|
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 |
$15.33 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.26
|
| Rate for Payer: BCN Commercial |
$18.23
|
| 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: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| 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 |
$5.60 |
| 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 |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$18.34
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| 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 Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Medicare |
$5.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| 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 Dual Complete DSNP |
$5.90
|
| Rate for Payer: UHC Exchange |
$5.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.90
|
| 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
|
$23.59
|
|
|
Service Code
|
NDC 00574402450
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.60 |
| 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 |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.39
|
| Rate for Payer: BCN Commercial |
$18.34
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.34
|
| 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 Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health HMO/PPO |
$20.52
|
| Rate for Payer: Priority Health Medicare |
$5.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.81
|
| 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 Dual Complete DSNP |
$5.90
|
| Rate for Payer: UHC Exchange |
$5.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.90
|
| Rate for Payer: VA VA |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
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 |
$546.18 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: BCBS Trust/PPO |
$685.91
|
| Rate for Payer: BCN Commercial |
$649.36
|
| 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: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health HMO/PPO |
$731.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.98
|
| 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 |
$199.56 |
| 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 |
$336.11
|
| Rate for Payer: BCBS MAPPO |
$210.07
|
| Rate for Payer: BCBS Trust/PPO |
$690.79
|
| Rate for Payer: BCN Commercial |
$653.31
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: Nomi Health Commercial |
$689.02
|
| 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 Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health HMO/PPO |
$731.03
|
| Rate for Payer: Priority Health Medicare |
$212.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.98
|
| 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 Dual Complete DSNP |
$210.07
|
| Rate for Payer: UHC Exchange |
$210.07
|
| Rate for Payer: UHC Medicare Advantage |
$210.07
|
| Rate for Payer: VA VA |
$210.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$198.99
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
2903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.34 |
| Max. Negotiated Rate |
$179.09 |
| Rate for Payer: Aetna Commercial |
$169.14
|
| Rate for Payer: BCBS Trust/PPO |
$162.44
|
| Rate for Payer: BCN Commercial |
$153.78
|
| Rate for Payer: Cash Price |
$159.19
|
| Rate for Payer: Cofinity Commercial |
$171.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.19
|
| Rate for Payer: Healthscope Commercial |
$179.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.14
|
| Rate for Payer: Nomi Health Commercial |
$163.17
|
| Rate for Payer: PHP Commercial |
$169.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.34
|
| Rate for Payer: Priority Health HMO/PPO |
$173.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.11
|
| Rate for Payer: UHC Core |
$166.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.24
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$198.99
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
2903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.26 |
| Max. Negotiated Rate |
$179.09 |
| Rate for Payer: Aetna Commercial |
$169.14
|
| Rate for Payer: Aetna Medicare |
$51.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.18
|
| Rate for Payer: BCBS Complete |
$79.60
|
| Rate for Payer: BCBS MAPPO |
$49.75
|
| Rate for Payer: BCBS Trust/PPO |
$163.59
|
| Rate for Payer: BCN Commercial |
$154.71
|
| Rate for Payer: BCN Medicare Advantage |
$49.75
|
| Rate for Payer: Cash Price |
$159.19
|
| Rate for Payer: Cofinity Commercial |
$171.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.75
|
| Rate for Payer: Healthscope Commercial |
$179.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.14
|
| Rate for Payer: Nomi Health Commercial |
$163.17
|
| Rate for Payer: PACE Senior Care Partners |
$47.26
|
| Rate for Payer: PACE SWMI |
$49.75
|
| Rate for Payer: PHP Commercial |
$169.14
|
| Rate for Payer: PHP Medicare Advantage |
$49.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.34
|
| Rate for Payer: Priority Health HMO/PPO |
$173.12
|
| Rate for Payer: Priority Health Medicare |
$50.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.32
|
| Rate for Payer: Railroad Medicare Medicare |
$49.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.11
|
| Rate for Payer: UHC Core |
$166.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.75
|
| Rate for Payer: UHC Exchange |
$49.75
|
| Rate for Payer: UHC Medicare Advantage |
$49.75
|
| Rate for Payer: VA VA |
$49.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.24
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.91 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: BCBS Trust/PPO |
