Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3,350.87

Service Code	NDC 00310028260
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$2,111.05
Max. Negotiated Rate	$3,015.78
Rate for Payer: Aetna Commercial	$2,848.24
Rate for Payer: Aetna New Business (MI Preferred)	$2,178.07
Rate for Payer: Cash Price	$2,680.70
Rate for Payer: Cofinity Advantage	$2,345.61
Rate for Payer: Cofinity Commercial	$2,881.75
Rate for Payer: Encore Health Key Benefits Commercial	$2,680.70
Rate for Payer: Healthscope Commercial	$3,015.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,848.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,513.15
Rate for Payer: PHP Commercial	$2,848.24
Rate for Payer: Priority Health SBD	$2,111.05

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$247.38

Service Code	NDC 16729009512
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$155.85
Max. Negotiated Rate	$222.64
Rate for Payer: Aetna Commercial	$210.27
Rate for Payer: Aetna New Business (MI Preferred)	$160.80
Rate for Payer: Cash Price	$197.90
Rate for Payer: Cofinity Advantage	$173.17
Rate for Payer: Cofinity Commercial	$212.75
Rate for Payer: Encore Health Key Benefits Commercial	$197.90
Rate for Payer: Healthscope Commercial	$222.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$210.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.53
Rate for Payer: PHP Commercial	$210.27
Rate for Payer: Priority Health SBD	$155.85

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$180.69

Service Code	NDC 68180061407
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$113.83
Max. Negotiated Rate	$162.62
Rate for Payer: Aetna Commercial	$153.59
Rate for Payer: Aetna New Business (MI Preferred)	$117.45
Rate for Payer: Cash Price	$144.55
Rate for Payer: Cofinity Advantage	$126.48
Rate for Payer: Cofinity Commercial	$155.39
Rate for Payer: Encore Health Key Benefits Commercial	$144.55
Rate for Payer: Healthscope Commercial	$162.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.52
Rate for Payer: PHP Commercial	$153.59
Rate for Payer: Priority Health SBD	$113.83

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$247.38

Service Code	NDC 16729009512
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$97.22
Max. Negotiated Rate	$222.64
Rate for Payer: Aetna Commercial	$210.27
Rate for Payer: Aetna Medicare	$123.69
Rate for Payer: Aetna New Business (MI Preferred)	$160.80
Rate for Payer: BCBS Complete	$98.95
Rate for Payer: Cash Price	$197.90
Rate for Payer: Cofinity Advantage	$173.17
Rate for Payer: Cofinity Commercial	$212.75
Rate for Payer: Encore Health Key Benefits Commercial	$197.90
Rate for Payer: Healthscope Commercial	$222.64
Rate for Payer: MI Amish Medical Board Commercial	$197.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$210.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.53
Rate for Payer: PHP Commercial	$210.27
Rate for Payer: Priority Health SBD	$155.85
Rate for Payer: UHC All Payor (Choice/PPO)	$160.80
Rate for Payer: UHC Core	$128.88
Rate for Payer: UHC Exchange	$97.22

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$425.76

Service Code	NDC 00904680361
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$167.32
Max. Negotiated Rate	$383.18
Rate for Payer: Aetna Commercial	$361.90
Rate for Payer: Aetna Medicare	$212.88
Rate for Payer: Aetna New Business (MI Preferred)	$276.74
Rate for Payer: BCBS Complete	$170.30
Rate for Payer: Cash Price	$340.61
Rate for Payer: Cofinity Advantage	$298.03
Rate for Payer: Cofinity Commercial	$366.15
Rate for Payer: Encore Health Key Benefits Commercial	$340.61
Rate for Payer: Healthscope Commercial	$383.18
Rate for Payer: MI Amish Medical Board Commercial	$340.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$361.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$319.32
Rate for Payer: PHP Commercial	$361.90
Rate for Payer: Priority Health SBD	$268.23
Rate for Payer: UHC All Payor (Choice/PPO)	$276.74
Rate for Payer: UHC Core	$221.82
Rate for Payer: UHC Exchange	$167.32

