|
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 Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| 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: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$101.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 51079054420
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| 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: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
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
|
$221.35
|
|
|
Service Code
|
NDC 68084061801
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Medicare |
$110.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: BCBS Complete |
$88.54
|
| 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 |
$81.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
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 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 Commercial |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.97
|
| 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: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.26
|
| 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
|
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 Commercial |
$649.57
|
| Rate for Payer: Cofinity Commercial |
$798.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.57
|
| 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: PHP Commercial |
$788.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.17
|
| Rate for Payer: Priority Health SBD |
$584.61
|
| 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
|
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 Commercial |
$499.97
|
| Rate for Payer: Cofinity Commercial |
$614.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$499.97
|
| 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: PHP Commercial |
$607.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.26
|
| Rate for Payer: Priority Health SBD |
$449.97
|
| 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
|
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 Commercial |
$475.78
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$475.78
|
| 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: PHP Commercial |
$577.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.79
|
| 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/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 Commercial |
$475.78
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$475.78
|
| 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: PHP Commercial |
$577.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.79
|
| Rate for Payer: Priority Health SBD |
$428.20
|
| 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
|
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 Commercial |
$649.57
|
| Rate for Payer: Cofinity Commercial |
$798.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.57
|
| 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: PHP Commercial |
$788.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.17
|
| 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 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 Commercial |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.99
|
| 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: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| 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
|
$5,060.49
|
|
|
Service Code
|
NDC 00456200501
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,226.62 |
| Max. Negotiated Rate |
$4,554.44 |
| Rate for Payer: Aetna American Axle |
$3,289.32
|
| Rate for Payer: Aetna Commercial |
$4,301.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,289.32
|
| Rate for Payer: Cash Price |
$4,048.39
|
| Rate for Payer: Cofinity Commercial |
$3,542.34
|
| Rate for Payer: Cofinity Commercial |
$4,352.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,542.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,048.39
|
| Rate for Payer: Healthscope Commercial |
$4,554.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,542.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,795.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,301.42
|
| Rate for Payer: PHP Commercial |
$4,301.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,289.32
|
| Rate for Payer: Priority Health SBD |
$3,188.11
|
| Rate for Payer: UMR Bronson Commercial |
$2,226.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,795.37
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$5,060.49
|
|
|
Service Code
|
NDC 00456200501
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,872.38 |
| Max. Negotiated Rate |
$4,554.44 |
| Rate for Payer: Aetna American Axle |
$3,289.32
|
| Rate for Payer: Aetna Commercial |
$4,301.42
|
| Rate for Payer: Aetna Medicare |
$2,530.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,289.32
|
| Rate for Payer: BCBS Complete |
$2,024.20
|
| Rate for Payer: Cash Price |
$4,048.39
|
| Rate for Payer: Cofinity Commercial |
$3,542.34
|
| Rate for Payer: Cofinity Commercial |
$4,352.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,542.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,048.39
|
| Rate for Payer: Healthscope Commercial |
$4,554.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,542.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,795.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,301.42
|
| Rate for Payer: PHP Commercial |
$4,301.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,289.32
|
| Rate for Payer: Priority Health SBD |
$3,188.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,872.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,795.37
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 43547028010
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna Medicare |
$64.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$47.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
ESCITALOPRAM 5 MG TABLET
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 Commercial |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.99
|
| 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: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.06
|
| 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
|
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 Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| 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: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| 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
|
$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 Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| 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: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| 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
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 43547028010
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$116.33 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$56.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48.82
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna American Axle |
$31.73
|
| Rate for Payer: Aetna American Axle |
$17.88
|
| Rate for Payer: Aetna American Axle |
$12.12
|
| Rate for Payer: Aetna American Axle |
$38.88
|
