Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION

Facility

$35.38

Service Code	HCPCS J0612
Hospital Charge Code	189461
Hospital Revenue Code	636
Min. Negotiated Rate	$22.29
Max. Negotiated Rate	$31.84
Rate for Payer: Aetna Commercial	$30.07
Rate for Payer: Aetna New Business (MI Preferred)	$23.00
Rate for Payer: Cash Price	$28.30
Rate for Payer: Cofinity Commercial	$24.77
Rate for Payer: Cofinity Commercial	$30.43
Rate for Payer: Cofinity Medicare Advantage	$24.77
Rate for Payer: Encore Health Key Benefits Commercial	$28.30
Rate for Payer: Healthscope Commercial	$31.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.07
Rate for Payer: PHP Commercial	$30.07
Rate for Payer: Priority Health Cigna Priority Health	$23.00
Rate for Payer: Priority Health SBD	$22.29

CALCIUM GLUCONATE 2.5 % GEL 25 GM

Facility

$192.00

Service Code	NDC 00295752040
Hospital Charge Code	301456
Hospital Revenue Code	637
Min. Negotiated Rate	$120.96
Max. Negotiated Rate	$172.80
Rate for Payer: Aetna Commercial	$163.20
Rate for Payer: Aetna New Business (MI Preferred)	$124.80
Rate for Payer: Cash Price	$153.60
Rate for Payer: Cofinity Commercial	$134.40
Rate for Payer: Cofinity Commercial	$165.12
Rate for Payer: Cofinity Medicare Advantage	$134.40
Rate for Payer: Encore Health Key Benefits Commercial	$153.60
Rate for Payer: Healthscope Commercial	$172.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.20
Rate for Payer: PHP Commercial	$163.20
Rate for Payer: Priority Health Cigna Priority Health	$124.80
Rate for Payer: Priority Health SBD	$120.96

CALCIUM GLUCONATE 2.5 % GEL 25 GM

Facility

$192.00

Service Code	NDC 00295752040
Hospital Charge Code	301456
Hospital Revenue Code	637
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$172.80
Rate for Payer: Aetna Commercial	$163.20
Rate for Payer: Aetna Medicare	$96.00
Rate for Payer: Aetna New Business (MI Preferred)	$124.80
Rate for Payer: BCBS Complete	$76.80
Rate for Payer: Cash Price	$153.60
Rate for Payer: Cofinity Commercial	$134.40
Rate for Payer: Cofinity Commercial	$165.12
Rate for Payer: Cofinity Medicare Advantage	$134.40
Rate for Payer: Encore Health Key Benefits Commercial	$153.60
Rate for Payer: Healthscope Commercial	$172.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.20
Rate for Payer: PHP Commercial	$163.20
Rate for Payer: Priority Health Cigna Priority Health	$124.80
Rate for Payer: Priority Health SBD	$120.96

CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION

Facility

$74.32

Service Code	HCPCS J0613
Hospital Charge Code	190608
Hospital Revenue Code	636
Min. Negotiated Rate	$46.82
Max. Negotiated Rate	$66.89
Rate for Payer: Aetna Commercial	$63.17
Rate for Payer: Aetna New Business (MI Preferred)	$48.31
Rate for Payer: Cash Price	$59.46
Rate for Payer: Cofinity Commercial	$52.02
Rate for Payer: Cofinity Commercial	$63.92
Rate for Payer: Cofinity Medicare Advantage	$52.02
Rate for Payer: Encore Health Key Benefits Commercial	$59.46
Rate for Payer: Healthscope Commercial	$66.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.17
Rate for Payer: PHP Commercial	$63.17
Rate for Payer: Priority Health Cigna Priority Health	$48.31
Rate for Payer: Priority Health SBD	$46.82

