|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$310.20
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$310.20 |
| Rate for Payer: Aetna Commercial |
$279.18
|
| Rate for Payer: Aetna Medicare |
$114.77
|
| Rate for Payer: ASR ASR |
$300.89
|
| Rate for Payer: BCBS Complete |
$124.08
|
| Rate for Payer: BCBS Trust/PPO |
$255.76
|
| Rate for Payer: BCN Commercial |
$255.76
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$291.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$300.89
|
| Rate for Payer: Healthscope Whirlpool |
$310.20
|
| Rate for Payer: Mclaren Commercial |
$279.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Nomi Health Commercial |
$254.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.80
|
| Rate for Payer: Priority Health Narrow Network |
$217.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.98
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$165.54
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.16 |
| Max. Negotiated Rate |
$165.54 |
| Rate for Payer: Aetna Commercial |
$148.99
|
| Rate for Payer: Aetna Commercial |
$61.08
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: ASR ASR |
$65.84
|
| Rate for Payer: ASR ASR |
$160.57
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: BCBS Trust/PPO |
$55.74
|
| Rate for Payer: BCBS Trust/PPO |
$135.94
|
| Rate for Payer: BCBS Trust/PPO |
$348.18
|
| Rate for Payer: BCN Commercial |
$348.18
|
| Rate for Payer: BCN Commercial |
$135.94
|
| Rate for Payer: BCN Commercial |
$55.74
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$63.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$411.28
|
| Rate for Payer: Healthscope Commercial |
$160.57
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Healthscope Whirlpool |
$424.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.87
|
| Rate for Payer: Healthscope Whirlpool |
$165.54
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Mclaren Commercial |
$148.99
|
| Rate for Payer: Mclaren Commercial |
$61.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$135.74
|
| Rate for Payer: Nomi Health Commercial |
$55.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.68
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$165.54
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$165.54 |
| Rate for Payer: Aetna Commercial |
$148.99
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Commercial |
$61.08
|
| Rate for Payer: Aetna Medicare |
$156.88
|
| Rate for Payer: Aetna Medicare |
$61.25
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: ASR ASR |
$65.84
|
| Rate for Payer: ASR ASR |
$160.57
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: BCBS Complete |
$66.22
|
| Rate for Payer: BCBS Complete |
$27.15
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Trust/PPO |
$136.49
|
| Rate for Payer: BCBS Trust/PPO |
$349.58
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$136.49
|
| Rate for Payer: BCN Commercial |
$349.58
|
| Rate for Payer: BCN Commercial |
$55.96
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$63.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Healthscope Commercial |
$160.57
|
| Rate for Payer: Healthscope Commercial |
$411.28
|
| Rate for Payer: Healthscope Whirlpool |
$424.00
|
| Rate for Payer: Healthscope Whirlpool |
$165.54
|
| Rate for Payer: Healthscope Whirlpool |
$67.87
|
| Rate for Payer: Mclaren Commercial |
$61.08
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Mclaren Commercial |
$148.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Nomi Health Commercial |
$55.66
|
| Rate for Payer: Nomi Health Commercial |
$135.74
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.68
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$67.87
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$67.87 |
| Rate for Payer: Aetna Commercial |
$61.08
|
| Rate for Payer: Aetna Commercial |
$64.63
|
| Rate for Payer: Aetna Commercial |
$148.99
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: Aetna Commercial |
$66.88
|
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: Aetna Commercial |
$59.59
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: Aetna Medicare |
$156.88
|
| Rate for Payer: Aetna Medicare |
$26.57
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: Aetna Medicare |
$33.69
|
| Rate for Payer: Aetna Medicare |
$16.83
|
| Rate for Payer: Aetna Medicare |
$61.25
|
| Rate for Payer: ASR ASR |
$65.84
|
| Rate for Payer: ASR ASR |
$64.23
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: ASR ASR |
$160.57
|
| Rate for Payer: ASR ASR |
$44.12
|
| Rate for Payer: ASR ASR |
$88.32
|
| Rate for Payer: ASR ASR |
$72.09
|
| Rate for Payer: ASR ASR |
$69.65
|
| Rate for Payer: BCBS Complete |
$18.19
|
| Rate for Payer: BCBS Complete |
$26.49
|
| Rate for Payer: BCBS Complete |
$27.15
|
| Rate for Payer: BCBS Complete |
