|
EPINEPHRINE ANAPHYLAXIS KIT
|
Facility
|
OP
|
$62.31
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
181607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$56.08 |
| Rate for Payer: Aetna Commercial |
$52.96
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.47
|
| Rate for Payer: BCBS Complete |
$24.92
|
| Rate for Payer: BCBS MAPPO |
$15.58
|
| Rate for Payer: BCBS Trust/PPO |
$51.23
|
| Rate for Payer: BCN Commercial |
$48.45
|
| Rate for Payer: BCN Medicare Advantage |
$15.58
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$53.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$56.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.96
|
| Rate for Payer: Nomi Health Commercial |
$51.09
|
| Rate for Payer: PACE Senior Care Partners |
$14.80
|
| Rate for Payer: PACE SWMI |
$15.58
|
| Rate for Payer: PHP Commercial |
$52.96
|
| Rate for Payer: PHP Medicare Advantage |
$15.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.50
|
| Rate for Payer: Priority Health HMO/PPO |
$54.21
|
| Rate for Payer: Priority Health Medicare |
$15.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.75
|
| Rate for Payer: Railroad Medicare Medicare |
$15.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.83
|
| Rate for Payer: UHC Core |
$52.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.58
|
| Rate for Payer: UHC Exchange |
$15.58
|
| Rate for Payer: UHC Medicare Advantage |
$15.58
|
| Rate for Payer: VA VA |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.73
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$29.06
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPINEPHRINE HCL 0.1 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$35.60
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
163700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$32.04 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$14.24
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCBS Trust/PPO |
$29.27
|
| Rate for Payer: BCN Commercial |
$27.68
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$30.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$32.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: PACE Senior Care Partners |
$8.46
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.14
|
| Rate for Payer: Priority Health HMO/PPO |
$30.97
|
| Rate for Payer: Priority Health Medicare |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.33
|
| Rate for Payer: UHC Core |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Exchange |
$8.90
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: VA VA |
$8.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.70
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$257.99
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.69 |
| Max. Negotiated Rate |
$232.19 |
| Rate for Payer: Aetna Commercial |
$219.29
|
| Rate for Payer: BCBS Trust/PPO |
$210.60
|
| Rate for Payer: BCN Commercial |
$199.37
|
| Rate for Payer: Cash Price |
$206.39
|
| Rate for Payer: Cofinity Commercial |
$221.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.39
|
| Rate for Payer: Healthscope Commercial |
$232.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.29
|
| Rate for Payer: Nomi Health Commercial |
$211.55
|
| Rate for Payer: PHP Commercial |
$219.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.69
|
| Rate for Payer: Priority Health HMO/PPO |
$224.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.03
|
| Rate for Payer: UHC Core |
$215.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.49
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$257.99
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.27 |
| Max. Negotiated Rate |
$232.19 |
| Rate for Payer: Aetna Commercial |
$219.29
|
| Rate for Payer: Aetna Medicare |
$67.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.62
|
| Rate for Payer: BCBS Complete |
$103.20
|
| Rate for Payer: BCBS MAPPO |
$64.50
|
| Rate for Payer: BCBS Trust/PPO |
$212.09
|
| Rate for Payer: BCN Commercial |
$200.59
|
| Rate for Payer: BCN Medicare Advantage |
$64.50
|
| Rate for Payer: Cash Price |
$206.39
|
| Rate for Payer: Cofinity Commercial |
$221.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$232.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.29
|
| Rate for Payer: Nomi Health Commercial |
$211.55
|
| Rate for Payer: PACE Senior Care Partners |
$61.27
|
| Rate for Payer: PACE SWMI |
$64.50
|
| Rate for Payer: PHP Commercial |
$219.29
|
| Rate for Payer: PHP Medicare Advantage |
$64.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.69
|
| Rate for Payer: Priority Health HMO/PPO |
$224.45
|
| Rate for Payer: Priority Health Medicare |
$65.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.85
|
| Rate for Payer: Railroad Medicare Medicare |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.03
|
| Rate for Payer: UHC Core |
$215.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.50
|
| Rate for Payer: UHC Exchange |
$64.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: VA VA |
$64.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.49
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.27
|
| Rate for Payer: BCBS Complete |
$119.38
|
| Rate for Payer: BCBS MAPPO |
$74.61
|
| Rate for Payer: BCBS Trust/PPO |
$245.36
|
| Rate for Payer: BCN Commercial |
$232.04
|
| Rate for Payer: BCN Medicare Advantage |
$74.61
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.61
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: PACE Senior Care Partners |
$70.88
|
| Rate for Payer: PACE SWMI |
$74.61
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: PHP Medicare Advantage |
$74.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Medicare |
$75.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.96
|
| Rate for Payer: Railroad Medicare Medicare |
