|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
OP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,683.75 |
| Max. Negotiated Rate |
$4,095.60 |
| Rate for Payer: Aetna American Axle |
$2,957.94
|
| Rate for Payer: Aetna Commercial |
$3,868.07
|
| Rate for Payer: Aetna Medicare |
$2,275.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,957.94
|
| Rate for Payer: BCBS Complete |
$1,820.27
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Commercial |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,185.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,640.54
|
| Rate for Payer: Healthscope Commercial |
$4,095.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,185.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,413.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,868.07
|
| Rate for Payer: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,957.94
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,683.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,413.00
|
|
|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
IP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,002.29 |
| Max. Negotiated Rate |
$4,095.60 |
| Rate for Payer: Aetna American Axle |
$2,957.94
|
| Rate for Payer: Aetna Commercial |
$3,868.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,957.94
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Commercial |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,185.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,640.54
|
| Rate for Payer: Healthscope Commercial |
$4,095.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,185.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,413.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,868.07
|
| Rate for Payer: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,957.94
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,002.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,413.00
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$561.22
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.94 |
| Max. Negotiated Rate |
$505.10 |
| Rate for Payer: Aetna American Axle |
$364.79
|
| Rate for Payer: Aetna Commercial |
$477.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.79
|
| Rate for Payer: Cash Price |
$448.98
|
| Rate for Payer: Cofinity Commercial |
$392.85
|
| Rate for Payer: Cofinity Commercial |
$482.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.98
|
| Rate for Payer: Healthscope Commercial |
$505.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.04
|
| Rate for Payer: PHP Commercial |
$477.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.79
|
| Rate for Payer: Priority Health SBD |
$353.57
|
| Rate for Payer: UMR Bronson Commercial |
$246.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.92
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$531.69
|
|
|
Service Code
|
NDC 24338012203
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.94 |
| Max. Negotiated Rate |
$478.52 |
| Rate for Payer: Aetna American Axle |
$345.60
|
| Rate for Payer: Aetna Commercial |
$451.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.60
|
| Rate for Payer: Cash Price |
$425.35
|
| Rate for Payer: Cofinity Commercial |
$372.18
|
| Rate for Payer: Cofinity Commercial |
$457.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.35
|
| Rate for Payer: Healthscope Commercial |
$478.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.94
|
| Rate for Payer: PHP Commercial |
$451.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.60
|
| Rate for Payer: Priority Health SBD |
$334.96
|
| Rate for Payer: UMR Bronson Commercial |
$233.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.77
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$561.22
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.65 |
| Max. Negotiated Rate |
$505.10 |
| Rate for Payer: Aetna American Axle |
$364.79
|
| Rate for Payer: Aetna Commercial |
$477.04
|
| Rate for Payer: Aetna Medicare |
$280.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.79
|
| Rate for Payer: BCBS Complete |
$224.49
|
| Rate for Payer: Cash Price |
$448.98
|
| Rate for Payer: Cofinity Commercial |
$392.85
|
| Rate for Payer: Cofinity Commercial |
$482.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.98
|
| Rate for Payer: Healthscope Commercial |
$505.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.04
|
| Rate for Payer: PHP Commercial |
$477.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.79
|
| Rate for Payer: Priority Health SBD |
$353.57
|
| Rate for Payer: UMR Bronson Commercial |
$207.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.92
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$514.93
|
|
|
Service Code
|
NDC 52536018003
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.52 |
| Max. Negotiated Rate |
$463.44 |
| Rate for Payer: Aetna American Axle |
$334.70
|
| Rate for Payer: Aetna Commercial |
$437.69
|
| Rate for Payer: Aetna Medicare |
$257.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.70
|
| Rate for Payer: BCBS Complete |
$205.97
|
| Rate for Payer: Cash Price |
$411.94
|
| Rate for Payer: Cofinity Commercial |
$360.45
|
| Rate for Payer: Cofinity Commercial |
$442.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$360.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.94
|
| Rate for Payer: Healthscope Commercial |
$463.44
|
| Rate for Payer: 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 Commercial |
$437.69
|
| Rate for Payer: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.70
|
| Rate for Payer: Priority Health SBD |
$324.41
|
| Rate for Payer: UMR Bronson Commercial |
$190.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$386.20
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$531.69
