|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$22.26
|
|
|
Service Code
|
NDC 72485067031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$20.03 |
| Rate for Payer: Aetna American Axle |
$14.47
|
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.47
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: Cash Price |
$17.81
|
| Rate for Payer: Cofinity Advantage |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.81
|
| Rate for Payer: Healthscope Commercial |
$20.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: PHP Commercial |
$18.92
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.47
|
| Rate for Payer: UHC Core |
$11.60
|
| Rate for Payer: UHC Exchange |
$8.75
|
| Rate for Payer: UMR Bronson Commercial |
$8.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.70
|
|
|
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 |
$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 Advantage |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: 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 Commercial |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: 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
|
$34.30
|
|
|
Service Code
|
NDC 48102005711
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.09 |
| Max. Negotiated Rate |
$30.87 |
| Rate for Payer: Aetna American Axle |
$22.30
|
| Rate for Payer: Aetna Commercial |
$29.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.30
|
| Rate for Payer: Cash Price |
$27.44
|
| Rate for Payer: Cofinity Advantage |
$24.01
|
| Rate for Payer: Cofinity Commercial |
$29.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.44
|
| Rate for Payer: Healthscope Commercial |
$30.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.73
|
| Rate for Payer: PHP Commercial |
$29.16
|
| Rate for Payer: Priority Health SBD |
$21.61
|
| Rate for Payer: UMR Bronson Commercial |
$15.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.73
|
|
|
ERYTHROMYCIN-BENZOYL PEROXIDE 3 %-5 % TOPICAL GEL
|
Facility
|
IP
|
$543.13
|
|
|
Service Code
|
NDC 00781705449
|
| 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 Advantage |
$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 Commercial |
$461.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$407.35
|
| Rate for Payer: PHP Commercial |
$461.66
|
| 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-BENZOYL PEROXIDE 3 %-5 % TOPICAL GEL
|
Facility
|
OP
|
$543.13
|
|
|
Service Code
|
NDC 00781705449
|
| Hospital Charge Code |
9254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.96 |
| Max. Negotiated Rate |
$488.82 |
| Rate for Payer: Aetna American Axle |
$353.03
|
| Rate for Payer: Aetna Commercial |
$461.66
|
| Rate for Payer: Aetna Medicare |
$271.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.03
|
| Rate for Payer: BCBS Complete |
$217.25
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$434.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$407.35
|
| Rate for Payer: PHP Commercial |
$461.66
|
| Rate for Payer: Priority Health SBD |
$342.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.03
|
| Rate for Payer: UHC Core |
$282.97
|
| Rate for Payer: UHC Exchange |
$213.45
|
| Rate for Payer: UMR Bronson Commercial |
$200.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.35
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
NDC 69238150301
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Aetna American Axle |
$382.20
|
| Rate for Payer: Aetna Commercial |
$499.80
|
| Rate for Payer: Aetna Medicare |
$294.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.20
|
| Rate for Payer: BCBS Complete |
$235.20
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$470.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.00
|
| Rate for Payer: PHP Commercial |
$499.80
|
| Rate for Payer: Priority Health SBD |
$370.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.20
|
| Rate for Payer: UHC Core |
$306.35
|
| Rate for Payer: UHC Exchange |
$231.08
|
| Rate for Payer: UMR Bronson Commercial |
$217.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.00
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$926.40
|
|
|
Service Code
|
NDC 62559063001
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$342.77 |
| Max. Negotiated Rate |
$833.76 |
| Rate for Payer: Aetna American Axle |
$602.16
|
| Rate for Payer: Aetna Commercial |
$787.44
|
| Rate for Payer: Aetna Medicare |
$463.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.16
|
| Rate for Payer: BCBS Complete |
$370.56
|
| Rate for Payer: Cash Price |
$741.12
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$741.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.80
|
| Rate for Payer: PHP Commercial |
$787.44
|
| Rate for Payer: Priority Health SBD |
$583.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.16
|
| Rate for Payer: UHC Core |
$482.65
|
| Rate for Payer: UHC Exchange |
$364.08
|
| Rate for Payer: UMR Bronson Commercial |
$342.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.80
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$840.27
|
|
|
Service Code
|
NDC 24338013213
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$369.72 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna American Axle |
$546.18
|
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.18
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Advantage |
$588.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$588.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.20
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| Rate for Payer: UMR Bronson Commercial |
$369.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
NDC 69238150301
|
| 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 Advantage |
$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 Commercial |
$499.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.00
|
| Rate for Payer: PHP Commercial |
$499.80
|
| 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 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$840.27
|
|
|
Service Code
|
NDC 24338013213
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.90 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna American Axle |
$546.18
|
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna Medicare |
$420.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.18
|
| Rate for Payer: BCBS Complete |
$336.11
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Advantage |
$588.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$588.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$672.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.20
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.18
|
| Rate for Payer: UHC Core |
$437.78
|
| Rate for Payer: UHC Exchange |
$330.23
|
| Rate for Payer: UMR Bronson Commercial |
$310.90
|
| 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 |
$310.90 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna American Axle |
$546.18
|
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna Medicare |
$420.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.18