$74.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.61
|
| Rate for Payer: UHC Exchange |
$74.61
|
| Rate for Payer: UHC Medicare Advantage |
$74.61
|
| Rate for Payer: VA VA |
$74.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: BCBS Trust/PPO |
$243.62
|
| Rate for Payer: BCN Commercial |
$230.64
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$110.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.50
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS MAPPO |
$106.00
|
| Rate for Payer: BCBS Trust/PPO |
$348.57
|
| Rate for Payer: BCN Commercial |
$329.66
|
| Rate for Payer: BCN Medicare Advantage |
$106.00
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.00
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: PACE Senior Care Partners |
$100.70
|
| Rate for Payer: PACE SWMI |
$106.00
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Medicare Advantage |
$106.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health HMO/PPO |
$368.88
|
| Rate for Payer: Priority Health Medicare |
$107.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.08
|
| Rate for Payer: Railroad Medicare Medicare |
$106.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.00
|
| Rate for Payer: UHC Exchange |
$106.00
|
| Rate for Payer: UHC Medicare Advantage |
$106.00
|
| Rate for Payer: VA VA |
$106.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: BCBS Trust/PPO |
$346.11
|
| Rate for Payer: BCN Commercial |
$327.67
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health HMO/PPO |
$368.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$101.40
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$27.70
|
| Rate for Payer: Aetna Medicare |
$26.36
|
| Rate for Payer: Aetna Medicare |
$32.28
|
| Rate for Payer: Aetna Medicare |
$110.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.69
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$49.66
|
| Rate for Payer: BCBS MAPPO |
$25.35
|
| Rate for Payer: BCBS MAPPO |
$26.63
|
| Rate for Payer: BCBS MAPPO |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$31.04
|
| Rate for Payer: BCBS Trust/PPO |
$83.36
|
| Rate for Payer: BCBS Trust/PPO |
$348.57
|
| Rate for Payer: BCBS Trust/PPO |
$87.58
|
| Rate for Payer: BCBS Trust/PPO |
$102.07
|
| Rate for Payer: BCN Commercial |
$78.84
|
| Rate for Payer: BCN Commercial |
$96.53
|
| Rate for Payer: BCN Commercial |
$82.83
|
| Rate for Payer: BCN Commercial |
$329.66
|
| Rate for Payer: BCN Medicare Advantage |
$26.63
|
| Rate for Payer: BCN Medicare Advantage |
$106.00
|
| Rate for Payer: BCN Medicare Advantage |
$25.35
|
| Rate for Payer: BCN Medicare Advantage |
$31.04
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.04
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$83.15
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: PACE Senior Care Partners |
$24.08
|
| Rate for Payer: PACE Senior Care Partners |
$29.49
|
| Rate for Payer: PACE Senior Care Partners |
$100.70
|
| Rate for Payer: PACE Senior Care Partners |
$25.30
|
| Rate for Payer: PACE SWMI |
$26.63
|
| Rate for Payer: PACE SWMI |
$25.35
|
| Rate for Payer: PACE SWMI |
$31.04
|
| Rate for Payer: PACE SWMI |
$106.00
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Medicare Advantage |
$26.63
|
| Rate for Payer: PHP Medicare Advantage |
$25.35
|
| Rate for Payer: PHP Medicare Advantage |
$106.00
|
| Rate for Payer: PHP Medicare Advantage |
$31.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.70
|
| 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 HMO/PPO |
$92.68
|
| Rate for Payer: Priority Health HMO/PPO |
$368.88
|
| Rate for Payer: Priority Health HMO/PPO |
$108.02
|
| Rate for Payer: Priority Health HMO/PPO |
$88.22
|
| Rate for Payer: Priority Health Medicare |
$31.35
|
| Rate for Payer: Priority Health Medicare |
$25.60
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: Priority Health Medicare |
$107.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.94
|
| Rate for Payer: Railroad Medicare Medicare |
$26.63
|
| Rate for Payer: Railroad Medicare Medicare |
$31.04
|
| Rate for Payer: Railroad Medicare Medicare |
$25.35
|
| Rate for Payer: Railroad Medicare Medicare |
$106.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC Core |
$84.67
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: UHC Core |
$103.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.63
|
| Rate for Payer: UHC Exchange |
$106.00
|
| Rate for Payer: UHC Exchange |
$26.63
|
| Rate for Payer: UHC Exchange |
$25.35
|
| Rate for Payer: UHC Exchange |
$31.04
|
| Rate for Payer: UHC Medicare Advantage |
$106.00
|
| Rate for Payer: UHC Medicare Advantage |
$25.35
|
| Rate for Payer: UHC Medicare Advantage |
$31.04
|
| Rate for Payer: UHC Medicare Advantage |
$26.63
|
| Rate for Payer: VA VA |
$26.63
|
| Rate for Payer: VA VA |
$106.00
|
| Rate for Payer: VA VA |
$31.04
|
| Rate for Payer: VA VA |
$25.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$124.16
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: BCBS Trust/PPO |
$101.35
|
| Rate for Payer: BCBS Trust/PPO |
$346.11
|
| Rate for Payer: BCBS Trust/PPO |
$86.96
|
| Rate for Payer: BCBS Trust/PPO |
$82.77
|
| Rate for Payer: BCN Commercial |
$95.95
|
| Rate for Payer: BCN Commercial |
$78.36
|
| Rate for Payer: BCN Commercial |
$327.67
|
| Rate for Payer: BCN Commercial |
$82.33
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| 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: Healthscope Commercial |
$111.74
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Nomi Health Commercial |
$83.15
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$105.54
|
| 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 |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.70
|
| Rate for Payer: Priority Health HMO/PPO |
