Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GASTROINTESTINAL OBSTRUCTION WITH CC

Facility

$12,148.29

Service Code	MS-DRG 389
Min. Negotiated Rate	$5,916.81
Max. Negotiated Rate	$12,148.29
Rate for Payer: Aetna Medicare	$6,477.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,785.28
Rate for Payer: Amish Plain Church Group Commercial	$7,785.28
Rate for Payer: BCBS MAPPO	$6,228.22
Rate for Payer: BCBS Trust/PPO	$11,502.12
Rate for Payer: BCN Medicare Advantage	$6,228.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,228.22
Rate for Payer: Mclaren Medicare	$6,228.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,539.63
Rate for Payer: MI Amish Medical Board Commercial	$7,162.45
Rate for Payer: PACE Medicare	$5,916.81
Rate for Payer: PACE SWMI	$6,228.22
Rate for Payer: PHP Medicare Advantage	$6,228.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,428.28
Rate for Payer: Priority Health Medicare	$6,228.22
Rate for Payer: Priority Health Narrow Network	$9,142.62
Rate for Payer: Railroad Medicare Medicare	$6,228.22
Rate for Payer: UHC All Payor (Choice/PPO)	$12,148.29
Rate for Payer: UHC Core	$7,454.30
Rate for Payer: UHC Dual Complete DSNP	$6,228.22
Rate for Payer: UHC Exchange	$7,983.91
Rate for Payer: UHC Medicare Advantage	$6,415.07
Rate for Payer: VA VA	$6,228.22

GASTROINTESTINAL OBSTRUCTION WITH MCC

Facility

$22,171.69

Service Code	MS-DRG 388
Min. Negotiated Rate	$10,412.52
Max. Negotiated Rate	$22,171.69
Rate for Payer: Aetna Medicare	$11,398.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,700.69
Rate for Payer: Amish Plain Church Group Commercial	$13,700.69
Rate for Payer: BCBS MAPPO	$10,960.55
Rate for Payer: BCBS Trust/PPO	$20,731.49
Rate for Payer: BCN Medicare Advantage	$10,960.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,960.55
Rate for Payer: Mclaren Medicare	$10,960.55
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,508.58
Rate for Payer: MI Amish Medical Board Commercial	$12,604.63
Rate for Payer: PACE Medicare	$10,412.52
Rate for Payer: PACE SWMI	$10,960.55
Rate for Payer: PHP Medicare Advantage	$10,960.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,857.61
Rate for Payer: Priority Health Medicare	$10,960.55
Rate for Payer: Priority Health Narrow Network	$16,686.09
Rate for Payer: Railroad Medicare Medicare	$10,960.55
Rate for Payer: UHC All Payor (Choice/PPO)	$22,171.69
Rate for Payer: UHC Core	$13,604.76
Rate for Payer: UHC Dual Complete DSNP	$10,960.55
Rate for Payer: UHC Exchange	$14,571.34
Rate for Payer: UHC Medicare Advantage	$11,289.37
Rate for Payer: VA VA	$10,960.55

GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC

Facility

$8,972.45

Service Code	MS-DRG 390
Min. Negotiated Rate	$4,292.60
Max. Negotiated Rate	$8,972.45
Rate for Payer: Aetna Medicare	$4,699.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,648.16
Rate for Payer: Amish Plain Church Group Commercial	$5,648.16
Rate for Payer: BCBS MAPPO	$4,518.53
Rate for Payer: BCBS Trust/PPO	$8,972.45
Rate for Payer: BCN Medicare Advantage	$4,518.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,518.53
Rate for Payer: Mclaren Medicare	$4,518.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,744.46
Rate for Payer: MI Amish Medical Board Commercial	$5,196.31
Rate for Payer: PACE Medicare	$4,292.60
Rate for Payer: PACE SWMI	$4,518.53
Rate for Payer: PHP Medicare Advantage	$4,518.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,021.61
Rate for Payer: Priority Health Medicare	$4,518.53
Rate for Payer: Priority Health Narrow Network	$6,417.29
Rate for Payer: Railroad Medicare Medicare	$4,518.53
Rate for Payer: UHC All Payor (Choice/PPO)	$8,526.99
Rate for Payer: UHC Core	$5,232.24
Rate for Payer: UHC Dual Complete DSNP	$4,518.53
Rate for Payer: UHC Exchange	$5,603.98
Rate for Payer: UHC Medicare Advantage	$4,654.09
Rate for Payer: VA VA	$4,518.53