$29.73
|
| Rate for Payer: BCBS Complete |
$36.42
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$28.72
|
| Rate for Payer: BCBS Complete |
$66.22
|
| Rate for Payer: BCBS Trust/PPO |
$349.58
|
| Rate for Payer: BCBS Trust/PPO |
$136.49
|
| Rate for Payer: BCBS Trust/PPO |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$75.07
|
| Rate for Payer: BCBS Trust/PPO |
$61.27
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCBS Trust/PPO |
$59.20
|
| Rate for Payer: BCBS Trust/PPO |
$54.60
|
| Rate for Payer: BCN Commercial |
$136.49
|
| Rate for Payer: BCN Commercial |
$55.96
|
| Rate for Payer: BCN Commercial |
$75.07
|
| Rate for Payer: BCN Commercial |
$37.50
|
| Rate for Payer: BCN Commercial |
$54.60
|
| Rate for Payer: BCN Commercial |
$349.58
|
| Rate for Payer: BCN Commercial |
$61.27
|
| Rate for Payer: BCN Commercial |
$59.20
|
| Rate for Payer: Cash Price |
$36.39
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$36.39
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Cash Price |
$59.45
|
| Rate for Payer: Cash Price |
$59.45
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$67.50
|
| Rate for Payer: Cofinity Commercial |
$85.58
|
| Rate for Payer: Cofinity Commercial |
$69.86
|
| Rate for Payer: Cofinity Commercial |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.30
|
| Rate for Payer: Healthscope Commercial |
$64.23
|
| Rate for Payer: Healthscope Commercial |
$88.32
|
| Rate for Payer: Healthscope Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$44.12
|
| Rate for Payer: Healthscope Commercial |
$411.28
|
| Rate for Payer: Healthscope Commercial |
$160.57
|
| Rate for Payer: Healthscope Commercial |
$69.65
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Healthscope Whirlpool |
$165.54
|
| Rate for Payer: Healthscope Whirlpool |
$91.05
|
| Rate for Payer: Healthscope Whirlpool |
$66.22
|
| Rate for Payer: Healthscope Whirlpool |
$67.87
|
| Rate for Payer: Healthscope Whirlpool |
$71.81
|
| Rate for Payer: Healthscope Whirlpool |
$424.00
|
| Rate for Payer: Healthscope Whirlpool |
$74.31
|
| Rate for Payer: Healthscope Whirlpool |
$45.48
|
| Rate for Payer: Mclaren Commercial |
$40.94
|
| Rate for Payer: Mclaren Commercial |
$59.59
|
| Rate for Payer: Mclaren Commercial |
$64.63
|
| Rate for Payer: Mclaren Commercial |
$66.88
|
| Rate for Payer: Mclaren Commercial |
$148.99
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Mclaren Commercial |
$61.08
|
| Rate for Payer: Mclaren Commercial |
$81.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Nomi Health Commercial |
$135.74
|
| Rate for Payer: Nomi Health Commercial |
$74.66
|
| Rate for Payer: Nomi Health Commercial |
$37.30
|
| Rate for Payer: Nomi Health Commercial |
$54.30
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$58.88
|
| Rate for Payer: Nomi Health Commercial |
$60.94
|
| Rate for Payer: Nomi Health Commercial |
$55.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.19
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$74.32
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.74 |
| Max. Negotiated Rate |
$74.31 |
| Rate for Payer: Aetna Commercial |
$66.88
|
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: Aetna Commercial |
$59.59
|
| Rate for Payer: Aetna Commercial |
$61.08
|
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Commercial |
$148.99
|
| Rate for Payer: Aetna Commercial |
$64.63
|
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: ASR ASR |
$44.12
|
| Rate for Payer: ASR ASR |
$72.09
|
| Rate for Payer: ASR ASR |
$65.84
|
| Rate for Payer: ASR ASR |
$88.32
|
| Rate for Payer: ASR ASR |
$411.28
|
| Rate for Payer: ASR ASR |
$64.23
|
| Rate for Payer: ASR ASR |
$160.57
|
| Rate for Payer: ASR ASR |
$69.65
|
| Rate for Payer: BCBS Trust/PPO |
$135.94
|
| Rate for Payer: BCBS Trust/PPO |
$348.18
|
| Rate for Payer: BCBS Trust/PPO |
$55.74
|
| Rate for Payer: BCBS Trust/PPO |
$74.77
|
| Rate for Payer: BCBS Trust/PPO |
$61.03
|
| Rate for Payer: BCBS Trust/PPO |
$58.97
|
| Rate for Payer: BCBS Trust/PPO |
$37.35
|
| Rate for Payer: BCBS Trust/PPO |
$54.38
|
| Rate for Payer: BCN Commercial |
$348.18
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Commercial |
$74.77
|
| Rate for Payer: BCN Commercial |
$54.38
|
| Rate for Payer: BCN Commercial |
$55.74
|
| Rate for Payer: BCN Commercial |
$135.94
|
| Rate for Payer: BCN Commercial |
$58.97
|
| Rate for Payer: BCN Commercial |
$61.03
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$132.43
|
| Rate for Payer: Cash Price |
$36.39
|
| Rate for Payer: Cash Price |
$52.97
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cash Price |
$59.45
|
| Rate for Payer: Cofinity Commercial |
$67.50
|
| Rate for Payer: Cofinity Commercial |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$85.58
|
