|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT
|
Facility
|
OP
|
$26.03
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$23.43 |
| Rate for Payer: Aetna American Axle |
$16.92
|
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.92
|
| Rate for Payer: BCBS Complete |
$10.41
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$23.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.92
|
| Rate for Payer: Priority Health SBD |
$16.40
|
| Rate for Payer: UMR Bronson Commercial |
$9.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.52
|
|
|
ERYTHROMYCIN-BENZOYL PEROXIDE 3 %-5 % TOPICAL GEL
|
Facility
|
IP
|
$543.13
|
|
|
Service Code
|
NDC 00781705449
|
| Hospital Charge Code |
9254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.98 |
| Max. Negotiated Rate |
$488.82 |
| Rate for Payer: Aetna American Axle |
$353.03
|
| Rate for Payer: Aetna Commercial |
$461.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.03
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cofinity Commercial |
$380.19
|
| Rate for Payer: Cofinity Commercial |
$467.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.50
|
| Rate for Payer: Healthscope Commercial |
$488.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$380.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$407.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.66
|
| Rate for Payer: PHP Commercial |
$461.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.03
|
| Rate for Payer: Priority Health SBD |
$342.17
|
| Rate for Payer: UMR Bronson Commercial |
$238.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.35
|
|
|
ERYTHROMYCIN-BENZOYL PEROXIDE 3 %-5 % TOPICAL GEL
|
Facility
|
OP
|
$543.13
|
|
|
Service Code
|
NDC 00781705449
|
| Hospital Charge Code |
9254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.96 |
| Max. Negotiated Rate |
$488.82 |
| Rate for Payer: Aetna American Axle |
$353.03
|
| Rate for Payer: Aetna Commercial |
$461.66
|
| Rate for Payer: Aetna Medicare |
$271.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.03
|
| Rate for Payer: BCBS Complete |
$217.25
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cofinity Commercial |
$380.19
|
| Rate for Payer: Cofinity Commercial |
$467.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$380.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.50
|
| Rate for Payer: Healthscope Commercial |
$488.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$380.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$407.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.66
|
| Rate for Payer: PHP Commercial |
$461.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.03
|
| Rate for Payer: Priority Health SBD |
$342.17
|
| Rate for Payer: UMR Bronson Commercial |
$200.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$407.35
|
|
|
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 |
$369.72 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna American Axle |
$546.18
|
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.18
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Commercial |
$588.19
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.22
|
| Rate for Payer: Healthscope Commercial |
$756.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$588.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| Rate for Payer: UMR Bronson Commercial |
$369.72
|
| 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 24338013213
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.90 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna American Axle |
$546.18
|
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna Medicare |
$420.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.18
|
| Rate for Payer: BCBS Complete |
$336.11
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Commercial |
$588.19
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.22
|
| Rate for Payer: Healthscope Commercial |
$756.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$588.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| Rate for Payer: UMR Bronson Commercial |
$310.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$926.40
|
|
|
Service Code
|
NDC 62559063001
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$407.62 |
| Max. Negotiated Rate |
$833.76 |
| Rate for Payer: Aetna American Axle |
$602.16
|
| Rate for Payer: Aetna Commercial |
$787.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.16
|
| Rate for Payer: Cash Price |
$741.12
|
| Rate for Payer: Cofinity Commercial |
$648.48
|
| Rate for Payer: Cofinity Commercial |
$796.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$648.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.12
|
| Rate for Payer: Healthscope Commercial |
$833.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$648.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.44
|
| Rate for Payer: PHP Commercial |
$787.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.16
|
| Rate for Payer: Priority Health SBD |
$583.63
|
| Rate for Payer: UMR Bronson Commercial |
$407.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.80
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
NDC 69238150301
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Aetna American Axle |
$382.20
|
| Rate for Payer: Aetna Commercial |
$499.80
|
| Rate for Payer: Aetna Medicare |
$294.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.20
|
| Rate for Payer: BCBS Complete |
$235.20
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cofinity Commercial |
$411.60
|
| Rate for Payer: Cofinity Commercial |
$505.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$411.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.40
|
| Rate for Payer: Healthscope Commercial |
$529.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.80
|
| Rate for Payer: PHP Commercial |
$499.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.20
|
| Rate for Payer: Priority Health SBD |
$370.44
|
| Rate for Payer: UMR Bronson Commercial |
$217.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.00
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
NDC 69238150301
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.72 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Aetna American Axle |
$382.20
|
| Rate for Payer: Aetna Commercial |
$499.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.20
