Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ESCITALOPRAM 10 MG TABLET

Facility

$333.70

Service Code	NDC 00904642661
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$133.48
Max. Negotiated Rate	$300.33
Rate for Payer: Aetna Commercial	$283.64
Rate for Payer: Aetna Medicare	$166.85
Rate for Payer: Aetna New Business (MI Preferred)	$216.91
Rate for Payer: BCBS Complete	$133.48
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

ESCITALOPRAM 10 MG TABLET

Facility

$201.40

Service Code	NDC 68084061701
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$80.56
Max. Negotiated Rate	$181.26
Rate for Payer: Aetna Commercial	$171.19
Rate for Payer: Aetna Medicare	$100.70
Rate for Payer: Aetna New Business (MI Preferred)	$130.91
Rate for Payer: BCBS Complete	$80.56
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

ESCITALOPRAM 10 MG TABLET

Facility

$2.02

Service Code	NDC 68084061711
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.82
Rate for Payer: Aetna Commercial	$1.72
Rate for Payer: Aetna New Business (MI Preferred)	$1.31
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cofinity Commercial	$1.41
Rate for Payer: Cofinity Commercial	$1.74
Rate for Payer: Cofinity Medicare Advantage	$1.41
Rate for Payer: Encore Health Key Benefits Commercial	$1.62
Rate for Payer: Healthscope Commercial	$1.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.72
Rate for Payer: PHP Commercial	$1.72
Rate for Payer: Priority Health Cigna Priority Health	$1.31
Rate for Payer: Priority Health SBD	$1.27

ESCITALOPRAM 20 MG TABLET

Facility

$273.60

Service Code	NDC 51079054420
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$172.37
Max. Negotiated Rate	$246.24
Rate for Payer: Aetna Commercial	$232.56
Rate for Payer: Aetna New Business (MI Preferred)	$177.84
Rate for Payer: Cash Price	$218.88
Rate for Payer: Cofinity Commercial	$191.52
Rate for Payer: Cofinity Commercial	$235.30
Rate for Payer: Cofinity Medicare Advantage	$191.52
Rate for Payer: Encore Health Key Benefits Commercial	$218.88
Rate for Payer: Healthscope Commercial	$246.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$232.56
Rate for Payer: PHP Commercial	$232.56
Rate for Payer: Priority Health Cigna Priority Health	$177.84
Rate for Payer: Priority Health SBD	$172.37

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 Commercial	$1.92
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Cofinity Medicare Advantage	$1.92
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: PHP Commercial	$2.33
Rate for Payer: Priority Health Cigna Priority Health	$1.78
Rate for Payer: Priority Health SBD	$1.73

ESCITALOPRAM 20 MG TABLET

Facility

$366.60

Service Code	NDC 00904642761
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$230.96
Max. Negotiated Rate	$329.94
Rate for Payer: Aetna Commercial	$311.61
Rate for Payer: Aetna New Business (MI Preferred)	$238.29
Rate for Payer: Cash Price	$293.28
Rate for Payer: Cofinity Commercial	$256.62
Rate for Payer: Cofinity Commercial	$315.28
Rate for Payer: Cofinity Medicare Advantage	$256.62
Rate for Payer: Encore Health Key Benefits Commercial	$293.28
Rate for Payer: Healthscope Commercial	$329.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.61
Rate for Payer: PHP Commercial	$311.61
Rate for Payer: Priority Health Cigna Priority Health	$238.29
Rate for Payer: Priority Health SBD	$230.96

ESCITALOPRAM 20 MG TABLET

Facility

$2.74

Service Code	NDC 51079054401
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$1.10
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 Commercial	$1.92
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Cofinity Medicare Advantage	$1.92
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: PHP Commercial	$2.33
Rate for Payer: Priority Health Cigna Priority Health	$1.78
Rate for Payer: Priority Health SBD	$1.73

ESCITALOPRAM 20 MG TABLET

Facility

$273.60

Service Code	NDC 51079054420
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$109.44
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 Commercial	$191.52
Rate for Payer: Cofinity Commercial	$235.30
Rate for Payer: Cofinity Medicare Advantage	$191.52
Rate for Payer: Encore Health Key Benefits Commercial	$218.88
Rate for Payer: Healthscope Commercial	$246.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$232.56
Rate for Payer: PHP Commercial	$232.56
Rate for Payer: Priority Health Cigna Priority Health	$177.84
Rate for Payer: Priority Health SBD	$172.37

