Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PROMETHAZINE 25 MG RECTAL SUPPOSITORY

Facility

$159.00

Service Code	NDC 00713052612
Hospital Charge Code	11144
Hospital Revenue Code	637
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$143.10
Rate for Payer: Aetna Commercial	$135.15
Rate for Payer: Aetna Medicare	$79.50
Rate for Payer: Aetna New Business (MI Preferred)	$103.35
Rate for Payer: BCBS Complete	$63.60
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cofinity Commercial	$111.30
Rate for Payer: Cofinity Commercial	$136.74
Rate for Payer: Cofinity Medicare Advantage	$111.30
Rate for Payer: Encore Health Key Benefits Commercial	$127.20
Rate for Payer: Healthscope Commercial	$143.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.15
Rate for Payer: PHP Commercial	$135.15
Rate for Payer: Priority Health Cigna Priority Health	$103.35
Rate for Payer: Priority Health SBD	$100.17

PROMETHAZINE 25 MG TABLET

Facility

$108.10

Service Code	NDC 10702000301
Hospital Charge Code	6622
Hospital Revenue Code	637
Min. Negotiated Rate	$43.24
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.88
Rate for Payer: Aetna Medicare	$54.05
Rate for Payer: Aetna New Business (MI Preferred)	$70.26
Rate for Payer: BCBS Complete	$43.24
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Cofinity Medicare Advantage	$75.67
Rate for Payer: Encore Health Key Benefits Commercial	$86.48
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.88
Rate for Payer: PHP Commercial	$91.88
Rate for Payer: Priority Health Cigna Priority Health	$70.26
Rate for Payer: Priority Health SBD	$68.10

PROMETHAZINE 25 MG TABLET

Facility

$108.10

Service Code	NDC 10702000301
Hospital Charge Code	6622
Hospital Revenue Code	637
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.88
Rate for Payer: Aetna New Business (MI Preferred)	$70.26
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Cofinity Medicare Advantage	$75.67
Rate for Payer: Encore Health Key Benefits Commercial	$86.48
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.88
Rate for Payer: PHP Commercial	$91.88
Rate for Payer: Priority Health Cigna Priority Health	$70.26
Rate for Payer: Priority Health SBD	$68.10

PROMETHAZINE 25 MG TABLET

Facility

$251.45

Service Code	NDC 00904646161
Hospital Charge Code	6622
Hospital Revenue Code	637
Min. Negotiated Rate	$100.58
Max. Negotiated Rate	$226.30
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna Medicare	$125.72
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: BCBS Complete	$100.58
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.02
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$176.02
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$158.41

PROMETHAZINE 25 MG TABLET

Facility

$251.45

Service Code	NDC 00904646161
Hospital Charge Code	6622
Hospital Revenue Code	637
Min. Negotiated Rate	$158.41
Max. Negotiated Rate	$226.30
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.02
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$176.02
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$158.41

PROMETHAZINE 50 MG RECTAL SUPPOSITORY

Facility

$1,107.61

Service Code	NDC 00713013212
Hospital Charge Code	6624
Hospital Revenue Code	637
Min. Negotiated Rate	$697.79
Max. Negotiated Rate	$996.85
Rate for Payer: Aetna Commercial	$941.47
Rate for Payer: Aetna New Business (MI Preferred)	$719.95
Rate for Payer: Cash Price	$886.09
Rate for Payer: Cofinity Commercial	$775.33
Rate for Payer: Cofinity Commercial	$952.54
Rate for Payer: Cofinity Medicare Advantage	$775.33
Rate for Payer: Encore Health Key Benefits Commercial	$886.09
Rate for Payer: Healthscope Commercial	$996.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$941.47
Rate for Payer: PHP Commercial	$941.47
Rate for Payer: Priority Health Cigna Priority Health	$719.95
Rate for Payer: Priority Health SBD	$697.79