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cofinity Commercial |
$411.60
|
| Rate for Payer: Cofinity Commercial |
$505.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$411.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.40
|
| Rate for Payer: Healthscope Commercial |
$529.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.80
|
| Rate for Payer: PHP Commercial |
$499.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.20
|
| Rate for Payer: Priority Health SBD |
$370.44
|
| Rate for Payer: UMR Bronson Commercial |
$258.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.00
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
IP
|
$840.27
|
|
|
Service Code
|
NDC 24338013213
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$369.72 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna American Axle |
$546.18
|
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.18
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Commercial |
$588.19
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.22
|
| Rate for Payer: Healthscope Commercial |
$756.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$588.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| Rate for Payer: UMR Bronson Commercial |
$369.72
|
| 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 |
$310.90 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna American Axle |
$546.18
|
| Rate for Payer: Aetna Commercial |
$714.23
|
| Rate for Payer: Aetna Medicare |
$420.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.18
|
| Rate for Payer: BCBS Complete |
$336.11
|
| Rate for Payer: Cash Price |
$672.22
|
| Rate for Payer: Cofinity Commercial |
$588.19
|
| Rate for Payer: Cofinity Commercial |
$722.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.22
|
| Rate for Payer: Healthscope Commercial |
$756.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$588.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.23
|
| Rate for Payer: PHP Commercial |
$714.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.18
|
| Rate for Payer: Priority Health SBD |
$529.37
|
| Rate for Payer: UMR Bronson Commercial |
$310.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.20
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION
|
Facility
|
OP
|
$926.40
|
|
|
Service Code
|
NDC 62559063001
|
| Hospital Charge Code |
2899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$342.77 |
| Max. Negotiated Rate |
$833.76 |
| Rate for Payer: Aetna American Axle |
$602.16
|
| Rate for Payer: Aetna Commercial |
$787.44
|
| Rate for Payer: Aetna Medicare |
$463.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.16
|
| Rate for Payer: BCBS Complete |
$370.56
|
| Rate for Payer: Cash Price |
$741.12
|
| Rate for Payer: Cofinity Commercial |
$648.48
|
| Rate for Payer: Cofinity Commercial |
$796.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$648.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.12
|
| Rate for Payer: Healthscope Commercial |
$833.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$648.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.44
|
| Rate for Payer: PHP Commercial |
$787.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.16
|
| Rate for Payer: Priority Health SBD |
$583.63
|
| Rate for Payer: UMR Bronson Commercial |
$342.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.80
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET
|
Facility
|
IP
|
$1,256.75
|
|
|
Service Code
|
NDC 24338011003
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$552.97 |
| Max. Negotiated Rate |
$1,131.08 |
| Rate for Payer: Aetna American Axle |
$816.89
|
| Rate for Payer: Aetna Commercial |
$1,068.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$816.89
|
| Rate for Payer: Cash Price |
$1,005.40
|
| Rate for Payer: Cofinity Commercial |
$1,080.81
|
| Rate for Payer: Cofinity Commercial |
$879.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$879.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.40
|
| Rate for Payer: Healthscope Commercial |
$1,131.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$879.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.24
|
| Rate for Payer: PHP Commercial |
$1,068.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$816.89
|
| Rate for Payer: Priority Health SBD |
$791.75
|
| Rate for Payer: UMR Bronson Commercial |
$552.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$942.56
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET
|
Facility
|
OP
|
$1,256.75
|
|
|
Service Code
|
NDC 24338011003
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,131.08 |
| Rate for Payer: Aetna American Axle |
$816.89
|
| Rate for Payer: Aetna Commercial |
$1,068.24
|
| Rate for Payer: Aetna Medicare |
$628.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$816.89
|
| Rate for Payer: BCBS Complete |
$502.70
|
| Rate for Payer: Cash Price |
$1,005.40
|
| Rate for Payer: Cofinity Commercial |
$1,080.81
|
| Rate for Payer: Cofinity Commercial |
$879.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$879.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.40
|
| Rate for Payer: Healthscope Commercial |
$1,131.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$879.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.24
|
| Rate for Payer: PHP Commercial |
$1,068.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$816.89
|
| Rate for Payer: Priority Health SBD |
$791.75
|
| Rate for Payer: UMR Bronson Commercial |
$465.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$942.56
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET
|
Facility
|
OP
|
$4,173.60
|
|
|
Service Code
|
NDC 24338011013
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,544.23 |
| Max. Negotiated Rate |
$3,756.24 |
| Rate for Payer: Aetna American Axle |
$2,712.84
|
| Rate for Payer: Aetna Commercial |
$3,547.56
|
| Rate for Payer: Aetna Medicare |
$2,086.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,712.84
|
| Rate for Payer: BCBS Complete |
$1,669.44
|
| Rate for Payer: Cash Price |
$3,338.88
|
| Rate for Payer: Cofinity Commercial |
$2,921.52
|
| Rate for Payer: Cofinity Commercial |
$3,589.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,921.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,338.88
|
| Rate for Payer: Healthscope Commercial |