CALCIUM GLUCONATE 2 GRAM/100 ML IN SODIUM CHLORIDE,ISO-OSM IV SOLUTION

Facility

$74.32

Service Code	HCPCS J0613
Hospital Charge Code	190608
Hospital Revenue Code	636
Min. Negotiated Rate	$29.73
Max. Negotiated Rate	$66.89
Rate for Payer: Aetna Commercial	$63.17
Rate for Payer: Aetna Medicare	$37.16
Rate for Payer: Aetna New Business (MI Preferred)	$48.31
Rate for Payer: BCBS Complete	$29.73
Rate for Payer: Cash Price	$59.46
Rate for Payer: Cofinity Commercial	$52.02
Rate for Payer: Cofinity Commercial	$63.92
Rate for Payer: Cofinity Medicare Advantage	$52.02
Rate for Payer: Encore Health Key Benefits Commercial	$59.46
Rate for Payer: Healthscope Commercial	$66.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.17
Rate for Payer: PHP Commercial	$63.17
Rate for Payer: Priority Health Cigna Priority Health	$48.31
Rate for Payer: Priority Health SBD	$46.82

CALCIUM GLUCONATE (BULK) POWDER

Facility

$366.00

Service Code	NDC 38779182608
Hospital Charge Code	1316
Hospital Revenue Code	637
Min. Negotiated Rate	$230.58
Max. Negotiated Rate	$329.40
Rate for Payer: Aetna Commercial	$311.10
Rate for Payer: Aetna New Business (MI Preferred)	$237.90
Rate for Payer: Cash Price	$292.80
Rate for Payer: Cofinity Commercial	$256.20
Rate for Payer: Cofinity Commercial	$314.76
Rate for Payer: Cofinity Medicare Advantage	$256.20
Rate for Payer: Encore Health Key Benefits Commercial	$292.80
Rate for Payer: Healthscope Commercial	$329.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.10
Rate for Payer: PHP Commercial	$311.10
Rate for Payer: Priority Health Cigna Priority Health	$237.90
Rate for Payer: Priority Health SBD	$230.58

CALCIUM GLUCONATE (BULK) POWDER

Facility

$366.00

Service Code	NDC 38779182608
Hospital Charge Code	1316
Hospital Revenue Code	637
Min. Negotiated Rate	$146.40
Max. Negotiated Rate	$329.40
Rate for Payer: Aetna Commercial	$311.10
Rate for Payer: Aetna Medicare	$183.00
Rate for Payer: Aetna New Business (MI Preferred)	$237.90
Rate for Payer: BCBS Complete	$146.40
Rate for Payer: Cash Price	$292.80
Rate for Payer: Cofinity Commercial	$256.20
Rate for Payer: Cofinity Commercial	$314.76
Rate for Payer: Cofinity Medicare Advantage	$256.20
Rate for Payer: Encore Health Key Benefits Commercial	$292.80
Rate for Payer: Healthscope Commercial	$329.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.10
Rate for Payer: PHP Commercial	$311.10
Rate for Payer: Priority Health Cigna Priority Health	$237.90
Rate for Payer: Priority Health SBD	$230.58

CAPSAICIN 0.025 % TOPICAL CREAM

Facility

$15.12

Service Code	NDC 00536252525
Hospital Charge Code	1350
Hospital Revenue Code	637
Min. Negotiated Rate	$9.53
Max. Negotiated Rate	$13.61
Rate for Payer: Aetna Commercial	$12.85
Rate for Payer: Aetna New Business (MI Preferred)	$9.83
Rate for Payer: Cash Price	$12.10
Rate for Payer: Cofinity Commercial	$10.58
Rate for Payer: Cofinity Commercial	$13.00
Rate for Payer: Cofinity Medicare Advantage	$10.58
Rate for Payer: Encore Health Key Benefits Commercial	$12.10
Rate for Payer: Healthscope Commercial	$13.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.85
Rate for Payer: PHP Commercial	$12.85
Rate for Payer: Priority Health Cigna Priority Health	$9.83
Rate for Payer: Priority Health SBD	$9.53

