Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$144.96

Service Code	NDC 50268071715
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$91.32
Max. Negotiated Rate	$130.46
Rate for Payer: Aetna Commercial	$123.22
Rate for Payer: Aetna New Business (MI Preferred)	$94.22
Rate for Payer: Cash Price	$115.97
Rate for Payer: Cofinity Advantage	$101.47
Rate for Payer: Cofinity Commercial	$124.67
Rate for Payer: Encore Health Key Benefits Commercial	$115.97
Rate for Payer: Healthscope Commercial	$130.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.72
Rate for Payer: PHP Commercial	$123.22
Rate for Payer: Priority Health SBD	$91.32

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$190.35

Service Code	NDC 65162035109
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$119.92
Max. Negotiated Rate	$171.31
Rate for Payer: Aetna Commercial	$161.80
Rate for Payer: Aetna New Business (MI Preferred)	$123.73
Rate for Payer: Cash Price	$152.28
Rate for Payer: Cofinity Advantage	$133.25
Rate for Payer: Cofinity Commercial	$163.70
Rate for Payer: Encore Health Key Benefits Commercial	$152.28
Rate for Payer: Healthscope Commercial	$171.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.76
Rate for Payer: PHP Commercial	$161.80
Rate for Payer: Priority Health SBD	$119.92

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$20,113.54

Service Code	NDC 00069419068
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$12,671.53
Max. Negotiated Rate	$18,102.19
Rate for Payer: Aetna Commercial	$17,096.51
Rate for Payer: Aetna New Business (MI Preferred)	$13,073.80
Rate for Payer: Cash Price	$16,090.83
Rate for Payer: Cofinity Advantage	$14,079.48
Rate for Payer: Cofinity Commercial	$17,297.64
Rate for Payer: Encore Health Key Benefits Commercial	$16,090.83
Rate for Payer: Healthscope Commercial	$18,102.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17,096.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$15,085.16
Rate for Payer: PHP Commercial	$17,096.51
Rate for Payer: Priority Health SBD	$12,671.53

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$2.90

Service Code	NDC 50268071711
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.61
Rate for Payer: Aetna Commercial	$2.46
Rate for Payer: Aetna New Business (MI Preferred)	$1.89
Rate for Payer: Cash Price	$2.32
Rate for Payer: Cofinity Advantage	$2.03
Rate for Payer: Cofinity Commercial	$2.49
Rate for Payer: Encore Health Key Benefits Commercial	$2.32
Rate for Payer: Healthscope Commercial	$2.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.17
Rate for Payer: PHP Commercial	$2.46
Rate for Payer: Priority Health SBD	$1.83

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$190.35

Service Code	NDC 65162035109
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$74.81
Max. Negotiated Rate	$171.31
Rate for Payer: Aetna Commercial	$161.80
Rate for Payer: Aetna Medicare	$95.17
Rate for Payer: Aetna New Business (MI Preferred)	$123.73
Rate for Payer: BCBS Complete	$76.14
Rate for Payer: Cash Price	$152.28
Rate for Payer: Cofinity Advantage	$133.25
Rate for Payer: Cofinity Commercial	$163.70
Rate for Payer: Encore Health Key Benefits Commercial	$152.28
Rate for Payer: Healthscope Commercial	$171.31
Rate for Payer: MI Amish Medical Board Commercial	$152.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.76
Rate for Payer: PHP Commercial	$161.80
Rate for Payer: Priority Health SBD	$119.92
Rate for Payer: UHC All Payor (Choice/PPO)	$123.73
Rate for Payer: UHC Core	$99.17
Rate for Payer: UHC Exchange	$74.81

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$2.90

Service Code	NDC 50268071711
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.61
Rate for Payer: Aetna Commercial	$2.46
Rate for Payer: Aetna Medicare	$1.45
Rate for Payer: Aetna New Business (MI Preferred)	$1.89
Rate for Payer: BCBS Complete	$1.16
Rate for Payer: Cash Price	$2.32
Rate for Payer: Cofinity Advantage	$2.03
Rate for Payer: Cofinity Commercial	$2.49
Rate for Payer: Encore Health Key Benefits Commercial	$2.32
Rate for Payer: Healthscope Commercial	$2.61
Rate for Payer: MI Amish Medical Board Commercial	$2.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.17
Rate for Payer: PHP Commercial	$2.46
Rate for Payer: Priority Health SBD	$1.83
Rate for Payer: UHC All Payor (Choice/PPO)	$1.89
Rate for Payer: UHC Core	$1.51
Rate for Payer: UHC Exchange	$1.14