| Rate for Payer: Cofinity Commercial |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$69.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.39
|
| Rate for Payer: Healthscope Commercial |
$65.84
|
| Rate for Payer: Healthscope Commercial |
$411.28
|
| Rate for Payer: Healthscope Commercial |
$44.12
|
| Rate for Payer: Healthscope Commercial |
$88.32
|
| Rate for Payer: Healthscope Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$69.65
|
| Rate for Payer: Healthscope Commercial |
$160.57
|
| Rate for Payer: Healthscope Commercial |
$64.23
|
| Rate for Payer: Healthscope Whirlpool |
$45.48
|
| Rate for Payer: Healthscope Whirlpool |
$66.22
|
| Rate for Payer: Healthscope Whirlpool |
$424.00
|
| Rate for Payer: Healthscope Whirlpool |
$67.87
|
| Rate for Payer: Healthscope Whirlpool |
$165.54
|
| Rate for Payer: Healthscope Whirlpool |
$71.81
|
| Rate for Payer: Healthscope Whirlpool |
$74.31
|
| Rate for Payer: Healthscope Whirlpool |
$91.05
|
| Rate for Payer: Mclaren Commercial |
$61.08
|
| Rate for Payer: Mclaren Commercial |
$81.94
|
| Rate for Payer: Mclaren Commercial |
$148.99
|
| Rate for Payer: Mclaren Commercial |
$381.60
|
| Rate for Payer: Mclaren Commercial |
$59.59
|
| Rate for Payer: Mclaren Commercial |
$66.88
|
| Rate for Payer: Mclaren Commercial |
$40.94
|
| Rate for Payer: Mclaren Commercial |
$64.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Nomi Health Commercial |
$55.66
|
| Rate for Payer: Nomi Health Commercial |
$74.66
|
| Rate for Payer: Nomi Health Commercial |
$58.88
|
| Rate for Payer: Nomi Health Commercial |
$135.74
|
| Rate for Payer: Nomi Health Commercial |
$54.30
|
| Rate for Payer: Nomi Health Commercial |
$347.68
|
| Rate for Payer: Nomi Health Commercial |
$37.30
|
| Rate for Payer: Nomi Health Commercial |
$60.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.19
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$91.05
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.29 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: ASR ASR |
$88.32
|
| Rate for Payer: BCBS Trust/PPO |
$74.77
|
| Rate for Payer: BCN Commercial |
$74.77
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$85.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Healthscope Commercial |
$88.32
|
| Rate for Payer: Healthscope Whirlpool |
$91.05
|
| Rate for Payer: Mclaren Commercial |
$81.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Nomi Health Commercial |
$74.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.12
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$91.05
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$91.05 |
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: Aetna Medicare |
$33.69
|
| Rate for Payer: ASR ASR |
$88.32
|
| Rate for Payer: BCBS Complete |
$36.42
|
| Rate for Payer: BCBS Trust/PPO |
$75.07
|
| Rate for Payer: BCN Commercial |
$75.07
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cash Price |
$72.84
|
| Rate for Payer: Cofinity Commercial |
$85.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.84
|
| Rate for Payer: Healthscope Commercial |
$88.32
|
| Rate for Payer: Healthscope Whirlpool |
$91.05
|
| Rate for Payer: Mclaren Commercial |
$81.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.39
|
| Rate for Payer: Nomi Health Commercial |
$74.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.51
|
| Rate for Payer: Priority Health Narrow Network |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.12
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$24.44
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare |
$9.04
|
| Rate for Payer: ASR ASR |
$23.71
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS Trust/PPO |
$20.15
|
| Rate for Payer: BCN Commercial |
$20.15
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Healthscope Whirlpool |
$24.44
|
| Rate for Payer: Mclaren Commercial |
$22.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.77
|
| Rate for Payer: Nomi Health Commercial |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$17.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.51
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$37.13
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$37.13 |
| Rate for Payer: Aetna Commercial |
$33.42
|
| Rate for Payer: Aetna Medicare |
$13.74
|
| Rate for Payer: ASR ASR |
$36.02
|
| Rate for Payer: BCBS Complete |
$14.85
|
| Rate for Payer: BCBS Trust/PPO |
$30.61
|
| Rate for Payer: BCN Commercial |
$30.61
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$34.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Healthscope Commercial |
$36.02
|
| Rate for Payer: Healthscope Whirlpool |
$37.13
|
| Rate for Payer: Mclaren Commercial |
$33.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.56
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32.53
|
| Rate for Payer: Priority Health Narrow Network |
