Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$819.46
Max. Negotiated Rate	$1,170.66
Rate for Payer: Aetna Commercial	$1,105.62
Rate for Payer: Aetna New Business (MI Preferred)	$845.47
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

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	$650.36
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

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$3.14

Service Code	NDC 51079087001
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Cofinity Medicare Advantage	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.98

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$313.50

Service Code	NDC 51079087020
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$125.40
Max. Negotiated Rate	$282.15
Rate for Payer: Aetna Commercial	$266.48
Rate for Payer: Aetna Medicare	$156.75
Rate for Payer: Aetna New Business (MI Preferred)	$203.78
Rate for Payer: BCBS Complete	$125.40
Rate for Payer: Cash Price	$250.80
Rate for Payer: Cofinity Commercial	$219.45
Rate for Payer: Cofinity Commercial	$269.61
Rate for Payer: Cofinity Medicare Advantage	$219.45
Rate for Payer: Encore Health Key Benefits Commercial	$250.80
Rate for Payer: Healthscope Commercial	$282.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$266.48
Rate for Payer: PHP Commercial	$266.48
Rate for Payer: Priority Health Cigna Priority Health	$203.78
Rate for Payer: Priority Health SBD	$197.50

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$320.15

Service Code	NDC 00904385461
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$201.69
Max. Negotiated Rate	$288.14
Rate for Payer: Aetna Commercial	$272.13
Rate for Payer: Aetna New Business (MI Preferred)	$208.10
Rate for Payer: Cash Price	$256.12
Rate for Payer: Cofinity Commercial	$224.10
Rate for Payer: Cofinity Commercial	$275.33
Rate for Payer: Cofinity Medicare Advantage	$224.10
Rate for Payer: Encore Health Key Benefits Commercial	$256.12
Rate for Payer: Healthscope Commercial	$288.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.13
Rate for Payer: PHP Commercial	$272.13
Rate for Payer: Priority Health Cigna Priority Health	$208.10
Rate for Payer: Priority Health SBD	$201.69

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$313.50

Service Code	NDC 51079087020
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$282.15
Rate for Payer: Aetna Commercial	$266.48
Rate for Payer: Aetna New Business (MI Preferred)	$203.78
Rate for Payer: Cash Price	$250.80
Rate for Payer: Cofinity Commercial	$219.45
Rate for Payer: Cofinity Commercial	$269.61
Rate for Payer: Cofinity Medicare Advantage	$219.45
Rate for Payer: Encore Health Key Benefits Commercial	$250.80
Rate for Payer: Healthscope Commercial	$282.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$266.48
Rate for Payer: PHP Commercial	$266.48
Rate for Payer: Priority Health Cigna Priority Health	$203.78
Rate for Payer: Priority Health SBD	$197.50

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$3.14

Service Code	NDC 51079087001
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna Medicare	$1.57
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: BCBS Complete	$1.26
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Cofinity Medicare Advantage	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.98

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$320.15

Service Code	NDC 00904385461
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$128.06
Max. Negotiated Rate	$288.14
Rate for Payer: Aetna Commercial	$272.13
Rate for Payer: Aetna Medicare	$160.08
Rate for Payer: Aetna New Business (MI Preferred)	$208.10
Rate for Payer: BCBS Complete	$128.06
Rate for Payer: Cash Price	$256.12
Rate for Payer: Cofinity Commercial	$224.10
Rate for Payer: Cofinity Commercial	$275.33
Rate for Payer: Cofinity Medicare Advantage	$224.10
Rate for Payer: Encore Health Key Benefits Commercial	$256.12
Rate for Payer: Healthscope Commercial	$288.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$272.13
Rate for Payer: PHP Commercial	$272.13
Rate for Payer: Priority Health Cigna Priority Health	$208.10
Rate for Payer: Priority Health SBD	$201.69

CARBAMAZEPINE 200 MG TABLET

Facility

$361.00

Service Code	NDC 51672400501
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$227.43
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna Commercial	$306.85
Rate for Payer: Aetna New Business (MI Preferred)	$234.65
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cofinity Commercial	$252.70
Rate for Payer: Cofinity Commercial	$310.46
Rate for Payer: Cofinity Medicare Advantage	$252.70
Rate for Payer: Encore Health Key Benefits Commercial	$288.80
Rate for Payer: Healthscope Commercial	$324.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$306.85
Rate for Payer: PHP Commercial	$306.85
Rate for Payer: Priority Health Cigna Priority Health	$234.65
Rate for Payer: Priority Health SBD	$227.43