$164.40
|
| Rate for Payer: BCN Commercial |
$155.64
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: Nomi Health Commercial |
$165.15
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health HMO/PPO |
$175.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.23
|
| Rate for Payer: UHC Core |
$168.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 68084061711
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$1.65
|
| Rate for Payer: BCN Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: Nomi Health Commercial |
$1.66
|
| Rate for Payer: PHP Commercial |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC Core |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.52
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$86.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.28
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: BCBS MAPPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$274.33
|
| Rate for Payer: BCN Commercial |
$259.45
|
| Rate for Payer: BCN Medicare Advantage |
$83.42
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.42
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: PACE Senior Care Partners |
$79.25
|
| Rate for Payer: PACE SWMI |
$83.42
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: PHP Medicare Advantage |
$83.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.90
|
| Rate for Payer: Priority Health HMO/PPO |
$290.32
|
| Rate for Payer: Priority Health Medicare |
$84.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.58
|
| Rate for Payer: Railroad Medicare Medicare |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.42
|
| Rate for Payer: UHC Exchange |
$83.42
|
| Rate for Payer: UHC Medicare Advantage |
$83.42
|
| Rate for Payer: VA VA |
$83.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 68084061711
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna Medicare |
$0.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.63
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: BCBS MAPPO |
$0.51
|
| Rate for Payer: BCBS Trust/PPO |
$1.66
|
| Rate for Payer: BCN Commercial |
$1.57
|
| Rate for Payer: BCN Medicare Advantage |
$0.51
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.51
|
| Rate for Payer: Healthscope Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: Nomi Health Commercial |
$1.66
|
| Rate for Payer: PACE Senior Care Partners |
$0.48
|
| Rate for Payer: PACE SWMI |
$0.51
|
| Rate for Payer: PHP Commercial |
$1.72
|
| Rate for Payer: PHP Medicare Advantage |
$0.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health HMO/PPO |
$1.76
|
| Rate for Payer: Priority Health Medicare |
$0.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.35
|
| Rate for Payer: Railroad Medicare Medicare |
$0.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC Core |
$1.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.51
|
| Rate for Payer: UHC Exchange |
$0.51
|
| Rate for Payer: UHC Medicare Advantage |
$0.51
|
| Rate for Payer: VA VA |
$0.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.52
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$52.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.94
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: BCBS MAPPO |
$50.35
|
| Rate for Payer: BCBS Trust/PPO |
$165.57
|
| Rate for Payer: BCN Commercial |
$156.59
|
| Rate for Payer: BCN Medicare Advantage |
$50.35
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.35
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: Nomi Health Commercial |
$165.15
|
| Rate for Payer: PACE Senior Care Partners |
$47.83
|
| Rate for Payer: PACE SWMI |
$50.35
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: PHP Medicare Advantage |
$50.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health HMO/PPO |
$175.22
|
| Rate for Payer: Priority Health Medicare |
$50.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.94
|
| Rate for Payer: Railroad Medicare Medicare |
$50.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.23
|
| Rate for Payer: UHC Core |
$168.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.35
|
| Rate for Payer: UHC Exchange |
$50.35
|
| Rate for Payer: UHC Medicare Advantage |
$50.35
|
| Rate for Payer: VA VA |
$50.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: BCBS Trust/PPO |
$272.40
|
| Rate for Payer: BCN Commercial |
$257.88
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.90
|
| Rate for Payer: Priority Health HMO/PPO |
$290.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079054401
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.12
|
| 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: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| 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
|
$273.60
|
|
|
Service Code
|
NDC 51079054420
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.84 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: BCBS Trust/PPO |
$223.34
|
| Rate for Payer: BCN Commercial |
$211.44
|
| 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: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health HMO/PPO |
$238.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.31
|
| 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
|
$2.74
|
|
|
Service Code
|
NDC 51079054401
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.86
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS MAPPO |
$0.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Medicare Advantage |
$0.69
|
| 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: Health Alliance Plan Medicare Advantage |
$0.69
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.69
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| Rate for Payer: Railroad Medicare Medicare |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.69