$26.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.67
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$48.72
|
|
|
Service Code
|
NDC 574402435
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.54 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Aetna Commercial |
$43.85
|
| Rate for Payer: ASR ASR |
$47.26
|
| Rate for Payer: BCBS Trust/PPO |
$40.01
|
| Rate for Payer: BCN Commercial |
$40.01
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Commercial |
$45.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Healthscope Whirlpool |
$48.72
|
| Rate for Payer: Mclaren Commercial |
$43.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.41
|
| Rate for Payer: Nomi Health Commercial |
$39.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.87
|
|
|
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 |
$35.98 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$13.31
|
| Rate for Payer: ASR ASR |
$34.90
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$33.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$34.90
|
| Rate for Payer: Healthscope Whirlpool |
$35.98
|
| Rate for Payer: Mclaren Commercial |
$32.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.58
|
| Rate for Payer: Nomi Health Commercial |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.52
|
| Rate for Payer: Priority Health Narrow Network |
$25.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.66
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$37.13
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$37.13 |
| Rate for Payer: Aetna Commercial |
$33.42
|
| Rate for Payer: ASR ASR |
$36.02
|
| Rate for Payer: BCBS Trust/PPO |
$30.49
|
| Rate for Payer: BCN Commercial |
$30.49
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cofinity Commercial |
$34.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.70
|
| Rate for Payer: Healthscope Commercial |
$36.02
|
| Rate for Payer: Healthscope Whirlpool |
$37.13
|
| Rate for Payer: Mclaren Commercial |
$33.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.56
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.67
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$48.72
|
|
|
Service Code
|
NDC 574402435
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Aetna Commercial |
$43.85
|
| Rate for Payer: Aetna Medicare |
$18.03
|
| Rate for Payer: ASR ASR |
$47.26
|
| Rate for Payer: BCBS Complete |
$19.49
|
| Rate for Payer: BCBS Trust/PPO |
$40.17
|
| Rate for Payer: BCN Commercial |
$40.17
|
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Cofinity Commercial |
$45.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.98
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Healthscope Whirlpool |
$48.72
|
| Rate for Payer: Mclaren Commercial |
$43.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.41
|
| Rate for Payer: Nomi Health Commercial |
$39.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.69
|
| Rate for Payer: Priority Health Narrow Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.87
|
|
|
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 |
$26.98 |
| Max. Negotiated Rate |
$35.98 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: ASR ASR |
$34.90
|
| Rate for Payer: BCBS Trust/PPO |
$29.55
|
| Rate for Payer: BCN Commercial |
$29.55
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$33.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$34.90
|
| Rate for Payer: Healthscope Whirlpool |
$35.98
|
| Rate for Payer: Mclaren Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.58
|
| Rate for Payer: Nomi Health Commercial |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.66
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$22.16
|
|
|
Service Code
|
NDC 17478007035
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$22.16 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: ASR ASR |
$21.50
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: Cash Price |
$17.73
|
| Rate for Payer: Cofinity Commercial |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.73
|
| Rate for Payer: Healthscope Commercial |
$21.50
|
| Rate for Payer: Healthscope Whirlpool |
$22.16
|
| Rate for Payer: Mclaren Commercial |
$19.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.84
|
| Rate for Payer: Nomi Health Commercial |
$18.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.42
|
| Rate for Payer: Priority Health Narrow Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.50
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$24.44
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: ASR ASR |
$23.71
|
| Rate for Payer: BCBS Trust/PPO |
$20.07
|
| Rate for Payer: BCN Commercial |
$20.07
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Healthscope Commercial |
$23.71
|
| Rate for Payer: Healthscope Whirlpool |
$24.44
|
| Rate for Payer: Mclaren Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.77