CARBAMAZEPINE 200 MG TABLET

Facility

$1,036.37

Service Code	NDC 00078050905
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$414.55
Max. Negotiated Rate	$932.73
Rate for Payer: Aetna Commercial	$880.91
Rate for Payer: Aetna Medicare	$518.18
Rate for Payer: Aetna New Business (MI Preferred)	$673.64
Rate for Payer: BCBS Complete	$414.55
Rate for Payer: Cash Price	$829.10
Rate for Payer: Cofinity Commercial	$725.46
Rate for Payer: Cofinity Commercial	$891.28
Rate for Payer: Cofinity Medicare Advantage	$725.46
Rate for Payer: Encore Health Key Benefits Commercial	$829.10
Rate for Payer: Healthscope Commercial	$932.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$880.91
Rate for Payer: PHP Commercial	$880.91
Rate for Payer: Priority Health Cigna Priority Health	$673.64
Rate for Payer: Priority Health SBD	$652.91

CARBAMAZEPINE 200 MG TABLET

Facility

$249.12

Service Code	NDC 00904617261
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$99.65
Max. Negotiated Rate	$224.21
Rate for Payer: Aetna Commercial	$211.75
Rate for Payer: Aetna Medicare	$124.56
Rate for Payer: Aetna New Business (MI Preferred)	$161.93
Rate for Payer: BCBS Complete	$99.65
Rate for Payer: Cash Price	$199.30
Rate for Payer: Cofinity Commercial	$174.38
Rate for Payer: Cofinity Commercial	$214.24
Rate for Payer: Cofinity Medicare Advantage	$174.38
Rate for Payer: Encore Health Key Benefits Commercial	$199.30
Rate for Payer: Healthscope Commercial	$224.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.75
Rate for Payer: PHP Commercial	$211.75
Rate for Payer: Priority Health Cigna Priority Health	$161.93
Rate for Payer: Priority Health SBD	$156.95

CARBAMAZEPINE 200 MG TABLET

Facility

$1,036.37

Service Code	NDC 00078050905
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$652.91
Max. Negotiated Rate	$932.73
Rate for Payer: Aetna Commercial	$880.91
Rate for Payer: Aetna New Business (MI Preferred)	$673.64
Rate for Payer: Cash Price	$829.10
Rate for Payer: Cofinity Commercial	$725.46
Rate for Payer: Cofinity Commercial	$891.28
Rate for Payer: Cofinity Medicare Advantage	$725.46
Rate for Payer: Encore Health Key Benefits Commercial	$829.10
Rate for Payer: Healthscope Commercial	$932.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$880.91
Rate for Payer: PHP Commercial	$880.91
Rate for Payer: Priority Health Cigna Priority Health	$673.64
Rate for Payer: Priority Health SBD	$652.91

CARBAMAZEPINE 200 MG TABLET

Facility

$361.00

Service Code	NDC 51672400501
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$144.40
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna Commercial	$306.85
Rate for Payer: Aetna Medicare	$180.50
Rate for Payer: Aetna New Business (MI Preferred)	$234.65
Rate for Payer: BCBS Complete	$144.40
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cofinity Commercial	$252.70
Rate for Payer: Cofinity Commercial	$310.46
Rate for Payer: Cofinity Medicare Advantage	$252.70
Rate for Payer: Encore Health Key Benefits Commercial	$288.80
Rate for Payer: Healthscope Commercial	$324.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$306.85
Rate for Payer: PHP Commercial	$306.85
Rate for Payer: Priority Health Cigna Priority Health	$234.65
Rate for Payer: Priority Health SBD	$227.43

CARBAMAZEPINE 200 MG TABLET

Facility

$249.12

Service Code	NDC 00904617261
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$156.95
Max. Negotiated Rate	$224.21
Rate for Payer: Aetna Commercial	$211.75
Rate for Payer: Aetna New Business (MI Preferred)	$161.93
Rate for Payer: Cash Price	$199.30
Rate for Payer: Cofinity Commercial	$174.38
Rate for Payer: Cofinity Commercial	$214.24
Rate for Payer: Cofinity Medicare Advantage	$174.38
Rate for Payer: Encore Health Key Benefits Commercial	$199.30
Rate for Payer: Healthscope Commercial	$224.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.75
Rate for Payer: PHP Commercial	$211.75
Rate for Payer: Priority Health Cigna Priority Health	$161.93
Rate for Payer: Priority Health SBD	$156.95

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR

Facility

$8.43

Service Code	NDC 50268017011
Hospital Charge Code	37567
Hospital Revenue Code	637
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$7.59
Rate for Payer: Aetna Commercial	$7.17
Rate for Payer: Aetna Medicare	$4.22
Rate for Payer: Aetna New Business (MI Preferred)	$5.48
Rate for Payer: BCBS Complete	$3.37
Rate for Payer: Cash Price	$6.74
Rate for Payer: Cofinity Commercial	$5.90
Rate for Payer: Cofinity Commercial	$7.25
Rate for Payer: Cofinity Medicare Advantage	$5.90
Rate for Payer: Encore Health Key Benefits Commercial	$6.74
Rate for Payer: Healthscope Commercial	$7.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.17
Rate for Payer: PHP Commercial	$7.17
Rate for Payer: Priority Health Cigna Priority Health	$5.48
Rate for Payer: Priority Health SBD	$5.31