CAPSAICIN 0.025 % TOPICAL CREAM

Facility

$15.12

Service Code	NDC 00536252525
Hospital Charge Code	1350
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$13.61
Rate for Payer: Aetna Commercial	$12.85
Rate for Payer: Aetna Medicare	$7.56
Rate for Payer: Aetna New Business (MI Preferred)	$9.83
Rate for Payer: BCBS Complete	$6.05
Rate for Payer: Cash Price	$12.10
Rate for Payer: Cofinity Commercial	$10.58
Rate for Payer: Cofinity Commercial	$13.00
Rate for Payer: Cofinity Medicare Advantage	$10.58
Rate for Payer: Encore Health Key Benefits Commercial	$12.10
Rate for Payer: Healthscope Commercial	$13.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.85
Rate for Payer: PHP Commercial	$12.85
Rate for Payer: Priority Health Cigna Priority Health	$9.83
Rate for Payer: Priority Health SBD	$9.53

CAPSAICIN 0.075 % TOPICAL CREAM

Facility

$18.99

Service Code	NDC 00536111825
Hospital Charge Code	9399
Hospital Revenue Code	637
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$17.09
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare	$9.49
Rate for Payer: Aetna New Business (MI Preferred)	$12.34
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: Cash Price	$15.19
Rate for Payer: Cofinity Commercial	$13.29
Rate for Payer: Cofinity Commercial	$16.33
Rate for Payer: Cofinity Medicare Advantage	$13.29
Rate for Payer: Encore Health Key Benefits Commercial	$15.19
Rate for Payer: Healthscope Commercial	$17.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.14
Rate for Payer: PHP Commercial	$16.14
Rate for Payer: Priority Health Cigna Priority Health	$12.34
Rate for Payer: Priority Health SBD	$11.96

CAPSAICIN 0.075 % TOPICAL CREAM

Facility

$18.99

Service Code	NDC 00536111825
Hospital Charge Code	9399
Hospital Revenue Code	637
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$17.09
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna New Business (MI Preferred)	$12.34
Rate for Payer: Cash Price	$15.19
Rate for Payer: Cofinity Commercial	$13.29
Rate for Payer: Cofinity Commercial	$16.33
Rate for Payer: Cofinity Medicare Advantage	$13.29
Rate for Payer: Encore Health Key Benefits Commercial	$15.19
Rate for Payer: Healthscope Commercial	$17.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.14
Rate for Payer: PHP Commercial	$16.14
Rate for Payer: Priority Health Cigna Priority Health	$12.34
Rate for Payer: Priority Health SBD	$11.96

CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)

Facility

$19,611.80

Service Code	CPT 23455
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)

Facility

$8,907.47

Service Code	CPT 28270
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE

Facility

$8,907.47

Service Code	CPT 27435
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

CAPTOPRIL 12.5 MG TABLET

Facility

$533.76

Service Code	NDC 00904710561
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$336.27
Max. Negotiated Rate	$480.38
Rate for Payer: Aetna Commercial	$453.70
Rate for Payer: Aetna New Business (MI Preferred)	$346.94
Rate for Payer: Cash Price	$427.01
Rate for Payer: Cofinity Commercial	$373.63
Rate for Payer: Cofinity Commercial	$459.03
Rate for Payer: Cofinity Medicare Advantage	$373.63
Rate for Payer: Encore Health Key Benefits Commercial	$427.01
Rate for Payer: Healthscope Commercial	$480.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$453.70
Rate for Payer: PHP Commercial	$453.70
Rate for Payer: Priority Health Cigna Priority Health	$346.94
Rate for Payer: Priority Health SBD	$336.27

CAPTOPRIL 12.5 MG TABLET

Facility

$5.80

Service Code	NDC 51079086301
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$4.93
Rate for Payer: Aetna Medicare	$2.90
Rate for Payer: Aetna New Business (MI Preferred)	$3.77
Rate for Payer: BCBS Complete	$2.32
Rate for Payer: Cash Price	$4.64
Rate for Payer: Cofinity Commercial	$4.06
Rate for Payer: Cofinity Commercial	$4.99
Rate for Payer: Cofinity Medicare Advantage	$4.06
Rate for Payer: Encore Health Key Benefits Commercial	$4.64
Rate for Payer: Healthscope Commercial	$5.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.93
Rate for Payer: PHP Commercial	$4.93
Rate for Payer: Priority Health Cigna Priority Health	$3.77
Rate for Payer: Priority Health SBD	$3.65

