$15.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.54
|
| 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: PHP Commercial |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.64
|
| Rate for Payer: Priority Health SBD |
$11.28
|
|
|
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 Commercial |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$15.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.54
|
| 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: PHP Commercial |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.64
|
| Rate for Payer: Priority Health SBD |
$11.28
|
|