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$131.76

Service Code	NDC 00904667106
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$51.78
Max. Negotiated Rate	$118.58
Rate for Payer: Aetna Commercial	$112.00
Rate for Payer: Aetna Medicare	$65.88
Rate for Payer: Aetna New Business (MI Preferred)	$85.64
Rate for Payer: BCBS Complete	$52.70
Rate for Payer: Cash Price	$105.41
Rate for Payer: Cofinity Advantage	$92.23
Rate for Payer: Cofinity Commercial	$113.31
Rate for Payer: Encore Health Key Benefits Commercial	$105.41
Rate for Payer: Healthscope Commercial	$118.58
Rate for Payer: MI Amish Medical Board Commercial	$105.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$98.82
Rate for Payer: PHP Commercial	$112.00
Rate for Payer: Priority Health SBD	$83.01
Rate for Payer: UHC All Payor (Choice/PPO)	$85.64
Rate for Payer: UHC Core	$68.65
Rate for Payer: UHC Exchange	$51.78

SILODOSIN 4 MG CAPSULE

Facility

$124.26

Service Code	NDC 27241014401
Hospital Charge Code	96984
Hospital Revenue Code	637
Min. Negotiated Rate	$48.83
Max. Negotiated Rate	$111.83
Rate for Payer: Aetna Commercial	$105.62
Rate for Payer: Aetna Medicare	$62.13
Rate for Payer: Aetna New Business (MI Preferred)	$80.77
Rate for Payer: BCBS Complete	$49.70
Rate for Payer: Cash Price	$99.41
Rate for Payer: Cofinity Advantage	$86.98
Rate for Payer: Cofinity Commercial	$106.86
Rate for Payer: Encore Health Key Benefits Commercial	$99.41
Rate for Payer: Healthscope Commercial	$111.83
Rate for Payer: MI Amish Medical Board Commercial	$99.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.19
Rate for Payer: PHP Commercial	$105.62
Rate for Payer: Priority Health SBD	$78.28
Rate for Payer: UHC All Payor (Choice/PPO)	$80.77
Rate for Payer: UHC Core	$64.74
Rate for Payer: UHC Exchange	$48.83

SILODOSIN 4 MG CAPSULE

Facility

$124.26

Service Code	NDC 27241014401
Hospital Charge Code	96984
Hospital Revenue Code	637
Min. Negotiated Rate	$78.28
Max. Negotiated Rate	$111.83
Rate for Payer: Aetna Commercial	$105.62
Rate for Payer: Aetna New Business (MI Preferred)	$80.77
Rate for Payer: Cash Price	$99.41
Rate for Payer: Cofinity Advantage	$86.98
Rate for Payer: Cofinity Commercial	$106.86
Rate for Payer: Encore Health Key Benefits Commercial	$99.41
Rate for Payer: Healthscope Commercial	$111.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.19
Rate for Payer: PHP Commercial	$105.62
Rate for Payer: Priority Health SBD	$78.28

SILVER ER TOPICAL GEL,EXTENDED RELEASE

Facility

$72.54

Service Code	NDC 80196029660
Hospital Charge Code	115249
Hospital Revenue Code	637
Min. Negotiated Rate	$45.70
Max. Negotiated Rate	$65.29
Rate for Payer: Aetna Commercial	$61.66
Rate for Payer: Aetna New Business (MI Preferred)	$47.15
Rate for Payer: Cash Price	$58.03
Rate for Payer: Cofinity Advantage	$50.78
Rate for Payer: Cofinity Commercial	$62.38
Rate for Payer: Encore Health Key Benefits Commercial	$58.03
Rate for Payer: Healthscope Commercial	$65.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.41
Rate for Payer: PHP Commercial	$61.66
Rate for Payer: Priority Health SBD	$45.70