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UHC Medicare Advantage |
$0.69
|
| Rate for Payer: VA VA |
$0.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 51079054420
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.98 |
| 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 |
$109.44
|
| Rate for Payer: BCBS MAPPO |
$68.40
|
| Rate for Payer: BCBS Trust/PPO |
$224.93
|
| Rate for Payer: BCN Commercial |
$212.72
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Nomi Health Commercial |
$224.35
|
| 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 Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health HMO/PPO |
$238.03
|
| Rate for Payer: Priority Health Medicare |
$69.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.31
|
| 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 Dual Complete DSNP |
$68.40
|
| Rate for Payer: UHC Exchange |
$68.40
|
| Rate for Payer: UHC Medicare Advantage |
$68.40
|
| Rate for Payer: VA VA |
$68.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$366.60
|
|
|
Service Code
|
NDC 00904642761
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.07 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna Medicare |
$95.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.56
|
| Rate for Payer: BCBS Complete |
$146.64
|
| Rate for Payer: BCBS MAPPO |
$91.65
|
| Rate for Payer: BCBS Trust/PPO |
$301.38
|
| Rate for Payer: BCN Commercial |
$285.03
|
| Rate for Payer: BCN Medicare Advantage |
$91.65
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.65
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Nomi Health Commercial |
$300.61
|
| Rate for Payer: PACE Senior Care Partners |
$87.07
|
| Rate for Payer: PACE SWMI |
$91.65
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: PHP Medicare Advantage |
$91.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.29
|
| Rate for Payer: Priority Health HMO/PPO |
$318.94
|
| Rate for Payer: Priority Health Medicare |
$92.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.62
|
| Rate for Payer: Railroad Medicare Medicare |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.61
|
| Rate for Payer: UHC Core |
$306.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.65
|
| Rate for Payer: UHC Exchange |
$91.65
|
| Rate for Payer: UHC Medicare Advantage |
$91.65
|
| Rate for Payer: VA VA |
$91.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$366.60
|
|
|
Service Code
|
NDC 00904642761
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.29 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: BCBS Trust/PPO |
$299.26
|
| Rate for Payer: BCN Commercial |
$283.31
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Nomi Health Commercial |
$300.61
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.29
|
| Rate for Payer: Priority Health HMO/PPO |
$318.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.61
|
| Rate for Payer: UHC Core |
$306.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 43547028010
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: BCBS Trust/PPO |
$105.51
|
| Rate for Payer: BCN Commercial |
$99.88
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: Nomi Health Commercial |
$105.98
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health HMO/PPO |
$112.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.74
|
| Rate for Payer: UHC Core |
$107.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.06 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: BCBS Trust/PPO |
$178.40
|
| Rate for Payer: BCN Commercial |
$168.90
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: Priority Health HMO/PPO |
$190.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.32
|
| Rate for Payer: UHC Core |
$182.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 43547028010
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.39
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: BCBS MAPPO |
$32.31
|
| Rate for Payer: BCBS Trust/PPO |
$106.26
|
| Rate for Payer: BCN Commercial |
$100.49
|
| Rate for Payer: BCN Medicare Advantage |
$32.31
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.31
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: Nomi Health Commercial |
$105.98
|
| Rate for Payer: PACE Senior Care Partners |
$30.70
|
| Rate for Payer: PACE SWMI |
$32.31
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: PHP Medicare Advantage |
$32.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health HMO/PPO |
$112.45
|
| Rate for Payer: Priority Health Medicare |
$32.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.60
|
| Rate for Payer: Railroad Medicare Medicare |
$32.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.74
|
| Rate for Payer: UHC Core |
$107.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.31
|
| Rate for Payer: UHC Exchange |
$32.31
|
| Rate for Payer: UHC Medicare Advantage |
$32.31
|
| Rate for Payer: VA VA |
$32.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.91 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$56.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.30
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: BCBS MAPPO |
$54.64
|
| Rate for Payer: BCBS Trust/PPO |
$179.67
|
| Rate for Payer: BCN Commercial |
$169.92
|
| Rate for Payer: BCN Medicare Advantage |
$54.64
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.64
|
| Rate for Payer: Healthscope Commercial |
$196.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: PACE Senior Care Partners |
$51.91
|
| Rate for Payer: PACE SWMI |
$54.64
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: Priority Health HMO/PPO |
$190.14
|
