Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$22.26

Service Code	NDC 72485067031
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$20.03
Rate for Payer: Aetna Commercial	$18.92
Rate for Payer: Aetna Medicare	$11.13
Rate for Payer: Aetna New Business (MI Preferred)	$14.47
Rate for Payer: BCBS Complete	$8.90
Rate for Payer: Cash Price	$17.81
Rate for Payer: Cofinity Advantage	$15.58
Rate for Payer: Cofinity Commercial	$19.14
Rate for Payer: Encore Health Key Benefits Commercial	$17.81
Rate for Payer: Healthscope Commercial	$20.03
Rate for Payer: MI Amish Medical Board Commercial	$17.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.70
Rate for Payer: PHP Commercial	$18.92
Rate for Payer: Priority Health SBD	$14.02
Rate for Payer: UHC All Payor (Choice/PPO)	$14.47
Rate for Payer: UHC Core	$11.60
Rate for Payer: UHC Exchange	$8.75

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION

Facility

$840.27

Service Code	NDC 24338013213
Hospital Charge Code	2899
Hospital Revenue Code	637
Min. Negotiated Rate	$529.37
Max. Negotiated Rate	$756.24
Rate for Payer: Aetna Commercial	$714.23
Rate for Payer: Aetna New Business (MI Preferred)	$546.18
Rate for Payer: Cash Price	$672.22
Rate for Payer: Cofinity Advantage	$588.19
Rate for Payer: Cofinity Commercial	$722.63
Rate for Payer: Encore Health Key Benefits Commercial	$672.22
Rate for Payer: Healthscope Commercial	$756.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$714.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.20
Rate for Payer: PHP Commercial	$714.23
Rate for Payer: Priority Health SBD	$529.37

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION

Facility

$753.12

Service Code	NDC 75834029501
Hospital Charge Code	2899
Hospital Revenue Code	637
Min. Negotiated Rate	$295.98
Max. Negotiated Rate	$677.81
Rate for Payer: Aetna Commercial	$640.15
Rate for Payer: Aetna Medicare	$376.56
Rate for Payer: Aetna New Business (MI Preferred)	$489.53
Rate for Payer: BCBS Complete	$301.25
Rate for Payer: Cash Price	$602.50
Rate for Payer: Cofinity Advantage	$527.18
Rate for Payer: Cofinity Commercial	$647.68
Rate for Payer: Encore Health Key Benefits Commercial	$602.50
Rate for Payer: Healthscope Commercial	$677.81
Rate for Payer: MI Amish Medical Board Commercial	$602.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$640.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$564.84
Rate for Payer: PHP Commercial	$640.15
Rate for Payer: Priority Health SBD	$474.47
Rate for Payer: UHC All Payor (Choice/PPO)	$489.53
Rate for Payer: UHC Core	$392.38
Rate for Payer: UHC Exchange	$295.98

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION

Facility

$840.27

Service Code	NDC 24338013402
Hospital Charge Code	2899
Hospital Revenue Code	637
Min. Negotiated Rate	$330.23
Max. Negotiated Rate	$756.24
Rate for Payer: Aetna Commercial	$714.23
Rate for Payer: Aetna Medicare	$420.13
Rate for Payer: Aetna New Business (MI Preferred)	$546.18
Rate for Payer: BCBS Complete	$336.11
Rate for Payer: Cash Price	$672.22
Rate for Payer: Cofinity Advantage	$588.19
Rate for Payer: Cofinity Commercial	$722.63
Rate for Payer: Encore Health Key Benefits Commercial	$672.22
Rate for Payer: Healthscope Commercial	$756.24
Rate for Payer: MI Amish Medical Board Commercial	$672.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$714.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.20
Rate for Payer: PHP Commercial	$714.23
Rate for Payer: Priority Health SBD	$529.37
Rate for Payer: UHC All Payor (Choice/PPO)	$546.18
Rate for Payer: UHC Core	$437.78
Rate for Payer: UHC Exchange	$330.23