SILVER ER TOPICAL GEL,EXTENDED RELEASE

Facility

$78.64

Service Code	NDC 08327030909
Hospital Charge Code	115249
Hospital Revenue Code	637
Min. Negotiated Rate	$49.54
Max. Negotiated Rate	$70.78
Rate for Payer: Aetna Commercial	$66.84
Rate for Payer: Aetna New Business (MI Preferred)	$51.12
Rate for Payer: Cash Price	$62.91
Rate for Payer: Cofinity Advantage	$55.05
Rate for Payer: Cofinity Commercial	$67.63
Rate for Payer: Encore Health Key Benefits Commercial	$62.91
Rate for Payer: Healthscope Commercial	$70.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.98
Rate for Payer: PHP Commercial	$66.84
Rate for Payer: Priority Health SBD	$49.54

SILVER ER TOPICAL GEL,EXTENDED RELEASE

Facility

$72.54

Service Code	NDC 80196029660
Hospital Charge Code	115249
Hospital Revenue Code	637
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$65.29
Rate for Payer: Aetna Commercial	$61.66
Rate for Payer: Aetna Medicare	$36.27
Rate for Payer: Aetna New Business (MI Preferred)	$47.15
Rate for Payer: BCBS Complete	$29.02
Rate for Payer: Cash Price	$58.03
Rate for Payer: Cofinity Advantage	$50.78
Rate for Payer: Cofinity Commercial	$62.38
Rate for Payer: Encore Health Key Benefits Commercial	$58.03
Rate for Payer: Healthscope Commercial	$65.29
Rate for Payer: MI Amish Medical Board Commercial	$58.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.41
Rate for Payer: PHP Commercial	$61.66
Rate for Payer: Priority Health SBD	$45.70
Rate for Payer: UHC All Payor (Choice/PPO)	$47.15
Rate for Payer: UHC Core	$37.79
Rate for Payer: UHC Exchange	$28.51

SILVER ER TOPICAL GEL,EXTENDED RELEASE

Facility

$78.64

Service Code	NDC 08327030909
Hospital Charge Code	115249
Hospital Revenue Code	637
Min. Negotiated Rate	$30.91
Max. Negotiated Rate	$70.78
Rate for Payer: Aetna Commercial	$66.84
Rate for Payer: Aetna Medicare	$39.32
Rate for Payer: Aetna New Business (MI Preferred)	$51.12
Rate for Payer: BCBS Complete	$31.46
Rate for Payer: Cash Price	$62.91
Rate for Payer: Cofinity Advantage	$55.05
Rate for Payer: Cofinity Commercial	$67.63
Rate for Payer: Encore Health Key Benefits Commercial	$62.91
Rate for Payer: Healthscope Commercial	$70.78
Rate for Payer: MI Amish Medical Board Commercial	$62.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.98
Rate for Payer: PHP Commercial	$66.84
Rate for Payer: Priority Health SBD	$49.54
Rate for Payer: UHC All Payor (Choice/PPO)	$51.12
Rate for Payer: UHC Core	$40.97
Rate for Payer: UHC Exchange	$30.91

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$5.16

Service Code	NDC 09900000976
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$4.64
Rate for Payer: Aetna Commercial	$4.39
Rate for Payer: Aetna New Business (MI Preferred)	$3.35
Rate for Payer: Cash Price	$4.13
Rate for Payer: Cofinity Advantage	$3.61
Rate for Payer: Cofinity Commercial	$4.44
Rate for Payer: Encore Health Key Benefits Commercial	$4.13
Rate for Payer: Healthscope Commercial	$4.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.87
Rate for Payer: PHP Commercial	$4.39
Rate for Payer: Priority Health SBD	$3.25

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$940.45

Service Code	NDC 12165010001
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$592.48
Max. Negotiated Rate	$846.40
Rate for Payer: Aetna Commercial	$799.38
Rate for Payer: Aetna New Business (MI Preferred)	$611.29
Rate for Payer: Cash Price	$752.36
Rate for Payer: Cofinity Advantage	$658.32
Rate for Payer: Cofinity Commercial	$808.79
Rate for Payer: Encore Health Key Benefits Commercial	$752.36
Rate for Payer: Healthscope Commercial	$846.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$799.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$705.34
Rate for Payer: PHP Commercial	$799.38
Rate for Payer: Priority Health SBD	$592.48

