|
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
|
$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 |
$1,080.80
|
| Rate for Payer: Cofinity Commercial |
$879.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$879.72
|
| 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 |
$879.72
|
| 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 |
$1,080.80
|
| Rate for Payer: Cofinity Commercial |
$879.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$879.72
|
| 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 |
$879.72
|
| 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
|
|
|
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 |
$1.52
|
| 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 |
$1.52
|
|
|
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
|
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 |
$216.90
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$166.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.90
|
| 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 |
$216.90
|
| 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
|
$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 |
$216.90
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.90
|
| 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 |
$216.90
|
| 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
|
$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 |
$1.52
|
| 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 |
$1.52
|
|
|
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 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
|
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 |
$110.68
|
| 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
|
$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 Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.30
|
| 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: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| 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
|
$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
|
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 |
$1.66
|
| 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 |
$1.66
|
|
|
ESCITALOPRAM 20 MG TABLET
|
Facility
|
IP
|
$2.22
|
|
|
Service Code
|
NDC 68084061811
|
| Hospital Charge Code |
33513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna American Axle |
$1.44
|
| Rate for Payer: Aetna Commercial |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| 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 |
$1.66
|
| 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 |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
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: Cash Price |
$263.20
|
| 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: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.30
|
| 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: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| 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 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
|
$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
|
$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 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
|
$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
|
$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
|
$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
|
$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
|
$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
|
|