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION

Facility

$840.27

Service Code	NDC 24338013402
Hospital Charge Code	2899
Hospital Revenue Code	637
Min. Negotiated Rate	$529.37
Max. Negotiated Rate	$756.24
Rate for Payer: Aetna Commercial	$714.23
Rate for Payer: Aetna New Business (MI Preferred)	$546.18
Rate for Payer: Cash Price	$672.22
Rate for Payer: Cofinity Advantage	$588.19
Rate for Payer: Cofinity Commercial	$722.63
Rate for Payer: Encore Health Key Benefits Commercial	$672.22
Rate for Payer: Healthscope Commercial	$756.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$714.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.20
Rate for Payer: PHP Commercial	$714.23
Rate for Payer: Priority Health SBD	$529.37

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION

Facility

$753.12

Service Code	NDC 75834029501
Hospital Charge Code	2899
Hospital Revenue Code	637
Min. Negotiated Rate	$474.47
Max. Negotiated Rate	$677.81
Rate for Payer: Aetna Commercial	$640.15
Rate for Payer: Aetna New Business (MI Preferred)	$489.53
Rate for Payer: Cash Price	$602.50
Rate for Payer: Cofinity Advantage	$527.18
Rate for Payer: Cofinity Commercial	$647.68
Rate for Payer: Encore Health Key Benefits Commercial	$602.50
Rate for Payer: Healthscope Commercial	$677.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$640.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$564.84
Rate for Payer: PHP Commercial	$640.15
Rate for Payer: Priority Health SBD	$474.47

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION

Facility

$840.27

Service Code	NDC 24338013213
Hospital Charge Code	2899
Hospital Revenue Code	637
Min. Negotiated Rate	$330.23
Max. Negotiated Rate	$756.24
Rate for Payer: Aetna Commercial	$714.23
Rate for Payer: Aetna Medicare	$420.13
Rate for Payer: Aetna New Business (MI Preferred)	$546.18
Rate for Payer: BCBS Complete	$336.11
Rate for Payer: Cash Price	$672.22
Rate for Payer: Cofinity Advantage	$588.19
Rate for Payer: Cofinity Commercial	$722.63
Rate for Payer: Encore Health Key Benefits Commercial	$672.22
Rate for Payer: Healthscope Commercial	$756.24
Rate for Payer: MI Amish Medical Board Commercial	$672.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$714.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.20
Rate for Payer: PHP Commercial	$714.23
Rate for Payer: Priority Health SBD	$529.37
Rate for Payer: UHC All Payor (Choice/PPO)	$546.18
Rate for Payer: UHC Core	$437.78
Rate for Payer: UHC Exchange	$330.23

ESCITALOPRAM 10 MG TABLET

Facility

$117.50

Service Code	NDC 43547028110
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$46.18
Max. Negotiated Rate	$105.75
Rate for Payer: Aetna Commercial	$99.88
Rate for Payer: Aetna Medicare	$58.75
Rate for Payer: Aetna New Business (MI Preferred)	$76.38
Rate for Payer: BCBS Complete	$47.00
Rate for Payer: Cash Price	$94.00
Rate for Payer: Cofinity Advantage	$82.25
Rate for Payer: Cofinity Commercial	$101.05
Rate for Payer: Encore Health Key Benefits Commercial	$94.00
Rate for Payer: Healthscope Commercial	$105.75
Rate for Payer: MI Amish Medical Board Commercial	$94.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.12
Rate for Payer: PHP Commercial	$99.88
Rate for Payer: Priority Health SBD	$74.03
Rate for Payer: UHC All Payor (Choice/PPO)	$76.38
Rate for Payer: UHC Core	$61.22
Rate for Payer: UHC Exchange	$46.18

ESCITALOPRAM 10 MG TABLET

Facility

$465.30

Service Code	NDC 68084061701
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$293.14
Max. Negotiated Rate	$418.77
Rate for Payer: Aetna Commercial	$395.50
Rate for Payer: Aetna New Business (MI Preferred)	$302.44
Rate for Payer: Cash Price	$372.24
Rate for Payer: Cofinity Advantage	$325.71
Rate for Payer: Cofinity Commercial	$400.16
Rate for Payer: Encore Health Key Benefits Commercial	$372.24
Rate for Payer: Healthscope Commercial	$418.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$395.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$348.98
Rate for Payer: PHP Commercial	$395.50
Rate for Payer: Priority Health SBD	$293.14