CAPTOPRIL 12.5 MG TABLET

Facility

$579.84

Service Code	NDC 51079086320
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$365.30
Max. Negotiated Rate	$521.86
Rate for Payer: Aetna Commercial	$492.86
Rate for Payer: Aetna New Business (MI Preferred)	$376.90
Rate for Payer: Cash Price	$463.87
Rate for Payer: Cofinity Commercial	$405.89
Rate for Payer: Cofinity Commercial	$498.66
Rate for Payer: Cofinity Medicare Advantage	$405.89
Rate for Payer: Encore Health Key Benefits Commercial	$463.87
Rate for Payer: Healthscope Commercial	$521.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$492.86
Rate for Payer: PHP Commercial	$492.86
Rate for Payer: Priority Health Cigna Priority Health	$376.90
Rate for Payer: Priority Health SBD	$365.30

CAPTOPRIL 12.5 MG TABLET

Facility

$579.84

Service Code	NDC 51079086320
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$231.94
Max. Negotiated Rate	$521.86
Rate for Payer: Aetna Commercial	$492.86
Rate for Payer: Aetna Medicare	$289.92
Rate for Payer: Aetna New Business (MI Preferred)	$376.90
Rate for Payer: BCBS Complete	$231.94
Rate for Payer: Cash Price	$463.87
Rate for Payer: Cofinity Commercial	$405.89
Rate for Payer: Cofinity Commercial	$498.66
Rate for Payer: Cofinity Medicare Advantage	$405.89
Rate for Payer: Encore Health Key Benefits Commercial	$463.87
Rate for Payer: Healthscope Commercial	$521.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$492.86
Rate for Payer: PHP Commercial	$492.86
Rate for Payer: Priority Health Cigna Priority Health	$376.90
Rate for Payer: Priority Health SBD	$365.30

CAPTOPRIL 12.5 MG TABLET

Facility

$533.76

Service Code	NDC 00904710561
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$213.50
Max. Negotiated Rate	$480.38
Rate for Payer: Aetna Commercial	$453.70
Rate for Payer: Aetna Medicare	$266.88
Rate for Payer: Aetna New Business (MI Preferred)	$346.94
Rate for Payer: BCBS Complete	$213.50
Rate for Payer: Cash Price	$427.01
Rate for Payer: Cofinity Commercial	$373.63
Rate for Payer: Cofinity Commercial	$459.03
Rate for Payer: Cofinity Medicare Advantage	$373.63
Rate for Payer: Encore Health Key Benefits Commercial	$427.01
Rate for Payer: Healthscope Commercial	$480.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$453.70
Rate for Payer: PHP Commercial	$453.70
Rate for Payer: Priority Health Cigna Priority Health	$346.94
Rate for Payer: Priority Health SBD	$336.27

CAPTOPRIL 12.5 MG TABLET

Facility

$5.80

Service Code	NDC 51079086301
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$4.93
Rate for Payer: Aetna New Business (MI Preferred)	$3.77
Rate for Payer: Cash Price	$4.64
Rate for Payer: Cofinity Commercial	$4.06
Rate for Payer: Cofinity Commercial	$4.99
Rate for Payer: Cofinity Medicare Advantage	$4.06
Rate for Payer: Encore Health Key Benefits Commercial	$4.64
Rate for Payer: Healthscope Commercial	$5.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.93
Rate for Payer: PHP Commercial	$4.93
Rate for Payer: Priority Health Cigna Priority Health	$3.77
Rate for Payer: Priority Health SBD	$3.65

