Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$63.25

Service Code	NDC 00378647016
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$24.86
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.76
Rate for Payer: Aetna Medicare	$31.62
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: BCBS Complete	$25.30
Rate for Payer: Cash Price	$50.60
Rate for Payer: Cofinity Advantage	$44.27
Rate for Payer: Cofinity Commercial	$54.40
Rate for Payer: Encore Health Key Benefits Commercial	$50.60
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: MI Amish Medical Board Commercial	$50.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.44
Rate for Payer: PHP Commercial	$53.76
Rate for Payer: Priority Health SBD	$39.85
Rate for Payer: UHC All Payor (Choice/PPO)	$41.11
Rate for Payer: UHC Core	$32.95
Rate for Payer: UHC Exchange	$24.86

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$1,051.31

Service Code	NDC 10019055304
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$662.33
Max. Negotiated Rate	$946.18
Rate for Payer: Aetna Commercial	$893.61
Rate for Payer: Aetna New Business (MI Preferred)	$683.35
Rate for Payer: Cash Price	$841.05
Rate for Payer: Cofinity Advantage	$735.92
Rate for Payer: Cofinity Commercial	$904.13
Rate for Payer: Encore Health Key Benefits Commercial	$841.05
Rate for Payer: Healthscope Commercial	$946.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$893.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$788.48
Rate for Payer: PHP Commercial	$893.61
Rate for Payer: Priority Health SBD	$662.33

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$438.05

Service Code	NDC 10019055303
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$172.15
Max. Negotiated Rate	$394.25
Rate for Payer: Aetna Commercial	$372.34
Rate for Payer: Aetna Medicare	$219.03
Rate for Payer: Aetna New Business (MI Preferred)	$284.73
Rate for Payer: BCBS Complete	$175.22
Rate for Payer: Cash Price	$350.44
Rate for Payer: Cofinity Advantage	$306.63
Rate for Payer: Cofinity Commercial	$376.72
Rate for Payer: Encore Health Key Benefits Commercial	$350.44
Rate for Payer: Healthscope Commercial	$394.25
Rate for Payer: MI Amish Medical Board Commercial	$350.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$372.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$328.54
Rate for Payer: PHP Commercial	$372.34
Rate for Payer: Priority Health SBD	$275.97
Rate for Payer: UHC All Payor (Choice/PPO)	$284.73
Rate for Payer: UHC Core	$228.22
Rate for Payer: UHC Exchange	$172.15

SCREENING OF A PATIENT

Professional

Both

$15.00

Service Code	HCPCS D0190
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$25.19
Rate for Payer: Aetna Commercial	$13.35
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: Aetna New Business (MI Preferred)	$13.35
Rate for Payer: BCBS Complete	$20.16
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Mclaren Medicaid	$19.20
Rate for Payer: Meridian Medicaid	$20.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25
Rate for Payer: Priority Health Choice Medicaid	$19.20
Rate for Payer: UHC All Payor (Choice/PPO)	$22.02
Rate for Payer: UHC Core	$22.02
Rate for Payer: UHC Exchange	$22.02
Rate for Payer: UHC Medicaid	$19.20
Rate for Payer: UHCCP Medicaid	$19.20

SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION

Facility

$5,734.02

Service Code	HCPCS J3247
Hospital Charge Code	205647
Hospital Revenue Code	636
Min. Negotiated Rate	$9.43
Max. Negotiated Rate	$5,160.62
Rate for Payer: Aetna Commercial	$4,873.92
Rate for Payer: Aetna Medicare	$18.76
Rate for Payer: Aetna New Business (MI Preferred)	$3,727.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$22.55
Rate for Payer: Amish Plain Church Group Commercial	$22.55
Rate for Payer: BCBS Complete	$9.91
Rate for Payer: BCBS MAPPO	$18.04
Rate for Payer: BCBS Trust/PPO	$45.33
Rate for Payer: BCN Commercial	$45.33
Rate for Payer: BCN Medicare Advantage	$18.04
Rate for Payer: Cash Price	$4,587.22
Rate for Payer: Cash Price	$4,587.22
Rate for Payer: Cofinity Advantage	$4,013.81
Rate for Payer: Cofinity Commercial	$4,931.26
Rate for Payer: Encore Health Key Benefits Commercial	$4,587.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.04
Rate for Payer: Healthscope Commercial	$5,160.62
Rate for Payer: Mclaren Medicaid	$9.43
Rate for Payer: Mclaren Medicare	$18.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18.94
Rate for Payer: Meridian Medicaid	$18.94
Rate for Payer: MI Amish Medical Board Commercial	$20.75
Rate for Payer: Molina Medicare/Medicaid	$19.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,873.92
Rate for Payer: Nomi Health Commercial	$54.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,300.52
Rate for Payer: PACE Medicare	$17.14
Rate for Payer: PACE SWMI	$18.04
Rate for Payer: PHP Commercial	$4,873.92
Rate for Payer: PHP Medicare Advantage	$18.04
Rate for Payer: Priority Health Choice Medicaid	$9.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$56.28
Rate for Payer: Priority Health Medicare	$18.04
Rate for Payer: Priority Health SBD	$3,612.43
Rate for Payer: Priority Health Tiered Network	$45.02
Rate for Payer: Railroad Medicare Medicare	$18.04
Rate for Payer: UHC All Payor (Choice/PPO)	$29.82
Rate for Payer: UHC Core	$29.82
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18.04
Rate for Payer: UHC Exchange	$29.82
Rate for Payer: UHC Medicaid	$9.43
Rate for Payer: UHCCP Medicaid	$9.43
Rate for Payer: VA VA	$18.04

SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION

Facility

$5,734.02

Service Code	HCPCS J3247
Hospital Charge Code	205647
Hospital Revenue Code	636
Min. Negotiated Rate	$3,612.43
Max. Negotiated Rate	$5,160.62
Rate for Payer: Aetna Commercial	$4,873.92
Rate for Payer: Aetna New Business (MI Preferred)	$3,727.11
Rate for Payer: Cash Price	$4,587.22
Rate for Payer: Cofinity Advantage	$4,013.81
Rate for Payer: Cofinity Commercial	$4,931.26
Rate for Payer: Encore Health Key Benefits Commercial	$4,587.22
Rate for Payer: Healthscope Commercial	$5,160.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,873.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,300.52
Rate for Payer: PHP Commercial	$4,873.92
Rate for Payer: Priority Health SBD	$3,612.43

SEIZURE

Facility

$3,609.50

Service Code	APR-DRG 0531
Min. Negotiated Rate	$3,437.62
Max. Negotiated Rate	$3,609.50
Rate for Payer: BCBS Complete	$3,609.50
Rate for Payer: Mclaren Medicaid	$3,437.62
Rate for Payer: Meridian Medicaid	$3,609.50
Rate for Payer: Priority Health Choice Medicaid	$3,437.62
Rate for Payer: UHC Medicaid	$3,437.62
Rate for Payer: UHCCP Medicaid	$3,437.62

SEIZURE

Facility

$4,615.06

Service Code	APR-DRG 0532
Min. Negotiated Rate	$4,395.30
Max. Negotiated Rate	$4,615.06
Rate for Payer: BCBS Complete	$4,615.06
Rate for Payer: Mclaren Medicaid	$4,395.30
Rate for Payer: Meridian Medicaid	$4,615.06
Rate for Payer: Priority Health Choice Medicaid	$4,395.30
Rate for Payer: UHC Medicaid	$4,395.30
Rate for Payer: UHCCP Medicaid	$4,395.30

SEIZURE

Facility

$6,864.69

Service Code	APR-DRG 0533
Min. Negotiated Rate	$6,537.80
Max. Negotiated Rate	$6,864.69
Rate for Payer: BCBS Complete	$6,864.69
Rate for Payer: Mclaren Medicaid	$6,537.80
Rate for Payer: Meridian Medicaid	$6,864.69
Rate for Payer: Priority Health Choice Medicaid	$6,537.80
Rate for Payer: UHC Medicaid	$6,537.80
Rate for Payer: UHCCP Medicaid	$6,537.80

SEIZURE

Facility

$14,107.19

Service Code	APR-DRG 0534
Min. Negotiated Rate	$13,435.42
Max. Negotiated Rate	$14,107.19
Rate for Payer: BCBS Complete	$14,107.19
Rate for Payer: Mclaren Medicaid	$13,435.42
Rate for Payer: Meridian Medicaid	$14,107.19
Rate for Payer: Priority Health Choice Medicaid	$13,435.42
Rate for Payer: UHC Medicaid	$13,435.42
Rate for Payer: UHCCP Medicaid	$13,435.42