ESCITALOPRAM 10 MG TABLET

Facility

$4.66

Service Code	NDC 68084061711
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Advantage	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.50
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health SBD	$2.94

ESCITALOPRAM 10 MG TABLET

Facility

$4.66

Service Code	NDC 68084061711
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Advantage	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: MI Amish Medical Board Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.50
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health SBD	$2.94
Rate for Payer: UHC All Payor (Choice/PPO)	$3.03
Rate for Payer: UHC Core	$2.43
Rate for Payer: UHC Exchange	$1.83

ESCITALOPRAM 10 MG TABLET

Facility

$324.30

Service Code	NDC 00904642661
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$204.31
Max. Negotiated Rate	$291.87
Rate for Payer: Aetna Commercial	$275.65
Rate for Payer: Aetna New Business (MI Preferred)	$210.79
Rate for Payer: Cash Price	$259.44
Rate for Payer: Cofinity Advantage	$227.01
Rate for Payer: Cofinity Commercial	$278.90
Rate for Payer: Encore Health Key Benefits Commercial	$259.44
Rate for Payer: Healthscope Commercial	$291.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$275.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$243.22
Rate for Payer: PHP Commercial	$275.65
Rate for Payer: Priority Health SBD	$204.31

ESCITALOPRAM 10 MG TABLET

Facility

$117.50

Service Code	NDC 43547028110
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$74.03
Max. Negotiated Rate	$105.75
Rate for Payer: Aetna Commercial	$99.88
Rate for Payer: Aetna New Business (MI Preferred)	$76.38
Rate for Payer: Cash Price	$94.00
Rate for Payer: Cofinity Advantage	$82.25
Rate for Payer: Cofinity Commercial	$101.05
Rate for Payer: Encore Health Key Benefits Commercial	$94.00
Rate for Payer: Healthscope Commercial	$105.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.12
Rate for Payer: PHP Commercial	$99.88
Rate for Payer: Priority Health SBD	$74.03

ESCITALOPRAM 10 MG TABLET

Facility

$465.30

Service Code	NDC 68084061701
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$182.86
Max. Negotiated Rate	$418.77
Rate for Payer: Aetna Commercial	$395.50
Rate for Payer: Aetna Medicare	$232.65
Rate for Payer: Aetna New Business (MI Preferred)	$302.44
Rate for Payer: BCBS Complete	$186.12
Rate for Payer: Cash Price	$372.24
Rate for Payer: Cofinity Advantage	$325.71
Rate for Payer: Cofinity Commercial	$400.16
Rate for Payer: Encore Health Key Benefits Commercial	$372.24
Rate for Payer: Healthscope Commercial	$418.77
Rate for Payer: MI Amish Medical Board Commercial	$372.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$395.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$348.98
Rate for Payer: PHP Commercial	$395.50
Rate for Payer: Priority Health SBD	$293.14
Rate for Payer: UHC All Payor (Choice/PPO)	$302.44
Rate for Payer: UHC Core	$242.42
Rate for Payer: UHC Exchange	$182.86

ESCITALOPRAM 10 MG TABLET

Facility

$324.30

Service Code	NDC 00904642661
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$291.87
Rate for Payer: Aetna Commercial	$275.65
Rate for Payer: Aetna Medicare	$162.15
Rate for Payer: Aetna New Business (MI Preferred)	$210.79
Rate for Payer: BCBS Complete	$129.72
Rate for Payer: Cash Price	$259.44
Rate for Payer: Cofinity Advantage	$227.01
Rate for Payer: Cofinity Commercial	$278.90
Rate for Payer: Encore Health Key Benefits Commercial	$259.44
Rate for Payer: Healthscope Commercial	$291.87
Rate for Payer: MI Amish Medical Board Commercial	$259.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$275.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$243.22
Rate for Payer: PHP Commercial	$275.65
Rate for Payer: Priority Health SBD	$204.31
Rate for Payer: UHC All Payor (Choice/PPO)	$210.79
Rate for Payer: UHC Core	$168.96
Rate for Payer: UHC Exchange	$127.45

