|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 09900001965
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$266.19
|
|
|
Service Code
|
NDC 69367028302
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.49 |
| Max. Negotiated Rate |
$239.57 |
| Rate for Payer: Aetna American Axle |
$173.02
|
| Rate for Payer: Aetna Commercial |
$226.26
|
| Rate for Payer: Aetna Medicare |
$133.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.02
|
| Rate for Payer: BCBS Complete |
$106.48
|
| Rate for Payer: Cash Price |
$212.95
|
| Rate for Payer: Cofinity Commercial |
$186.33
|
| Rate for Payer: Cofinity Commercial |
$228.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.95
|
| Rate for Payer: Healthscope Commercial |
$239.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.26
|
| Rate for Payer: PHP Commercial |
$226.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.02
|
| Rate for Payer: Priority Health SBD |
$167.70
|
| Rate for Payer: UMR Bronson Commercial |
$98.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.64
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$266.19
|
|
|
Service Code
|
NDC 69367028302
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$239.57 |
| Rate for Payer: Aetna American Axle |
$173.02
|
| Rate for Payer: Aetna Commercial |
$226.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.02
|
| Rate for Payer: Cash Price |
$212.95
|
| Rate for Payer: Cofinity Commercial |
$186.33
|
| Rate for Payer: Cofinity Commercial |
$228.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.95
|
| Rate for Payer: Healthscope Commercial |
$239.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.26
|
| Rate for Payer: PHP Commercial |
$226.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.02
|
| Rate for Payer: Priority Health SBD |
$167.70
|
| Rate for Payer: UMR Bronson Commercial |
$117.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.64
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$277.59
|
|
|
Service Code
|
NDC 47781064726
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.14 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna American Axle |
$180.43
|
| Rate for Payer: Aetna Commercial |
$235.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: Cash Price |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$238.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.07
|
| Rate for Payer: Healthscope Commercial |
$249.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.95
|
| Rate for Payer: PHP Commercial |
$235.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.43
|
| Rate for Payer: Priority Health SBD |
$174.88
|
| Rate for Payer: UMR Bronson Commercial |
$122.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.19
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$277.59
|
|
|
Service Code
|
NDC 47781064726
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.71 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna American Axle |
$180.43
|
| Rate for Payer: Aetna Commercial |
$235.95
|
| Rate for Payer: Aetna Medicare |
$138.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: BCBS Complete |
$111.04
|
| Rate for Payer: Cash Price |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$238.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.07
|
| Rate for Payer: Healthscope Commercial |
$249.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.95
|
| Rate for Payer: PHP Commercial |
$235.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.43
|
| Rate for Payer: Priority Health SBD |
$174.88
|
| Rate for Payer: UMR Bronson Commercial |
$102.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.19
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$260.49
|
|
|
Service Code
|
NDC 75834001060
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.38 |
| Max. Negotiated Rate |
$234.44 |
| Rate for Payer: Aetna American Axle |
$169.32
|
| Rate for Payer: Aetna Commercial |
$221.42
|
| Rate for Payer: Aetna Medicare |
$130.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.32
|
| Rate for Payer: BCBS Complete |
$104.20
|
| Rate for Payer: Cash Price |
$208.39
|
| Rate for Payer: Cofinity Commercial |
$182.34
|
| Rate for Payer: Cofinity Commercial |
$224.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.39
|
| Rate for Payer: Healthscope Commercial |
$234.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.42
|
| Rate for Payer: PHP Commercial |
$221.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.32
|
| Rate for Payer: Priority Health SBD |
$164.11
|
| Rate for Payer: UMR Bronson Commercial |
$96.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.37
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,330.90
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
106773
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.46 |
| Max. Negotiated Rate |
$5,697.81 |
| Rate for Payer: Aetna American Axle |
$4,115.08
|
| Rate for Payer: Aetna Commercial |
$5,381.26
|
| Rate for Payer: Aetna Medicare |
$138.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,115.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.65
|
| Rate for Payer: BCBS Complete |
$75.03
|
| Rate for Payer: BCBS MAPPO |
$133.32
|
| Rate for Payer: BCBS Trust/PPO |
$359.33
|
| Rate for Payer: BCN Commercial |
$359.33
|
| Rate for Payer: BCN Medicare Advantage |
$133.32
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cofinity Commercial |
$5,444.57
|
| Rate for Payer: Cofinity Commercial |
$4,431.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,431.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,064.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.32
