|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$207.10
|
|
|
Service Code
|
NDC 68084061801
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.63 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna American Axle |
$134.62
|
| Rate for Payer: Aetna Commercial |
$176.03
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.62
|
| Rate for Payer: BCBS Complete |
$82.84
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Advantage |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.32
|
| Rate for Payer: PHP Commercial |
$176.03
|
| Rate for Payer: Priority Health SBD |
$130.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.62
|
| Rate for Payer: UHC Core |
$107.90
|
| Rate for Payer: UHC Exchange |
$81.39
|
| Rate for Payer: UMR Bronson Commercial |
$76.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00904642761
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 51079054420
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Advantage |
$191.52
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.84
|
| Rate for Payer: UHC Core |
$142.55
|
| Rate for Payer: UHC Exchange |
$107.52
|
| Rate for Payer: UMR Bronson Commercial |
$101.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
NDC 65862037501
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna Medicare |
$164.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Advantage |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.85
|
| Rate for Payer: UHC Core |
$171.41
|
| Rate for Payer: UHC Exchange |
$129.30
|
| Rate for Payer: UMR Bronson Commercial |
$121.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00904642761
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$204.47
|
| Rate for Payer: UHC Exchange |
$154.23
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 68084061811
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 68084061811
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.35
|
| Rate for Payer: UHC Core |
$1.08
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 65862037501
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Advantage |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$714.24
|
|
|
Service Code
|
NDC 54838055170
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.27 |
| Max. Negotiated Rate |
$642.82 |
| Rate for Payer: Aetna American Axle |
$464.26
|
| Rate for Payer: Aetna Commercial |
$607.10
|
| Rate for Payer: Aetna Medicare |
$357.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.26
|
| Rate for Payer: BCBS Complete |
$285.70
|
| Rate for Payer: Cash Price |
$571.39
|
| Rate for Payer: Cofinity Advantage |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.39
|
| Rate for Payer: Healthscope Commercial |
$642.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$535.68
|
| Rate for Payer: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health SBD |
$449.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.26
|
| Rate for Payer: UHC Core |
$372.12
|
| Rate for Payer: UHC Exchange |
$280.70
|
| Rate for Payer: UMR Bronson Commercial |
$264.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.68
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$679.68
|
|
|
Service Code
|
NDC 31722056924
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$611.71 |
| Rate for Payer: Aetna American Axle |
$441.79
|
| Rate for Payer: Aetna Commercial |
$577.73
|
| Rate for Payer: Aetna Medicare |
$339.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.79
|
| Rate for Payer: BCBS Complete |
$271.87
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Advantage |
$475.78
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Healthscope Commercial |
$611.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.76
|
| Rate for Payer: PHP Commercial |
$577.73
|
| Rate for Payer: Priority Health SBD |
$428.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.79
|
| Rate for Payer: UHC Core |
$354.11
|
| Rate for Payer: UHC Exchange |
$267.11
|
| Rate for Payer: UMR Bronson Commercial |
$251.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.76
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$927.96
|
|
|
Service Code
|
NDC 65162070588
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.35 |
| Max. Negotiated Rate |
$835.16 |
| Rate for Payer: Aetna American Axle |
$603.17
|
| Rate for Payer: Aetna Commercial |
$788.77
|
| Rate for Payer: Aetna Medicare |
$463.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.17
|
| Rate for Payer: BCBS Complete |
$371.18
|
| Rate for Payer: Cash Price |
$742.37
|
| Rate for Payer: Cofinity Advantage |
$649.57
|
| Rate for Payer: Cofinity Commercial |
$798.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.37
|
| Rate for Payer: Healthscope Commercial |
$835.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$742.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.97
|
| Rate for Payer: PHP Commercial |
$788.77
|
| Rate for Payer: Priority Health SBD |
$584.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.17
|
| Rate for Payer: UHC Core |
$483.47
|
| Rate for Payer: UHC Exchange |
$364.69
|
| Rate for Payer: UMR Bronson Commercial |
$343.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.97
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$927.96
|
|
|
Service Code
|
NDC 65162070588
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.30 |
| Max. Negotiated Rate |
$835.16 |
| Rate for Payer: Aetna American Axle |
$603.17
|
| Rate for Payer: Aetna Commercial |
$788.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.17
|
| Rate for Payer: Cash Price |
$742.37
|
| Rate for Payer: Cofinity Advantage |
$649.57
|
| Rate for Payer: Cofinity Commercial |
$798.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.37
|
| Rate for Payer: Healthscope Commercial |
$835.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.97
|
| Rate for Payer: PHP Commercial |
$788.77
|
| Rate for Payer: Priority Health SBD |
$584.61
|
| Rate for Payer: UMR Bronson Commercial |
$408.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.97
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$714.24
|
|
|
Service Code
|
NDC 54838055170
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.27 |
| Max. Negotiated Rate |
$642.82 |
| Rate for Payer: Aetna American Axle |
$464.26
|
| Rate for Payer: Aetna Commercial |
$607.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.26
|
| Rate for Payer: Cash Price |
$571.39
|
| Rate for Payer: Cofinity Advantage |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.39
|
| Rate for Payer: Healthscope Commercial |
$642.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$499.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$535.68
|
| Rate for Payer: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health SBD |
$449.97
|
| Rate for Payer: UMR Bronson Commercial |
$314.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.68
|
|
|
ESCITALOPRAM 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$679.68
|
|
|
Service Code
|
NDC 31722056924
|
| Hospital Charge Code |
34897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.06 |
| Max. Negotiated Rate |
$611.71 |
| Rate for Payer: Aetna American Axle |
$441.79
|
| Rate for Payer: Aetna Commercial |
$577.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.79
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Advantage |
$475.78
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Healthscope Commercial |
$611.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.76
|
| Rate for Payer: PHP Commercial |
$577.73
|
| Rate for Payer: Priority Health SBD |
$428.20
|
| Rate for Payer: UMR Bronson Commercial |
$299.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.76
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$86.95
|
|
|
Service Code
|
NDC 43547028010