PROMETHAZINE 50 MG RECTAL SUPPOSITORY

Facility

$1,107.61

Service Code	NDC 00713013212
Hospital Charge Code	6624
Hospital Revenue Code	637
Min. Negotiated Rate	$443.04
Max. Negotiated Rate	$996.85
Rate for Payer: Aetna Commercial	$941.47
Rate for Payer: Aetna Medicare	$553.80
Rate for Payer: Aetna New Business (MI Preferred)	$719.95
Rate for Payer: BCBS Complete	$443.04
Rate for Payer: Cash Price	$886.09
Rate for Payer: Cofinity Commercial	$775.33
Rate for Payer: Cofinity Commercial	$952.54
Rate for Payer: Cofinity Medicare Advantage	$775.33
Rate for Payer: Encore Health Key Benefits Commercial	$886.09
Rate for Payer: Healthscope Commercial	$996.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$941.47
Rate for Payer: PHP Commercial	$941.47
Rate for Payer: Priority Health Cigna Priority Health	$719.95
Rate for Payer: Priority Health SBD	$697.79

PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP

Facility

$206.94

Service Code	NDC 00121092716
Hospital Charge Code	6620
Hospital Revenue Code	637
Min. Negotiated Rate	$82.78
Max. Negotiated Rate	$186.25
Rate for Payer: Aetna Commercial	$175.90
Rate for Payer: Aetna Medicare	$103.47
Rate for Payer: Aetna New Business (MI Preferred)	$134.51
Rate for Payer: BCBS Complete	$82.78
Rate for Payer: Cash Price	$165.55
Rate for Payer: Cofinity Commercial	$144.86
Rate for Payer: Cofinity Commercial	$177.97
Rate for Payer: Cofinity Medicare Advantage	$144.86
Rate for Payer: Encore Health Key Benefits Commercial	$165.55
Rate for Payer: Healthscope Commercial	$186.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.90
Rate for Payer: PHP Commercial	$175.90
Rate for Payer: Priority Health Cigna Priority Health	$134.51
Rate for Payer: Priority Health SBD	$130.37

PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP

Facility

$389.05

Service Code	NDC 60432060816
Hospital Charge Code	6620
Hospital Revenue Code	637
Min. Negotiated Rate	$155.62
Max. Negotiated Rate	$350.14
Rate for Payer: Aetna Commercial	$330.69
Rate for Payer: Aetna Medicare	$194.52
Rate for Payer: Aetna New Business (MI Preferred)	$252.88
Rate for Payer: BCBS Complete	$155.62
Rate for Payer: Cash Price	$311.24
Rate for Payer: Cofinity Commercial	$272.34
Rate for Payer: Cofinity Commercial	$334.58
Rate for Payer: Cofinity Medicare Advantage	$272.34
Rate for Payer: Encore Health Key Benefits Commercial	$311.24
Rate for Payer: Healthscope Commercial	$350.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.69
Rate for Payer: PHP Commercial	$330.69
Rate for Payer: Priority Health Cigna Priority Health	$252.88
Rate for Payer: Priority Health SBD	$245.10

PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP

Facility

$206.94

Service Code	NDC 00121092716
Hospital Charge Code	6620
Hospital Revenue Code	637
Min. Negotiated Rate	$130.37
Max. Negotiated Rate	$186.25
Rate for Payer: Aetna Commercial	$175.90
Rate for Payer: Aetna New Business (MI Preferred)	$134.51
Rate for Payer: Cash Price	$165.55
Rate for Payer: Cofinity Commercial	$144.86
Rate for Payer: Cofinity Commercial	$177.97
Rate for Payer: Cofinity Medicare Advantage	$144.86
Rate for Payer: Encore Health Key Benefits Commercial	$165.55
Rate for Payer: Healthscope Commercial	$186.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.90
Rate for Payer: PHP Commercial	$175.90
Rate for Payer: Priority Health Cigna Priority Health	$134.51
Rate for Payer: Priority Health SBD	$130.37

PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP

Facility

$389.05

Service Code	NDC 60432060816
Hospital Charge Code	6620
Hospital Revenue Code	637
Min. Negotiated Rate	$245.10
Max. Negotiated Rate	$350.14
Rate for Payer: Aetna Commercial	$330.69
Rate for Payer: Aetna New Business (MI Preferred)	$252.88
Rate for Payer: Cash Price	$311.24
Rate for Payer: Cofinity Commercial	$272.34
Rate for Payer: Cofinity Commercial	$334.58
Rate for Payer: Cofinity Medicare Advantage	$272.34
Rate for Payer: Encore Health Key Benefits Commercial	$311.24
Rate for Payer: Healthscope Commercial	$350.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.69
Rate for Payer: PHP Commercial	$330.69
Rate for Payer: Priority Health Cigna Priority Health	$252.88
Rate for Payer: Priority Health SBD	$245.10

PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP

Facility

$766.97

Service Code	NDC 60432060416
Hospital Charge Code	11145
Hospital Revenue Code	637
Min. Negotiated Rate	$483.19
Max. Negotiated Rate	$690.27
Rate for Payer: Aetna Commercial	$651.92
Rate for Payer: Aetna New Business (MI Preferred)	$498.53
Rate for Payer: Cash Price	$613.58
Rate for Payer: Cofinity Commercial	$536.88
Rate for Payer: Cofinity Commercial	$659.59
Rate for Payer: Cofinity Medicare Advantage	$536.88
Rate for Payer: Encore Health Key Benefits Commercial	$613.58
Rate for Payer: Healthscope Commercial	$690.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$651.92
Rate for Payer: PHP Commercial	$651.92
Rate for Payer: Priority Health Cigna Priority Health	$498.53
Rate for Payer: Priority Health SBD	$483.19

PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP

Facility

$766.97

Service Code	NDC 60432060416
Hospital Charge Code	11145
Hospital Revenue Code	637
Min. Negotiated Rate	$306.79
Max. Negotiated Rate	$690.27
Rate for Payer: Aetna Commercial	$651.92
Rate for Payer: Aetna Medicare	$383.48
Rate for Payer: Aetna New Business (MI Preferred)	$498.53
Rate for Payer: BCBS Complete	$306.79
Rate for Payer: Cash Price	$613.58
Rate for Payer: Cofinity Commercial	$536.88
Rate for Payer: Cofinity Commercial	$659.59
Rate for Payer: Cofinity Medicare Advantage	$536.88
Rate for Payer: Encore Health Key Benefits Commercial	$613.58
Rate for Payer: Healthscope Commercial	$690.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$651.92
Rate for Payer: PHP Commercial	$651.92
Rate for Payer: Priority Health Cigna Priority Health	$498.53
Rate for Payer: Priority Health SBD	$483.19

PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX

Professional

Both

$2,127.00

Service Code	HCPCS 49255
Min. Negotiated Rate	$512.05
Max. Negotiated Rate	$141,158.00
Rate for Payer: Aetna Commercial	$1,028.83
Rate for Payer: Aetna Medicare	$798.49
Rate for Payer: Aetna New Business (MI Preferred)	$1,028.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,105.60
Rate for Payer: BCBS Complete	$537.65
Rate for Payer: BCBS MAPPO	$767.78
Rate for Payer: BCBS Trust/PPO	$1,221.96
Rate for Payer: BCN Commercial	$1,157.67
Rate for Payer: BCN Medicare Advantage	$767.78
Rate for Payer: Cash Price	$1,701.60
Rate for Payer: Cash Price	$1,701.60
Rate for Payer: Cofinity Commercial	$1,105.60
Rate for Payer: Cofinity Commercial	$1,028.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$767.78
Rate for Payer: Healthscope Commercial	$1,420.39
Rate for Payer: Healthscope Commercial	$1,228.45
Rate for Payer: Mclaren Medicaid	$512.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$806.17
Rate for Payer: Meridian Medicaid	$537.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141,158.00
Rate for Payer: Nomi Health Commercial	$921.34
Rate for Payer: PACE SWMI	$767.78
Rate for Payer: PHP Medicare Advantage	$767.78
Rate for Payer: Priority Health Choice Medicaid	$512.05
Rate for Payer: Priority Health Cigna Priority Health	$1,382.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,424.67
Rate for Payer: Priority Health Medicare	$767.78
Rate for Payer: Priority Health Narrow Network	$1,424.67
Rate for Payer: Priority Health SBD	$1,424.67
Rate for Payer: UHC All Payor (Choice/PPO)	$801.80
Rate for Payer: UHC Dual Complete DSNP	$767.78
Rate for Payer: UHC Exchange	$801.80
Rate for Payer: UHC Medicare Advantage	$767.78
Rate for Payer: UHCCP Medicaid	$512.05

PROMOTE BOLUS FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	200092
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE BOLUS FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	200092
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE BOLUS FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	200092
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE BOLUS FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	200092
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	180296
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	180296
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	180296
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	180296
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	200094
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	200094
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	200094
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

Know your out-of-pocket cost for care.

All Charges