$108.02
|
| Rate for Payer: Priority Health HMO/PPO |
$368.88
|
| Rate for Payer: Priority Health HMO/PPO |
$88.22
|
| Rate for Payer: Priority Health HMO/PPO |
$92.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.26
|
| Rate for Payer: UHC Core |
$103.67
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: UHC Core |
$84.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.12
|
|
|
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 |
$69.24 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: BCBS Trust/PPO |
$86.96
|
| Rate for Payer: BCN Commercial |
$82.33
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health HMO/PPO |
$92.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
|
|
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 |
$25.30 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$27.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.29
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS MAPPO |
$26.63
|
| Rate for Payer: BCBS Trust/PPO |
$87.58
|
| Rate for Payer: BCN Commercial |
$82.83
|
| Rate for Payer: BCN Medicare Advantage |
$26.63
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Nomi Health Commercial |
$87.35
|
| Rate for Payer: PACE Senior Care Partners |
$25.30
|
| Rate for Payer: PACE SWMI |
$26.63
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Medicare Advantage |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health HMO/PPO |
$92.68
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.38
|
| Rate for Payer: Railroad Medicare Medicare |
$26.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.63
|
| Rate for Payer: UHC Exchange |
$26.63
|
| Rate for Payer: UHC Medicare Advantage |
$26.63
|
| Rate for Payer: VA VA |
$26.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
|
|
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 |
$16.92 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.25
|
| Rate for Payer: BCN Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.34
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: Priority Health HMO/PPO |
$22.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.91
|
| Rate for Payer: UHC Core |
$21.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.52
|
|
|
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 |
$5.60 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$6.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.37
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$18.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.90
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.90
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: PACE Senior Care Partners |
$5.60
|
| Rate for Payer: PACE SWMI |
$5.90
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Medicare |
$5.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| Rate for Payer: Railroad Medicare Medicare |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.90
|
| Rate for Payer: UHC Exchange |
$5.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.90
|
| Rate for Payer: VA VA |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
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 |
$6.18 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$10.41
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.40
|
| Rate for Payer: BCN Commercial |
$20.24
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Nomi Health Commercial |
$21.34
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: Priority Health HMO/PPO |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.44
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.91
|
| Rate for Payer: UHC Core |
$21.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.51
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UHC Medicare Advantage |
$6.51
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.52
|
|
|
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 |
$5.60 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$6.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.37
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$18.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.90
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.90
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: PACE Senior Care Partners |
$5.60
|
| Rate for Payer: PACE SWMI |
$5.90
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Medicare |
$5.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| Rate for Payer: Railroad Medicare Medicare |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.90
|
| Rate for Payer: UHC Exchange |
$5.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.90
|
| Rate for Payer: VA VA |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
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 |
$15.33 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.26
|
| Rate for Payer: BCN Commercial |
$18.23
|
| Rate for Payer: Cash Price |
$18.87
|
| 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: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
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 |
$15.33 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.26
|
| Rate for Payer: BCN Commercial |
$18.23
|
| Rate for Payer: Cash Price |
$18.87
|
| 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: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$840.27
|
|
|
Service Code
|
NDC 24338013402
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$546.18 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: BCBS Trust/PPO |
$685.91
|
| Rate for Payer: BCN Commercial |
$649.36
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.22
|
| Rate for Payer: Healthscope Commercial |
$756.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Nomi Health Commercial |
$689.02
