|
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
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$196.70 |
| 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 |
$152.98
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.98
|
| 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
|
$129.25
|
|
|
Service Code
|
NDC 43547028010
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$116.32 |
| 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 |
$90.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.48
|
| 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
|
|
|
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 |
$116.32 |
| 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 |
$90.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.48
|
| 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
|
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
|
$218.55
|
|
|
Service Code
|
NDC 65862037301
|
| Hospital Charge Code |
37635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.16 |
| Max. Negotiated Rate |
$196.70 |
| 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 |
$152.98
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.98
|
| 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
|
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
|
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
|
|
|
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 |
$13.06
|
| 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 |
$13.06
|
| 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 |
$16.78
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Healthscope Commercial |
$53.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.06
|
| 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
|
$59.81
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$53.83 |
| Rate for Payer: Aetna American Axle |
$38.88
|
| Rate for Payer: Aetna American Axle |
$31.73
|
| Rate for Payer: Aetna American Axle |
$12.12
|
| Rate for Payer: Aetna American Axle |
$17.88
|
| 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 Commercial |
$41.50
|
| Rate for Payer: Aetna Medicare |
$24.41
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Aetna Medicare |
$9.32
|
| Rate for Payer: Aetna Medicare |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: BCBS Complete |
$19.53
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS Complete |
$23.92
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Cofinity Commercial |
$51.44
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$34.17
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Cofinity Commercial |
$41.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| 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 |
$14.92
|
| Rate for Payer: Healthscope Commercial |
$16.78
|
| Rate for Payer: Healthscope Commercial |
$53.83
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.06
|
| 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: Lakeland Regional Health Systems Commercial |
$44.86
|
| 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 |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.85
|
| Rate for Payer: PHP Commercial |
$50.84
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$15.85
|
| Rate for Payer: PHP Commercial |
$41.50
|
| 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 Cigna Priority Health |
$31.73
|
| Rate for Payer: Priority Health SBD |
$11.75
|
| Rate for Payer: Priority Health SBD |
$30.76
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: Priority Health SBD |
$37.68
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
| Rate for Payer: UMR Bronson Commercial |
$18.06
|
| Rate for Payer: UMR Bronson Commercial |
$22.13
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
|
|
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 |
$0.50 |
| Max. Negotiated Rate |
$448.97 |
| Rate for Payer: Aetna American Axle |
$324.26
|
| Rate for Payer: Aetna American Axle |
$291.80
|
| Rate for Payer: Aetna American Axle |
$238.26
|
| Rate for Payer: Aetna Commercial |
$424.03
|
| Rate for Payer: Aetna Commercial |
$311.58
|
| Rate for Payer: Aetna Commercial |
$381.58
|
| Rate for Payer: Aetna Medicare |
$224.46
|
| Rate for Payer: Aetna Medicare |
$183.28
|
| Rate for Payer: Aetna Medicare |
$249.43
|
| 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: BCBS Complete |
$179.57
|
| Rate for Payer: BCBS Complete |
$199.54
|
| Rate for Payer: BCBS Complete |
$146.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$359.14
|
| Rate for Payer: Cash Price |
$399.09
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cash Price |
$359.14
|
| Rate for Payer: Cash Price |
$293.25
|
| Rate for Payer: Cash Price |
$399.09
|
| 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 |
$314.24
|
| Rate for Payer: Cofinity Commercial |
$349.20
|
| Rate for Payer: Cofinity Commercial |
$429.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.09
|
| Rate for Payer: Healthscope Commercial |
$448.97
|
| Rate for Payer: Healthscope Commercial |
$404.03
|
| Rate for Payer: Healthscope Commercial |
$329.90
|
| 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 |
$274.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.69
|
| 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 |
$424.03
|
| Rate for Payer: PHP Commercial |
$311.58
|
| Rate for Payer: PHP Commercial |
$381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.26
|
| 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 SBD |
$282.82
|
| Rate for Payer: Priority Health SBD |
$314.28
|
| Rate for Payer: Priority Health SBD |
$230.93
|
| 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
|
IP
|
$310.88
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.79 |
| Max. Negotiated Rate |
$279.79 |
| Rate for Payer: Aetna American Axle |
$202.07
|
| Rate for Payer: Aetna Commercial |
$264.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.07
|
| 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 |
$136.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.16
|
|
|
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
|
$310.88
|
|
|
Service Code
|
HCPCS J1806
|
| Hospital Charge Code |
29805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| 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: BCBS Trust/PPO |
$0.95
|
| Rate for Payer: BCN Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$248.70
|
| 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
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$2,840.83
|
|
|
Service Code
|
NDC 00186502054
|
| Hospital Charge Code |
29745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,249.97 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Commercial |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,988.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,414.71
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,846.54
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,249.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$2,840.83
|
|
|
Service Code
|
NDC 00186502054
|
| Hospital Charge Code |
29745
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,051.11 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna Medicare |
$1,420.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: BCBS Complete |
$1,136.33
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Commercial |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,988.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,414.71