| Rate for Payer: Priority Health Medicare |
$55.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.43
|
| Rate for Payer: Railroad Medicare Medicare |
$54.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.32
|
| Rate for Payer: UHC Core |
$182.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.64
|
| Rate for Payer: UHC Exchange |
$54.64
|
| Rate for Payer: UHC Medicare Advantage |
$54.64
|
| Rate for Payer: VA VA |
$54.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.65
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna Commercial |
$15.85
|
| Rate for Payer: Aetna Commercial |
$50.84
|
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Medicare |
$7.15
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.83
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: BCBS Complete |
$23.92
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS MAPPO |
$4.66
|
| Rate for Payer: BCBS MAPPO |
$6.88
|
| Rate for Payer: BCBS MAPPO |
$14.95
|
| Rate for Payer: BCBS MAPPO |
$12.20
|
| Rate for Payer: BCBS Trust/PPO |
$15.33
|
| Rate for Payer: BCBS Trust/PPO |
$49.17
|
| Rate for Payer: BCBS Trust/PPO |
$22.62
|
| Rate for Payer: BCBS Trust/PPO |
$40.13
|
| Rate for Payer: BCN Commercial |
$14.50
|
| Rate for Payer: BCN Commercial |
$37.96
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: BCN Commercial |
$46.50
|
| Rate for Payer: BCN Medicare Advantage |
$6.88
|
| Rate for Payer: BCN Medicare Advantage |
$14.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.66
|
| Rate for Payer: BCN Medicare Advantage |
$12.20
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cofinity Commercial |
$51.44
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$16.78
|
| Rate for Payer: Healthscope Commercial |
$53.83
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Nomi Health Commercial |
$49.04
|
| Rate for Payer: Nomi Health Commercial |
$15.29
|
| Rate for Payer: Nomi Health Commercial |
$22.56
|
| Rate for Payer: PACE Senior Care Partners |
$4.43
|
| Rate for Payer: PACE Senior Care Partners |
$11.59
|
| Rate for Payer: PACE Senior Care Partners |
$14.20
|
| Rate for Payer: PACE Senior Care Partners |
$6.53
|
| Rate for Payer: PACE SWMI |
$6.88
|
| Rate for Payer: PACE SWMI |
$4.66
|
| Rate for Payer: PACE SWMI |
$12.20
|
| Rate for Payer: PACE SWMI |
$14.95
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Commercial |
$50.84
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$15.85
|
| Rate for Payer: PHP Medicare Advantage |
$6.88
|
| Rate for Payer: PHP Medicare Advantage |
$4.66
|
| Rate for Payer: PHP Medicare Advantage |
$14.95
|
| Rate for Payer: PHP Medicare Advantage |
$12.20
|
| 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 |
$38.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.12
|
| Rate for Payer: Priority Health HMO/PPO |
$23.93
|
| Rate for Payer: Priority Health HMO/PPO |
$52.03
|
| Rate for Payer: Priority Health HMO/PPO |
$42.47
|
| Rate for Payer: Priority Health HMO/PPO |
$16.23
|
| Rate for Payer: Priority Health Medicare |
$12.33
|
| Rate for Payer: Priority Health Medicare |
$4.71
|
| Rate for Payer: Priority Health Medicare |
$6.95
|
| Rate for Payer: Priority Health Medicare |
$15.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.50
|
| Rate for Payer: Railroad Medicare Medicare |
$6.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.21
|
| Rate for Payer: UHC Core |
$15.57
|
| Rate for Payer: UHC Core |
$49.94
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Core |
$40.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.88
|
| Rate for Payer: UHC Exchange |
$14.95
|
| Rate for Payer: UHC Exchange |
$6.88
|
| Rate for Payer: UHC Exchange |
$4.66
|
| Rate for Payer: UHC Exchange |
$12.20
|
| Rate for Payer: UHC Medicare Advantage |
$14.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: UHC Medicare Advantage |
$12.20
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
| Rate for Payer: VA VA |
$6.88
|
| Rate for Payer: VA VA |
$14.95
|
| Rate for Payer: VA VA |
$12.20
|
| Rate for Payer: VA VA |
$4.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.82
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Commercial |
$15.85
|
| Rate for Payer: Aetna Commercial |
$50.84
|
| Rate for Payer: BCBS Trust/PPO |
$39.85
|
| Rate for Payer: BCBS Trust/PPO |
$48.82
|
| Rate for Payer: BCBS Trust/PPO |
$22.46
|
| Rate for Payer: BCBS Trust/PPO |
$15.22
|
| Rate for Payer: BCN Commercial |
$37.73
|
| Rate for Payer: BCN Commercial |
$14.41
|
| Rate for Payer: BCN Commercial |
$46.22
|
| Rate for Payer: BCN Commercial |
$21.26
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$51.44
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| 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 |
$53.83
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Healthscope Commercial |
$16.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.84
|
| Rate for Payer: Nomi Health Commercial |
$15.29
|
| Rate for Payer: Nomi Health Commercial |
$22.56
|
| Rate for Payer: Nomi Health Commercial |
$49.04
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$15.85
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Commercial |
$50.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.12
|
| 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 HMO/PPO |
$42.47
|
| Rate for Payer: Priority Health HMO/PPO |
$52.03
|
| Rate for Payer: Priority Health HMO/PPO |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$23.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.96
|
| Rate for Payer: UHC Core |
$40.76
|
| Rate for Payer: UHC Core |
$49.94
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Core |
$15.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