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Commercial |
$50.84
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Commercial |
$15.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.73
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Cofinity Commercial |
$51.44
|
| Rate for Payer: Cofinity Commercial |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$34.17
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Healthscope Commercial |
$16.79
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Healthscope Commercial |
$53.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Commercial |
$50.84
|
| Rate for Payer: PHP Commercial |
$15.85
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.12
|
| Rate for Payer: Priority Health SBD |
$37.68
|
| Rate for Payer: Priority Health SBD |
$11.75
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: Priority Health SBD |
$30.76
|
| Rate for Payer: UMR Bronson Commercial |
$21.48
|
| Rate for Payer: UMR Bronson Commercial |
$26.32
|
| Rate for Payer: UMR Bronson Commercial |
$12.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.51
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$24.76 |
| Rate for Payer: Aetna American Axle |
$17.88
|
| Rate for Payer: Aetna American Axle |
$38.88
|
| Rate for Payer: Aetna American Axle |
$12.12
|
| Rate for Payer: Aetna American Axle |
$31.73
|
| Rate for Payer: Aetna Commercial |
$50.84
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Commercial |
$15.85
|
| Rate for Payer: Aetna Medicare |
$24.41
|
| Rate for Payer: Aetna Medicare |
$9.32
|
| Rate for Payer: Aetna Medicare |
$29.91
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.12
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS Complete |
$23.92
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$51.44
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Cofinity Commercial |
$34.17
|
| Rate for Payer: Cofinity Commercial |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Healthscope Commercial |
$16.79
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Healthscope Commercial |
$53.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$50.84
|
| Rate for Payer: PHP Commercial |
$15.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.12
|
| Rate for Payer: Priority Health SBD |
$30.76
|
| Rate for Payer: Priority Health SBD |
$37.68
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: Priority Health SBD |
$11.75
|
| Rate for Payer: UMR Bronson Commercial |
$18.06
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: UMR Bronson Commercial |
$22.13
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
IP
|
$366.56
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.29 |
| Max. Negotiated Rate |
$329.90 |
| Rate for Payer: Aetna American Axle |
$238.26
|
| Rate for Payer: Aetna American Axle |
$291.80
|
| Rate for Payer: Aetna American Axle |
$324.26
|
| Rate for Payer: Aetna Commercial |
$381.58
|
| Rate for Payer: Aetna Commercial |
$311.58
|
| Rate for Payer: Aetna Commercial |
$424.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.80
|
| Rate for Payer: Cash Price |
$399.09
|
| Rate for Payer: Cash Price |
$359.14
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cofinity Commercial |
$315.24
|
| Rate for Payer: Cofinity Commercial |
$386.07
|
| Rate for Payer: Cofinity Commercial |
$314.24
|
| Rate for Payer: Cofinity Commercial |
$429.02
|
| Rate for Payer: Cofinity Commercial |
$349.20
|
| Rate for Payer: Cofinity Commercial |
$256.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.14
|
| Rate for Payer: Healthscope Commercial |
$404.03
|
| Rate for Payer: Healthscope Commercial |
$329.90
|
| Rate for Payer: Healthscope Commercial |
$448.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.58
|
| Rate for Payer: PHP Commercial |
$424.03
|
| Rate for Payer: PHP Commercial |
$381.58
|
| Rate for Payer: PHP Commercial |
$311.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.26
|
| Rate for Payer: Priority Health SBD |
$314.28
|
| Rate for Payer: Priority Health SBD |
$282.82
|
| Rate for Payer: Priority Health SBD |
$230.93
|
| Rate for Payer: UMR Bronson Commercial |
$161.29
|
| Rate for Payer: UMR Bronson Commercial |
$219.50
|
| Rate for Payer: UMR Bronson Commercial |
$197.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.69
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
OP
|
$498.86
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.58 |
| Max. Negotiated Rate |
$448.97 |
| Rate for Payer: Aetna American Axle |
$324.26
|
| Rate for Payer: Aetna American Axle |
$238.26
|
| Rate for Payer: Aetna American Axle |
$291.80
|
| Rate for Payer: Aetna Commercial |
$424.03
|
| Rate for Payer: Aetna Commercial |
$381.58
|
| Rate for Payer: Aetna Commercial |
$311.58
|
| Rate for Payer: Aetna Medicare |
$249.43
|
| Rate for Payer: Aetna Medicare |
$224.46
|
| Rate for Payer: Aetna Medicare |
$183.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.26
|
| Rate for Payer: BCBS Complete |
$146.62
|
| Rate for Payer: BCBS Complete |
$179.57
|
| Rate for Payer: BCBS Complete |
$199.54
|
| Rate for Payer: Cash Price |
$399.09
|
| Rate for Payer: Cash Price |
$359.14
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cofinity Commercial |
$386.07
|
| Rate for Payer: Cofinity Commercial |
$256.59
|
| Rate for Payer: Cofinity Commercial |
$315.24
|
| Rate for Payer: Cofinity Commercial |
$429.02
|
| Rate for Payer: Cofinity Commercial |
$349.20
|
| Rate for Payer: Cofinity Commercial |
$314.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.09
|
| Rate for Payer: Healthscope Commercial |
$329.90
|
| Rate for Payer: Healthscope Commercial |
$404.03
|
| Rate for Payer: Healthscope Commercial |
$448.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.03
|
| Rate for Payer: PHP Commercial |
$311.58
|
| Rate for Payer: PHP Commercial |
$381.58
|
| Rate for Payer: PHP Commercial |
$424.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.26
|
| Rate for Payer: Priority Health SBD |
$282.82
|
| Rate for Payer: Priority Health SBD |
$230.93
|
| Rate for Payer: Priority Health SBD |
$314.28
|
| Rate for Payer: UMR Bronson Commercial |
$184.58
|
| Rate for Payer: UMR Bronson Commercial |
$135.63
|
| Rate for Payer: UMR Bronson Commercial |
$166.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.14
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV
|
Facility
|
OP
|
$310.88
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.03 |
| Max. Negotiated Rate |
$279.79 |
| Rate for Payer: Aetna American Axle |
$202.07
|
| Rate for Payer: Aetna Commercial |
$264.25
|
| Rate for Payer: Aetna Medicare |
$155.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.07
|
| Rate for Payer: BCBS Complete |
$124.35
|
| Rate for Payer: Cash Price |
$248.70
|
| Rate for Payer: Cofinity Commercial |
$217.62
|
| Rate for Payer: Cofinity Commercial |
$267.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.70
|
| Rate for Payer: Healthscope Commercial |
$279.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.25
|
| Rate for Payer: PHP Commercial |
$264.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.07
|
| Rate for Payer: Priority Health SBD |
$195.85
|
| Rate for Payer: UMR Bronson Commercial |
$115.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.16
|
|