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$180.69

Service Code	NDC 68180061407
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$71.01
Max. Negotiated Rate	$162.62
Rate for Payer: Aetna Commercial	$153.59
Rate for Payer: Aetna Medicare	$90.34
Rate for Payer: Aetna New Business (MI Preferred)	$117.45
Rate for Payer: BCBS Complete	$72.28
Rate for Payer: Cash Price	$144.55
Rate for Payer: Cofinity Advantage	$126.48
Rate for Payer: Cofinity Commercial	$155.39
Rate for Payer: Encore Health Key Benefits Commercial	$144.55
Rate for Payer: Healthscope Commercial	$162.62
Rate for Payer: MI Amish Medical Board Commercial	$144.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.52
Rate for Payer: PHP Commercial	$153.59
Rate for Payer: Priority Health SBD	$113.83
Rate for Payer: UHC All Payor (Choice/PPO)	$117.45
Rate for Payer: UHC Core	$94.14
Rate for Payer: UHC Exchange	$71.01

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3,350.87

Service Code	NDC 00310028260
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$1,316.89
Max. Negotiated Rate	$3,015.78
Rate for Payer: Aetna Commercial	$2,848.24
Rate for Payer: Aetna Medicare	$1,675.43
Rate for Payer: Aetna New Business (MI Preferred)	$2,178.07
Rate for Payer: BCBS Complete	$1,340.35
Rate for Payer: Cash Price	$2,680.70
Rate for Payer: Cofinity Advantage	$2,345.61
Rate for Payer: Cofinity Commercial	$2,881.75
Rate for Payer: Encore Health Key Benefits Commercial	$2,680.70
Rate for Payer: Healthscope Commercial	$3,015.78
Rate for Payer: MI Amish Medical Board Commercial	$2,680.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,848.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,513.15
Rate for Payer: PHP Commercial	$2,848.24
Rate for Payer: Priority Health SBD	$2,111.05
Rate for Payer: UHC All Payor (Choice/PPO)	$2,178.07
Rate for Payer: UHC Core	$1,745.80
Rate for Payer: UHC Exchange	$1,316.89

QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$467.52

Service Code	NDC 00904680461
Hospital Charge Code	82090
Hospital Revenue Code	637
Min. Negotiated Rate	$294.54
Max. Negotiated Rate	$420.77
Rate for Payer: Aetna Commercial	$397.39
Rate for Payer: Aetna New Business (MI Preferred)	$303.89
Rate for Payer: Cash Price	$374.02
Rate for Payer: Cofinity Advantage	$327.26
Rate for Payer: Cofinity Commercial	$402.07
Rate for Payer: Encore Health Key Benefits Commercial	$374.02
Rate for Payer: Healthscope Commercial	$420.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$350.64
Rate for Payer: PHP Commercial	$397.39
Rate for Payer: Priority Health SBD	$294.54

QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$467.52

Service Code	NDC 00904680461
Hospital Charge Code	82090
Hospital Revenue Code	637
Min. Negotiated Rate	$183.74
Max. Negotiated Rate	$420.77
Rate for Payer: Aetna Commercial	$397.39
Rate for Payer: Aetna Medicare	$233.76
Rate for Payer: Aetna New Business (MI Preferred)	$303.89
Rate for Payer: BCBS Complete	$187.01
Rate for Payer: Cash Price	$374.02
Rate for Payer: Cofinity Advantage	$327.26
Rate for Payer: Cofinity Commercial	$402.07
Rate for Payer: Encore Health Key Benefits Commercial	$374.02
Rate for Payer: Healthscope Commercial	$420.77
Rate for Payer: MI Amish Medical Board Commercial	$374.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$350.64
Rate for Payer: PHP Commercial	$397.39
Rate for Payer: Priority Health SBD	$294.54
Rate for Payer: UHC All Payor (Choice/PPO)	$303.89
Rate for Payer: UHC Core	$243.58
Rate for Payer: UHC Exchange	$183.74

QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$4,393.38

Service Code	NDC 00310028360
Hospital Charge Code	82090
Hospital Revenue Code	637
Min. Negotiated Rate	$1,726.60
Max. Negotiated Rate	$3,954.04
Rate for Payer: Aetna Commercial	$3,734.37
Rate for Payer: Aetna Medicare	$2,196.69
Rate for Payer: Aetna New Business (MI Preferred)	$2,855.70
Rate for Payer: BCBS Complete	$1,757.35
Rate for Payer: Cash Price	$3,514.70
Rate for Payer: Cofinity Advantage	$3,075.37
Rate for Payer: Cofinity Commercial	$3,778.31
Rate for Payer: Encore Health Key Benefits Commercial	$3,514.70
Rate for Payer: Healthscope Commercial	$3,954.04
Rate for Payer: MI Amish Medical Board Commercial	$3,514.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,734.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,295.03
Rate for Payer: PHP Commercial	$3,734.37
Rate for Payer: Priority Health SBD	$2,767.83
Rate for Payer: UHC All Payor (Choice/PPO)	$2,855.70
Rate for Payer: UHC Core	$2,288.95
Rate for Payer: UHC Exchange	$1,726.60

QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$4,393.38

Service Code	NDC 00310028360
Hospital Charge Code	82090
Hospital Revenue Code	637
Min. Negotiated Rate	$2,767.83
Max. Negotiated Rate	$3,954.04
Rate for Payer: Aetna Commercial	$3,734.37
Rate for Payer: Aetna New Business (MI Preferred)	$2,855.70
Rate for Payer: Cash Price	$3,514.70
Rate for Payer: Cofinity Advantage	$3,075.37
Rate for Payer: Cofinity Commercial	$3,778.31
Rate for Payer: Encore Health Key Benefits Commercial	$3,514.70
Rate for Payer: Healthscope Commercial	$3,954.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,734.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,295.03
Rate for Payer: PHP Commercial	$3,734.37
Rate for Payer: Priority Health SBD	$2,767.83

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,695.42

Service Code	NDC 00310028060
Hospital Charge Code	95676
Hospital Revenue Code	637
Min. Negotiated Rate	$1,068.11
Max. Negotiated Rate	$1,525.88
Rate for Payer: Aetna Commercial	$1,441.11
Rate for Payer: Aetna New Business (MI Preferred)	$1,102.02
Rate for Payer: Cash Price	$1,356.34
Rate for Payer: Cofinity Advantage	$1,186.79
Rate for Payer: Cofinity Commercial	$1,458.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,356.34
Rate for Payer: Healthscope Commercial	$1,525.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,441.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,271.57
Rate for Payer: PHP Commercial	$1,441.11
Rate for Payer: Priority Health SBD	$1,068.11

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$300.00

Service Code	NDC 00904680161
Hospital Charge Code	95676
Hospital Revenue Code	637
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna New Business (MI Preferred)	$195.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cofinity Advantage	$210.00
Rate for Payer: Cofinity Commercial	$258.00
Rate for Payer: Encore Health Key Benefits Commercial	$240.00
Rate for Payer: Healthscope Commercial	$270.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$255.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$225.00
Rate for Payer: PHP Commercial	$255.00
Rate for Payer: Priority Health SBD	$189.00

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$300.00

Service Code	NDC 00904680161
Hospital Charge Code	95676
Hospital Revenue Code	637
Min. Negotiated Rate	$117.90
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare	$150.00
Rate for Payer: Aetna New Business (MI Preferred)	$195.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cofinity Advantage	$210.00
Rate for Payer: Cofinity Commercial	$258.00
Rate for Payer: Encore Health Key Benefits Commercial	$240.00
Rate for Payer: Healthscope Commercial	$270.00
Rate for Payer: MI Amish Medical Board Commercial	$240.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$255.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$225.00
Rate for Payer: PHP Commercial	$255.00
Rate for Payer: Priority Health SBD	$189.00
Rate for Payer: UHC All Payor (Choice/PPO)	$195.00
Rate for Payer: UHC Core	$156.30
Rate for Payer: UHC Exchange	$117.90

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,695.42

Service Code	NDC 00310028060
Hospital Charge Code	95676
Hospital Revenue Code	637
Min. Negotiated Rate	$666.30
Max. Negotiated Rate	$1,525.88
Rate for Payer: Aetna Commercial	$1,441.11
Rate for Payer: Aetna Medicare	$847.71
Rate for Payer: Aetna New Business (MI Preferred)	$1,102.02
Rate for Payer: BCBS Complete	$678.17
Rate for Payer: Cash Price	$1,356.34
Rate for Payer: Cofinity Advantage	$1,186.79
Rate for Payer: Cofinity Commercial	$1,458.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,356.34
Rate for Payer: Healthscope Commercial	$1,525.88
Rate for Payer: MI Amish Medical Board Commercial	$1,356.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,441.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,271.57
Rate for Payer: PHP Commercial	$1,441.11
Rate for Payer: Priority Health SBD	$1,068.11
Rate for Payer: UHC All Payor (Choice/PPO)	$1,102.02
Rate for Payer: UHC Core	$883.31
Rate for Payer: UHC Exchange	$666.30

RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION

Facility

$2,850.96

Service Code	HCPCS 90375
Hospital Charge Code	186395
Hospital Revenue Code	636
Min. Negotiated Rate	$143.92
Max. Negotiated Rate	$2,565.86
Rate for Payer: Aetna Commercial	$2,423.32
Rate for Payer: Aetna Medicare	$286.19
Rate for Payer: Aetna New Business (MI Preferred)	$1,853.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$343.98
Rate for Payer: Amish Plain Church Group Commercial	$343.98
Rate for Payer: BCBS Complete	$151.13
Rate for Payer: BCBS MAPPO	$275.18
Rate for Payer: BCBS Trust/PPO	$854.60
Rate for Payer: BCN Commercial	$854.60
Rate for Payer: BCN Medicare Advantage	$275.18
Rate for Payer: Cash Price	$2,280.77
Rate for Payer: Cash Price	$2,280.77
Rate for Payer: Cofinity Advantage	$1,995.67
Rate for Payer: Cofinity Commercial	$2,451.83
Rate for Payer: Encore Health Key Benefits Commercial	$2,280.77
Rate for Payer: Health Alliance Plan Medicare Advantage	$275.18
Rate for Payer: Healthscope Commercial	$2,565.86
Rate for Payer: Mclaren Medicaid	$143.92
Rate for Payer: Mclaren Medicare	$275.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$288.94
Rate for Payer: Meridian Medicaid	$288.94
Rate for Payer: MI Amish Medical Board Commercial	$316.46
Rate for Payer: Molina Medicare/Medicaid	$302.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,423.32
Rate for Payer: Nomi Health Commercial	$825.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,138.22
Rate for Payer: PACE Medicare	$261.42
Rate for Payer: PACE SWMI	$275.18
Rate for Payer: PHP Commercial	$2,423.32
Rate for Payer: PHP Medicare Advantage	$275.18
Rate for Payer: Priority Health Choice Medicaid	$143.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$882.66
Rate for Payer: Priority Health Medicare	$275.18
Rate for Payer: Priority Health SBD	$1,796.10
Rate for Payer: Priority Health Tiered Network	$706.13
Rate for Payer: Railroad Medicare Medicare	$275.18
Rate for Payer: UHC All Payor (Choice/PPO)	$461.92
Rate for Payer: UHC Core	$461.92
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$275.18
Rate for Payer: UHC Exchange	$461.92
Rate for Payer: UHC Medicaid	$143.92
Rate for Payer: UHCCP Medicaid	$143.92
Rate for Payer: VA VA	$275.18

RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION

Facility

$2,850.96

Service Code	HCPCS 90375
Hospital Charge Code	186395
Hospital Revenue Code	636
Min. Negotiated Rate	$1,796.10
Max. Negotiated Rate	$2,565.86
Rate for Payer: Aetna Commercial	$2,423.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,853.12
Rate for Payer: Cash Price	$2,280.77
Rate for Payer: Cofinity Advantage	$1,995.67
Rate for Payer: Cofinity Commercial	$2,451.83
Rate for Payer: Encore Health Key Benefits Commercial	$2,280.77
Rate for Payer: Healthscope Commercial	$2,565.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,423.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,138.22
Rate for Payer: PHP Commercial	$2,423.32
Rate for Payer: Priority Health SBD	$1,796.10

RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION

Facility

$1,890.12

Service Code	HCPCS 90675
Hospital Charge Code	11257
Hospital Revenue Code	636
Min. Negotiated Rate	$1,190.78
Max. Negotiated Rate	$1,701.11
Rate for Payer: Aetna Commercial	$1,606.60
Rate for Payer: Aetna New Business (MI Preferred)	$1,228.58
Rate for Payer: Cash Price	$1,512.10
Rate for Payer: Cofinity Advantage	$1,323.08
Rate for Payer: Cofinity Commercial	$1,625.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,512.10
Rate for Payer: Healthscope Commercial	$1,701.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,606.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,417.59
Rate for Payer: PHP Commercial	$1,606.60
Rate for Payer: Priority Health SBD	$1,190.78

RABIES VACCINE,HUMAN DIPLOID (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION

Facility

$1,890.12

Service Code	HCPCS 90675
Hospital Charge Code	11257
Hospital Revenue Code	636
Min. Negotiated Rate	$164.86
Max. Negotiated Rate	$1,701.11
Rate for Payer: Aetna Commercial	$1,606.60
Rate for Payer: Aetna Medicare	$327.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,228.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$394.02
Rate for Payer: Amish Plain Church Group Commercial	$394.02
Rate for Payer: BCBS Complete	$173.12
Rate for Payer: BCBS MAPPO	$315.22
Rate for Payer: BCBS Trust/PPO	$1,070.18
Rate for Payer: BCN Commercial	$1,070.18
Rate for Payer: BCN Medicare Advantage	$315.22
Rate for Payer: Cash Price	$1,512.10
Rate for Payer: Cash Price	$1,512.10
Rate for Payer: Cofinity Advantage	$1,323.08
Rate for Payer: Cofinity Commercial	$1,625.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,512.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$315.22
Rate for Payer: Healthscope Commercial	$1,701.11
Rate for Payer: Mclaren Medicaid	$164.86
Rate for Payer: Mclaren Medicare	$315.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$330.98
Rate for Payer: Meridian Medicaid	$330.98
Rate for Payer: MI Amish Medical Board Commercial	$362.50
Rate for Payer: Molina Medicare/Medicaid	$346.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,606.60
Rate for Payer: Nomi Health Commercial	$945.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,417.59
Rate for Payer: PACE Medicare	$299.46
Rate for Payer: PACE SWMI	$315.22
Rate for Payer: PHP Commercial	$1,606.60
Rate for Payer: PHP Medicare Advantage	$315.22
Rate for Payer: Priority Health Choice Medicaid	$164.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$989.34
Rate for Payer: Priority Health Medicare	$315.22
Rate for Payer: Priority Health SBD	$1,190.78
Rate for Payer: Priority Health Tiered Network	$791.47
Rate for Payer: Railroad Medicare Medicare	$315.22
Rate for Payer: UHC All Payor (Choice/PPO)	$527.59
Rate for Payer: UHC Core	$527.59
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$315.22
Rate for Payer: UHC Exchange	$527.59
Rate for Payer: UHC Medicaid	$164.86
Rate for Payer: UHCCP Medicaid	$164.86
Rate for Payer: VA VA	$315.22

RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP

Facility

$1,890.12

Service Code	HCPCS 90675
Hospital Charge Code	22120
Hospital Revenue Code	636
Min. Negotiated Rate	$1,190.78
Max. Negotiated Rate	$1,701.11
Rate for Payer: Aetna Commercial	$1,606.60
Rate for Payer: Aetna New Business (MI Preferred)	$1,228.58
Rate for Payer: Cash Price	$1,512.10
Rate for Payer: Cofinity Advantage	$1,323.08
Rate for Payer: Cofinity Commercial	$1,625.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,512.10
Rate for Payer: Healthscope Commercial	$1,701.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,606.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,417.59
Rate for Payer: PHP Commercial	$1,606.60
Rate for Payer: Priority Health SBD	$1,190.78

RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP

Facility

$1,890.12

Service Code	HCPCS 90675
Hospital Charge Code	22120
Hospital Revenue Code	636
Min. Negotiated Rate	$164.86
Max. Negotiated Rate	$1,701.11
Rate for Payer: Aetna Commercial	$1,606.60
Rate for Payer: Aetna Medicare	$327.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,228.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$394.02
Rate for Payer: Amish Plain Church Group Commercial	$394.02
Rate for Payer: BCBS Complete	$173.12
Rate for Payer: BCBS MAPPO	$315.22
Rate for Payer: BCBS Trust/PPO	$1,070.18
Rate for Payer: BCN Commercial	$1,070.18
Rate for Payer: BCN Medicare Advantage	$315.22
Rate for Payer: Cash Price	$1,512.10
Rate for Payer: Cash Price	$1,512.10
Rate for Payer: Cofinity Advantage	$1,323.08
Rate for Payer: Cofinity Commercial	$1,625.50
Rate for Payer: Encore Health Key Benefits Commercial	$1,512.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$315.22
Rate for Payer: Healthscope Commercial	$1,701.11
Rate for Payer: Mclaren Medicaid	$164.86
Rate for Payer: Mclaren Medicare	$315.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$330.98
Rate for Payer: Meridian Medicaid	$330.98
Rate for Payer: MI Amish Medical Board Commercial	$362.50
Rate for Payer: Molina Medicare/Medicaid	$346.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,606.60
Rate for Payer: Nomi Health Commercial	$945.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,417.59
Rate for Payer: PACE Medicare	$299.46
Rate for Payer: PACE SWMI	$315.22
Rate for Payer: PHP Commercial	$1,606.60
Rate for Payer: PHP Medicare Advantage	$315.22
Rate for Payer: Priority Health Choice Medicaid	$164.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$989.34
Rate for Payer: Priority Health Medicare	$315.22
Rate for Payer: Priority Health SBD	$1,190.78
Rate for Payer: Priority Health Tiered Network	$791.47
Rate for Payer: Railroad Medicare Medicare	$315.22
Rate for Payer: UHC All Payor (Choice/PPO)	$527.59
Rate for Payer: UHC Core	$527.59
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$315.22
Rate for Payer: UHC Exchange	$527.59
Rate for Payer: UHC Medicaid	$164.86
Rate for Payer: UHCCP Medicaid	$164.86
Rate for Payer: VA VA	$315.22

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION

Facility

$3.72

Service Code	NDC 00487278401
Hospital Charge Code	2851
Hospital Revenue Code	637
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Advantage	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.79
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health SBD	$2.34

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION

Facility

$6.69

Service Code	NDC 00487590199
Hospital Charge Code	2851
Hospital Revenue Code	637
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$6.02
Rate for Payer: Aetna Commercial	$5.69
Rate for Payer: Aetna Medicare	$3.35
Rate for Payer: Aetna New Business (MI Preferred)	$4.35
Rate for Payer: BCBS Complete	$2.68
Rate for Payer: Cash Price	$5.35
Rate for Payer: Cofinity Advantage	$4.68
Rate for Payer: Cofinity Commercial	$5.75
Rate for Payer: Encore Health Key Benefits Commercial	$5.35
Rate for Payer: Healthscope Commercial	$6.02
Rate for Payer: MI Amish Medical Board Commercial	$5.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.02
Rate for Payer: PHP Commercial	$5.69
Rate for Payer: Priority Health SBD	$4.21
Rate for Payer: UHC All Payor (Choice/PPO)	$4.35
Rate for Payer: UHC Core	$3.49
Rate for Payer: UHC Exchange	$2.63

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION

Facility

$3.72

Service Code	NDC 00487278401
Hospital Charge Code	2851
Hospital Revenue Code	637
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna Medicare	$1.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: BCBS Complete	$1.49
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Advantage	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: MI Amish Medical Board Commercial	$2.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.79
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health SBD	$2.34
Rate for Payer: UHC All Payor (Choice/PPO)	$2.42
Rate for Payer: UHC Core	$1.94
Rate for Payer: UHC Exchange	$1.46

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION

Facility

$6.69

Service Code	NDC 00487590199
Hospital Charge Code	2851
Hospital Revenue Code	637
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$6.02
Rate for Payer: Aetna Commercial	$5.69
Rate for Payer: Aetna New Business (MI Preferred)	$4.35
Rate for Payer: Cash Price	$5.35
Rate for Payer: Cofinity Advantage	$4.68
Rate for Payer: Cofinity Commercial	$5.75
Rate for Payer: Encore Health Key Benefits Commercial	$5.35
Rate for Payer: Healthscope Commercial	$6.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.02
Rate for Payer: PHP Commercial	$5.69
Rate for Payer: Priority Health SBD	$4.21

Know your out-of-pocket cost for care.

All Charges