|
| Rate for Payer: Nomi Health Commercial |
$20.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.51
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$22.16
|
|
|
Service Code
|
NDC 17478007035
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$22.16 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: ASR ASR |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$18.20
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$17.73
|
| Rate for Payer: Cofinity Commercial |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.73
|
| Rate for Payer: Healthscope Commercial |
$21.50
|
| Rate for Payer: Healthscope Whirlpool |
$22.16
|
| Rate for Payer: Mclaren Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.84
|
| Rate for Payer: Nomi Health Commercial |
$18.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.50
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna Commercial |
$291.87
|
| Rate for Payer: Aetna Medicare |
$119.99
|
| Rate for Payer: ASR ASR |
$314.57
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS Trust/PPO |
$267.39
|
| Rate for Payer: BCN Commercial |
$267.39
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$304.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$314.57
|
| Rate for Payer: Healthscope Whirlpool |
$324.30
|
| Rate for Payer: Mclaren Commercial |
$291.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$284.15
|
| Rate for Payer: Priority Health Narrow Network |
$227.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.38
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.22 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna Commercial |
$291.87
|
| Rate for Payer: ASR ASR |
$314.57
|
| Rate for Payer: BCBS Trust/PPO |
$266.32
|
| Rate for Payer: BCN Commercial |
$266.32
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$304.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$314.57
|
| Rate for Payer: Healthscope Whirlpool |
$324.30
|
| Rate for Payer: Mclaren Commercial |
$291.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.38
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
OP
|
$627.16
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$627.16 |
| Rate for Payer: Aetna Commercial |
$564.45
|
| Rate for Payer: Aetna Commercial |
$329.90
|
| Rate for Payer: Aetna Medicare |
$135.63
|
| Rate for Payer: Aetna Medicare |
$232.05
|
| Rate for Payer: ASR ASR |
$608.35
|
| Rate for Payer: ASR ASR |
$355.56
|
| Rate for Payer: BCBS Complete |
$146.62
|
| Rate for Payer: BCBS Complete |
$250.87
|
| Rate for Payer: BCBS Trust/PPO |
$517.10
|
| Rate for Payer: BCBS Trust/PPO |
$302.23
|
| Rate for Payer: BCN Commercial |
$302.23
|
| Rate for Payer: BCN Commercial |
$517.10
|
| Rate for Payer: Cash Price |
$501.73
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cash Price |
$501.73
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Cofinity Commercial |
$589.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Healthscope Commercial |
$608.35
|
| Rate for Payer: Healthscope Commercial |
$355.56
|
| Rate for Payer: Healthscope Whirlpool |
$627.16
|
| Rate for Payer: Healthscope Whirlpool |
$366.56
|
| Rate for Payer: Mclaren Commercial |
$564.45
|
| Rate for Payer: Mclaren Commercial |
$329.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$501.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.09
|
| Rate for Payer: Nomi Health Commercial |
$300.58
|
| Rate for Payer: Nomi Health Commercial |
$514.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.22
|
| Rate for Payer: Priority Health Narrow Network |
$0.18
|
| Rate for Payer: Priority Health Narrow Network |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.90
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$366.56
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$274.92 |
| Max. Negotiated Rate |
$366.56 |
| Rate for Payer: Aetna Commercial |
$329.90
|
| Rate for Payer: Aetna Commercial |
$564.45
|
| Rate for Payer: ASR ASR |
$608.35
|
| Rate for Payer: ASR ASR |
$355.56
|
| Rate for Payer: BCBS Trust/PPO |
$515.03
|
| Rate for Payer: BCBS Trust/PPO |
$301.02
|
| Rate for Payer: BCN Commercial |
$515.03
|
| Rate for Payer: BCN Commercial |
$301.02
|
| Rate for Payer: Cash Price |
$501.73
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Cofinity Commercial |
$589.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$501.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Healthscope Commercial |
$355.56
|
| Rate for Payer: Healthscope Commercial |
$608.35
|
| Rate for Payer: Healthscope Whirlpool |
$627.16
|
| Rate for Payer: Healthscope Whirlpool |
$366.56
|
| Rate for Payer: Mclaren Commercial |
$564.45
|
| Rate for Payer: Mclaren Commercial |
$329.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Nomi Health Commercial |
$514.27
|