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$13.59

Service Code	NDC 68094000762
Hospital Charge Code	119222
Hospital Revenue Code	637
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$12.23
Rate for Payer: Aetna Commercial	$11.55
Rate for Payer: Aetna Medicare	$6.79
Rate for Payer: Aetna New Business (MI Preferred)	$8.83
Rate for Payer: BCBS Complete	$5.44
Rate for Payer: Cash Price	$10.87
Rate for Payer: Cofinity Commercial	$11.69
Rate for Payer: Cofinity Commercial	$9.51
Rate for Payer: Cofinity Medicare Advantage	$9.51
Rate for Payer: Encore Health Key Benefits Commercial	$10.87
Rate for Payer: Healthscope Commercial	$12.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.55
Rate for Payer: PHP Commercial	$11.55
Rate for Payer: Priority Health Cigna Priority Health	$8.83
Rate for Payer: Priority Health SBD	$8.56

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$13.59

Service Code	NDC 68094000762
Hospital Charge Code	119222
Hospital Revenue Code	637
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$12.23
Rate for Payer: Aetna Commercial	$11.55
Rate for Payer: Aetna New Business (MI Preferred)	$8.83
Rate for Payer: Cash Price	$10.87
Rate for Payer: Cofinity Commercial	$11.69
Rate for Payer: Cofinity Commercial	$9.51
Rate for Payer: Cofinity Medicare Advantage	$9.51
Rate for Payer: Encore Health Key Benefits Commercial	$10.87
Rate for Payer: Healthscope Commercial	$12.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.55
Rate for Payer: PHP Commercial	$11.55
Rate for Payer: Priority Health Cigna Priority Health	$8.83
Rate for Payer: Priority Health SBD	$8.56

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$13.59

Service Code	NDC 68094000759
Hospital Charge Code	119222
Hospital Revenue Code	637
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$12.23
Rate for Payer: Aetna Commercial	$11.55
Rate for Payer: Aetna Medicare	$6.79
Rate for Payer: Aetna New Business (MI Preferred)	$8.83
Rate for Payer: BCBS Complete	$5.44
Rate for Payer: Cash Price	$10.87
Rate for Payer: Cofinity Commercial	$11.69
Rate for Payer: Cofinity Commercial	$9.51
Rate for Payer: Cofinity Medicare Advantage	$9.51
Rate for Payer: Encore Health Key Benefits Commercial	$10.87
Rate for Payer: Healthscope Commercial	$12.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.55
Rate for Payer: PHP Commercial	$11.55
Rate for Payer: Priority Health Cigna Priority Health	$8.83
Rate for Payer: Priority Health SBD	$8.56

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$13.59

Service Code	NDC 68094000759
Hospital Charge Code	119222
Hospital Revenue Code	637
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$12.23
Rate for Payer: Aetna Commercial	$11.55
Rate for Payer: Aetna New Business (MI Preferred)	$8.83
Rate for Payer: Cash Price	$10.87
Rate for Payer: Cofinity Commercial	$11.69
Rate for Payer: Cofinity Commercial	$9.51
Rate for Payer: Cofinity Medicare Advantage	$9.51
Rate for Payer: Encore Health Key Benefits Commercial	$10.87
Rate for Payer: Healthscope Commercial	$12.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.55
Rate for Payer: PHP Commercial	$11.55
Rate for Payer: Priority Health Cigna Priority Health	$8.83
Rate for Payer: Priority Health SBD	$8.56

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,300.73

Service Code	NDC 60432012916
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$520.29
Max. Negotiated Rate	$1,170.66
Rate for Payer: Aetna Commercial	$1,105.62
Rate for Payer: Aetna Medicare	$650.37
Rate for Payer: Aetna New Business (MI Preferred)	$845.47
Rate for Payer: BCBS Complete	$520.29
Rate for Payer: Cash Price	$1,040.58
Rate for Payer: Cofinity Commercial	$1,118.63
Rate for Payer: Cofinity Commercial	$910.51
Rate for Payer: Cofinity Medicare Advantage	$910.51
Rate for Payer: Encore Health Key Benefits Commercial	$1,040.58
Rate for Payer: Healthscope Commercial	$1,170.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,105.62
Rate for Payer: PHP Commercial	$1,105.62
Rate for Payer: Priority Health Cigna Priority Health	$845.47
Rate for Payer: Priority Health SBD	$819.46

Know your out-of-pocket cost for care.

All Charges