Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ERTAPENEM IVPB (INTRA-OP)

Facility

$4,550.67

Service Code	HCPCS J1335
Hospital Charge Code	167002
Hospital Revenue Code	636
Min. Negotiated Rate	$1,820.27
Max. Negotiated Rate	$4,095.60
Rate for Payer: Aetna Commercial	$3,868.07
Rate for Payer: Aetna Medicare	$2,275.34
Rate for Payer: Aetna New Business (MI Preferred)	$2,957.94
Rate for Payer: BCBS Complete	$1,820.27
Rate for Payer: Cash Price	$3,640.54
Rate for Payer: Cofinity Commercial	$3,185.47
Rate for Payer: Cofinity Commercial	$3,913.58
Rate for Payer: Cofinity Medicare Advantage	$3,185.47
Rate for Payer: Encore Health Key Benefits Commercial	$3,640.54
Rate for Payer: Healthscope Commercial	$4,095.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,868.07
Rate for Payer: PHP Commercial	$3,868.07
Rate for Payer: Priority Health Cigna Priority Health	$2,957.94
Rate for Payer: Priority Health SBD	$2,866.92

ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE

Facility

$514.93

Service Code	NDC 52536018003
Hospital Charge Code	108619
Hospital Revenue Code	637
Min. Negotiated Rate	$324.41
Max. Negotiated Rate	$463.44
Rate for Payer: Aetna Commercial	$437.69
Rate for Payer: Aetna New Business (MI Preferred)	$334.70
Rate for Payer: Cash Price	$411.94
Rate for Payer: Cofinity Commercial	$360.45
Rate for Payer: Cofinity Commercial	$442.84
Rate for Payer: Cofinity Medicare Advantage	$360.45
Rate for Payer: Encore Health Key Benefits Commercial	$411.94
Rate for Payer: Healthscope Commercial	$463.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$437.69
Rate for Payer: PHP Commercial	$437.69
Rate for Payer: Priority Health Cigna Priority Health	$334.70
Rate for Payer: Priority Health SBD	$324.41

ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE

Facility

$531.69

Service Code	NDC 24338012203
Hospital Charge Code	108619
Hospital Revenue Code	637
Min. Negotiated Rate	$212.68
Max. Negotiated Rate	$478.52
Rate for Payer: Aetna Commercial	$451.94
Rate for Payer: Aetna Medicare	$265.85
Rate for Payer: Aetna New Business (MI Preferred)	$345.60
Rate for Payer: BCBS Complete	$212.68
Rate for Payer: Cash Price	$425.35
Rate for Payer: Cofinity Commercial	$372.18
Rate for Payer: Cofinity Commercial	$457.25
Rate for Payer: Cofinity Medicare Advantage	$372.18
Rate for Payer: Encore Health Key Benefits Commercial	$425.35
Rate for Payer: Healthscope Commercial	$478.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$451.94
Rate for Payer: PHP Commercial	$451.94
Rate for Payer: Priority Health Cigna Priority Health	$345.60
Rate for Payer: Priority Health SBD	$334.96

ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE

Facility

$531.69

Service Code	NDC 24338012203
Hospital Charge Code	108619
Hospital Revenue Code	637
Min. Negotiated Rate	$334.96
Max. Negotiated Rate	$478.52
Rate for Payer: Aetna Commercial	$451.94
Rate for Payer: Aetna New Business (MI Preferred)	$345.60
Rate for Payer: Cash Price	$425.35
Rate for Payer: Cofinity Commercial	$372.18
Rate for Payer: Cofinity Commercial	$457.25
Rate for Payer: Cofinity Medicare Advantage	$372.18
Rate for Payer: Encore Health Key Benefits Commercial	$425.35
Rate for Payer: Healthscope Commercial	$478.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$451.94
Rate for Payer: PHP Commercial	$451.94
Rate for Payer: Priority Health Cigna Priority Health	$345.60
Rate for Payer: Priority Health SBD	$334.96

ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE

Facility

$514.93

Service Code	NDC 52536018003
Hospital Charge Code	108619
Hospital Revenue Code	637
Min. Negotiated Rate	$205.97
Max. Negotiated Rate	$463.44
Rate for Payer: Aetna Commercial	$437.69
Rate for Payer: Aetna Medicare	$257.46
Rate for Payer: Aetna New Business (MI Preferred)	$334.70
Rate for Payer: BCBS Complete	$205.97
Rate for Payer: Cash Price	$411.94
Rate for Payer: Cofinity Commercial	$360.45
Rate for Payer: Cofinity Commercial	$442.84
Rate for Payer: Cofinity Medicare Advantage	$360.45
Rate for Payer: Encore Health Key Benefits Commercial	$411.94
Rate for Payer: Healthscope Commercial	$463.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$437.69
Rate for Payer: PHP Commercial	$437.69
Rate for Payer: Priority Health Cigna Priority Health	$334.70
Rate for Payer: Priority Health SBD	$324.41

ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE

Facility

$561.22

Service Code	NDC 69238147103
Hospital Charge Code	108619
Hospital Revenue Code	637
Min. Negotiated Rate	$353.57
Max. Negotiated Rate	$505.10
Rate for Payer: Aetna Commercial	$477.04
Rate for Payer: Aetna New Business (MI Preferred)	$364.79
Rate for Payer: Cash Price	$448.98
Rate for Payer: Cofinity Commercial	$392.85
Rate for Payer: Cofinity Commercial	$482.65
Rate for Payer: Cofinity Medicare Advantage	$392.85
Rate for Payer: Encore Health Key Benefits Commercial	$448.98
Rate for Payer: Healthscope Commercial	$505.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$477.04
Rate for Payer: PHP Commercial	$477.04
Rate for Payer: Priority Health Cigna Priority Health	$364.79
Rate for Payer: Priority Health SBD	$353.57

ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE

Facility

$561.22

Service Code	NDC 69238147103
Hospital Charge Code	108619
Hospital Revenue Code	637
Min. Negotiated Rate	$224.49
Max. Negotiated Rate	$505.10
Rate for Payer: Aetna Commercial	$477.04
Rate for Payer: Aetna Medicare	$280.61
Rate for Payer: Aetna New Business (MI Preferred)	$364.79
Rate for Payer: BCBS Complete	$224.49
Rate for Payer: Cash Price	$448.98
Rate for Payer: Cofinity Commercial	$392.85
Rate for Payer: Cofinity Commercial	$482.65
Rate for Payer: Cofinity Medicare Advantage	$392.85
Rate for Payer: Encore Health Key Benefits Commercial	$448.98
Rate for Payer: Healthscope Commercial	$505.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$477.04
Rate for Payer: PHP Commercial	$477.04
Rate for Payer: Priority Health Cigna Priority Health	$364.79
Rate for Payer: Priority Health SBD	$353.57

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$22.23

Service Code	NDC 72485067031
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$20.01
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$23.59

Service Code	NDC 00574402411
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$14.86
Max. Negotiated Rate	$21.23
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$22.23

Service Code	NDC 72485067031
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$20.01
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$23.59

Service Code	NDC 00574402450
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$21.23
Rate for Payer: Aetna Commercial	$20.05
Rate for Payer: Aetna Medicare	$11.79
Rate for Payer: Aetna New Business (MI Preferred)	$15.33
Rate for Payer: BCBS Complete	$9.44
Rate for Payer: Cash Price	$18.87
Rate for Payer: Cofinity Commercial	$16.51
Rate for Payer: Cofinity Commercial	$20.29
Rate for Payer: Cofinity Medicare Advantage	$16.51
Rate for Payer: Encore Health Key Benefits Commercial	$18.87
Rate for Payer: Healthscope Commercial	$21.23
Rate for Payer: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$17.91

Service Code	NDC 17478007031
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$16.12
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$26.03

Service Code	NDC 24208091019
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$23.43
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$23.59

Service Code	NDC 00574402411
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$21.23
Rate for Payer: Aetna Commercial	$20.05
Rate for Payer: Aetna Medicare	$11.79
Rate for Payer: Aetna New Business (MI Preferred)	$15.33
Rate for Payer: BCBS Complete	$9.44
Rate for Payer: Cash Price	$18.87
Rate for Payer: Cofinity Commercial	$16.51
Rate for Payer: Cofinity Commercial	$20.29
Rate for Payer: Cofinity Medicare Advantage	$16.51
Rate for Payer: Encore Health Key Benefits Commercial	$18.87
Rate for Payer: Healthscope Commercial	$21.23
Rate for Payer: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$26.03

Service Code	NDC 24208091019
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$23.43
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$17.91

Service Code	NDC 17478007031
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$16.12
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$34.30

Service Code	NDC 48102005711
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$21.61
Max. Negotiated Rate	$30.87
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$23.59

Service Code	NDC 00574402450
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$14.86
Max. Negotiated Rate	$21.23
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: 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

ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT

Facility

$34.30

Service Code	NDC 48102005711
Hospital Charge Code	2888
Hospital Revenue Code	637
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$30.87
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: 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

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 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: 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

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 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: 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

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	$336.11
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 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: 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

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	$336.11
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 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: 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

ESCITALOPRAM 10 MG TABLET

Facility

$201.40

Service Code	NDC 68084061701
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$126.88
Max. Negotiated Rate	$181.26
Rate for Payer: Aetna Commercial	$171.19
Rate for Payer: Aetna New Business (MI Preferred)	$130.91
Rate for Payer: Cash Price	$161.12
Rate for Payer: Cofinity Commercial	$140.98
Rate for Payer: Cofinity Commercial	$173.20
Rate for Payer: Cofinity Medicare Advantage	$140.98
Rate for Payer: Encore Health Key Benefits Commercial	$161.12
Rate for Payer: Healthscope Commercial	$181.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$171.19
Rate for Payer: PHP Commercial	$171.19
Rate for Payer: Priority Health Cigna Priority Health	$130.91
Rate for Payer: Priority Health SBD	$126.88

ESCITALOPRAM 10 MG TABLET

Facility

$333.70

Service Code	NDC 00904642661
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$210.23
Max. Negotiated Rate	$300.33
Rate for Payer: Aetna Commercial	$283.64
Rate for Payer: Aetna New Business (MI Preferred)	$216.91
Rate for Payer: Cash Price	$266.96
Rate for Payer: Cofinity Commercial	$233.59
Rate for Payer: Cofinity Commercial	$286.98
Rate for Payer: Cofinity Medicare Advantage	$233.59
Rate for Payer: Encore Health Key Benefits Commercial	$266.96
Rate for Payer: Healthscope Commercial	$300.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$283.64
Rate for Payer: PHP Commercial	$283.64
Rate for Payer: Priority Health Cigna Priority Health	$216.91
Rate for Payer: Priority Health SBD	$210.23

Know your out-of-pocket cost for care.

All Charges