|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$258.60 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: BCBS Trust/PPO |
$327.67
|
| Rate for Payer: BCN Commercial |
$327.67
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.40
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.84 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: BCBS Trust/PPO |
$327.67
|
| Rate for Payer: BCBS Trust/PPO |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$95.95
|
| Rate for Payer: BCBS Trust/PPO |
$82.33
|
| Rate for Payer: BCN Commercial |
$95.95
|
| Rate for Payer: BCN Commercial |
$327.67
|
| Rate for Payer: BCN Commercial |
$78.36
|
| Rate for Payer: BCN Commercial |
$82.33
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.55
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.26
|
| Rate for Payer: UHC Core |
$103.67
|
| Rate for Payer: UHC Core |
$84.67
|
| Rate for Payer: UHC Core |
$354.04
|
| Rate for Payer: UHC Core |
$88.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 0574-4024-50
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$18.23
|
| 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 Multiplan/Beech St/PHCS |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.39
|
| 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
|
$23.33
|
|
|
Service Code
|
NDC 24208-910-19
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$19.83
|
| Rate for Payer: BCBS Trust/PPO |
$18.03
|
| Rate for Payer: BCN Commercial |
$18.03
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$21.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.83
|
| Rate for Payer: PHP Commercial |
$19.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.53
|
| Rate for Payer: UHC Core |
$19.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.50
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 0574-4024-11
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$18.23
|
| 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 Multiplan/Beech St/PHCS |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.39
|
| 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 ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$841.38
|
|
|
Service Code
|
NDC 24338-134-02
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$513.16 |
| Max. Negotiated Rate |
$757.24 |
| Rate for Payer: Aetna Commercial |
$715.17
|
| Rate for Payer: BCBS Trust/PPO |
$650.22
|
| Rate for Payer: BCN Commercial |
$650.22
|
| Rate for Payer: Cash Price |
$673.10
|
| Rate for Payer: Cofinity Commercial |
$723.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.10
|
| Rate for Payer: Healthscope Commercial |
$757.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$715.17
|
| Rate for Payer: PHP Commercial |
$715.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$740.41
|
| Rate for Payer: UHC Core |
$702.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.04
|
|
|
ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$189.51
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
2903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.58 |
| Max. Negotiated Rate |
$170.56 |
| Rate for Payer: Aetna Commercial |
$161.08
|
| Rate for Payer: BCBS Trust/PPO |
$146.45
|
| Rate for Payer: BCN Commercial |
$146.45
|
| Rate for Payer: Cash Price |
$151.61
|
| Rate for Payer: Cofinity Commercial |
$162.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.61
|
| Rate for Payer: Healthscope Commercial |
$170.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.08
|
| Rate for Payer: PHP Commercial |
$161.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.77
|
| Rate for Payer: UHC Core |
$158.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.13
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 68084-617-11
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: BCN Commercial |
$1.55
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.76
|
| Rate for Payer: UHC Core |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 0904-6426-61
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.96 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: BCBS Trust/PPO |
$259.70
|
| Rate for Payer: BCN Commercial |
$259.70
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$292.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 68084-617-01
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$169.58
|
| Rate for Payer: BCBS Trust/PPO |
$154.17
|
| Rate for Payer: BCN Commercial |
$154.17
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.58
|
| Rate for Payer: PHP Commercial |
$169.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.56
|
| Rate for Payer: UHC Core |
$166.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 0904-6427-61
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.29 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: BCBS Trust/PPO |
$277.86
|
| Rate for Payer: BCN Commercial |
$277.86
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.62
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.40
|
| Rate for Payer: UHC Core |
$300.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079-544-01
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| 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 Multiplan/Beech St/PHCS |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.67
|