$3,756.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,921.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,130.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,547.56
|
| Rate for Payer: PHP Commercial |
$3,547.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,712.84
|
| Rate for Payer: Priority Health SBD |
$2,629.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,544.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,130.20
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET
|
Facility
|
IP
|
$4,173.60
|
|
|
Service Code
|
NDC 24338011013
|
| Hospital Charge Code |
2901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,836.38 |
| Max. Negotiated Rate |
$3,756.24 |
| Rate for Payer: Aetna American Axle |
$2,712.84
|
| Rate for Payer: Aetna Commercial |
$3,547.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,712.84
|
| Rate for Payer: Cash Price |
$3,338.88
|
| Rate for Payer: Cofinity Commercial |
$2,921.52
|
| Rate for Payer: Cofinity Commercial |
$3,589.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,921.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,338.88
|
| Rate for Payer: Healthscope Commercial |
$3,756.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,921.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,130.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,547.56
|
| Rate for Payer: PHP Commercial |
$3,547.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,712.84
|
| Rate for Payer: Priority Health SBD |
$2,629.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,836.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,130.20
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 00904642661
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna American Axle |
$216.91
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$166.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.91
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.91
|
| Rate for Payer: Priority Health SBD |
$210.23
|
| Rate for Payer: UMR Bronson Commercial |
$123.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$201.40
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$88.62
|
| 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 |
$146.83 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna American Axle |
$216.91
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.91
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.91
|
| Rate for Payer: Priority Health SBD |
$210.23
|
| Rate for Payer: UMR Bronson Commercial |
$146.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$201.40
|
|
|
Service Code
|
NDC 68084061701
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.52 |
| Max. Negotiated Rate |
$181.26 |
| Rate for Payer: Aetna American Axle |
$130.91
|
| Rate for Payer: Aetna Commercial |
$171.19
|
| Rate for Payer: Aetna Medicare |
$100.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.91
|
| Rate for Payer: BCBS Complete |
$80.56
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cofinity Commercial |
$140.98
|
| Rate for Payer: Cofinity Commercial |
$173.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.12
|
| Rate for Payer: Healthscope Commercial |
$181.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.19
|
| Rate for Payer: PHP Commercial |
$171.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.91
|
| Rate for Payer: Priority Health SBD |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$74.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.05
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 68084061711
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna American Axle |
$1.31
|
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.31
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: PHP Commercial |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health SBD |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$0.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.51
|
|
|
ESCITALOPRAM 10 MG TABLET
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 68084061711
|
| Hospital Charge Code |
33512
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna American Axle |
$1.31
|
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
| Rate for Payer: Healthscope Commercial |
$1.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.72
|
| Rate for Payer: PHP Commercial |
$1.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.31
|
| Rate for Payer: Priority Health SBD |
$1.27
|
| Rate for Payer: UMR Bronson Commercial |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.51
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$366.60
|
|
|
Service Code
|
NDC 00904642761
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.64 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna American Axle |
$238.29
|
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna Medicare |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.29
|
| Rate for Payer: BCBS Complete |
$146.64
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$256.62
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.29
|
| Rate for Payer: Priority Health SBD |
$230.96
|
| Rate for Payer: UMR Bronson Commercial |
$135.64
|
| 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 |
$161.30 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna American Axle |
$238.29
|
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.29
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$256.62
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.29
|
| Rate for Payer: Priority Health SBD |
$230.96
|
| Rate for Payer: UMR Bronson Commercial |
$161.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 68084061801
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.39 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: UMR Bronson Commercial |
$97.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
OP
|
$2.22
|
|
|
Service Code
|
NDC 68084061811
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna American Axle |
$1.44
|
| Rate for Payer: Aetna Commercial |
$1.89
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.89
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$2.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.89
|
| Rate for Payer: PHP Commercial |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health SBD |
$1.40
|
| Rate for Payer: UMR Bronson Commercial |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.67
|
|