SEIZURES WITH MCC

Facility

$31,569.84

Service Code	MSDRG 100
Min. Negotiated Rate	$14,769.69
Max. Negotiated Rate	$31,569.84
Rate for Payer: Aetna Medicare	$16,168.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,433.80
Rate for Payer: Amish Plain Church Group Commercial	$19,433.80
Rate for Payer: BCBS MAPPO	$15,547.04
Rate for Payer: BCBS Trust/PPO	$29,206.16
Rate for Payer: BCN Commercial	$29,206.16
Rate for Payer: BCN Medicare Advantage	$15,547.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,547.04
Rate for Payer: Mclaren Medicare	$15,547.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,324.39
Rate for Payer: MI Amish Medical Board Commercial	$17,879.10
Rate for Payer: Molina Medicare/Medicaid	$17,101.74
Rate for Payer: Nomi Health Commercial	$24,984.72
Rate for Payer: PACE Medicare	$14,769.69
Rate for Payer: PACE SWMI	$15,547.04
Rate for Payer: PHP Medicare Advantage	$15,547.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$31,225.36
Rate for Payer: Priority Health Medicare	$15,547.04
Rate for Payer: Priority Health Tiered Network	$24,980.28
Rate for Payer: Railroad Medicare Medicare	$15,547.04
Rate for Payer: UHC All Payor (Choice/PPO)	$31,569.84
Rate for Payer: UHC Core	$26,412.14
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,547.04
Rate for Payer: UHC Exchange	$21,570.14
Rate for Payer: VA VA	$15,547.04

SEIZURES WITHOUT MCC

Facility

$14,712.38

Service Code	MSDRG 101
Min. Negotiated Rate	$7,176.77
Max. Negotiated Rate	$14,712.38
Rate for Payer: Aetna Medicare	$7,856.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,443.11
Rate for Payer: Amish Plain Church Group Commercial	$9,443.11
Rate for Payer: BCBS MAPPO	$7,554.49
Rate for Payer: BCBS Trust/PPO	$13,595.37
Rate for Payer: BCN Commercial	$13,595.37
Rate for Payer: BCN Medicare Advantage	$7,554.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,554.49
Rate for Payer: Mclaren Medicare	$7,554.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,932.21
Rate for Payer: MI Amish Medical Board Commercial	$8,687.66
Rate for Payer: Molina Medicare/Medicaid	$8,309.94
Rate for Payer: Nomi Health Commercial	$11,643.54
Rate for Payer: PACE Medicare	$7,176.77
Rate for Payer: PACE SWMI	$7,554.49
Rate for Payer: PHP Medicare Advantage	$7,554.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$14,551.84
Rate for Payer: Priority Health Medicare	$7,554.49
Rate for Payer: Priority Health Tiered Network	$11,641.47
Rate for Payer: Railroad Medicare Medicare	$7,554.49
Rate for Payer: UHC All Payor (Choice/PPO)	$14,712.38
Rate for Payer: UHC Core	$12,308.76
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,554.49
Rate for Payer: UHC Exchange	$10,052.26
Rate for Payer: VA VA	$7,554.49

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY

Facility

$2,957.29

Service Code	CPT 36215
Hospital Revenue Code	360
Min. Negotiated Rate	$2,957.29
Max. Negotiated Rate	$2,957.29
Rate for Payer: BCBS Trust/PPO	$2,957.29
Rate for Payer: BCN Commercial	$2,957.29

SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION

Facility

$705.82

Service Code	NDC 00517656025
Hospital Charge Code	190643
Hospital Revenue Code	250
Min. Negotiated Rate	$277.39
Max. Negotiated Rate	$635.24
Rate for Payer: Aetna Commercial	$599.95
Rate for Payer: Aetna Medicare	$352.91
Rate for Payer: Aetna New Business (MI Preferred)	$458.78
Rate for Payer: BCBS Complete	$282.33
Rate for Payer: Cash Price	$564.66
Rate for Payer: Cofinity Advantage	$494.07
Rate for Payer: Cofinity Commercial	$607.01
Rate for Payer: Encore Health Key Benefits Commercial	$564.66
Rate for Payer: Healthscope Commercial	$635.24
Rate for Payer: MI Amish Medical Board Commercial	$564.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$599.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$529.37
Rate for Payer: PHP Commercial	$599.95
Rate for Payer: Priority Health SBD	$444.67
Rate for Payer: UHC All Payor (Choice/PPO)	$458.78
Rate for Payer: UHC Core	$367.73
Rate for Payer: UHC Exchange	$277.39

SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION

Facility

$705.82

Service Code	NDC 00517656025
Hospital Charge Code	190643
Hospital Revenue Code	250
Min. Negotiated Rate	$444.67
Max. Negotiated Rate	$635.24
Rate for Payer: Aetna Commercial	$599.95
Rate for Payer: Aetna New Business (MI Preferred)	$458.78
Rate for Payer: Cash Price	$564.66
Rate for Payer: Cofinity Advantage	$494.07
Rate for Payer: Cofinity Commercial	$607.01
Rate for Payer: Encore Health Key Benefits Commercial	$564.66
Rate for Payer: Healthscope Commercial	$635.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$599.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$529.37
Rate for Payer: PHP Commercial	$599.95
Rate for Payer: Priority Health SBD	$444.67

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$103.62

Service Code	NDC 60258095106
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$65.28
Max. Negotiated Rate	$93.26
Rate for Payer: Aetna Commercial	$88.08
Rate for Payer: Aetna New Business (MI Preferred)	$67.35
Rate for Payer: Cash Price	$82.90
Rate for Payer: Cofinity Advantage	$72.53
Rate for Payer: Cofinity Commercial	$89.11
Rate for Payer: Encore Health Key Benefits Commercial	$82.90
Rate for Payer: Healthscope Commercial	$93.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.72
Rate for Payer: PHP Commercial	$88.08
Rate for Payer: Priority Health SBD	$65.28

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$44.52

Service Code	NDC 67618031030
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$40.07
Rate for Payer: Aetna Commercial	$37.84
Rate for Payer: Aetna New Business (MI Preferred)	$28.94
Rate for Payer: Cash Price	$35.62
Rate for Payer: Cofinity Advantage	$31.16
Rate for Payer: Cofinity Commercial	$38.29
Rate for Payer: Encore Health Key Benefits Commercial	$35.62
Rate for Payer: Healthscope Commercial	$40.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.39
Rate for Payer: PHP Commercial	$37.84
Rate for Payer: Priority Health SBD	$28.05

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$88.20

Service Code	NDC 09629513881
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Advantage	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.15
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health SBD	$55.57

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$94.50

Service Code	NDC 70000052601
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$37.14
Max. Negotiated Rate	$85.05
Rate for Payer: Aetna Commercial	$80.33
Rate for Payer: Aetna Medicare	$47.25
Rate for Payer: Aetna New Business (MI Preferred)	$61.42
Rate for Payer: BCBS Complete	$37.80
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cofinity Advantage	$66.15
Rate for Payer: Cofinity Commercial	$81.27
Rate for Payer: Encore Health Key Benefits Commercial	$75.60
Rate for Payer: Healthscope Commercial	$85.05
Rate for Payer: MI Amish Medical Board Commercial	$75.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.88
Rate for Payer: PHP Commercial	$80.33
Rate for Payer: Priority Health SBD	$59.53
Rate for Payer: UHC All Payor (Choice/PPO)	$61.42
Rate for Payer: UHC Core	$49.23
Rate for Payer: UHC Exchange	$37.14

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$84.63

Service Code	NDC 67618011030
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$33.26
Max. Negotiated Rate	$76.17
Rate for Payer: Aetna Commercial	$71.94
Rate for Payer: Aetna Medicare	$42.31
Rate for Payer: Aetna New Business (MI Preferred)	$55.01
Rate for Payer: BCBS Complete	$33.85
Rate for Payer: Cash Price	$67.70
Rate for Payer: Cofinity Advantage	$59.24
Rate for Payer: Cofinity Commercial	$72.78
Rate for Payer: Encore Health Key Benefits Commercial	$67.70
Rate for Payer: Healthscope Commercial	$76.17
Rate for Payer: MI Amish Medical Board Commercial	$67.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.47
Rate for Payer: PHP Commercial	$71.94
Rate for Payer: Priority Health SBD	$53.32
Rate for Payer: UHC All Payor (Choice/PPO)	$55.01
Rate for Payer: UHC Core	$44.09
Rate for Payer: UHC Exchange	$33.26