| 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 51079-544-20
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.87 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: BCBS Trust/PPO |
$211.44
|
| 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 Multiplan/Beech St/PHCS |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.87
|
| 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 5 MG TABLET
|
Facility
|
IP
|
$77.55
|
|
|
Service Code
|
NDC 43547-280-10
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.30 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: BCBS Trust/PPO |
$59.93
|
| Rate for Payer: BCN Commercial |
$59.93
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.92
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 65862-373-01
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.29 |
| Max. Negotiated Rate |
$196.70 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: BCBS Trust/PPO |
$168.90
|
| 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 Multiplan/Beech St/PHCS |
$185.77
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.29
|
| 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
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$59.81
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$53.83 |
| Rate for Payer: Aetna Commercial |
$50.84
|
| Rate for Payer: Aetna Commercial |
$21.72
|
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: BCBS Trust/PPO |
$46.22
|
| Rate for Payer: BCBS Trust/PPO |
$11.62
|
| Rate for Payer: BCBS Trust/PPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$11.62
|
| Rate for Payer: BCN Commercial |
$46.22
|
| Rate for Payer: BCN Commercial |
$37.73
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cash Price |
$20.44
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cofinity Commercial |
$21.97
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Cofinity Commercial |
$12.93
|
| Rate for Payer: Cofinity Commercial |
$51.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.85
|
| Rate for Payer: Healthscope Commercial |
$23.00
|
| Rate for Payer: Healthscope Commercial |
$53.83
|
| Rate for Payer: Healthscope Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.84
|
| Rate for Payer: PHP Commercial |
$50.84
|
| Rate for Payer: PHP Commercial |
$21.72
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.96
|
| Rate for Payer: UHC Core |
$40.76
|
| Rate for Payer: UHC Core |
$21.33
|
| Rate for Payer: UHC Core |
$12.55
|
| Rate for Payer: UHC Core |
$49.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.27
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$96.39
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$86.75 |
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: BCBS Trust/PPO |
$74.49
|
| Rate for Payer: BCN Commercial |
$74.49
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.93
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.82
|
| Rate for Payer: UHC Core |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$624.38
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.64 |
| Max. Negotiated Rate |
$624.38 |
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$624.38
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.64 |
| Max. Negotiated Rate |
$624.38 |
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY PASSAGE OF DILATOR(S) THROUGH ESOPHAGUS OVER GUIDE WIRE
|
Facility
|
OP
|
$624.38
|
|
|
Service Code
|
CPT 43248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.64 |
| Max. Negotiated Rate |
$624.38 |
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$624.38
|
|
|
Service Code
|
CPT 43247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.64 |
| Max. Negotiated Rate |
$624.38 |
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS
|
Facility
|
OP
|
$1,310.64
|
|
|
Service Code
|
CPT 43250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.23 |
| Max. Negotiated Rate |
$1,310.64 |
| Rate for Payer: BCBS Complete |
$1,310.64
|
| Rate for Payer: Mclaren Medicaid |
$1,248.23
|
| Rate for Payer: Meridian Medicaid |
$1,310.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,248.23
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$1,310.64
|
|
|
Service Code
|
CPT 43251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.23 |
| Max. Negotiated Rate |
$1,310.64 |
| Rate for Payer: BCBS Complete |
$1,310.64
|
| Rate for Payer: Mclaren Medicaid |
$1,248.23
|
| Rate for Payer: Meridian Medicaid |
$1,310.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,248.23
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$1,310.64
|
|
|
Service Code
|
CPT 43249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.23 |
| Max. Negotiated Rate |
$1,310.64 |
| Rate for Payer: BCBS Complete |
$1,310.64
|
| Rate for Payer: Mclaren Medicaid |
$1,248.23
|
| Rate for Payer: Meridian Medicaid |
$1,310.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,248.23
|
|
|
ESTRADIOL 0.5 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 0555-0899-02
|
| Hospital Charge Code |
12491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: BCBS Trust/PPO |
$184.27
|
| Rate for Payer: BCN Commercial |
$184.27
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$207.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.84
|
| Rate for Payer: UHC Core |
$199.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
