|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$65.84
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$59.26 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Medicare |
$17.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.57
|
| Rate for Payer: BCBS Complete |
$12.19
|
| Rate for Payer: BCBS MAPPO |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$54.13
|
| Rate for Payer: BCN Commercial |
$54.13
|
| Rate for Payer: BCN Medicare Advantage |
$16.46
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.38
|
| Rate for Payer: Mclaren Medicaid |
$11.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.28
|
| Rate for Payer: Meridian Medicaid |
$12.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Nomi Health Commercial |
$53.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: PACE Senior Care Partners |
$15.64
|
| Rate for Payer: PACE SWMI |
$16.46
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: PHP Medicare Advantage |
$16.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.28
|
| Rate for Payer: Priority Health Medicare |
$16.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.82
|
| Rate for Payer: Railroad Medicare Medicare |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.94
|
| Rate for Payer: UHC Core |
$54.98
|
| Rate for Payer: UHC Exchange |
$16.46
|
| Rate for Payer: UHC Medicaid |
$11.61
|
| Rate for Payer: UHC Medicare Advantage |
$16.46
|
| Rate for Payer: UHCCP Medicaid |
$11.61
|
| Rate for Payer: VA VA |
$16.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.38
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$692.76
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.13 |
| Max. Negotiated Rate |
$623.48 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Medicare |
$180.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.49
|
| Rate for Payer: BCBS Complete |
$128.23
|
| Rate for Payer: BCBS MAPPO |
$173.19
|
| Rate for Payer: BCBS Trust/PPO |
$569.52
|
| Rate for Payer: BCN Commercial |
$569.52
|
| Rate for Payer: BCN Medicare Advantage |
$173.19
|
| Rate for Payer: Cash Price |
$554.21
|
| Rate for Payer: Cofinity Commercial |
$595.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.19
|
| Rate for Payer: Healthscope Commercial |
$623.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$519.57
|
| Rate for Payer: Mclaren Medicaid |
$122.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.85
|
| Rate for Payer: Meridian Medicaid |
$128.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$190.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.85
|
| Rate for Payer: Nomi Health Commercial |
$568.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.57
|
| Rate for Payer: PACE Senior Care Partners |
$164.53
|
| Rate for Payer: PACE SWMI |
$173.19
|
| Rate for Payer: PHP Commercial |
$588.85
|
| Rate for Payer: PHP Medicare Advantage |
$173.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$602.70
|
| Rate for Payer: Priority Health Medicare |
$174.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$482.16
|
| Rate for Payer: Railroad Medicare Medicare |
$173.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.63
|
| Rate for Payer: UHC Core |
$578.45
|
| Rate for Payer: UHC Exchange |
$173.19
|
| Rate for Payer: UHC Medicaid |
$122.13
|
| Rate for Payer: UHC Medicare Advantage |
$173.19
|
| Rate for Payer: UHCCP Medicaid |
$122.13
|
| Rate for Payer: VA VA |
$173.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.57
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$692.76
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$623.48 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: BCBS Trust/PPO |
$572.15
|
| Rate for Payer: BCN Commercial |
$572.15
|
| Rate for Payer: Cash Price |
$554.21
|
| Rate for Payer: Cofinity Commercial |
$595.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.21
|
| Rate for Payer: Healthscope Commercial |
$623.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$519.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.85
|
| Rate for Payer: Nomi Health Commercial |
$568.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.57
|
| Rate for Payer: PHP Commercial |
$588.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$602.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$482.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.63
|
| Rate for Payer: UHC Core |
$578.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.57
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 00574402450
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$6.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.37
|
| Rate for Payer: BCBS Complete |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$19.39
|
| Rate for Payer: BCN Medicare Advantage |
$5.90
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.90
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Mclaren Medicaid |
$4.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.19
|
| Rate for Payer: Meridian Medicaid |
$4.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PACE Senior Care Partners |
$5.60
|
| Rate for Payer: PACE SWMI |
$5.90
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Medicare |
$5.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: UHC Exchange |
$5.90
|
| Rate for Payer: UHC Medicaid |
$4.16
|
| Rate for Payer: UHC Medicare Advantage |
$5.90
|
| Rate for Payer: UHCCP Medicaid |
$4.16
|
| Rate for Payer: VA VA |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 00574402450
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.48
|
| Rate for Payer: BCN Commercial |
$19.48
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$24.45
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Aetna Commercial |
$20.78
|
| Rate for Payer: BCBS Trust/PPO |
$20.19
|
| Rate for Payer: BCN Commercial |
$20.19
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.78
|
| Rate for Payer: Nomi Health Commercial |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.34
|
| Rate for Payer: PHP Commercial |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$20.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.34
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 00574402411
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.48
|
| Rate for Payer: BCN Commercial |
$19.48
