Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

$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

$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 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 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	$336.11
Max. Negotiated Rate	$756.24
Rate for Payer: Aetna Commercial	$714.23
Rate for Payer: Aetna Medicare	$420.14
Rate for Payer: Aetna New Business (MI Preferred)	$546.18
Rate for Payer: BCBS Complete	$336.11
Rate for Payer: Cash Price	$672.22
Rate for Payer: Cofinity Commercial	$588.19
Rate for Payer: Cofinity Commercial	$722.63
Rate for Payer: Cofinity Medicare Advantage	$588.19
Rate for Payer: Encore Health Key Benefits Commercial	$672.22
Rate for Payer: Healthscope Commercial	$756.24
Rate for Payer: 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	$420.14
Rate for Payer: Aetna New Business (MI Preferred)	$546.18
Rate for Payer: BCBS Complete	$336.11
Rate for Payer: Cash Price	$672.22
Rate for Payer: Cofinity Commercial	$588.19
Rate for Payer: Cofinity Commercial	$722.63
Rate for Payer: Cofinity Medicare Advantage	$588.19
Rate for Payer: Encore Health Key Benefits Commercial	$672.22
Rate for Payer: Healthscope Commercial	$756.24
Rate for Payer: 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	$722.63
Rate for Payer: Cofinity Commercial	$588.19
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

$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)	$216.90
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	$216.90
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 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

$2.02

Service Code	NDC 68084061711
Hospital Charge Code	33512
Hospital Revenue Code	637
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.82
Rate for Payer: Aetna Commercial	$1.72
Rate for Payer: Aetna Medicare	$1.01
Rate for Payer: Aetna New Business (MI Preferred)	$1.31
Rate for Payer: BCBS Complete	$0.81
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 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)	$216.90
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	$216.90
Rate for Payer: Priority Health SBD	$210.23

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

$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

$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

$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

$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

$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

$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

$2.74

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

$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	$110.68
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 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 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	$196.70
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	$152.98
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Cofinity Medicare Advantage	$152.98
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.70
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

Know your out-of-pocket cost for care.

All Charges