ESCITALOPRAM 20 MG TABLET

Facility

$221.35

Service Code	NDC 68084061801
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$139.45
Max. Negotiated Rate	$199.22
Rate for Payer: Aetna Commercial	$188.15
Rate for Payer: Aetna New Business (MI Preferred)	$143.88
Rate for Payer: Cash Price	$177.08
Rate for Payer: Cofinity Commercial	$154.94
Rate for Payer: Cofinity Commercial	$190.36
Rate for Payer: Cofinity Medicare Advantage	$154.94
Rate for Payer: Encore Health Key Benefits Commercial	$177.08
Rate for Payer: Healthscope Commercial	$199.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.15
Rate for Payer: PHP Commercial	$188.15
Rate for Payer: Priority Health Cigna Priority Health	$143.88
Rate for Payer: Priority Health SBD	$139.45

ESCITALOPRAM 20 MG TABLET

Facility

$2.22

Service Code	NDC 68084061811
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.89
Rate for Payer: Aetna New Business (MI Preferred)	$1.44
Rate for Payer: Cash Price	$1.78
Rate for Payer: Cofinity Commercial	$1.55
Rate for Payer: Cofinity Commercial	$1.91
Rate for Payer: Cofinity Medicare Advantage	$1.55
Rate for Payer: Encore Health Key Benefits Commercial	$1.78
Rate for Payer: Healthscope Commercial	$2.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.89
Rate for Payer: PHP Commercial	$1.89
Rate for Payer: Priority Health Cigna Priority Health	$1.44
Rate for Payer: Priority Health SBD	$1.40

ESCITALOPRAM 20 MG TABLET

Facility

$2.22

Service Code	NDC 68084061811
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.89
Rate for Payer: Aetna Medicare	$1.11
Rate for Payer: Aetna New Business (MI Preferred)	$1.44
Rate for Payer: BCBS Complete	$0.89
Rate for Payer: Cash Price	$1.78
Rate for Payer: Cofinity Commercial	$1.55
Rate for Payer: Cofinity Commercial	$1.91
Rate for Payer: Cofinity Medicare Advantage	$1.55
Rate for Payer: Encore Health Key Benefits Commercial	$1.78
Rate for Payer: Healthscope Commercial	$2.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.89
Rate for Payer: PHP Commercial	$1.89
Rate for Payer: Priority Health Cigna Priority Health	$1.44
Rate for Payer: Priority Health SBD	$1.40

ESCITALOPRAM 20 MG TABLET

Facility

$366.60

Service Code	NDC 00904642761
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$146.64
Max. Negotiated Rate	$329.94
Rate for Payer: Aetna Commercial	$311.61
Rate for Payer: Aetna Medicare	$183.30
Rate for Payer: Aetna New Business (MI Preferred)	$238.29
Rate for Payer: BCBS Complete	$146.64
Rate for Payer: Cash Price	$293.28
Rate for Payer: Cofinity Commercial	$256.62
Rate for Payer: Cofinity Commercial	$315.28
Rate for Payer: Cofinity Medicare Advantage	$256.62
Rate for Payer: Encore Health Key Benefits Commercial	$293.28
Rate for Payer: Healthscope Commercial	$329.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.61
Rate for Payer: PHP Commercial	$311.61
Rate for Payer: Priority Health Cigna Priority Health	$238.29
Rate for Payer: Priority Health SBD	$230.96

ESCITALOPRAM 20 MG TABLET

Facility

$221.35

Service Code	NDC 68084061801
Hospital Charge Code	33513
Hospital Revenue Code	637
Min. Negotiated Rate	$88.54
Max. Negotiated Rate	$199.22
Rate for Payer: Aetna Commercial	$188.15
Rate for Payer: Aetna Medicare	$110.67
Rate for Payer: Aetna New Business (MI Preferred)	$143.88
Rate for Payer: BCBS Complete	$88.54
Rate for Payer: Cash Price	$177.08
Rate for Payer: Cofinity Commercial	$154.94
Rate for Payer: Cofinity Commercial	$190.36
Rate for Payer: Cofinity Medicare Advantage	$154.94
Rate for Payer: Encore Health Key Benefits Commercial	$177.08
Rate for Payer: Healthscope Commercial	$199.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.15
Rate for Payer: PHP Commercial	$188.15
Rate for Payer: Priority Health Cigna Priority Health	$143.88
Rate for Payer: Priority Health SBD	$139.45

ESCITALOPRAM 5 MG TABLET

Facility

$218.55

Service Code	NDC 65862037301
Hospital Charge Code	37635
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Commercial	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Cofinity Medicare Advantage	$152.99
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$142.06
Rate for Payer: Priority Health SBD	$137.69