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 00574402411
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$6.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.37
|
| Rate for Payer: BCBS Complete |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$19.39
|
| Rate for Payer: BCN Medicare Advantage |
$5.90
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.90
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Mclaren Medicaid |
$4.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.19
|
| Rate for Payer: Meridian Medicaid |
$4.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.69
|
| Rate for Payer: PACE Senior Care Partners |
$5.60
|
| Rate for Payer: PACE SWMI |
$5.90
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Medicare |
$5.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.76
|
| Rate for Payer: UHC Core |
$19.70
|
| Rate for Payer: UHC Exchange |
$5.90
|
| Rate for Payer: UHC Medicaid |
$4.16
|
| Rate for Payer: UHC Medicare Advantage |
$5.90
|
| Rate for Payer: UHCCP Medicaid |
$4.16
|
| Rate for Payer: VA VA |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$24.45
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Aetna Commercial |
$20.78
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.64
|
| Rate for Payer: BCBS Complete |
$4.53
|
| Rate for Payer: BCBS MAPPO |
$6.11
|
| Rate for Payer: BCBS Trust/PPO |
$20.10
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: BCN Medicare Advantage |
$6.11
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.11
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.34
|
| Rate for Payer: Mclaren Medicaid |
$4.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.42
|
| Rate for Payer: Meridian Medicaid |
$4.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.78
|
| Rate for Payer: Nomi Health Commercial |
$20.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.34
|
| Rate for Payer: PACE Senior Care Partners |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.11
|
| Rate for Payer: PHP Commercial |
$20.78
|
| Rate for Payer: PHP Medicare Advantage |
$6.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.27
|
| Rate for Payer: Priority Health Medicare |
$6.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.02
|
| Rate for Payer: Railroad Medicare Medicare |
$6.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$20.42
|
| Rate for Payer: UHC Exchange |
$6.11
|
| Rate for Payer: UHC Medicaid |
$4.31
|
| Rate for Payer: UHC Medicare Advantage |
$6.11
|
| Rate for Payer: UHCCP Medicaid |
$4.31
|
| Rate for Payer: VA VA |
$6.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.34
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$840.27
|
|
|
Service Code
|
NDC 24338013402
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$584.83 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: BCBS Trust/PPO |
$693.98
|
| Rate for Payer: BCN Commercial |
$693.98
|
| Rate for Payer: Cash Price |
$672.22
|
| 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: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Nomi Health Commercial |
$689.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.20
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$731.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$584.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.44
|
| Rate for Payer: UHC Core |
$701.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$840.27
|
|
|
Service Code
|
NDC 24338013402
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.14 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna Medicare |
$218.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.58
|
| Rate for Payer: BCBS Complete |
$155.53
|
| Rate for Payer: BCBS MAPPO |
$210.07
|
| Rate for Payer: BCBS Trust/PPO |
$690.79
|
| Rate for Payer: BCN Commercial |
$690.79
|
| Rate for Payer: BCN Medicare Advantage |
$210.07
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.07
|
| Rate for Payer: Healthscope Commercial |
$756.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Mclaren Medicaid |
$148.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.57
|
| Rate for Payer: Meridian Medicaid |
$155.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$231.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Nomi Health Commercial |
$689.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.20
|
| Rate for Payer: PACE Senior Care Partners |
$199.56
|
| Rate for Payer: PACE SWMI |
$210.07
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: PHP Medicare Advantage |
$210.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$731.03
|
| Rate for Payer: Priority Health Medicare |
$212.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$584.83
|
| Rate for Payer: Railroad Medicare Medicare |
$210.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.44
|
| Rate for Payer: UHC Core |
$701.63
|
| Rate for Payer: UHC Exchange |
$210.07
|
| Rate for Payer: UHC Medicaid |
$148.14
|
| Rate for Payer: UHC Medicare Advantage |
$210.07
|
| Rate for Payer: UHCCP Medicaid |
$148.14
|
| Rate for Payer: VA VA |
$210.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
NDC 60219150301
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.66 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Aetna Commercial |
$499.80
|
| Rate for Payer: Aetna Medicare |
$152.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$183.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$183.75
|
| Rate for Payer: BCBS Complete |
$108.84
|
| Rate for Payer: BCBS MAPPO |
$147.00
|
| Rate for Payer: BCBS Trust/PPO |
$483.39
|
| Rate for Payer: BCN Commercial |
$483.39
|
| Rate for Payer: BCN Medicare Advantage |
$147.00
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cofinity Commercial |
$505.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.00
|
| Rate for Payer: Healthscope Commercial |
$529.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.00
|
| Rate for Payer: Mclaren Medicaid |
$103.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.35
|
| Rate for Payer: Meridian Medicaid |
$108.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$161.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.80
|
| Rate for Payer: Nomi Health Commercial |
$482.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.00
|
| Rate for Payer: PACE Senior Care Partners |