ESCITALOPRAM 20 MG TABLET

Facility

$166.85

Service Code	NDC 43547028210
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$65.57
Max. Negotiated Rate	$150.16
Rate for Payer: Aetna Commercial	$141.82
Rate for Payer: Aetna Medicare	$83.42
Rate for Payer: Aetna New Business (MI Preferred)	$108.45
Rate for Payer: BCBS Complete	$66.74
Rate for Payer: Cash Price	$133.48
Rate for Payer: Cofinity Advantage	$116.80
Rate for Payer: Cofinity Commercial	$143.49
Rate for Payer: Encore Health Key Benefits Commercial	$133.48
Rate for Payer: Healthscope Commercial	$150.16
Rate for Payer: MI Amish Medical Board Commercial	$133.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$125.14
Rate for Payer: PHP Commercial	$141.82
Rate for Payer: Priority Health SBD	$105.12
Rate for Payer: UHC All Payor (Choice/PPO)	$108.45
Rate for Payer: UHC Core	$86.93
Rate for Payer: UHC Exchange	$65.57

ESCITALOPRAM 20 MG TABLET

Facility

$2.74

Service Code	NDC 51079054401
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna Medicare	$1.37
Rate for Payer: Aetna New Business (MI Preferred)	$1.78
Rate for Payer: BCBS Complete	$1.10
Rate for Payer: Cash Price	$2.19
Rate for Payer: Cofinity Advantage	$1.92
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Encore Health Key Benefits Commercial	$2.19
Rate for Payer: Healthscope Commercial	$2.47
Rate for Payer: MI Amish Medical Board Commercial	$2.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.06
Rate for Payer: PHP Commercial	$2.33
Rate for Payer: Priority Health SBD	$1.73
Rate for Payer: UHC All Payor (Choice/PPO)	$1.78
Rate for Payer: UHC Core	$1.43
Rate for Payer: UHC Exchange	$1.08

ESCITALOPRAM 20 MG TABLET

Facility

$273.60

Service Code	NDC 51079054420
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$107.52
Max. Negotiated Rate	$246.24
Rate for Payer: Aetna Commercial	$232.56
Rate for Payer: Aetna Medicare	$136.80
Rate for Payer: Aetna New Business (MI Preferred)	$177.84
Rate for Payer: BCBS Complete	$109.44
Rate for Payer: Cash Price	$218.88
Rate for Payer: Cofinity Advantage	$191.52
Rate for Payer: Cofinity Commercial	$235.30
Rate for Payer: Encore Health Key Benefits Commercial	$218.88
Rate for Payer: Healthscope Commercial	$246.24
Rate for Payer: MI Amish Medical Board Commercial	$218.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$232.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$205.20
Rate for Payer: PHP Commercial	$232.56
Rate for Payer: Priority Health SBD	$172.37
Rate for Payer: UHC All Payor (Choice/PPO)	$177.84
Rate for Payer: UHC Core	$142.55
Rate for Payer: UHC Exchange	$107.52

ESCITALOPRAM 20 MG TABLET

Facility

$2.74

Service Code	NDC 51079054401
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$1.78
Rate for Payer: Cash Price	$2.19
Rate for Payer: Cofinity Advantage	$1.92
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Encore Health Key Benefits Commercial	$2.19
Rate for Payer: Healthscope Commercial	$2.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.06
Rate for Payer: PHP Commercial	$2.33
Rate for Payer: Priority Health SBD	$1.73

ESCITALOPRAM 20 MG TABLET

Facility

$2.08

Service Code	NDC 68084061811
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.87
Rate for Payer: Aetna Commercial	$1.77
Rate for Payer: Aetna New Business (MI Preferred)	$1.35
Rate for Payer: Cash Price	$1.66
Rate for Payer: Cofinity Advantage	$1.46
Rate for Payer: Cofinity Commercial	$1.79
Rate for Payer: Encore Health Key Benefits Commercial	$1.66
Rate for Payer: Healthscope Commercial	$1.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.56
Rate for Payer: PHP Commercial	$1.77
Rate for Payer: Priority Health SBD	$1.31