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.17 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna American Axle |
$56.52
|
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: Aetna Medicare |
$43.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.52
|
| Rate for Payer: BCBS Complete |
$34.78
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Advantage |
$60.87
|
| Rate for Payer: Cofinity Commercial |
$74.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.21
|
| Rate for Payer: PHP Commercial |
$73.91
|
| Rate for Payer: Priority Health SBD |
$54.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.52
|
| Rate for Payer: UHC Core |
$45.30
|
| Rate for Payer: UHC Exchange |
$34.17
|
| Rate for Payer: UMR Bronson Commercial |
$32.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$5,313.20
|
|
|
Service Code
|
NDC 00456200501
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,965.88 |
| Max. Negotiated Rate |
$4,781.88 |
| Rate for Payer: Aetna American Axle |
$3,453.58
|
| Rate for Payer: Aetna Commercial |
$4,516.22
|
| Rate for Payer: Aetna Medicare |
$2,656.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,453.58
|
| Rate for Payer: BCBS Complete |
$2,125.28
|
| Rate for Payer: Cash Price |
$4,250.56
|
| Rate for Payer: Cofinity Advantage |
$3,719.24
|
| Rate for Payer: Cofinity Commercial |
$4,569.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,250.56
|
| Rate for Payer: Healthscope Commercial |
$4,781.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,719.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,984.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,250.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,516.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,984.90
|
| Rate for Payer: PHP Commercial |
$4,516.22
|
| Rate for Payer: Priority Health SBD |
$3,347.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,453.58
|
| Rate for Payer: UHC Core |
$2,768.18
|
| Rate for Payer: UHC Exchange |
$2,088.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,965.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,984.90
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.16 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna American Axle |
$142.06
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UMR Bronson Commercial |
$96.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$5,313.20
|
|
|
Service Code
|
NDC 00456200501
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,337.81 |
| Max. Negotiated Rate |
$4,781.88 |
| Rate for Payer: Aetna American Axle |
$3,453.58
|
| Rate for Payer: Aetna Commercial |
$4,516.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,453.58
|
| Rate for Payer: Cash Price |
$4,250.56
|
| Rate for Payer: Cofinity Advantage |
$3,719.24
|
| Rate for Payer: Cofinity Commercial |
$4,569.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,250.56
|
| Rate for Payer: Healthscope Commercial |
$4,781.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,719.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,984.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,516.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,984.90
|
| Rate for Payer: PHP Commercial |
$4,516.22
|
| Rate for Payer: Priority Health SBD |
$3,347.32
|
| Rate for Payer: UMR Bronson Commercial |
$2,337.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,984.90
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna American Axle |
$142.06
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$109.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.06
|
| Rate for Payer: UHC Core |
$113.86
|
| Rate for Payer: UHC Exchange |
$85.89
|
| Rate for Payer: UMR Bronson Commercial |
$80.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 69097084705
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 69097084705
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
| Rate for Payer: UMR Bronson Commercial |
$80.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$86.95
|
|
|
Service Code
|
NDC 43547028010
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna American Axle |
$56.52
|
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.52
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Advantage |
$60.87
|
| Rate for Payer: Cofinity Commercial |
$74.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.21
|
| Rate for Payer: PHP Commercial |
$73.91
|
| Rate for Payer: Priority Health SBD |
$54.78
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.28
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$66.85 |
| Rate for Payer: Aetna American Axle |
$48.28
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna American Axle |
$17.88
|
| Rate for Payer: Aetna American Axle |
$32.71
|
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Aetna Commercial |
$42.78
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Medicare |
$25.16
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Aetna Medicare |
$37.14
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.71
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCBS Complete |
$29.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$40.26
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Cash Price |
$40.26
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Advantage |
$35.23
|
| Rate for Payer: Cofinity Advantage |
$19.26
|
| Rate for Payer: Cofinity Advantage |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Healthscope Commercial |
$66.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.71
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$42.78
|
| Rate for Payer: PHP Commercial |
$63.14
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: Priority Health SBD |
$31.71
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Core |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UMR Bronson Commercial |
$27.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: UMR Bronson Commercial |
$18.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.71
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50.33
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Aetna American Axle |
$32.71
|
| Rate for Payer: Aetna American Axle |
$17.88
|
| Rate for Payer: Aetna American Axle |
$48.28
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Aetna Commercial |
$42.78
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$59.42
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$40.26
|
| Rate for Payer: Cofinity Advantage |
$19.26
|
| Rate for Payer: Cofinity Advantage |
$18.27
|
| Rate for Payer: Cofinity Advantage |
$35.23
|
| Rate for Payer: Cofinity Advantage |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$63.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Healthscope Commercial |
$66.85
|
| Rate for Payer: Healthscope Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.57
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$42.78
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$63.14
|
| Rate for Payer: Priority Health SBD |
$46.80
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$31.71
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: UMR Bronson Commercial |
$12.10
|
| Rate for Payer: UMR Bronson Commercial |
$22.15
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$32.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.71
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$280.72
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.52 |
| Max. Negotiated Rate |
$252.65 |
| Rate for Payer: Aetna American Axle |
$182.47
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cofinity Advantage |
$196.50
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.54
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: UMR Bronson Commercial |
$123.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
|