$139.65
|
| Rate for Payer: PACE SWMI |
$147.00
|
| Rate for Payer: PHP Commercial |
$499.80
|
| Rate for Payer: PHP Medicare Advantage |
$147.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$511.56
|
| Rate for Payer: Priority Health Medicare |
$148.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.25
|
| Rate for Payer: Railroad Medicare Medicare |
$147.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.44
|
| Rate for Payer: UHC Core |
$490.98
|
| Rate for Payer: UHC Exchange |
$147.00
|
| Rate for Payer: UHC Medicaid |
$103.66
|
| Rate for Payer: UHC Medicare Advantage |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$103.66
|
| Rate for Payer: VA VA |
$147.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.00
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
NDC 60219150301
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$409.25 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Aetna Commercial |
$499.80
|
| Rate for Payer: BCBS Trust/PPO |
$485.63
|
| Rate for Payer: BCN Commercial |
$485.63
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cofinity Commercial |
$505.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.40
|
| Rate for Payer: Healthscope Commercial |
$529.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.80
|
| Rate for Payer: Nomi Health Commercial |
$482.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.00
|
| Rate for Payer: PHP Commercial |
$499.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$511.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.44
|
| Rate for Payer: UHC Core |
$490.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.00
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$222.21
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
2903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.18 |
| Max. Negotiated Rate |
$199.99 |
| Rate for Payer: Aetna Commercial |
$188.88
|
| Rate for Payer: Aetna Medicare |
$57.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.44
|
| Rate for Payer: BCBS Complete |
$41.13
|
| Rate for Payer: BCBS MAPPO |
$55.55
|
| Rate for Payer: BCBS Trust/PPO |
$182.68
|
| Rate for Payer: BCN Commercial |
$182.68
|
| Rate for Payer: BCN Medicare Advantage |
$55.55
|
| Rate for Payer: Cash Price |
$177.77
|
| Rate for Payer: Cofinity Commercial |
$191.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.55
|
| Rate for Payer: Healthscope Commercial |
$199.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.66
|
| Rate for Payer: Mclaren Medicaid |
$39.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.33
|
| Rate for Payer: Meridian Medicaid |
$41.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.88
|
| Rate for Payer: Nomi Health Commercial |
$182.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.66
|
| Rate for Payer: PACE Senior Care Partners |
$52.77
|
| Rate for Payer: PACE SWMI |
$55.55
|
| Rate for Payer: PHP Commercial |
$188.88
|
| Rate for Payer: PHP Medicare Advantage |
$55.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$193.32
|
| Rate for Payer: Priority Health Medicare |
$56.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.66
|
| Rate for Payer: Railroad Medicare Medicare |
$55.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.54
|
| Rate for Payer: UHC Core |
$185.55
|
| Rate for Payer: UHC Exchange |
$55.55
|
| Rate for Payer: UHC Medicaid |
$39.18
|
| Rate for Payer: UHC Medicare Advantage |
$55.55
|
| Rate for Payer: UHCCP Medicaid |
$39.18
|
| Rate for Payer: VA VA |
$55.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.66
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$222.21
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
2903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.66 |
| Max. Negotiated Rate |
$199.99 |
| Rate for Payer: Aetna Commercial |
$188.88
|
| Rate for Payer: BCBS Trust/PPO |
$183.52
|
| Rate for Payer: BCN Commercial |
$183.52
|
| Rate for Payer: Cash Price |
$177.77
|
| Rate for Payer: Cofinity Commercial |
$191.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.77
|
| Rate for Payer: Healthscope Commercial |
$199.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.88
|
| Rate for Payer: Nomi Health Commercial |
$182.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.66
|
| Rate for Payer: PHP Commercial |
$188.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$193.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.54
|
| Rate for Payer: UHC Core |
$185.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.66
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$465.30
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Aetna Medicare |
$120.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.41
|
| Rate for Payer: BCBS Complete |
$86.13
|
| Rate for Payer: BCBS MAPPO |
$116.33
|
| Rate for Payer: BCBS Trust/PPO |
$382.52
|
| Rate for Payer: BCN Commercial |
$382.52
|
| Rate for Payer: BCN Medicare Advantage |
$116.33
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.33
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Mclaren Medicaid |
$82.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.14
|
| Rate for Payer: Meridian Medicaid |
$86.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Nomi Health Commercial |
$381.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PACE Senior Care Partners |
$110.51
|
| Rate for Payer: PACE SWMI |
$116.33
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: PHP Medicare Advantage |
$116.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$404.81
|
| Rate for Payer: Priority Health Medicare |
$117.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.85
|
| Rate for Payer: Railroad Medicare Medicare |
$116.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.46
|
| Rate for Payer: UHC Core |
$388.53
|
| Rate for Payer: UHC Exchange |
$116.33
|
| Rate for Payer: UHC Medicaid |
$82.03
|
| Rate for Payer: UHC Medicare Advantage |
$116.33
|
| Rate for Payer: UHCCP Medicaid |
$82.03
|
| Rate for Payer: VA VA |
$116.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$465.30
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.85 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: BCBS Trust/PPO |
$384.29
|
| Rate for Payer: BCN Commercial |
$384.29
|
| Rate for Payer: Cash Price |
$372.24
|