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$101.20

Service Code	NDC 51645085099
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$91.08
Rate for Payer: Aetna Commercial	$86.02
Rate for Payer: Aetna Medicare	$50.60
Rate for Payer: Aetna New Business (MI Preferred)	$65.78
Rate for Payer: BCBS Complete	$40.48
Rate for Payer: Cash Price	$80.96
Rate for Payer: Cofinity Advantage	$70.84
Rate for Payer: Cofinity Commercial	$87.03
Rate for Payer: Encore Health Key Benefits Commercial	$80.96
Rate for Payer: Healthscope Commercial	$91.08
Rate for Payer: MI Amish Medical Board Commercial	$80.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$75.90
Rate for Payer: PHP Commercial	$86.02
Rate for Payer: Priority Health SBD	$63.76
Rate for Payer: UHC All Payor (Choice/PPO)	$65.78
Rate for Payer: UHC Core	$52.73
Rate for Payer: UHC Exchange	$39.77

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$1.60

Service Code	NDC 60687062211
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.44
Rate for Payer: Aetna Commercial	$1.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.04
Rate for Payer: Cash Price	$1.28
Rate for Payer: Cofinity Advantage	$1.12
Rate for Payer: Cofinity Commercial	$1.38
Rate for Payer: Encore Health Key Benefits Commercial	$1.28
Rate for Payer: Healthscope Commercial	$1.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.20
Rate for Payer: PHP Commercial	$1.36
Rate for Payer: Priority Health SBD	$1.01

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$145.20

Service Code	NDC 00904744061
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$91.48
Max. Negotiated Rate	$130.68
Rate for Payer: Aetna Commercial	$123.42
Rate for Payer: Aetna New Business (MI Preferred)	$94.38
Rate for Payer: Cash Price	$116.16
Rate for Payer: Cofinity Advantage	$101.64
Rate for Payer: Cofinity Commercial	$124.87
Rate for Payer: Encore Health Key Benefits Commercial	$116.16
Rate for Payer: Healthscope Commercial	$130.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.90
Rate for Payer: PHP Commercial	$123.42
Rate for Payer: Priority Health SBD	$91.48

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$84.63

Service Code	NDC 67618011030
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$53.32
Max. Negotiated Rate	$76.17
Rate for Payer: Aetna Commercial	$71.94
Rate for Payer: Aetna New Business (MI Preferred)	$55.01
Rate for Payer: Cash Price	$67.70
Rate for Payer: Cofinity Advantage	$59.24
Rate for Payer: Cofinity Commercial	$72.78
Rate for Payer: Encore Health Key Benefits Commercial	$67.70
Rate for Payer: Healthscope Commercial	$76.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.47
Rate for Payer: PHP Commercial	$71.94
Rate for Payer: Priority Health SBD	$53.32

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$103.62

Service Code	NDC 60258095106
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$40.72
Max. Negotiated Rate	$93.26
Rate for Payer: Aetna Commercial	$88.08
Rate for Payer: Aetna Medicare	$51.81
Rate for Payer: Aetna New Business (MI Preferred)	$67.35
Rate for Payer: BCBS Complete	$41.45
Rate for Payer: Cash Price	$82.90
Rate for Payer: Cofinity Advantage	$72.53
Rate for Payer: Cofinity Commercial	$89.11
Rate for Payer: Encore Health Key Benefits Commercial	$82.90
Rate for Payer: Healthscope Commercial	$93.26
Rate for Payer: MI Amish Medical Board Commercial	$82.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.72
Rate for Payer: PHP Commercial	$88.08
Rate for Payer: Priority Health SBD	$65.28
Rate for Payer: UHC All Payor (Choice/PPO)	$67.35
Rate for Payer: UHC Core	$53.99
Rate for Payer: UHC Exchange	$40.72

Know your out-of-pocket cost for care.

All Charges