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR

Facility

$8.43

Service Code	NDC 50268017011
Hospital Charge Code	37567
Hospital Revenue Code	637
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$7.59
Rate for Payer: Aetna Commercial	$7.17
Rate for Payer: Aetna New Business (MI Preferred)	$5.48
Rate for Payer: Cash Price	$6.74
Rate for Payer: Cofinity Commercial	$5.90
Rate for Payer: Cofinity Commercial	$7.25
Rate for Payer: Cofinity Medicare Advantage	$5.90
Rate for Payer: Encore Health Key Benefits Commercial	$6.74
Rate for Payer: Healthscope Commercial	$7.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.17
Rate for Payer: PHP Commercial	$7.17
Rate for Payer: Priority Health Cigna Priority Health	$5.48
Rate for Payer: Priority Health SBD	$5.31

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR

Facility

$878.40

Service Code	NDC 66993040732
Hospital Charge Code	37567
Hospital Revenue Code	637
Min. Negotiated Rate	$553.39
Max. Negotiated Rate	$790.56
Rate for Payer: Aetna Commercial	$746.64
Rate for Payer: Aetna New Business (MI Preferred)	$570.96
Rate for Payer: Cash Price	$702.72
Rate for Payer: Cofinity Commercial	$614.88
Rate for Payer: Cofinity Commercial	$755.42
Rate for Payer: Cofinity Medicare Advantage	$614.88
Rate for Payer: Encore Health Key Benefits Commercial	$702.72
Rate for Payer: Healthscope Commercial	$790.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$746.64
Rate for Payer: PHP Commercial	$746.64
Rate for Payer: Priority Health Cigna Priority Health	$570.96
Rate for Payer: Priority Health SBD	$553.39

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR

Facility

$252.86

Service Code	NDC 50268017013
Hospital Charge Code	37567
Hospital Revenue Code	637
Min. Negotiated Rate	$159.30
Max. Negotiated Rate	$227.57
Rate for Payer: Aetna Commercial	$214.93
Rate for Payer: Aetna New Business (MI Preferred)	$164.36
Rate for Payer: Cash Price	$202.29
Rate for Payer: Cofinity Commercial	$177.00
Rate for Payer: Cofinity Commercial	$217.46
Rate for Payer: Cofinity Medicare Advantage	$177.00
Rate for Payer: Encore Health Key Benefits Commercial	$202.29
Rate for Payer: Healthscope Commercial	$227.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.93
Rate for Payer: PHP Commercial	$214.93
Rate for Payer: Priority Health Cigna Priority Health	$164.36
Rate for Payer: Priority Health SBD	$159.30

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR

Facility

$878.40

Service Code	NDC 66993040732
Hospital Charge Code	37567
Hospital Revenue Code	637
Min. Negotiated Rate	$351.36
Max. Negotiated Rate	$790.56
Rate for Payer: Aetna Commercial	$746.64
Rate for Payer: Aetna Medicare	$439.20
Rate for Payer: Aetna New Business (MI Preferred)	$570.96
Rate for Payer: BCBS Complete	$351.36
Rate for Payer: Cash Price	$702.72
Rate for Payer: Cofinity Commercial	$614.88
Rate for Payer: Cofinity Commercial	$755.42
Rate for Payer: Cofinity Medicare Advantage	$614.88
Rate for Payer: Encore Health Key Benefits Commercial	$702.72
Rate for Payer: Healthscope Commercial	$790.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$746.64
Rate for Payer: PHP Commercial	$746.64
Rate for Payer: Priority Health Cigna Priority Health	$570.96
Rate for Payer: Priority Health SBD	$553.39

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR

Facility

$252.86

Service Code	NDC 50268017013
Hospital Charge Code	37567
Hospital Revenue Code	637
Min. Negotiated Rate	$101.14
Max. Negotiated Rate	$227.57
Rate for Payer: Aetna Commercial	$214.93
Rate for Payer: Aetna Medicare	$126.43
Rate for Payer: Aetna New Business (MI Preferred)	$164.36
Rate for Payer: BCBS Complete	$101.14
Rate for Payer: Cash Price	$202.29
Rate for Payer: Cofinity Commercial	$177.00
Rate for Payer: Cofinity Commercial	$217.46
Rate for Payer: Cofinity Medicare Advantage	$177.00
Rate for Payer: Encore Health Key Benefits Commercial	$202.29
Rate for Payer: Healthscope Commercial	$227.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.93
Rate for Payer: PHP Commercial	$214.93
Rate for Payer: Priority Health Cigna Priority Health	$164.36
Rate for Payer: Priority Health SBD	$159.30