|
|
|
Service Code
|
NDC 24338012203
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.73 |
| Max. Negotiated Rate |
$478.52 |
| Rate for Payer: Aetna American Axle |
$345.60
|
| Rate for Payer: Aetna Commercial |
$451.94
|
| Rate for Payer: Aetna Medicare |
$265.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.60
|
| Rate for Payer: BCBS Complete |
$212.68
|
| Rate for Payer: Cash Price |
$425.35
|
| Rate for Payer: Cofinity Commercial |
$372.18
|
| Rate for Payer: Cofinity Commercial |
$457.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.35
|
| Rate for Payer: Healthscope Commercial |
$478.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$372.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.94
|
| Rate for Payer: PHP Commercial |
$451.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.60
|
| Rate for Payer: Priority Health SBD |
$334.96
|
| Rate for Payer: UMR Bronson Commercial |
$196.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.77
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$514.93
|
|
|
Service Code
|
NDC 52536018003
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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: Cofinity Medicare Advantage |
$360.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.94
|
| Rate for Payer: Healthscope Commercial |
$463.44
|
| Rate for Payer: 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 Commercial |
$437.69
|
| Rate for Payer: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.70
|
| Rate for Payer: Priority Health SBD |
$324.41
|
| Rate for Payer: UMR Bronson Commercial |
$226.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$386.20
|
|
|
ERYTHROMYCIN 500 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$798.43
|
|
|
Service Code
|
NDC 52536018603
|
| 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: Cofinity Medicare Advantage |
$558.90
|
| 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 Commercial |
$678.67
|
| Rate for Payer: PHP Commercial |
$678.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.98
|
| 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
|
$895.00
|
|
|
Service Code
|
NDC 69238147303
|
| Hospital Charge Code |
108526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Aetna American Axle |
$581.75
|
| Rate for Payer: Aetna Commercial |
$760.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.75
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$626.50
|
| Rate for Payer: Cofinity Commercial |
$769.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.00
|
| Rate for Payer: Healthscope Commercial |
$805.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: PHP Commercial |
$760.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.75
|
| Rate for Payer: Priority Health SBD |
$563.85
|
| Rate for Payer: UMR Bronson Commercial |
$393.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.25
|
|
|
ERYTHROMYCIN 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$798.43
|
|
|
Service Code
|
NDC 52536018603
|
| Hospital Charge Code |
108526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.42 |
| Max. Negotiated Rate |
$718.59 |
| Rate for Payer: Aetna American Axle |
$518.98
|
| Rate for Payer: Aetna Commercial |
$678.67
|
| Rate for Payer: Aetna Medicare |
$399.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.98
|
| Rate for Payer: BCBS Complete |
$319.37
|
| Rate for Payer: Cash Price |
$638.74
|
| Rate for Payer: Cofinity Commercial |
$558.90
|
| Rate for Payer: Cofinity Commercial |
$686.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$558.90
|
| 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 Commercial |
$678.67
|
| Rate for Payer: PHP Commercial |
$678.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.98
|
| Rate for Payer: Priority Health SBD |
$503.01
|
| Rate for Payer: UMR Bronson Commercial |
$295.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$598.82
|
|
|
ERYTHROMYCIN 500 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
NDC 69238147303
|
| Hospital Charge Code |
108526
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.15 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Aetna American Axle |
$581.75
|
| Rate for Payer: Aetna Commercial |
$760.75
|
| Rate for Payer: Aetna Medicare |
$447.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.75
|
| Rate for Payer: BCBS Complete |
$358.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$626.50
|
| Rate for Payer: Cofinity Commercial |
$769.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.00
|
| Rate for Payer: Healthscope Commercial |
$805.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.75
|
| Rate for Payer: PHP Commercial |
$760.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.75
|
| Rate for Payer: Priority Health SBD |
$563.85
|
| Rate for Payer: UMR Bronson Commercial |
$331.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.25
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$34.30
|
|
|
Service Code
|
NDC 48102005711
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$30.87 |
| Rate for Payer: Aetna American Axle |
$22.30
|
| Rate for Payer: Aetna Commercial |
$29.16
|
| Rate for Payer: Aetna Medicare |
$17.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.30
|
| Rate for Payer: BCBS Complete |
$13.72
|
| Rate for Payer: Cash Price |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Cofinity Commercial |
$29.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.01
|
| 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: PHP Commercial |
$29.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.30
|
| Rate for Payer: Priority Health SBD |
$21.61
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.73
|
|
|
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 |