ESCITALOPRAM 5 MG TABLET

Facility

$336.05

Service Code	NDC 13668013501
Hospital Charge Code	37635
Hospital Revenue Code	637
Min. Negotiated Rate	$134.42
Max. Negotiated Rate	$302.44
Rate for Payer: Aetna Commercial	$285.64
Rate for Payer: Aetna Medicare	$168.03
Rate for Payer: Aetna New Business (MI Preferred)	$218.43
Rate for Payer: BCBS Complete	$134.42
Rate for Payer: Cash Price	$268.84
Rate for Payer: Cofinity Commercial	$235.24
Rate for Payer: Cofinity Commercial	$289.00
Rate for Payer: Cofinity Medicare Advantage	$235.24
Rate for Payer: Encore Health Key Benefits Commercial	$268.84
Rate for Payer: Healthscope Commercial	$302.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.64
Rate for Payer: PHP Commercial	$285.64
Rate for Payer: Priority Health Cigna Priority Health	$218.43
Rate for Payer: Priority Health SBD	$211.71

ESCITALOPRAM 5 MG TABLET

Facility

$336.05

Service Code	NDC 13668013501
Hospital Charge Code	37635
Hospital Revenue Code	637
Min. Negotiated Rate	$211.71
Max. Negotiated Rate	$302.44
Rate for Payer: Aetna Commercial	$285.64
Rate for Payer: Aetna New Business (MI Preferred)	$218.43
Rate for Payer: Cash Price	$268.84
Rate for Payer: Cofinity Commercial	$235.24
Rate for Payer: Cofinity Commercial	$289.00
Rate for Payer: Cofinity Medicare Advantage	$235.24
Rate for Payer: Encore Health Key Benefits Commercial	$268.84
Rate for Payer: Healthscope Commercial	$302.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.64
Rate for Payer: PHP Commercial	$285.64
Rate for Payer: Priority Health Cigna Priority Health	$218.43
Rate for Payer: Priority Health SBD	$211.71

ESCITALOPRAM 5 MG TABLET

Facility

$218.55

Service Code	NDC 65862037301
Hospital Charge Code	37635
Hospital Revenue Code	637
Min. Negotiated Rate	$87.42
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna Medicare	$109.28
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: BCBS Complete	$87.42
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Commercial	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Cofinity Medicare Advantage	$152.99
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$142.06
Rate for Payer: Priority Health SBD	$137.69

ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION

Facility

$48.82

Service Code	HCPCS J1805
Hospital Charge Code	9957
Hospital Revenue Code	636
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$43.94
Rate for Payer: Aetna Commercial	$41.50
Rate for Payer: Aetna Commercial	$23.38
Rate for Payer: Aetna Commercial	$50.84
Rate for Payer: Aetna Commercial	$15.85
Rate for Payer: Aetna Medicare	$29.91
Rate for Payer: Aetna Medicare	$24.41
Rate for Payer: Aetna Medicare	$13.76
Rate for Payer: Aetna Medicare	$9.32
Rate for Payer: Aetna New Business (MI Preferred)	$31.73
Rate for Payer: Aetna New Business (MI Preferred)	$12.12
Rate for Payer: Aetna New Business (MI Preferred)	$17.88
Rate for Payer: Aetna New Business (MI Preferred)	$38.88
Rate for Payer: BCBS Complete	$7.46
Rate for Payer: BCBS Complete	$23.92
Rate for Payer: BCBS Complete	$11.00
Rate for Payer: BCBS Complete	$19.53
Rate for Payer: Cash Price	$47.85
Rate for Payer: Cash Price	$22.01
Rate for Payer: Cash Price	$39.06
Rate for Payer: Cash Price	$14.92
Rate for Payer: Cofinity Commercial	$23.66
Rate for Payer: Cofinity Commercial	$51.44
Rate for Payer: Cofinity Commercial	$34.17
Rate for Payer: Cofinity Commercial	$41.87
Rate for Payer: Cofinity Commercial	$41.99
Rate for Payer: Cofinity Commercial	$13.05
Rate for Payer: Cofinity Commercial	$16.04
Rate for Payer: Cofinity Commercial	$19.26
Rate for Payer: Cofinity Medicare Advantage	$34.17
Rate for Payer: Cofinity Medicare Advantage	$13.05
Rate for Payer: Cofinity Medicare Advantage	$19.26
Rate for Payer: Cofinity Medicare Advantage	$41.87
Rate for Payer: Encore Health Key Benefits Commercial	$39.06
Rate for Payer: Encore Health Key Benefits Commercial	$47.85
Rate for Payer: Encore Health Key Benefits Commercial	$14.92
Rate for Payer: Encore Health Key Benefits Commercial	$22.01
Rate for Payer: Healthscope Commercial	$16.79
Rate for Payer: Healthscope Commercial	$53.83
Rate for Payer: Healthscope Commercial	$24.76
Rate for Payer: Healthscope Commercial	$43.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.85
Rate for Payer: PHP Commercial	$23.38
Rate for Payer: PHP Commercial	$50.84
Rate for Payer: PHP Commercial	$41.50
Rate for Payer: PHP Commercial	$15.85
Rate for Payer: Priority Health Cigna Priority Health	$17.88
Rate for Payer: Priority Health Cigna Priority Health	$31.73
Rate for Payer: Priority Health Cigna Priority Health	$12.12
Rate for Payer: Priority Health Cigna Priority Health	$38.88
Rate for Payer: Priority Health SBD	$11.75
Rate for Payer: Priority Health SBD	$30.76
Rate for Payer: Priority Health SBD	$17.33
Rate for Payer: Priority Health SBD	$37.68

ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION

Facility

$48.82

Service Code	HCPCS J1805
Hospital Charge Code	9957
Hospital Revenue Code	636
Min. Negotiated Rate	$30.76
Max. Negotiated Rate	$43.94
Rate for Payer: Aetna Commercial	$41.50
Rate for Payer: Aetna Commercial	$23.38
Rate for Payer: Aetna Commercial	$50.84
Rate for Payer: Aetna Commercial	$15.85
Rate for Payer: Aetna New Business (MI Preferred)	$17.88
Rate for Payer: Aetna New Business (MI Preferred)	$12.12
Rate for Payer: Aetna New Business (MI Preferred)	$31.73
Rate for Payer: Aetna New Business (MI Preferred)	$38.88
Rate for Payer: Cash Price	$39.06
Rate for Payer: Cash Price	$22.01
Rate for Payer: Cash Price	$14.92
Rate for Payer: Cash Price	$47.85
Rate for Payer: Cofinity Commercial	$13.05
Rate for Payer: Cofinity Commercial	$51.44
Rate for Payer: Cofinity Commercial	$41.87
Rate for Payer: Cofinity Commercial	$19.26
Rate for Payer: Cofinity Commercial	$23.66
Rate for Payer: Cofinity Commercial	$41.99
Rate for Payer: Cofinity Commercial	$34.17
Rate for Payer: Cofinity Commercial	$16.04
Rate for Payer: Cofinity Medicare Advantage	$13.05
Rate for Payer: Cofinity Medicare Advantage	$19.26
Rate for Payer: Cofinity Medicare Advantage	$34.17
Rate for Payer: Cofinity Medicare Advantage	$41.87
Rate for Payer: Encore Health Key Benefits Commercial	$39.06
Rate for Payer: Encore Health Key Benefits Commercial	$14.92
Rate for Payer: Encore Health Key Benefits Commercial	$22.01
Rate for Payer: Encore Health Key Benefits Commercial	$47.85
Rate for Payer: Healthscope Commercial	$24.76
Rate for Payer: Healthscope Commercial	$16.79
Rate for Payer: Healthscope Commercial	$53.83
Rate for Payer: Healthscope Commercial	$43.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.85
Rate for Payer: PHP Commercial	$15.85
Rate for Payer: PHP Commercial	$41.50
Rate for Payer: PHP Commercial	$23.38
Rate for Payer: PHP Commercial	$50.84
Rate for Payer: Priority Health Cigna Priority Health	$17.88
Rate for Payer: Priority Health Cigna Priority Health	$31.73
Rate for Payer: Priority Health Cigna Priority Health	$12.12
Rate for Payer: Priority Health Cigna Priority Health	$38.88
Rate for Payer: Priority Health SBD	$11.75
Rate for Payer: Priority Health SBD	$30.76
Rate for Payer: Priority Health SBD	$17.33
Rate for Payer: Priority Health SBD	$37.68

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV

Facility

$366.56

Service Code	HCPCS J1805
Hospital Charge Code	29805
Hospital Revenue Code	636
Min. Negotiated Rate	$230.93
Max. Negotiated Rate	$329.90
Rate for Payer: Aetna Commercial	$311.58
Rate for Payer: Aetna New Business (MI Preferred)	$238.26
Rate for Payer: Cash Price	$293.25
Rate for Payer: Cofinity Commercial	$256.59
Rate for Payer: Cofinity Commercial	$315.24
Rate for Payer: Cofinity Medicare Advantage	$256.59
Rate for Payer: Encore Health Key Benefits Commercial	$293.25
Rate for Payer: Healthscope Commercial	$329.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.58
Rate for Payer: PHP Commercial	$311.58
Rate for Payer: Priority Health Cigna Priority Health	$238.26
Rate for Payer: Priority Health SBD	$230.93