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,846.54
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,051.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$2,840.83
|
|
|
Service Code
|
NDC 00186504054
|
| Hospital Charge Code |
29746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,051.11 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna Medicare |
$1,420.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: BCBS Complete |
$1,136.33
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Commercial |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,988.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,414.71
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,846.54
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,051.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$2,840.83
|
|
|
Service Code
|
NDC 00186504054
|
| Hospital Charge Code |
29746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,249.97 |
| Max. Negotiated Rate |
$2,556.75 |
| Rate for Payer: Aetna American Axle |
$1,846.54
|
| Rate for Payer: Aetna Commercial |
$2,414.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,846.54
|
| Rate for Payer: Cash Price |
$2,272.66
|
| Rate for Payer: Cofinity Commercial |
$1,988.58
|
| Rate for Payer: Cofinity Commercial |
$2,443.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,988.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,272.66
|
| Rate for Payer: Healthscope Commercial |
$2,556.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,988.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,414.71
|
| Rate for Payer: PHP Commercial |
$2,414.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,846.54
|
| Rate for Payer: Priority Health SBD |
$1,789.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,249.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,130.62
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
OP
|
$987.46
|
|
|
Service Code
|
NDC 00186401001
|
| Hospital Charge Code |
91031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.36 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna Medicare |
$493.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: BCBS Complete |
$394.98
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$691.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.34
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.85
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$365.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 10 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
IP
|
$987.46
|
|
|
Service Code
|
NDC 00186401001
|
| Hospital Charge Code |
91031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$691.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.34
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.85
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$434.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 2.5 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
OP
|
$987.46
|
|
|
Service Code
|
NDC 00186402501
|
| Hospital Charge Code |
162053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.36 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna Medicare |
$493.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: BCBS Complete |
$394.98
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$691.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.34
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.85
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$365.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE MAGNESIUM DR 2.5 MG GRANULES DELAYED RELEASE FOR SUSP
|
Facility
|
IP
|
$987.46
|
|
|
Service Code
|
NDC 00186402501
|
| Hospital Charge Code |
162053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.48 |
| Max. Negotiated Rate |
$888.71 |
| Rate for Payer: Aetna American Axle |
$641.85
|
| Rate for Payer: Aetna Commercial |
$839.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.85
|
| Rate for Payer: Cash Price |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$691.22
|
| Rate for Payer: Cofinity Commercial |
$849.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$691.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.97
|
| Rate for Payer: Healthscope Commercial |
$888.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$691.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$839.34
|
| Rate for Payer: PHP Commercial |
$839.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.85
|
| Rate for Payer: Priority Health SBD |
$622.10
|
| Rate for Payer: UMR Bronson Commercial |
$434.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.60
|
|
|
ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.37
|
|
|
Service Code
|
NDC 55150018505
|
| Hospital Charge Code |
41174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna American Axle |
$15.19
|
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.86
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.19
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$10.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.53
|
|
|
ESOMEPRAZOLE SODIUM 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.37
|
|
|
Service Code
|
NDC 55150018505
|
| Hospital Charge Code |
41174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna American Axle |
$15.19
|
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna Medicare |
$11.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.19
|
| Rate for Payer: BCBS Complete |
$9.35
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.70
|
| Rate for Payer: Healthscope Commercial |
$21.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.86
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.19
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.53
|
|
|
ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY WITH INTERPRETATION AND REPORT;
|
Facility
|
OP
|
$1,633.95
|
|
|
Service Code
|
CPT 91010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$202.19 |
| Max. Negotiated Rate |
$1,633.95 |
| Rate for Payer: Aetna Medicare |
$540.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$649.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$649.84
|
| Rate for Payer: BCBS Complete |
$292.58
|
| Rate for Payer: BCBS MAPPO |
$519.87
|
| Rate for Payer: BCBS Trust/PPO |
$666.68
|
| Rate for Payer: BCN Commercial |
$666.68
|
| Rate for Payer: BCN Medicare Advantage |
$519.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.87
|
| Rate for Payer: Mclaren Medicaid |
$278.65
|
| Rate for Payer: Mclaren Medicare |
$519.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.86
|
| Rate for Payer: Meridian Medicaid |
$292.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$597.85
|
| Rate for Payer: Nomi Health Commercial |
$1,559.61
|
| Rate for Payer: PACE Medicare |
$493.88
|
| Rate for Payer: PACE SWMI |
$519.87
|
| Rate for Payer: PHP Medicare Advantage |
$519.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,633.95
|
| Rate for Payer: Priority Health Medicare |
$519.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.16
|
| Rate for Payer: Railroad Medicare Medicare |
$519.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.41
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.87
|
| Rate for Payer: UHC Exchange |
$202.19
|
| Rate for Payer: UHC Medicare Advantage |
$519.87
|
| Rate for Payer: UHCCP Medicaid |
$278.65
|
| Rate for Payer: VA VA |
$519.87
|
|