$11.45 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna American Axle |
$16.92
|
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.92
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$23.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: Priority Health SBD |
$16.40
|
| Rate for Payer: UMR Bronson Commercial |
$11.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.52
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$22.23
|
|
|
Service Code
|
NDC 72485067031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Aetna American Axle |
$14.45
|
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: BCBS Complete |
$8.89
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$15.56
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$20.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.45
|
| Rate for Payer: Priority Health SBD |
$14.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.67
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$22.23
|
|
|
Service Code
|
NDC 72485067031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Aetna American Axle |
$14.45
|
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$15.56
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$20.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.45
|
| Rate for Payer: Priority Health SBD |
$14.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.67
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$35.98
|
|
|
Service Code
|
NDC 72485067035
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: Aetna American Axle |
$23.39
|
| Rate for Payer: Aetna Commercial |
$30.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.39
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$30.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$32.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.58
|
| Rate for Payer: PHP Commercial |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.39
|
| Rate for Payer: Priority Health SBD |
$22.67
|
| Rate for Payer: UMR Bronson Commercial |
$15.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.98
|
|
|
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 Commercial |
$24.01
|
| Rate for Payer: Cofinity Commercial |
$29.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.01
|
| 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: PHP Commercial |
$29.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.30
|
| 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 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
NDC 72485067035
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: Aetna American Axle |
$23.39
|
| Rate for Payer: Aetna Commercial |
$30.58
|
| Rate for Payer: Aetna Medicare |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.39
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$30.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$32.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.58
|
| Rate for Payer: PHP Commercial |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.39
|
| Rate for Payer: Priority Health SBD |
$22.67
|
| Rate for Payer: UMR Bronson Commercial |
$13.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.98
|
|
|
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 |
$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: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: 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: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| 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
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 00574402450
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: 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: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| 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 |
$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: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: 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: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| 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
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 00574402411
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: 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: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$17.91
|
|
|
Service Code
|
NDC 17478007031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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: Cofinity Medicare Advantage |
$12.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.33
|
| Rate for Payer: Healthscope Commercial |
$16.12
|
| Rate for Payer: 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 Commercial |
$15.22
|
| Rate for Payer: PHP Commercial |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.64
|
| Rate for Payer: Priority Health SBD |
$11.28
|
| 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
|
OP
|
$17.91
|
|
|
Service Code
|
NDC 17478007031
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$16.12 |
| Rate for Payer: Aetna American Axle |
$11.64
|
| Rate for Payer: Aetna Commercial |
$15.22
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.64
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: Cash Price |
$14.33
|
| Rate for Payer: Cofinity Commercial |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$15.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.33
|
| Rate for Payer: Healthscope Commercial |
$16.12
|
| Rate for Payer: 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 Commercial |
$15.22
|
| Rate for Payer: PHP Commercial |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.64
|
| Rate for Payer: Priority Health SBD |
$11.28
|
| Rate for Payer: UMR Bronson Commercial |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.43
|
|