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE

Facility

$422.18

Service Code	NDC 0009-0342-01
Hospital Charge Code	28025
Hospital Revenue Code	250
Min. Negotiated Rate	$265.97
Max. Negotiated Rate	$379.96
Rate for Payer: Aetna Commercial	$358.85
Rate for Payer: Aetna New Business (MI Preferred)	$274.42
Rate for Payer: Cash Price	$337.74
Rate for Payer: Cofinity Commercial	$295.53
Rate for Payer: Cofinity Commercial	$363.07
Rate for Payer: Healthscope Commercial	$379.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$358.85
Rate for Payer: PHP Commercial	$358.85
Rate for Payer: Priority Health Cigna Priority Health	$295.53
Rate for Payer: Priority Health SBD	$265.97

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE

Facility

$659.90

Service Code	NDC 6371301974
Hospital Charge Code	28025
Hospital Revenue Code	250
Min. Negotiated Rate	$415.74
Max. Negotiated Rate	$593.91
Rate for Payer: Aetna Commercial	$560.92
Rate for Payer: Aetna New Business (MI Preferred)	$428.94
Rate for Payer: Cash Price	$527.92
Rate for Payer: Cofinity Commercial	$461.93
Rate for Payer: Cofinity Commercial	$567.51
Rate for Payer: Healthscope Commercial	$593.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$560.92
Rate for Payer: PHP Commercial	$560.92
Rate for Payer: Priority Health Cigna Priority Health	$461.93
Rate for Payer: Priority Health SBD	$415.74

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE

Facility

$270.31

Service Code	NDC 6371301972
Hospital Charge Code	28018
Hospital Revenue Code	250
Min. Negotiated Rate	$170.30
Max. Negotiated Rate	$243.28
Rate for Payer: Aetna Commercial	$229.76
Rate for Payer: Aetna New Business (MI Preferred)	$175.70
Rate for Payer: Cash Price	$216.25
Rate for Payer: Cofinity Commercial	$189.22
Rate for Payer: Cofinity Commercial	$232.47
Rate for Payer: Healthscope Commercial	$243.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.76
Rate for Payer: PHP Commercial	$229.76
Rate for Payer: Priority Health Cigna Priority Health	$189.22
Rate for Payer: Priority Health SBD	$170.30

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE

Facility

$184.84

Service Code	NDC 0009-0315-08
Hospital Charge Code	28018
Hospital Revenue Code	250
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$166.36
Rate for Payer: Aetna Commercial	$157.11
Rate for Payer: Aetna New Business (MI Preferred)	$120.15
Rate for Payer: Cash Price	$147.87
Rate for Payer: Cofinity Commercial	$129.39
Rate for Payer: Cofinity Commercial	$158.96
Rate for Payer: Healthscope Commercial	$166.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$157.11
Rate for Payer: PHP Commercial	$157.11
Rate for Payer: Priority Health Cigna Priority Health	$129.39
Rate for Payer: Priority Health SBD	$116.45

GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION

Facility

$236.15

Service Code	HCPCS J9201
Hospital Charge Code	155791
Hospital Revenue Code	636
Min. Negotiated Rate	$148.77
Max. Negotiated Rate	$212.54
Rate for Payer: Aetna Commercial	$200.73
Rate for Payer: Aetna New Business (MI Preferred)	$153.50
Rate for Payer: Cash Price	$188.92
Rate for Payer: Cofinity Commercial	$165.30
Rate for Payer: Cofinity Commercial	$203.09
Rate for Payer: Healthscope Commercial	$212.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.73
Rate for Payer: PHP Commercial	$200.73
Rate for Payer: Priority Health Cigna Priority Health	$165.30
Rate for Payer: Priority Health SBD	$148.77

GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION

Facility

$236.15

Service Code	HCPCS J9201
Hospital Charge Code	155791
Hospital Revenue Code	636
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$212.54
Rate for Payer: Aetna Commercial	$200.73
Rate for Payer: Aetna New Business (MI Preferred)	$153.50
Rate for Payer: BCBS Complete	$94.46
Rate for Payer: BCBS Trust/PPO	$10.78
Rate for Payer: Cash Price	$188.92
Rate for Payer: Cash Price	$188.92
Rate for Payer: Cofinity Commercial	$203.09
Rate for Payer: Cofinity Commercial	$165.30
Rate for Payer: Healthscope Commercial	$212.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.73
Rate for Payer: PHP Commercial	$200.73
Rate for Payer: Priority Health Cigna Priority Health	$165.30
Rate for Payer: Priority Health SBD	$148.77

GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION

Facility

$467.20

Service Code	HCPCS J9201
Hospital Charge Code	17122
Hospital Revenue Code	636
Min. Negotiated Rate	$294.34
Max. Negotiated Rate	$420.48
Rate for Payer: Aetna Commercial	$397.12
Rate for Payer: Aetna New Business (MI Preferred)	$303.68
Rate for Payer: Cash Price	$373.76
Rate for Payer: Cofinity Commercial	$327.04
Rate for Payer: Cofinity Commercial	$401.79
Rate for Payer: Healthscope Commercial	$420.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$397.12
Rate for Payer: PHP Commercial	$397.12
Rate for Payer: Priority Health Cigna Priority Health	$327.04
Rate for Payer: Priority Health SBD	$294.34

GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION

Facility

$270.12

Service Code	HCPCS J9201
Hospital Charge Code	155792
Hospital Revenue Code	636
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$243.11
Rate for Payer: Aetna Commercial	$229.60
Rate for Payer: Aetna New Business (MI Preferred)	$175.58
Rate for Payer: BCBS Complete	$108.05
Rate for Payer: BCBS Trust/PPO	$10.78
Rate for Payer: Cash Price	$216.10
Rate for Payer: Cash Price	$216.10
Rate for Payer: Cofinity Commercial	$189.08
Rate for Payer: Cofinity Commercial	$232.30
Rate for Payer: Healthscope Commercial	$243.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.60
Rate for Payer: PHP Commercial	$229.60
Rate for Payer: Priority Health Cigna Priority Health	$189.08
Rate for Payer: Priority Health SBD	$170.18

GEMFIBROZIL 600 MG TABLET

Facility

$202.35

Service Code	NDC 60687-224-01
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$127.48
Max. Negotiated Rate	$182.12
Rate for Payer: Aetna Commercial	$172.00
Rate for Payer: Aetna New Business (MI Preferred)	$131.53
Rate for Payer: Cash Price	$161.88
Rate for Payer: Cofinity Commercial	$141.64
Rate for Payer: Cofinity Commercial	$174.02
Rate for Payer: Healthscope Commercial	$182.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$172.00
Rate for Payer: PHP Commercial	$172.00
Rate for Payer: Priority Health Cigna Priority Health	$141.64
Rate for Payer: Priority Health SBD	$127.48

GEMFIBROZIL 600 MG TABLET

Facility

$146.64

Service Code	NDC 69097-821-03
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$92.38
Max. Negotiated Rate	$131.98
Rate for Payer: Aetna Commercial	$124.64
Rate for Payer: Aetna New Business (MI Preferred)	$95.32
Rate for Payer: Cash Price	$117.31
Rate for Payer: Cofinity Commercial	$102.65
Rate for Payer: Cofinity Commercial	$126.11
Rate for Payer: Healthscope Commercial	$131.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$124.64
Rate for Payer: PHP Commercial	$124.64
Rate for Payer: Priority Health Cigna Priority Health	$102.65
Rate for Payer: Priority Health SBD	$92.38

GEMFIBROZIL 600 MG TABLET

Facility

$2.03

Service Code	NDC 60687-224-11
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.83
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna New Business (MI Preferred)	$1.32
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cofinity Commercial	$1.75
Rate for Payer: Cofinity Commercial	$1.42
Rate for Payer: Healthscope Commercial	$1.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.73
Rate for Payer: PHP Commercial	$1.73
Rate for Payer: Priority Health Cigna Priority Health	$1.42
Rate for Payer: Priority Health SBD	$1.28