| Rate for Payer: Nomi Health Commercial |
$300.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$470.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$551.90
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$17,424.92
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$10,343.40 |
| Max. Negotiated Rate |
$17,424.92 |
| Rate for Payer: Aetna Medicare |
$10,887.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,609.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,609.74
|
| Rate for Payer: BCBS MAPPO |
$10,887.79
|
| Rate for Payer: BCN Medicare Advantage |
$10,887.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,887.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,887.79
|
| Rate for Payer: Mclaren Medicare |
$10,887.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,432.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,520.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,976.57
|
| Rate for Payer: PACE Medicare |
$10,343.40
|
| Rate for Payer: PACE SWMI |
$10,887.79
|
| Rate for Payer: PHP Commercial |
$11,976.57
|
| Rate for Payer: PHP Medicare Advantage |
$10,887.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,424.92
|
| Rate for Payer: Priority Health Medicare |
$10,887.79
|
| Rate for Payer: Priority Health Narrow Network |
$13,939.94
|
| Rate for Payer: Railroad Medicare Medicare |
$10,887.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,887.79
|
| Rate for Payer: UHC Exchange |
$16,876.07
|
| Rate for Payer: UHCCP DNSP |
$10,887.79
|
| Rate for Payer: VA VA |
$10,887.79
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$11,421.25
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$7,000.12 |
| Max. Negotiated Rate |
$11,421.25 |
| Rate for Payer: Aetna Medicare |
$7,368.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,210.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,210.69
|
| Rate for Payer: BCBS MAPPO |
$7,368.55
|
| Rate for Payer: BCN Medicare Advantage |
$7,368.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,368.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,368.55
|
| Rate for Payer: Mclaren Medicare |
$7,368.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,736.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,473.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,105.40
|
| Rate for Payer: PACE Medicare |
$7,000.12
|
| Rate for Payer: PACE SWMI |
$7,368.55
|
| Rate for Payer: PHP Commercial |
$8,105.40
|
| Rate for Payer: PHP Medicare Advantage |
$7,368.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,710.77
|
| Rate for Payer: Priority Health Medicare |
$7,368.55
|
| Rate for Payer: Priority Health Narrow Network |
$8,568.61
|
| Rate for Payer: Railroad Medicare Medicare |
$7,368.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,368.55
|
| Rate for Payer: UHC Exchange |
$11,421.25
|
| Rate for Payer: UHCCP DNSP |
$7,368.55
|
| Rate for Payer: VA VA |
$7,368.55
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
OP
|
$544.43
|
|
|
Service Code
|
NDC 47781010444
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.44 |
| Max. Negotiated Rate |
$544.42 |
| Rate for Payer: Aetna Commercial |
$489.98
|
| Rate for Payer: Aetna Medicare |
$201.44
|
| Rate for Payer: ASR ASR |
$528.09
|
| Rate for Payer: BCBS Complete |
$217.77
|
| Rate for Payer: BCBS Trust/PPO |
$448.88
|
| Rate for Payer: BCN Commercial |
$448.88
|
| Rate for Payer: Cash Price |
$435.54
|
| Rate for Payer: Cofinity Commercial |
$511.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.54
|
| Rate for Payer: Healthscope Commercial |
$528.09
|
| Rate for Payer: Healthscope Whirlpool |
$544.42
|
| Rate for Payer: Mclaren Commercial |
$489.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.76
|
| Rate for Payer: Nomi Health Commercial |
$446.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$477.03
|
| Rate for Payer: Priority Health Narrow Network |
$381.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.09
|
|
|
ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM
|
Facility
|
IP
|
$544.43
|
|
|
Service Code
|
NDC 47781010444
|
| Hospital Charge Code |
9969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.32 |
| Max. Negotiated Rate |
$544.42 |
| Rate for Payer: Aetna Commercial |
$489.98
|
| Rate for Payer: ASR ASR |
$528.09
|
| Rate for Payer: BCBS Trust/PPO |
$447.08
|
| Rate for Payer: BCN Commercial |
$447.08
|
| Rate for Payer: Cash Price |
$435.54
|
| Rate for Payer: Cofinity Commercial |
$511.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$435.54
|
| Rate for Payer: Healthscope Commercial |
$528.09
|
| Rate for Payer: Healthscope Whirlpool |
$544.42
|
| Rate for Payer: Mclaren Commercial |
$489.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$462.76
|
| Rate for Payer: Nomi Health Commercial |
$446.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.09
|
|