|
| Rate for Payer: BCBS Complete |
$336.11
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Advantage |
$588.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$588.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$672.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.20
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.18
|
| Rate for Payer: UHC Core |
$437.78
|
| Rate for Payer: UHC Exchange |
$330.23
|
| Rate for Payer: UMR Bronson Commercial |
$310.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
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 |
$369.72 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna American Axle |
$546.18
|
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.18
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Advantage |
$588.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$588.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.20
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| Rate for Payer: UMR Bronson Commercial |
$369.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$926.40
|
|
|
Service Code
|
NDC 62559063001
|
| 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 Advantage |
$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 Commercial |
$787.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.80
|
| Rate for Payer: PHP Commercial |
$787.44
|
| 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 400 MG TABLET
|
Facility
|
OP
|
$1,256.75
|
|
|
Service Code
|
NDC 24338011003
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$465.00 |
| 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 Medicare |
$628.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$816.89
|
| Rate for Payer: BCBS Complete |
$502.70
|
| Rate for Payer: Cash Price |
$1,005.40
|
| Rate for Payer: Cofinity Advantage |
$879.73
|
| Rate for Payer: Cofinity Commercial |
$1,080.81
|
| 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 |
$879.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,005.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$942.56
|
| Rate for Payer: PHP Commercial |
$1,068.24
|
| Rate for Payer: Priority Health SBD |
$791.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.89
|
| Rate for Payer: UHC Core |
$654.77
|
| Rate for Payer: UHC Exchange |
$493.90
|
| Rate for Payer: UMR Bronson Commercial |
$465.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$942.56
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET
|
Facility
|
OP
|
$1,256.75
|
|
|
Service Code
|
NDC 80005016108
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$465.00 |
| 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 Medicare |
$628.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$816.89
|
| Rate for Payer: BCBS Complete |
$502.70
|
| Rate for Payer: Cash Price |
$1,005.40
|
| Rate for Payer: Cofinity Advantage |
$879.73
|
| Rate for Payer: Cofinity Commercial |
$1,080.81
|
| 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 |
$879.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,005.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$942.56
|
| Rate for Payer: PHP Commercial |
$1,068.24
|
| Rate for Payer: Priority Health SBD |
$791.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.89
|
| Rate for Payer: UHC Core |
$654.77
|
| Rate for Payer: UHC Exchange |
$493.90
|
| Rate for Payer: UMR Bronson Commercial |
$465.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$942.56
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET
|
Facility
|
IP
|
$1,256.75
|
|
|
Service Code
|
NDC 80005016108
|
| 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 Advantage |
$879.73
|
| Rate for Payer: Cofinity Commercial |
$1,080.81
|
| 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 |
$879.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$942.56
|
| Rate for Payer: PHP Commercial |
$1,068.24
|
| 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
|
$1,256.75
|
|
|
Service Code
|
NDC 24338011003
|
| 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 Advantage |
$879.73
|
| Rate for Payer: Cofinity Commercial |
$1,080.81
|
| 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 |
$879.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$942.56
|
| Rate for Payer: PHP Commercial |
$1,068.24
|
| 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
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna American Axle |
$210.79
|
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.79
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Advantage |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.22
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health SBD |
$204.31
|
| Rate for Payer: UMR Bronson Commercial |
$142.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna American Axle |
$210.79
|
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Medicare |
$162.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.79
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Advantage |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.22
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health SBD |
$204.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.79
|
| Rate for Payer: UHC Core |
$168.96
|
| Rate for Payer: UHC Exchange |
$127.45
|
| Rate for Payer: UMR Bronson Commercial |
$119.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.73 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Advantage |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UMR Bronson Commercial |
$204.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.16 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna American Axle |
$302.44
|
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna Medicare |
$232.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.44
|
| Rate for Payer: BCBS Complete |
$186.12
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Advantage |
$325.71
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health SBD |
$293.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.44
|
| Rate for Payer: UHC Core |
$242.42
|
| Rate for Payer: UHC Exchange |
$182.86
|
| Rate for Payer: UMR Bronson Commercial |
$172.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 68084061711
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Advantage |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 68084061711
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Advantage |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.03
|
| Rate for Payer: UHC Core |
$2.43
|
| Rate for Payer: UHC Exchange |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 51079054420
|
| 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 Advantage |
$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 Commercial |
$232.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: PHP Commercial |
$232.56
|
| 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
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 65862037501
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Advantage |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
