|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$514.93
|
|
|
Service Code
|
NDC 52536-180-03
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.57 |
| Max. Negotiated Rate |
$463.44 |
| Rate for Payer: Aetna American Axle |
$334.70
|
| 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: Encore Health Key Benefits Commercial |
$411.94
|
| Rate for Payer: Healthscope Commercial |
$463.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$360.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$386.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$437.69
|
| Rate for Payer: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.45
|
| Rate for Payer: Priority Health SBD |
$324.41
|
| Rate for Payer: UMR Bronson Commercial |
$226.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$386.20
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$513.16
|
|
|
Service Code
|
NDC 69238-1471-3
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.79 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna American Axle |
$333.55
|
| Rate for Payer: Aetna Commercial |
$436.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.55
|
| Rate for Payer: Cash Price |
$410.53
|
| Rate for Payer: Cofinity Commercial |
$359.21
|
| Rate for Payer: Cofinity Commercial |
$441.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.53
|
| Rate for Payer: Healthscope Commercial |
$461.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$436.19
|
| Rate for Payer: PHP Commercial |
$436.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.21
|
| Rate for Payer: Priority Health SBD |
$323.29
|
| Rate for Payer: UMR Bronson Commercial |
$225.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.87
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$2,418.69
|
|
|
Service Code
|
NDC 24338-122-13
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,064.22 |
| Max. Negotiated Rate |
$2,176.82 |
| Rate for Payer: Aetna American Axle |
$1,572.15
|
| Rate for Payer: Aetna Commercial |
$2,055.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,572.15
|
| Rate for Payer: Cash Price |
$1,934.95
|
| Rate for Payer: Cofinity Commercial |
$1,693.08
|
| Rate for Payer: Cofinity Commercial |
$2,080.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,934.95
|
| Rate for Payer: Healthscope Commercial |
$2,176.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,693.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,814.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,055.89
|
| Rate for Payer: PHP Commercial |
$2,055.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,693.08
|
| Rate for Payer: Priority Health SBD |
$1,523.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,064.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,814.02
|
|
|
ERYTHROMYCIN 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$798.43
|
|
|
Service Code
|
NDC 52536-186-03
|
| Hospital Charge Code |
108526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.31 |
| Max. Negotiated Rate |
$718.59 |
| Rate for Payer: Aetna American Axle |
$518.98
|
| Rate for Payer: Aetna Commercial |
$678.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.98
|
| Rate for Payer: Cash Price |
$638.74
|
| Rate for Payer: Cofinity Commercial |
$558.90
|
| Rate for Payer: Cofinity Commercial |
$686.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$638.74
|
| Rate for Payer: Healthscope Commercial |
$718.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$558.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$598.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$678.67
|
| Rate for Payer: PHP Commercial |
$678.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$558.90
|
| Rate for Payer: Priority Health SBD |
$503.01
|
| Rate for Payer: UMR Bronson Commercial |
$351.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$598.82
|
|
|
ERYTHROMYCIN 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$875.35
|
|
|
Service Code
|
NDC 69238-1473-3
|
| Hospital Charge Code |
108526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.15 |
| Max. Negotiated Rate |
$787.82 |
| Rate for Payer: Aetna American Axle |
$568.98
|
| Rate for Payer: Aetna Commercial |
$744.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.98
|
| Rate for Payer: Cash Price |
$700.28
|
| Rate for Payer: Cofinity Commercial |
$612.74
|
| Rate for Payer: Cofinity Commercial |
$752.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.28
|
| Rate for Payer: Healthscope Commercial |
$787.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$656.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$744.05
|
| Rate for Payer: PHP Commercial |
$744.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.74
|
| Rate for Payer: Priority Health SBD |
$551.47
|
| Rate for Payer: UMR Bronson Commercial |
$385.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$656.51
|
|
|
ERYTHROMYCIN 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3,749.58
|
|
|
Service Code
|
NDC 24338-126-13
|
| Hospital Charge Code |
108526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,649.82 |
| Max. Negotiated Rate |
$3,374.62 |
| Rate for Payer: Aetna American Axle |
$2,437.23
|
| Rate for Payer: Aetna Commercial |
$3,187.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,437.23
|
| Rate for Payer: Cash Price |
$2,999.66
|
| Rate for Payer: Cofinity Commercial |
$2,624.71
|
| Rate for Payer: Cofinity Commercial |
$3,224.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,999.66
|
| Rate for Payer: Healthscope Commercial |
$3,374.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,624.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,812.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,187.14
|
| Rate for Payer: PHP Commercial |
$3,187.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,624.71
|
| Rate for Payer: Priority Health SBD |
$2,362.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,649.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,812.18