GENTAMICIN 0.1 % TOPICAL CREAM

Facility

$131.36

Service Code	NDC 45802-056-35
Hospital Charge Code	3423
Hospital Revenue Code	637
Min. Negotiated Rate	$82.76
Max. Negotiated Rate	$118.22
Rate for Payer: Aetna Commercial	$111.66
Rate for Payer: Aetna New Business (MI Preferred)	$85.38
Rate for Payer: Cash Price	$105.09
Rate for Payer: Cofinity Commercial	$112.97
Rate for Payer: Cofinity Commercial	$91.95
Rate for Payer: Healthscope Commercial	$118.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.66
Rate for Payer: PHP Commercial	$111.66
Rate for Payer: Priority Health Cigna Priority Health	$91.95
Rate for Payer: Priority Health SBD	$82.76

GENTAMICIN 0.3 % EYE DROPS

Facility

$18.77

Service Code	NDC 61314-633-05
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$16.89
Rate for Payer: Aetna Commercial	$15.95
Rate for Payer: Aetna New Business (MI Preferred)	$12.20
Rate for Payer: Cash Price	$15.02
Rate for Payer: Cofinity Commercial	$13.14
Rate for Payer: Cofinity Commercial	$16.14
Rate for Payer: Healthscope Commercial	$16.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.95
Rate for Payer: PHP Commercial	$15.95
Rate for Payer: Priority Health Cigna Priority Health	$13.14
Rate for Payer: Priority Health SBD	$11.83

GENTAMICIN 0.3 % EYE DROPS

Facility

$116.24

Service Code	NDC 24208-580-60
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$73.23
Max. Negotiated Rate	$104.62
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna New Business (MI Preferred)	$75.56
Rate for Payer: Cash Price	$92.99
Rate for Payer: Cofinity Commercial	$81.37
Rate for Payer: Cofinity Commercial	$99.97
Rate for Payer: Healthscope Commercial	$104.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.80
Rate for Payer: PHP Commercial	$98.80
Rate for Payer: Priority Health Cigna Priority Health	$81.37
Rate for Payer: Priority Health SBD	$73.23

GENTAMICIN 120 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK

Facility

$80.41

Service Code	HCPCS J1580
Hospital Charge Code	114156
Hospital Revenue Code	636
Min. Negotiated Rate	$50.66
Max. Negotiated Rate	$72.37
Rate for Payer: Aetna Commercial	$68.35
Rate for Payer: Aetna New Business (MI Preferred)	$52.27
Rate for Payer: Cash Price	$64.33
Rate for Payer: Cofinity Commercial	$56.29
Rate for Payer: Cofinity Commercial	$69.15
Rate for Payer: Healthscope Commercial	$72.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.35
Rate for Payer: PHP Commercial	$68.35
Rate for Payer: Priority Health Cigna Priority Health	$56.29
Rate for Payer: Priority Health SBD	$50.66

GENTAMICIN 40 MG/ML FOR INHALATION

Facility

$19.55

Service Code	HCPCS J1580
Hospital Charge Code	180596
Hospital Revenue Code	636
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$17.60
Rate for Payer: Aetna Commercial	$16.62
Rate for Payer: Aetna Commercial	$46.55
Rate for Payer: Aetna New Business (MI Preferred)	$35.59
Rate for Payer: Aetna New Business (MI Preferred)	$12.71
Rate for Payer: Cash Price	$15.64
Rate for Payer: Cash Price	$43.81
Rate for Payer: Cofinity Commercial	$16.81
Rate for Payer: Cofinity Commercial	$13.68
Rate for Payer: Cofinity Commercial	$38.33
Rate for Payer: Cofinity Commercial	$47.09
Rate for Payer: Healthscope Commercial	$17.60
Rate for Payer: Healthscope Commercial	$49.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$46.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.62
Rate for Payer: PHP Commercial	$46.55
Rate for Payer: PHP Commercial	$16.62
Rate for Payer: Priority Health Cigna Priority Health	$13.68
Rate for Payer: Priority Health Cigna Priority Health	$38.33
Rate for Payer: Priority Health SBD	$12.32
Rate for Payer: Priority Health SBD	$34.50

