Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ROSUVASTATIN 5 MG TABLET

Facility

$222.30

Service Code	NDC 00781540092
Hospital Charge Code	36612
Hospital Revenue Code	637
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$200.07
Rate for Payer: Aetna Commercial	$188.96
Rate for Payer: Aetna Medicare	$111.15
Rate for Payer: Aetna New Business (MI Preferred)	$144.50
Rate for Payer: BCBS Complete	$88.92
Rate for Payer: Cash Price	$177.84
Rate for Payer: Cofinity Commercial	$155.61
Rate for Payer: Cofinity Commercial	$191.18
Rate for Payer: Cofinity Medicare Advantage	$155.61
Rate for Payer: Encore Health Key Benefits Commercial	$177.84
Rate for Payer: Healthscope Commercial	$200.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.96
Rate for Payer: PHP Commercial	$188.96
Rate for Payer: Priority Health Cigna Priority Health	$144.50
Rate for Payer: Priority Health SBD	$140.05

ROSUVASTATIN 5 MG TABLET

Facility

$395.04

Service Code	NDC 00904677861
Hospital Charge Code	36612
Hospital Revenue Code	637
Min. Negotiated Rate	$248.88
Max. Negotiated Rate	$355.54
Rate for Payer: Aetna Commercial	$335.78
Rate for Payer: Aetna New Business (MI Preferred)	$256.78
Rate for Payer: Cash Price	$316.03
Rate for Payer: Cofinity Commercial	$276.53
Rate for Payer: Cofinity Commercial	$339.73
Rate for Payer: Cofinity Medicare Advantage	$276.53
Rate for Payer: Encore Health Key Benefits Commercial	$316.03
Rate for Payer: Healthscope Commercial	$355.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$335.78
Rate for Payer: PHP Commercial	$335.78
Rate for Payer: Priority Health Cigna Priority Health	$256.78
Rate for Payer: Priority Health SBD	$248.88

ROSUVASTATIN 5 MG TABLET

Facility

$2,813.52

Service Code	NDC 00310075590
Hospital Charge Code	36612
Hospital Revenue Code	637
Min. Negotiated Rate	$1,125.41
Max. Negotiated Rate	$2,532.17
Rate for Payer: Aetna Commercial	$2,391.49
Rate for Payer: Aetna Medicare	$1,406.76
Rate for Payer: Aetna New Business (MI Preferred)	$1,828.79
Rate for Payer: BCBS Complete	$1,125.41
Rate for Payer: Cash Price	$2,250.82
Rate for Payer: Cofinity Commercial	$1,969.46
Rate for Payer: Cofinity Commercial	$2,419.63
Rate for Payer: Cofinity Medicare Advantage	$1,969.46
Rate for Payer: Encore Health Key Benefits Commercial	$2,250.82
Rate for Payer: Healthscope Commercial	$2,532.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,391.49
Rate for Payer: PHP Commercial	$2,391.49
Rate for Payer: Priority Health Cigna Priority Health	$1,828.79
Rate for Payer: Priority Health SBD	$1,772.52

ROSUVASTATIN 5 MG TABLET

Facility

$222.30

Service Code	NDC 00781540092
Hospital Charge Code	36612
Hospital Revenue Code	637
Min. Negotiated Rate	$140.05
Max. Negotiated Rate	$200.07
Rate for Payer: Aetna Commercial	$188.96
Rate for Payer: Aetna New Business (MI Preferred)	$144.50
Rate for Payer: Cash Price	$177.84
Rate for Payer: Cofinity Commercial	$155.61
Rate for Payer: Cofinity Commercial	$191.18
Rate for Payer: Cofinity Medicare Advantage	$155.61
Rate for Payer: Encore Health Key Benefits Commercial	$177.84
Rate for Payer: Healthscope Commercial	$200.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.96
Rate for Payer: PHP Commercial	$188.96
Rate for Payer: Priority Health Cigna Priority Health	$144.50
Rate for Payer: Priority Health SBD	$140.05