CARBAMIDE PEROXIDE 6.5 % EAR DROPS

Facility

$12.63

Service Code	NDC 70000049002
Hospital Charge Code	1359
Hospital Revenue Code	637
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$11.37
Rate for Payer: Aetna Commercial	$10.74
Rate for Payer: Aetna Medicare	$6.32
Rate for Payer: Aetna New Business (MI Preferred)	$8.21
Rate for Payer: BCBS Complete	$5.05
Rate for Payer: Cash Price	$10.10
Rate for Payer: Cofinity Commercial	$10.86
Rate for Payer: Cofinity Commercial	$8.84
Rate for Payer: Cofinity Medicare Advantage	$8.84
Rate for Payer: Encore Health Key Benefits Commercial	$10.10
Rate for Payer: Healthscope Commercial	$11.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.74
Rate for Payer: PHP Commercial	$10.74
Rate for Payer: Priority Health Cigna Priority Health	$8.21
Rate for Payer: Priority Health SBD	$7.96

CARBAMIDE PEROXIDE 6.5 % EAR DROPS

Facility

$22.75

Service Code	NDC 78112073623
Hospital Charge Code	1359
Hospital Revenue Code	637
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$20.48
Rate for Payer: Aetna Commercial	$19.34
Rate for Payer: Aetna Medicare	$11.38
Rate for Payer: Aetna New Business (MI Preferred)	$14.79
Rate for Payer: BCBS Complete	$9.10
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cofinity Commercial	$15.92
Rate for Payer: Cofinity Commercial	$19.56
Rate for Payer: Cofinity Medicare Advantage	$15.92
Rate for Payer: Encore Health Key Benefits Commercial	$18.20
Rate for Payer: Healthscope Commercial	$20.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.34
Rate for Payer: PHP Commercial	$19.34
Rate for Payer: Priority Health Cigna Priority Health	$14.79
Rate for Payer: Priority Health SBD	$14.33

CARBAMIDE PEROXIDE 6.5 % EAR DROPS

Facility

$22.75

Service Code	NDC 78112073623
Hospital Charge Code	1359
Hospital Revenue Code	637
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$20.48
Rate for Payer: Aetna Commercial	$19.34
Rate for Payer: Aetna New Business (MI Preferred)	$14.79
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cofinity Commercial	$15.92
Rate for Payer: Cofinity Commercial	$19.56
Rate for Payer: Cofinity Medicare Advantage	$15.92
Rate for Payer: Encore Health Key Benefits Commercial	$18.20
Rate for Payer: Healthscope Commercial	$20.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.34
Rate for Payer: PHP Commercial	$19.34
Rate for Payer: Priority Health Cigna Priority Health	$14.79
Rate for Payer: Priority Health SBD	$14.33

CARBAMIDE PEROXIDE 6.5 % EAR DROPS

Facility

$26.13

Service Code	NDC 78112073621
Hospital Charge Code	1359
Hospital Revenue Code	637
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$23.52
Rate for Payer: Aetna Commercial	$22.21
Rate for Payer: Aetna Medicare	$13.06
Rate for Payer: Aetna New Business (MI Preferred)	$16.98
Rate for Payer: BCBS Complete	$10.45
Rate for Payer: Cash Price	$20.90
Rate for Payer: Cofinity Commercial	$18.29
Rate for Payer: Cofinity Commercial	$22.47
Rate for Payer: Cofinity Medicare Advantage	$18.29
Rate for Payer: Encore Health Key Benefits Commercial	$20.90
Rate for Payer: Healthscope Commercial	$23.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.21
Rate for Payer: PHP Commercial	$22.21
Rate for Payer: Priority Health Cigna Priority Health	$16.98
Rate for Payer: Priority Health SBD	$16.46

CARBAMIDE PEROXIDE 6.5 % EAR DROPS

Facility

$12.63

Service Code	NDC 70000049002
Hospital Charge Code	1359
Hospital Revenue Code	637
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$11.37
Rate for Payer: Aetna Commercial	$10.74
Rate for Payer: Aetna New Business (MI Preferred)	$8.21
Rate for Payer: Cash Price	$10.10
Rate for Payer: Cofinity Commercial	$10.86
Rate for Payer: Cofinity Commercial	$8.84
Rate for Payer: Cofinity Medicare Advantage	$8.84
Rate for Payer: Encore Health Key Benefits Commercial	$10.10
Rate for Payer: Healthscope Commercial	$11.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.74
Rate for Payer: PHP Commercial	$10.74
Rate for Payer: Priority Health Cigna Priority Health	$8.21
Rate for Payer: Priority Health SBD	$7.96

Know your out-of-pocket cost for care.

All Charges