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
NDC 0574-4024-39
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Aetna American Axle |
$28.83
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.83
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cofinity Commercial |
$31.05
|
| Rate for Payer: Cofinity Commercial |
$38.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.49
|
| Rate for Payer: Healthscope Commercial |
$39.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.71
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.05
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: UMR Bronson Commercial |
$19.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.27
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 0574-4024-50
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| 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 Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.51
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.33
|
|
|
Service Code
|
NDC 24208-910-19
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna American Axle |
$15.16
|
| Rate for Payer: Aetna Commercial |
$19.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.16
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$21.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.83
|
| Rate for Payer: PHP Commercial |
$19.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.33
|
| Rate for Payer: Priority Health SBD |
$14.70
|
| Rate for Payer: UMR Bronson Commercial |
$10.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.50
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$17.91
|
|
|
Service Code
|
NDC 17478-070-31
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Aetna American Axle |
$11.64
|
| 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: Encore Health Key Benefits Commercial |
$14.33
|
| Rate for Payer: Healthscope Commercial |
$16.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.22
|
| Rate for Payer: PHP Commercial |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.54
|
| Rate for Payer: Priority Health SBD |
$11.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.43
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$27.20
|
|
|
Service Code
|
NDC 24208-910-55
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$24.48 |
| Rate for Payer: Aetna American Axle |
$17.68
|
| Rate for Payer: Aetna Commercial |
$23.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.68
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cofinity Commercial |
$19.04
|
| Rate for Payer: Cofinity Commercial |
$23.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.76
|
| Rate for Payer: Healthscope Commercial |
$24.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.12
|
| Rate for Payer: PHP Commercial |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.04
|
| Rate for Payer: Priority Health SBD |
$17.14
|
| Rate for Payer: UMR Bronson Commercial |
$11.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.40
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 0574-4024-11
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| 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 Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.51
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$48.72
|
|
|
Service Code
|
NDC 0574-4024-35
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.44 |
| Max. Negotiated Rate |
$43.85 |
| Rate for Payer: Aetna American Axle |
$31.67
|
| Rate for Payer: Aetna Commercial |
$41.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.67
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Commercial |
$34.10
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Healthscope Commercial |
$43.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.41
|
| Rate for Payer: PHP Commercial |
$41.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.10
|
| Rate for Payer: Priority Health SBD |
$30.69
|
| Rate for Payer: UMR Bronson Commercial |
$21.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.54
|
|
|
ERYTHROMYCIN-BENZOYL PEROXIDE 3 %-5 % TOPICAL GEL
|
Facility
|
IP
|
$543.13
|
|
|
Service Code
|
NDC 0781-7054-49
|
| Hospital Charge Code |
9254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.98 |
| Max. Negotiated Rate |
$488.82 |
| Rate for Payer: Aetna American Axle |
$353.03
|
| Rate for Payer: Aetna Commercial |
$461.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.03
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cofinity Commercial |
$380.19
|
| Rate for Payer: Cofinity Commercial |
$467.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.50
|
| Rate for Payer: Healthscope Commercial |
$488.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$380.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$407.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.66
|
| Rate for Payer: PHP Commercial |
$461.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.19
|
| Rate for Payer: Priority Health SBD |
$342.17
|
| Rate for Payer: UMR Bronson Commercial |
$238.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.35
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$838.05
|
|
|
Service Code
|
NDC 24338-132-13
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.74 |
| Max. Negotiated Rate |
$754.24 |
| Rate for Payer: Aetna American Axle |
$544.73
|
| Rate for Payer: Aetna Commercial |
$712.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.73
|
| Rate for Payer: Cash Price |
$670.44
|
| Rate for Payer: Cofinity Commercial |
$586.64
|
| Rate for Payer: Cofinity Commercial |
$720.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.44
|
| Rate for Payer: Healthscope Commercial |
$754.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$586.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$628.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$712.34
|
| Rate for Payer: PHP Commercial |
$712.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.64
|
| Rate for Payer: Priority Health SBD |
$527.97
|