| 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: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.50
|
| Rate for Payer: Nomi Health Commercial |
$381.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.98
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$404.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.46
|
| Rate for Payer: UHC Core |
$388.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 68084061711
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.17
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: BCN Medicare Advantage |
$1.17
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.17
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Mclaren Medicaid |
$0.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.22
|
| Rate for Payer: Meridian Medicaid |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PACE Senior Care Partners |
$1.11
|
| Rate for Payer: PACE SWMI |
$1.17
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Medicare |
$1.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.10
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: UHC Exchange |
$1.17
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$1.17
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: VA VA |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.71 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: BCBS Trust/PPO |
$267.84
|
| Rate for Payer: BCN Commercial |
$267.84
|
| Rate for Payer: Cash Price |
$259.44
|
| 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: Lakeland Regional Health Systems Commercial |
$243.22
|
| 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: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$282.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.38
|
| Rate for Payer: UHC Core |
$270.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.17 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Medicare |
$84.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.34
|
| Rate for Payer: BCBS Complete |
$60.03
|
| Rate for Payer: BCBS MAPPO |
$81.08
|
| Rate for Payer: BCBS Trust/PPO |
$266.61
|
| Rate for Payer: BCN Commercial |
$266.61
|
| Rate for Payer: BCN Medicare Advantage |
$81.08
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.08
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Mclaren Medicaid |
$57.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.13
|
| Rate for Payer: Meridian Medicaid |
$60.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.18
|
| 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: PACE Senior Care Partners |
$77.02
|
| Rate for Payer: PACE SWMI |
$81.08
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: PHP Medicare Advantage |
$81.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$282.14
|
| Rate for Payer: Priority Health Medicare |
$81.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.71
|
| Rate for Payer: Railroad Medicare Medicare |
$81.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.38
|
| Rate for Payer: UHC Core |
$270.79
|
| Rate for Payer: UHC Exchange |
$81.08
|
| Rate for Payer: UHC Medicaid |
$57.17
|
| Rate for Payer: UHC Medicare Advantage |
$81.08
|
| Rate for Payer: UHCCP Medicaid |
$57.17
|
| Rate for Payer: VA VA |
$81.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 68084061711
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$3.73
|
| 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: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.10
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079054401
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.26
|
| Rate for Payer: BCN Commercial |
$2.26
|
| Rate for Payer: Cash Price |
$2.19
|
| 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: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.06
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00904642761
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.15 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: BCBS Trust/PPO |
$324.12
|
| Rate for Payer: BCN Commercial |
$324.12
|
| Rate for Payer: Cash Price |
$313.96
|
| 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: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$341.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.36
|
| Rate for Payer: UHC Core |
$327.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 51079054420
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.43 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: BCBS Trust/PPO |
$225.97
|
| Rate for Payer: BCN Commercial |
$225.97
|
| Rate for Payer: Cash Price |
$218.88
|
| 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: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Nomi Health Commercial |
$224.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.77
|
| Rate for Payer: UHC Core |
$228.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 51079054420
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$71.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.50
|
| Rate for Payer: BCBS Complete |
$50.64
|
| Rate for Payer: BCBS MAPPO |
$68.40
|
| Rate for Payer: BCBS Trust/PPO |
$224.93
|
| Rate for Payer: BCN Commercial |
$224.93
|
| Rate for Payer: BCN Medicare Advantage |
$68.40
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.40
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Mclaren Medicaid |
$48.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.82
|
| Rate for Payer: Meridian Medicaid |
$50.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Nomi Health Commercial |
$224.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: PACE Senior Care Partners |
$64.98
|
| Rate for Payer: PACE SWMI |
$68.40
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: PHP Medicare Advantage |
$68.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.03
|
| Rate for Payer: Priority Health Medicare |
$69.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.43
|
| Rate for Payer: Railroad Medicare Medicare |
$68.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.77
|
| Rate for Payer: UHC Core |
$228.46
|
| Rate for Payer: UHC Exchange |
$68.40
|
| Rate for Payer: UHC Medicaid |
$48.24
|
| Rate for Payer: UHC Medicare Advantage |
$68.40
|
| Rate for Payer: UHCCP Medicaid |
$48.24
|
| Rate for Payer: VA VA |
$68.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