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$940.45

Service Code	NDC 12165010001
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$846.40
Rate for Payer: Aetna Commercial	$799.38
Rate for Payer: Aetna Medicare	$470.23
Rate for Payer: Aetna New Business (MI Preferred)	$611.29
Rate for Payer: BCBS Complete	$376.18
Rate for Payer: Cash Price	$752.36
Rate for Payer: Cofinity Advantage	$658.32
Rate for Payer: Cofinity Commercial	$808.79
Rate for Payer: Encore Health Key Benefits Commercial	$752.36
Rate for Payer: Healthscope Commercial	$846.40
Rate for Payer: MI Amish Medical Board Commercial	$752.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$799.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$705.34
Rate for Payer: PHP Commercial	$799.38
Rate for Payer: Priority Health SBD	$592.48
Rate for Payer: UHC All Payor (Choice/PPO)	$611.29
Rate for Payer: UHC Core	$489.97
Rate for Payer: UHC Exchange	$369.60

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$5.16

Service Code	NDC 09900000976
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$4.64
Rate for Payer: Aetna Commercial	$4.39
Rate for Payer: Aetna Medicare	$2.58
Rate for Payer: Aetna New Business (MI Preferred)	$3.35
Rate for Payer: BCBS Complete	$2.06
Rate for Payer: Cash Price	$4.13
Rate for Payer: Cofinity Advantage	$3.61
Rate for Payer: Cofinity Commercial	$4.44
Rate for Payer: Encore Health Key Benefits Commercial	$4.13
Rate for Payer: Healthscope Commercial	$4.64
Rate for Payer: MI Amish Medical Board Commercial	$4.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.87
Rate for Payer: PHP Commercial	$4.39
Rate for Payer: Priority Health SBD	$3.25
Rate for Payer: UHC All Payor (Choice/PPO)	$3.35
Rate for Payer: UHC Core	$2.69
Rate for Payer: UHC Exchange	$2.03

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$148.40

Service Code	NDC 61570013140
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$93.49
Max. Negotiated Rate	$133.56
Rate for Payer: Aetna Commercial	$126.14
Rate for Payer: Aetna New Business (MI Preferred)	$96.46
Rate for Payer: Cash Price	$118.72
Rate for Payer: Cofinity Advantage	$103.88
Rate for Payer: Cofinity Commercial	$127.62
Rate for Payer: Encore Health Key Benefits Commercial	$118.72
Rate for Payer: Healthscope Commercial	$133.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.30
Rate for Payer: PHP Commercial	$126.14
Rate for Payer: Priority Health SBD	$93.49

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$22.58

Service Code	NDC 67877012425
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$20.32
Rate for Payer: Aetna Commercial	$19.19
Rate for Payer: Aetna Medicare	$11.29
Rate for Payer: Aetna New Business (MI Preferred)	$14.68
Rate for Payer: BCBS Complete	$9.03
Rate for Payer: Cash Price	$18.06
Rate for Payer: Cofinity Advantage	$15.81
Rate for Payer: Cofinity Commercial	$19.42
Rate for Payer: Encore Health Key Benefits Commercial	$18.06
Rate for Payer: Healthscope Commercial	$20.32
Rate for Payer: MI Amish Medical Board Commercial	$18.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.93
Rate for Payer: PHP Commercial	$19.19
Rate for Payer: Priority Health SBD	$14.23
Rate for Payer: UHC All Payor (Choice/PPO)	$14.68
Rate for Payer: UHC Core	$11.76
Rate for Payer: UHC Exchange	$8.87

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$24.15

Service Code	NDC 43598021025
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$15.21
Max. Negotiated Rate	$21.73
Rate for Payer: Aetna Commercial	$20.53
Rate for Payer: Aetna New Business (MI Preferred)	$15.70
Rate for Payer: Cash Price	$19.32
Rate for Payer: Cofinity Advantage	$16.91
Rate for Payer: Cofinity Commercial	$20.77
Rate for Payer: Encore Health Key Benefits Commercial	$19.32
Rate for Payer: Healthscope Commercial	$21.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.11
Rate for Payer: PHP Commercial	$20.53
Rate for Payer: Priority Health SBD	$15.21