| Rate for Payer: UMR Bronson Commercial |
$368.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$628.54
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$926.40
|
|
|
Service Code
|
NDC 62559-630-01
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$407.62 |
| Max. Negotiated Rate |
$833.76 |
| Rate for Payer: Aetna American Axle |
$602.16
|
| Rate for Payer: Aetna Commercial |
$787.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.16
|
| Rate for Payer: Cash Price |
$741.12
|
| Rate for Payer: Cofinity Commercial |
$648.48
|
| Rate for Payer: Cofinity Commercial |
$796.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.12
|
| Rate for Payer: Healthscope Commercial |
$833.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$648.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$787.44
|
| Rate for Payer: PHP Commercial |
$787.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.48
|
| Rate for Payer: Priority Health SBD |
$583.63
|
| Rate for Payer: UMR Bronson Commercial |
$407.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.80
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$841.38
|
|
|
Service Code
|
NDC 24338-134-02
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$370.21 |
| Max. Negotiated Rate |
$757.24 |
| Rate for Payer: Aetna American Axle |
$546.90
|
| Rate for Payer: Aetna Commercial |
$715.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.90
|
| Rate for Payer: Cash Price |
$673.10
|
| Rate for Payer: Cofinity Commercial |
$588.97
|
| Rate for Payer: Cofinity Commercial |
$723.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.10
|
| Rate for Payer: Healthscope Commercial |
$757.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$588.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$715.17
|
| Rate for Payer: PHP Commercial |
$715.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.97
|
| Rate for Payer: Priority Health SBD |
$530.07
|
| Rate for Payer: UMR Bronson Commercial |
$370.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.04
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
NDC 69238-1503-1
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.72 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Aetna American Axle |
$382.20
|
| Rate for Payer: Aetna Commercial |
$499.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.20
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cofinity Commercial |
$411.60
|
| Rate for Payer: Cofinity Commercial |
$505.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.40
|
| Rate for Payer: Healthscope Commercial |
$529.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$499.80
|
| Rate for Payer: PHP Commercial |
$499.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.60
|
| Rate for Payer: Priority Health SBD |
$370.44
|
| Rate for Payer: UMR Bronson Commercial |
$258.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.00
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET
|
Facility
|
IP
|
$1,256.75
|
|
|
Service Code
|
NDC 24338-110-03
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$552.97 |
| Max. Negotiated Rate |
$1,131.08 |
| Rate for Payer: Aetna American Axle |
$816.89
|
| Rate for Payer: Aetna Commercial |
$1,068.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$816.89
|
| Rate for Payer: Cash Price |
$1,005.40
|
| Rate for Payer: Cofinity Commercial |
$1,080.80
|
| Rate for Payer: Cofinity Commercial |
$879.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.40
|
| Rate for Payer: Healthscope Commercial |
$1,131.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$879.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,068.24
|
| Rate for Payer: PHP Commercial |
$1,068.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.72
|
| Rate for Payer: Priority Health SBD |
$791.75
|
| Rate for Payer: UMR Bronson Commercial |
$552.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$942.56
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET
|
Facility
|
IP
|
$4,173.60
|
|
|
Service Code
|
NDC 24338-110-13
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,836.38 |
| Max. Negotiated Rate |
$3,756.24 |
| Rate for Payer: Aetna American Axle |
$2,712.84
|
| Rate for Payer: Aetna Commercial |
$3,547.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,712.84
|
| Rate for Payer: Cash Price |
$3,338.88
|
| Rate for Payer: Cofinity Commercial |
$2,921.52
|
| Rate for Payer: Cofinity Commercial |
$3,589.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,338.88
|
| Rate for Payer: Healthscope Commercial |
$3,756.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,921.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,130.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,547.56
|
| Rate for Payer: PHP Commercial |
$3,547.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,921.52
|
| Rate for Payer: Priority Health SBD |
$2,629.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,836.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,130.20
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 68084-617-01
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.58
|
| Rate for Payer: PHP Commercial |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.65
|
| Rate for Payer: Priority Health SBD |
$125.68
|
| Rate for Payer: UMR Bronson Commercial |
$87.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 0904-6426-61
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 68084-617-11
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 0904-6427-61
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna American Axle |
$233.71
|
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$251.68
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.62
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.68
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UMR Bronson Commercial |
$158.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 51079-544-20
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.52
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