|
| Rate for Payer: Healthscope Commercial |
$5,697.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,431.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,748.18
|
| Rate for Payer: Mclaren Medicaid |
$71.46
|
| Rate for Payer: Mclaren Medicare |
$133.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.99
|
| Rate for Payer: Meridian Medicaid |
$75.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,381.26
|
| Rate for Payer: Nomi Health Commercial |
$399.96
|
| Rate for Payer: PACE Medicare |
$126.65
|
| Rate for Payer: PACE SWMI |
$133.32
|
| Rate for Payer: PHP Commercial |
$5,381.26
|
| Rate for Payer: PHP Medicare Advantage |
$133.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,115.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.80
|
| Rate for Payer: Priority Health Medicare |
$133.32
|
| Rate for Payer: Priority Health Narrow Network |
$312.64
|
| Rate for Payer: Priority Health SBD |
$3,988.47
|
| Rate for Payer: Railroad Medicare Medicare |
$133.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.32
|
| Rate for Payer: UHC Exchange |
$254.79
|
| Rate for Payer: UHC Medicare Advantage |
$133.32
|
| Rate for Payer: UHCCP Medicaid |
$71.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,342.43
|
| Rate for Payer: VA VA |
$133.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,748.18
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$206.93
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: UMR Bronson Commercial |
$186.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$206.93
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Medicare |
$103.46
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$76.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.56 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna American Axle |
$65.91
|
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna American Axle |
$53.51
|
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$69.98
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$65.86
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$57.63
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$70.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$74.10
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$69.98
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health SBD |
$51.87
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.87
|
| Rate for Payer: UMR Bronson Commercial |
$186.56
|
| Rate for Payer: UMR Bronson Commercial |
$36.23
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$65.91
|
| Rate for Payer: Aetna American Axle |
$53.51
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$69.98
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$103.46
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$53.26
|
| Rate for Payer: Aetna Medicare |
$50.70
|
| Rate for Payer: Aetna Medicare |
$41.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$32.93
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$65.86
|
| Rate for Payer: Cash Price |
$65.86
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$70.80
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$57.63
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$74.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$69.98
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$51.87
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$37.52
|
| Rate for Payer: UMR Bronson Commercial |
$76.56
|
| Rate for Payer: UMR Bronson Commercial |
$39.42
|
| Rate for Payer: UMR Bronson Commercial |
$156.88
|
| Rate for Payer: UMR Bronson Commercial |
$30.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$53.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: UMR Bronson Commercial |
$39.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.87 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: UMR Bronson Commercial |
$46.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
|
|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
OP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.08 |
| 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: BCBS Trust/PPO |
$28.08
|
| Rate for Payer: BCN Commercial |
$28.08
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Commercial |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,185.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,640.54
|
| Rate for Payer: Healthscope Commercial |
$4,095.60
|
| Rate for Payer: 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
|
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
|
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 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
|
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
|
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 |
$265.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.60
|
| Rate for Payer: BCBS Complete |
$212.68
|
| Rate for Payer: Cash Price |
$425.35
|
| Rate for Payer: Cofinity Commercial |
$372.18
|
| Rate for Payer: Cofinity Commercial |
$457.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$372.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.35
|
| Rate for Payer: Healthscope Commercial |
$478.52
|
| Rate for Payer: 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
|
$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 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
|
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 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 |
$399.22
|
| 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
|
|