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$22.58

Service Code	NDC 67877012425
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$20.32
Rate for Payer: Aetna Commercial	$19.19
Rate for Payer: Aetna New Business (MI Preferred)	$14.68
Rate for Payer: Cash Price	$18.06
Rate for Payer: Cofinity Advantage	$15.81
Rate for Payer: Cofinity Commercial	$19.42
Rate for Payer: Encore Health Key Benefits Commercial	$18.06
Rate for Payer: Healthscope Commercial	$20.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.93
Rate for Payer: PHP Commercial	$19.19
Rate for Payer: Priority Health SBD	$14.23

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$148.40

Service Code	NDC 61570013140
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$58.32
Max. Negotiated Rate	$133.56
Rate for Payer: Aetna Commercial	$126.14
Rate for Payer: Aetna Medicare	$74.20
Rate for Payer: Aetna New Business (MI Preferred)	$96.46
Rate for Payer: BCBS Complete	$59.36
Rate for Payer: Cash Price	$118.72
Rate for Payer: Cofinity Advantage	$103.88
Rate for Payer: Cofinity Commercial	$127.62
Rate for Payer: Encore Health Key Benefits Commercial	$118.72
Rate for Payer: Healthscope Commercial	$133.56
Rate for Payer: MI Amish Medical Board Commercial	$118.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.30
Rate for Payer: PHP Commercial	$126.14
Rate for Payer: Priority Health SBD	$93.49
Rate for Payer: UHC All Payor (Choice/PPO)	$96.46
Rate for Payer: UHC Core	$77.32
Rate for Payer: UHC Exchange	$58.32

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$134.40

Service Code	NDC 67877012440
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$52.82
Max. Negotiated Rate	$120.96
Rate for Payer: Aetna Commercial	$114.24
Rate for Payer: Aetna Medicare	$67.20
Rate for Payer: Aetna New Business (MI Preferred)	$87.36
Rate for Payer: BCBS Complete	$53.76
Rate for Payer: Cash Price	$107.52
Rate for Payer: Cofinity Advantage	$94.08
Rate for Payer: Cofinity Commercial	$115.58
Rate for Payer: Encore Health Key Benefits Commercial	$107.52
Rate for Payer: Healthscope Commercial	$120.96
Rate for Payer: MI Amish Medical Board Commercial	$107.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$100.80
Rate for Payer: PHP Commercial	$114.24
Rate for Payer: Priority Health SBD	$84.67
Rate for Payer: UHC All Payor (Choice/PPO)	$87.36
Rate for Payer: UHC Core	$70.02
Rate for Payer: UHC Exchange	$52.82

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$134.40

Service Code	NDC 67877012440
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$84.67
Max. Negotiated Rate	$120.96
Rate for Payer: Aetna Commercial	$114.24
Rate for Payer: Aetna New Business (MI Preferred)	$87.36
Rate for Payer: Cash Price	$107.52
Rate for Payer: Cofinity Advantage	$94.08
Rate for Payer: Cofinity Commercial	$115.58
Rate for Payer: Encore Health Key Benefits Commercial	$107.52
Rate for Payer: Healthscope Commercial	$120.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$100.80
Rate for Payer: PHP Commercial	$114.24
Rate for Payer: Priority Health SBD	$84.67

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$24.15

Service Code	NDC 43598021025
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$21.73
Rate for Payer: Aetna Commercial	$20.53
Rate for Payer: Aetna Medicare	$12.07
Rate for Payer: Aetna New Business (MI Preferred)	$15.70
Rate for Payer: BCBS Complete	$9.66
Rate for Payer: Cash Price	$19.32
Rate for Payer: Cofinity Advantage	$16.91
Rate for Payer: Cofinity Commercial	$20.77
Rate for Payer: Encore Health Key Benefits Commercial	$19.32
Rate for Payer: Healthscope Commercial	$21.73
Rate for Payer: MI Amish Medical Board Commercial	$19.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.11
Rate for Payer: PHP Commercial	$20.53
Rate for Payer: Priority Health SBD	$15.21
Rate for Payer: UHC All Payor (Choice/PPO)	$15.70
Rate for Payer: UHC Core	$12.58
Rate for Payer: UHC Exchange	$9.49

Know your out-of-pocket cost for care.

All Charges