GENTAMICIN 40 MG/ML INJECTION SOLUTION

Facility

$19.55

Service Code	HCPCS J1580
Hospital Charge Code	3426
Hospital Revenue Code	636
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$17.60
Rate for Payer: Aetna Commercial	$16.62
Rate for Payer: Aetna Commercial	$285.94
Rate for Payer: Aetna New Business (MI Preferred)	$218.66
Rate for Payer: Aetna New Business (MI Preferred)	$12.71
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cash Price	$15.64
Rate for Payer: Cofinity Commercial	$235.48
Rate for Payer: Cofinity Commercial	$13.68
Rate for Payer: Cofinity Commercial	$16.81
Rate for Payer: Cofinity Commercial	$289.30
Rate for Payer: Healthscope Commercial	$17.60
Rate for Payer: Healthscope Commercial	$302.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$285.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.62
Rate for Payer: PHP Commercial	$16.62
Rate for Payer: PHP Commercial	$285.94
Rate for Payer: Priority Health Cigna Priority Health	$13.68
Rate for Payer: Priority Health Cigna Priority Health	$235.48
Rate for Payer: Priority Health SBD	$12.32
Rate for Payer: Priority Health SBD	$211.93

GENTAMICIN 80 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK

Facility

$64.68

Service Code	NDC 0338-0509-41
Hospital Charge Code	15911
Hospital Revenue Code	250
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$58.21
Rate for Payer: Aetna Commercial	$54.98
Rate for Payer: Aetna New Business (MI Preferred)	$42.04
Rate for Payer: Cash Price	$51.74
Rate for Payer: Cofinity Commercial	$45.28
Rate for Payer: Cofinity Commercial	$55.62
Rate for Payer: Healthscope Commercial	$58.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.98
Rate for Payer: PHP Commercial	$54.98
Rate for Payer: Priority Health Cigna Priority Health	$45.28
Rate for Payer: Priority Health SBD	$40.75

GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION

Facility

$27.93

Service Code	HCPCS J1580
Hospital Charge Code	117665
Hospital Revenue Code	636
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.14
Rate for Payer: Aetna Commercial	$23.74
Rate for Payer: Aetna New Business (MI Preferred)	$18.15
Rate for Payer: Cash Price	$22.34
Rate for Payer: Cofinity Commercial	$24.02
Rate for Payer: Cofinity Commercial	$19.55
Rate for Payer: Healthscope Commercial	$25.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.74
Rate for Payer: PHP Commercial	$23.74
Rate for Payer: Priority Health Cigna Priority Health	$19.55
Rate for Payer: Priority Health SBD	$17.60

GLASSIA (ALPHA-1-PROTEINASE INHIBITOR) 1 GRAM/50 ML(2 %) IV SOLN

Facility

$1.57

Service Code	HCPCS J0257
Hospital Charge Code	106274
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna Commercial	$1.33
Rate for Payer: Aetna New Business (MI Preferred)	$1.02
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cofinity Commercial	$1.10
Rate for Payer: Cofinity Commercial	$1.35
Rate for Payer: Healthscope Commercial	$1.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.33
Rate for Payer: PHP Commercial	$1.33
Rate for Payer: Priority Health Cigna Priority Health	$1.10
Rate for Payer: Priority Health SBD	$0.99

GLIMEPIRIDE 1 MG TABLET

Facility

$175.28

Service Code	NDC 50268-358-15
Hospital Charge Code	16355
Hospital Revenue Code	637
Min. Negotiated Rate	$110.43
Max. Negotiated Rate	$157.75
Rate for Payer: Aetna Commercial	$148.99
Rate for Payer: Aetna New Business (MI Preferred)	$113.93
Rate for Payer: Cash Price	$140.22
Rate for Payer: Cofinity Commercial	$122.70
Rate for Payer: Cofinity Commercial	$150.74
Rate for Payer: Healthscope Commercial	$157.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$148.99
Rate for Payer: PHP Commercial	$148.99
Rate for Payer: Priority Health Cigna Priority Health	$122.70
Rate for Payer: Priority Health SBD	$110.43

GLIMEPIRIDE 1 MG TABLET

Facility

$3.51

Service Code	NDC 50268-358-11
Hospital Charge Code	16355
Hospital Revenue Code	637
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$3.16
Rate for Payer: Aetna Commercial	$2.98
Rate for Payer: Aetna New Business (MI Preferred)	$2.28
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cofinity Commercial	$2.46
Rate for Payer: Cofinity Commercial	$3.02
Rate for Payer: Healthscope Commercial	$3.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.98
Rate for Payer: PHP Commercial	$2.98
Rate for Payer: Priority Health Cigna Priority Health	$2.46
Rate for Payer: Priority Health SBD	$2.21

Know your out-of-pocket cost for care.

All Charges