ESCITALOPRAM 20 MG TABLET

Facility

$207.10

Service Code	NDC 68084061801
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$81.39
Max. Negotiated Rate	$186.39
Rate for Payer: Aetna Commercial	$176.03
Rate for Payer: Aetna Medicare	$103.55
Rate for Payer: Aetna New Business (MI Preferred)	$134.62
Rate for Payer: BCBS Complete	$82.84
Rate for Payer: Cash Price	$165.68
Rate for Payer: Cofinity Advantage	$144.97
Rate for Payer: Cofinity Commercial	$178.11
Rate for Payer: Encore Health Key Benefits Commercial	$165.68
Rate for Payer: Healthscope Commercial	$186.39
Rate for Payer: MI Amish Medical Board Commercial	$165.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.32
Rate for Payer: PHP Commercial	$176.03
Rate for Payer: Priority Health SBD	$130.47
Rate for Payer: UHC All Payor (Choice/PPO)	$134.62
Rate for Payer: UHC Core	$107.90
Rate for Payer: UHC Exchange	$81.39

ESCITALOPRAM 20 MG TABLET

Facility

$166.85

Service Code	NDC 43547028210
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$105.12
Max. Negotiated Rate	$150.16
Rate for Payer: Aetna Commercial	$141.82
Rate for Payer: Aetna New Business (MI Preferred)	$108.45
Rate for Payer: Cash Price	$133.48
Rate for Payer: Cofinity Advantage	$116.80
Rate for Payer: Cofinity Commercial	$143.49
Rate for Payer: Encore Health Key Benefits Commercial	$133.48
Rate for Payer: Healthscope Commercial	$150.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$125.14
Rate for Payer: PHP Commercial	$141.82
Rate for Payer: Priority Health SBD	$105.12

ESCITALOPRAM 20 MG TABLET

Facility

$392.45

Service Code	NDC 00904642761
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$247.24
Max. Negotiated Rate	$353.20
Rate for Payer: Aetna Commercial	$333.58
Rate for Payer: Aetna New Business (MI Preferred)	$255.09
Rate for Payer: Cash Price	$313.96
Rate for Payer: Cofinity Advantage	$274.71
Rate for Payer: Cofinity Commercial	$337.51
Rate for Payer: Encore Health Key Benefits Commercial	$313.96
Rate for Payer: Healthscope Commercial	$353.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$333.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$294.34
Rate for Payer: PHP Commercial	$333.58
Rate for Payer: Priority Health SBD	$247.24

ESCITALOPRAM 20 MG TABLET

Facility

$2.08

Service Code	NDC 68084061811
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.87
Rate for Payer: Aetna Commercial	$1.77
Rate for Payer: Aetna Medicare	$1.04
Rate for Payer: Aetna New Business (MI Preferred)	$1.35
Rate for Payer: BCBS Complete	$0.83
Rate for Payer: Cash Price	$1.66
Rate for Payer: Cofinity Advantage	$1.46
Rate for Payer: Cofinity Commercial	$1.79
Rate for Payer: Encore Health Key Benefits Commercial	$1.66
Rate for Payer: Healthscope Commercial	$1.87
Rate for Payer: MI Amish Medical Board Commercial	$1.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.56
Rate for Payer: PHP Commercial	$1.77
Rate for Payer: Priority Health SBD	$1.31
Rate for Payer: UHC All Payor (Choice/PPO)	$1.35
Rate for Payer: UHC Core	$1.08
Rate for Payer: UHC Exchange	$0.82

ESCITALOPRAM 20 MG TABLET

Facility

$207.10

Service Code	NDC 68084061801
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$130.47
Max. Negotiated Rate	$186.39
Rate for Payer: Aetna Commercial	$176.03
Rate for Payer: Aetna New Business (MI Preferred)	$134.62
Rate for Payer: Cash Price	$165.68
Rate for Payer: Cofinity Advantage	$144.97
Rate for Payer: Cofinity Commercial	$178.11
Rate for Payer: Encore Health Key Benefits Commercial	$165.68
Rate for Payer: Healthscope Commercial	$186.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.32
Rate for Payer: PHP Commercial	$176.03
Rate for Payer: Priority Health SBD	$130.47

Know your out-of-pocket cost for care.

All Charges