|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$26.03
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna American Axle |
$16.92
|
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.92
|
| Rate for Payer: BCBS Complete |
$10.41
|
| 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 |
$9.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.52
|
|
|
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
|
$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 |
$25.72
|
| 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 |
$25.72
|
|
|
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
|
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: Cofinity Commercial |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$30.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.19
|
| 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: 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
|
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
|
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 |
$11.80
|
| 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
|
$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 |
$25.72
|
| 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 |
$25.72
|
|
|
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
|
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 |
$11.80
|
| 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
|
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
|
|
|
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
|
$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
|
$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-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 Commercial |
$380.19
|
| Rate for Payer: Cofinity Commercial |
$467.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.19
|
| 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: PHP Commercial |
$461.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.03
|
| Rate for Payer: Priority Health SBD |
$342.17
|
| Rate for Payer: UMR Bronson Commercial |
$200.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.35
|
|
|
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 Commercial |
$380.19
|
| Rate for Payer: Cofinity Commercial |
$467.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.19
|
| 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: PHP Commercial |
$461.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.03
|
| Rate for Payer: Priority Health SBD |
$342.17
|
| Rate for Payer: UMR Bronson Commercial |
$238.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.35
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$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: PHP Commercial |
$714.23
|
| 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 Commercial |
$588.19
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.19
|
| 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: Priority Health Cigna Priority Health |
$546.18
|
| 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
|
$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 Commercial |
$588.19
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.19
|
| 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: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| 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
|
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 |
$420.14
|
| 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 Commercial |
$588.19
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.19
|
| 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: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| 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
|
$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 Commercial |
$411.60
|
| Rate for Payer: Cofinity Commercial |
$505.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$411.60
|
| 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: PHP Commercial |
$499.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.20
|
| 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
|
$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: Cofinity Commercial |
$796.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$648.48
|
| 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 Commercial |
$648.48
|
| 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: PHP Commercial |
$787.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.16
|
| Rate for Payer: Priority Health SBD |
$583.63
|
| 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
|
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 |
$420.14
|
| 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 Commercial |
$588.19
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.19
|
| 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: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| 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
|
$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 Commercial |
$411.60
|
| Rate for Payer: Cofinity Commercial |
$505.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$411.60
|
| 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: PHP Commercial |
$499.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.20
|
| Rate for Payer: Priority Health SBD |
$370.44
|
| 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
|
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 Commercial |
$648.48
|
| Rate for Payer: Cofinity Commercial |
$796.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$648.48
|
| 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: PHP Commercial |
$787.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.16
|
| 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
|
$4,173.60
|
|
|
Service Code
|
NDC 24338011013
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,544.23 |
| Max. Negotiated Rate |
$3,756.24 |
| Rate for Payer: Aetna American Axle |
$2,712.84
|
| Rate for Payer: Aetna Commercial |
$3,547.56
|
| Rate for Payer: Aetna Medicare |
$2,086.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,712.84
|
| Rate for Payer: BCBS Complete |
$1,669.44
|
| Rate for Payer: Cash Price |
$3,338.88
|
| Rate for Payer: Cofinity Commercial |
$2,921.52
|
| Rate for Payer: Cofinity Commercial |
$3,589.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,921.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,338.88
|
| Rate for Payer: Healthscope Commercial |
$3,756.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,921.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,130.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,547.56
|
| Rate for Payer: PHP Commercial |
$3,547.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,712.84
|
| Rate for Payer: Priority Health SBD |
$2,629.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,544.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,130.20
|
|