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV

Facility

$366.56

Service Code	HCPCS J1805
Hospital Charge Code	29805
Hospital Revenue Code	636
Min. Negotiated Rate	$146.62
Max. Negotiated Rate	$329.90
Rate for Payer: Aetna Commercial	$311.58
Rate for Payer: Aetna Medicare	$183.28
Rate for Payer: Aetna New Business (MI Preferred)	$238.26
Rate for Payer: BCBS Complete	$146.62
Rate for Payer: Cash Price	$293.25
Rate for Payer: Cofinity Commercial	$256.59
Rate for Payer: Cofinity Commercial	$315.24
Rate for Payer: Cofinity Medicare Advantage	$256.59
Rate for Payer: Encore Health Key Benefits Commercial	$293.25
Rate for Payer: Healthscope Commercial	$329.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.58
Rate for Payer: PHP Commercial	$311.58
Rate for Payer: Priority Health Cigna Priority Health	$238.26
Rate for Payer: Priority Health SBD	$230.93

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN STERILE WATER INTRAVENOUS SOLN

Facility

$435.00

Service Code	HCPCS J1806
Hospital Charge Code	185900
Hospital Revenue Code	636
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$391.50
Rate for Payer: Aetna Commercial	$369.75
Rate for Payer: Aetna Medicare	$217.50
Rate for Payer: Aetna New Business (MI Preferred)	$282.75
Rate for Payer: BCBS Complete	$174.00
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cofinity Commercial	$304.50
Rate for Payer: Cofinity Commercial	$374.10
Rate for Payer: Cofinity Medicare Advantage	$304.50
Rate for Payer: Encore Health Key Benefits Commercial	$348.00
Rate for Payer: Healthscope Commercial	$391.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.75
Rate for Payer: PHP Commercial	$369.75
Rate for Payer: Priority Health Cigna Priority Health	$282.75
Rate for Payer: Priority Health SBD	$274.05

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN STERILE WATER INTRAVENOUS SOLN

Facility

$435.00

Service Code	HCPCS J1806
Hospital Charge Code	185900
Hospital Revenue Code	636
Min. Negotiated Rate	$274.05
Max. Negotiated Rate	$391.50
Rate for Payer: Aetna Commercial	$369.75
Rate for Payer: Aetna New Business (MI Preferred)	$282.75
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cofinity Commercial	$304.50
Rate for Payer: Cofinity Commercial	$374.10
Rate for Payer: Cofinity Medicare Advantage	$304.50
Rate for Payer: Encore Health Key Benefits Commercial	$348.00
Rate for Payer: Healthscope Commercial	$391.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.75
Rate for Payer: PHP Commercial	$369.75
Rate for Payer: Priority Health Cigna Priority Health	$282.75
Rate for Payer: Priority Health SBD	$274.05

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$2,573.89

Service Code	CPT 43235
Hospital Revenue Code	360
Min. Negotiated Rate	$490.11
Max. Negotiated Rate	$2,573.89
Rate for Payer: Aetna Medicare	$950.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,142.97
Rate for Payer: Amish Plain Church Group Commercial	$1,142.97
Rate for Payer: BCBS Complete	$514.61
Rate for Payer: BCBS MAPPO	$914.38
Rate for Payer: BCN Medicare Advantage	$914.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$914.38
Rate for Payer: Mclaren Medicaid	$490.11
Rate for Payer: Mclaren Medicare	$914.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$960.10
Rate for Payer: Meridian Medicaid	$514.61
Rate for Payer: MI Amish Medical Board Commercial	$1,051.54
Rate for Payer: PACE Medicare	$868.66
Rate for Payer: PACE SWMI	$914.38
Rate for Payer: PHP Medicare Advantage	$914.38
Rate for Payer: Priority Health Choice Medicaid	$490.11
Rate for Payer: Priority Health Medicare	$914.38
Rate for Payer: Railroad Medicare Medicare	$914.38
Rate for Payer: UHC All Payor (Choice/PPO)	$2,573.89
Rate for Payer: UHC Dual Complete DSNP	$914.38
Rate for Payer: UHC Medicare Advantage	$914.38
Rate for Payer: UHCCP Medicaid	$514.80
Rate for Payer: VA VA	$914.38

Know your out-of-pocket cost for care.

All Charges