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health HMO/PPO |
$731.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.44
|
| Rate for Payer: UHC Core |
$701.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$840.27
|
|
|
Service Code
|
NDC 24338013402
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna Medicare |
$218.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.58
|
| Rate for Payer: BCBS Complete |
$336.11
|
| Rate for Payer: BCBS MAPPO |
$210.07
|
| Rate for Payer: BCBS Trust/PPO |
$690.79
|
| Rate for Payer: BCN Commercial |
$653.31
|
| Rate for Payer: BCN Medicare Advantage |
$210.07
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.07
|
| Rate for Payer: Healthscope Commercial |
$756.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Nomi Health Commercial |
$689.02
|
| Rate for Payer: PACE Senior Care Partners |
$199.56
|
| Rate for Payer: PACE SWMI |
$210.07
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: PHP Medicare Advantage |
$210.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health HMO/PPO |
$731.03
|
| Rate for Payer: Priority Health Medicare |
$212.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.98
|
| Rate for Payer: Railroad Medicare Medicare |
$210.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.44
|
| Rate for Payer: UHC Core |
$701.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.07
|
| Rate for Payer: UHC Exchange |
$210.07
|
| Rate for Payer: UHC Medicare Advantage |
$210.07
|
| Rate for Payer: VA VA |
$210.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$198.99
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
2903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.34 |
| Max. Negotiated Rate |
$179.09 |
| Rate for Payer: Aetna Commercial |
$169.14
|
| Rate for Payer: BCBS Trust/PPO |
$162.44
|
| Rate for Payer: BCN Commercial |
$153.78
|
| Rate for Payer: Cash Price |
$159.19
|
| Rate for Payer: Cofinity Commercial |
$171.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.19
|
| Rate for Payer: Healthscope Commercial |
$179.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.14
|
| Rate for Payer: Nomi Health Commercial |
$163.17
|
| Rate for Payer: PHP Commercial |
$169.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.34
|
| Rate for Payer: Priority Health HMO/PPO |
$173.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.11
|
| Rate for Payer: UHC Core |
$166.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.24
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$198.99
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
2903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.26 |
| Max. Negotiated Rate |
$179.09 |
| Rate for Payer: Aetna Commercial |
$169.14
|
| Rate for Payer: Aetna Medicare |
$51.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.18
|
| Rate for Payer: BCBS Complete |
$79.60
|
| Rate for Payer: BCBS MAPPO |
$49.75
|
| Rate for Payer: BCBS Trust/PPO |
$163.59
|
| Rate for Payer: BCN Commercial |
$154.71
|
| Rate for Payer: BCN Medicare Advantage |
$49.75
|
| Rate for Payer: Cash Price |
$159.19
|
| Rate for Payer: Cofinity Commercial |
$171.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.75
|
| Rate for Payer: Healthscope Commercial |
$179.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.14
|
| Rate for Payer: Nomi Health Commercial |
$163.17
|
| Rate for Payer: PACE Senior Care Partners |
$47.26
|
| Rate for Payer: PACE SWMI |
$49.75
|
| Rate for Payer: PHP Commercial |
$169.14
|
| Rate for Payer: PHP Medicare Advantage |
$49.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.34
|
| Rate for Payer: Priority Health HMO/PPO |
$173.12
|
| Rate for Payer: Priority Health Medicare |
$50.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.32
|
| Rate for Payer: Railroad Medicare Medicare |
$49.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.11
|
| Rate for Payer: UHC Core |
$166.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.75
|
| Rate for Payer: UHC Exchange |
$49.75
|
| Rate for Payer: UHC Medicare Advantage |
$49.75
|
| Rate for Payer: VA VA |
$49.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.24
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$52.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.94
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: BCBS MAPPO |
$50.35
|
| Rate for Payer: BCBS Trust/PPO |
$165.57
|
| Rate for Payer: BCN Commercial |
$156.59
|
| Rate for Payer: BCN Medicare Advantage |
$50.35
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.35
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: Nomi Health Commercial |
$165.15
|
| Rate for Payer: PACE Senior Care Partners |
$47.83
|
| Rate for Payer: PACE SWMI |
$50.35
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: PHP Medicare Advantage |
$50.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health HMO/PPO |
$175.22
|
| Rate for Payer: Priority Health Medicare |
$50.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.94
|
| Rate for Payer: Railroad Medicare Medicare |
$50.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.23
|
| Rate for Payer: UHC Core |
$168.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.35
|
| Rate for Payer: UHC Exchange |
$50.35
|
| Rate for Payer: UHC Medicare Advantage |
$50.35
|
| Rate for Payer: VA VA |
$50.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.91 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: BCBS Trust/PPO |
$164.40
|
| Rate for Payer: BCN Commercial |
$155.64
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: Nomi Health Commercial |
$165.15
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health HMO/PPO |
$175.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.23
|
| Rate for Payer: UHC Core |
$168.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