ROSUVASTATIN 5 MG TABLET

Facility

$2,813.52

Service Code	NDC 00310075590
Hospital Charge Code	36612
Hospital Revenue Code	637
Min. Negotiated Rate	$1,772.52
Max. Negotiated Rate	$2,532.17
Rate for Payer: Aetna Commercial	$2,391.49
Rate for Payer: Aetna New Business (MI Preferred)	$1,828.79
Rate for Payer: Cash Price	$2,250.82
Rate for Payer: Cofinity Commercial	$1,969.46
Rate for Payer: Cofinity Commercial	$2,419.63
Rate for Payer: Cofinity Medicare Advantage	$1,969.46
Rate for Payer: Encore Health Key Benefits Commercial	$2,250.82
Rate for Payer: Healthscope Commercial	$2,532.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,391.49
Rate for Payer: PHP Commercial	$2,391.49
Rate for Payer: Priority Health Cigna Priority Health	$1,828.79
Rate for Payer: Priority Health SBD	$1,772.52

ROSUVASTATIN 5 MG TABLET

Facility

$395.04

Service Code	NDC 00904677861
Hospital Charge Code	36612
Hospital Revenue Code	637
Min. Negotiated Rate	$158.02
Max. Negotiated Rate	$355.54
Rate for Payer: Aetna Commercial	$335.78
Rate for Payer: Aetna Medicare	$197.52
Rate for Payer: Aetna New Business (MI Preferred)	$256.78
Rate for Payer: BCBS Complete	$158.02
Rate for Payer: Cash Price	$316.03
Rate for Payer: Cofinity Commercial	$276.53
Rate for Payer: Cofinity Commercial	$339.73
Rate for Payer: Cofinity Medicare Advantage	$276.53
Rate for Payer: Encore Health Key Benefits Commercial	$316.03
Rate for Payer: Healthscope Commercial	$355.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$335.78
Rate for Payer: PHP Commercial	$335.78
Rate for Payer: Priority Health Cigna Priority Health	$256.78
Rate for Payer: Priority Health SBD	$248.88

ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH

Facility

$2,972.81

Service Code	NDC 50474080203
Hospital Charge Code	82100
Hospital Revenue Code	637
Min. Negotiated Rate	$1,189.12
Max. Negotiated Rate	$2,675.53
Rate for Payer: Aetna Commercial	$2,526.89
Rate for Payer: Aetna Medicare	$1,486.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,932.33
Rate for Payer: BCBS Complete	$1,189.12
Rate for Payer: Cash Price	$2,378.25
Rate for Payer: Cofinity Commercial	$2,080.97
Rate for Payer: Cofinity Commercial	$2,556.62
Rate for Payer: Cofinity Medicare Advantage	$2,080.97
Rate for Payer: Encore Health Key Benefits Commercial	$2,378.25
Rate for Payer: Healthscope Commercial	$2,675.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,526.89
Rate for Payer: PHP Commercial	$2,526.89
Rate for Payer: Priority Health Cigna Priority Health	$1,932.33
Rate for Payer: Priority Health SBD	$1,872.87

ROTIGOTINE 2 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH

Facility

$2,972.81

Service Code	NDC 50474080203
Hospital Charge Code	82100
Hospital Revenue Code	637
Min. Negotiated Rate	$1,872.87
Max. Negotiated Rate	$2,675.53
Rate for Payer: Aetna Commercial	$2,526.89
Rate for Payer: Aetna New Business (MI Preferred)	$1,932.33
Rate for Payer: Cash Price	$2,378.25
Rate for Payer: Cofinity Commercial	$2,080.97
Rate for Payer: Cofinity Commercial	$2,556.62
Rate for Payer: Cofinity Medicare Advantage	$2,080.97
Rate for Payer: Encore Health Key Benefits Commercial	$2,378.25
Rate for Payer: Healthscope Commercial	$2,675.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,526.89
Rate for Payer: PHP Commercial	$2,526.89
Rate for Payer: Priority Health Cigna Priority Health	$1,932.33
Rate for Payer: Priority Health SBD	$1,872.87

SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION

Facility

$11,284.45

Service Code	HCPCS J9317
Hospital Charge Code	193479
Hospital Revenue Code	636
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$10,156.00
Rate for Payer: Aetna Commercial	$9,591.78
Rate for Payer: Aetna Medicare	$36.86
Rate for Payer: Aetna New Business (MI Preferred)	$7,334.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$44.30
Rate for Payer: Amish Plain Church Group Commercial	$44.30
Rate for Payer: BCBS Complete	$19.95
Rate for Payer: BCBS MAPPO	$35.44
Rate for Payer: BCBS Trust/PPO	$100.09
Rate for Payer: BCN Commercial	$100.09
Rate for Payer: BCN Medicare Advantage	$35.44
Rate for Payer: Cash Price	$9,027.56
Rate for Payer: Cash Price	$9,027.56
Rate for Payer: Cofinity Commercial	$9,704.63
Rate for Payer: Cofinity Commercial	$7,899.12
Rate for Payer: Cofinity Medicare Advantage	$7,899.12
Rate for Payer: Encore Health Key Benefits Commercial	$9,027.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.44
Rate for Payer: Healthscope Commercial	$10,156.00
Rate for Payer: Mclaren Medicaid	$19.00
Rate for Payer: Mclaren Medicare	$35.44
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$37.21
Rate for Payer: Meridian Medicaid	$19.95
Rate for Payer: MI Amish Medical Board Commercial	$40.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,591.78
Rate for Payer: Nomi Health Commercial	$106.32
Rate for Payer: PACE Medicare	$33.67
Rate for Payer: PACE SWMI	$35.44
Rate for Payer: PHP Commercial	$9,591.78
Rate for Payer: PHP Medicare Advantage	$35.44
Rate for Payer: Priority Health Choice Medicaid	$19.00
Rate for Payer: Priority Health Cigna Priority Health	$7,334.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.78
Rate for Payer: Priority Health Medicare	$35.44
Rate for Payer: Priority Health Narrow Network	$79.82
Rate for Payer: Priority Health SBD	$7,109.20
Rate for Payer: Railroad Medicare Medicare	$35.44
Rate for Payer: UHC All Payor (Choice/PPO)	$99.76
Rate for Payer: UHC Dual Complete DSNP	$35.44
Rate for Payer: UHC Medicare Advantage	$35.44
Rate for Payer: UHCCP Medicaid	$19.95
Rate for Payer: VA VA	$35.44

SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION

Facility

$11,284.45

Service Code	HCPCS J9317
Hospital Charge Code	193479
Hospital Revenue Code	636
Min. Negotiated Rate	$7,109.20
Max. Negotiated Rate	$10,156.00
Rate for Payer: Aetna Commercial	$9,591.78
Rate for Payer: Aetna New Business (MI Preferred)	$7,334.89
Rate for Payer: Cash Price	$9,027.56
Rate for Payer: Cofinity Commercial	$7,899.12
Rate for Payer: Cofinity Commercial	$9,704.63
Rate for Payer: Cofinity Medicare Advantage	$7,899.12
Rate for Payer: Encore Health Key Benefits Commercial	$9,027.56
Rate for Payer: Healthscope Commercial	$10,156.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,591.78
Rate for Payer: PHP Commercial	$9,591.78
Rate for Payer: Priority Health Cigna Priority Health	$7,334.89
Rate for Payer: Priority Health SBD	$7,109.20

SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET

Facility

$2,343.88

Service Code	NDC 00078065920
Hospital Charge Code	174639
Hospital Revenue Code	637
Min. Negotiated Rate	$1,476.64
Max. Negotiated Rate	$2,109.49
Rate for Payer: Aetna Commercial	$1,992.30
Rate for Payer: Aetna New Business (MI Preferred)	$1,523.52
Rate for Payer: Cash Price	$1,875.10
Rate for Payer: Cofinity Commercial	$1,640.72
Rate for Payer: Cofinity Commercial	$2,015.74
Rate for Payer: Cofinity Medicare Advantage	$1,640.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,875.10
Rate for Payer: Healthscope Commercial	$2,109.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,992.30
Rate for Payer: PHP Commercial	$1,992.30
Rate for Payer: Priority Health Cigna Priority Health	$1,523.52
Rate for Payer: Priority Health SBD	$1,476.64

SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET

Facility

$2,343.88

Service Code	NDC 00078065920
Hospital Charge Code	174639
Hospital Revenue Code	637
Min. Negotiated Rate	$937.55
Max. Negotiated Rate	$2,109.49
Rate for Payer: Aetna Commercial	$1,992.30
Rate for Payer: Aetna Medicare	$1,171.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,523.52
Rate for Payer: BCBS Complete	$937.55
Rate for Payer: Cash Price	$1,875.10
Rate for Payer: Cofinity Commercial	$1,640.72
Rate for Payer: Cofinity Commercial	$2,015.74
Rate for Payer: Cofinity Medicare Advantage	$1,640.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,875.10
Rate for Payer: Healthscope Commercial	$2,109.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,992.30
Rate for Payer: PHP Commercial	$1,992.30
Rate for Payer: Priority Health Cigna Priority Health	$1,523.52
Rate for Payer: Priority Health SBD	$1,476.64

SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET

Facility

$2,343.88

Service Code	NDC 00078077720
Hospital Charge Code	174640
Hospital Revenue Code	637
Min. Negotiated Rate	$1,476.64
Max. Negotiated Rate	$2,109.49
Rate for Payer: Aetna Commercial	$1,992.30
Rate for Payer: Aetna New Business (MI Preferred)	$1,523.52
Rate for Payer: Cash Price	$1,875.10
Rate for Payer: Cofinity Commercial	$1,640.72
Rate for Payer: Cofinity Commercial	$2,015.74
Rate for Payer: Cofinity Medicare Advantage	$1,640.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,875.10
Rate for Payer: Healthscope Commercial	$2,109.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,992.30
Rate for Payer: PHP Commercial	$1,992.30
Rate for Payer: Priority Health Cigna Priority Health	$1,523.52
Rate for Payer: Priority Health SBD	$1,476.64

SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET

Facility

$2,343.88

Service Code	NDC 00078077720
Hospital Charge Code	174640
Hospital Revenue Code	637
Min. Negotiated Rate	$937.55
Max. Negotiated Rate	$2,109.49
Rate for Payer: Aetna Commercial	$1,992.30
Rate for Payer: Aetna Medicare	$1,171.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,523.52
Rate for Payer: BCBS Complete	$937.55
Rate for Payer: Cash Price	$1,875.10
Rate for Payer: Cofinity Commercial	$1,640.72
Rate for Payer: Cofinity Commercial	$2,015.74
Rate for Payer: Cofinity Medicare Advantage	$1,640.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,875.10
Rate for Payer: Healthscope Commercial	$2,109.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,992.30
Rate for Payer: PHP Commercial	$1,992.30
Rate for Payer: Priority Health Cigna Priority Health	$1,523.52
Rate for Payer: Priority Health SBD	$1,476.64

SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET

Facility

$2,343.88

Service Code	NDC 00078069620
Hospital Charge Code	174641
Hospital Revenue Code	637
Min. Negotiated Rate	$937.55
Max. Negotiated Rate	$2,109.49
Rate for Payer: Aetna Commercial	$1,992.30
Rate for Payer: Aetna Medicare	$1,171.94
Rate for Payer: Aetna New Business (MI Preferred)	$1,523.52
Rate for Payer: BCBS Complete	$937.55
Rate for Payer: Cash Price	$1,875.10
Rate for Payer: Cofinity Commercial	$1,640.72
Rate for Payer: Cofinity Commercial	$2,015.74
Rate for Payer: Cofinity Medicare Advantage	$1,640.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,875.10
Rate for Payer: Healthscope Commercial	$2,109.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,992.30
Rate for Payer: PHP Commercial	$1,992.30
Rate for Payer: Priority Health Cigna Priority Health	$1,523.52
Rate for Payer: Priority Health SBD	$1,476.64

SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET

Facility

$2,343.88

Service Code	NDC 00078069620
Hospital Charge Code	174641
Hospital Revenue Code	637
Min. Negotiated Rate	$1,476.64
Max. Negotiated Rate	$2,109.49
Rate for Payer: Aetna Commercial	$1,992.30
Rate for Payer: Aetna New Business (MI Preferred)	$1,523.52
Rate for Payer: Cash Price	$1,875.10
Rate for Payer: Cofinity Commercial	$1,640.72
Rate for Payer: Cofinity Commercial	$2,015.74
Rate for Payer: Cofinity Medicare Advantage	$1,640.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,875.10
Rate for Payer: Healthscope Commercial	$2,109.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,992.30
Rate for Payer: PHP Commercial	$1,992.30
Rate for Payer: Priority Health Cigna Priority Health	$1,523.52
Rate for Payer: Priority Health SBD	$1,476.64

SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY

Facility

$24.97

Service Code	NDC 48582000155
Hospital Charge Code	118454
Hospital Revenue Code	637
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$22.47
Rate for Payer: Aetna Commercial	$21.22
Rate for Payer: Aetna New Business (MI Preferred)	$16.23
Rate for Payer: Cash Price	$19.98
Rate for Payer: Cofinity Commercial	$17.48
Rate for Payer: Cofinity Commercial	$21.47
Rate for Payer: Cofinity Medicare Advantage	$17.48
Rate for Payer: Encore Health Key Benefits Commercial	$19.98
Rate for Payer: Healthscope Commercial	$22.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.22
Rate for Payer: PHP Commercial	$21.22
Rate for Payer: Priority Health Cigna Priority Health	$16.23
Rate for Payer: Priority Health SBD	$15.73

SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY

Facility

$24.97

Service Code	NDC 48582000155
Hospital Charge Code	118454
Hospital Revenue Code	637
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$22.47
Rate for Payer: Aetna Commercial	$21.22
Rate for Payer: Aetna Medicare	$12.48
Rate for Payer: Aetna New Business (MI Preferred)	$16.23
Rate for Payer: BCBS Complete	$9.99
Rate for Payer: Cash Price	$19.98
Rate for Payer: Cofinity Commercial	$17.48
Rate for Payer: Cofinity Commercial	$21.47
Rate for Payer: Cofinity Medicare Advantage	$17.48
Rate for Payer: Encore Health Key Benefits Commercial	$19.98
Rate for Payer: Healthscope Commercial	$22.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.22
Rate for Payer: PHP Commercial	$21.22
Rate for Payer: Priority Health Cigna Priority Health	$16.23
Rate for Payer: Priority Health SBD	$15.73

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$32.69

Service Code	NDC 45802058001
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$13.08
Max. Negotiated Rate	$29.42
Rate for Payer: Aetna Commercial	$27.79
Rate for Payer: Aetna Medicare	$16.34
Rate for Payer: Aetna New Business (MI Preferred)	$21.25
Rate for Payer: BCBS Complete	$13.08
Rate for Payer: Cash Price	$26.15
Rate for Payer: Cofinity Commercial	$22.88
Rate for Payer: Cofinity Commercial	$28.11
Rate for Payer: Cofinity Medicare Advantage	$22.88
Rate for Payer: Encore Health Key Benefits Commercial	$26.15
Rate for Payer: Healthscope Commercial	$29.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.79
Rate for Payer: PHP Commercial	$27.79
Rate for Payer: Priority Health Cigna Priority Health	$21.25
Rate for Payer: Priority Health SBD	$20.59

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$586.71

Service Code	NDC 50742050524
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$234.68
Max. Negotiated Rate	$528.04
Rate for Payer: Aetna Commercial	$498.70
Rate for Payer: Aetna Medicare	$293.36
Rate for Payer: Aetna New Business (MI Preferred)	$381.36
Rate for Payer: BCBS Complete	$234.68
Rate for Payer: Cash Price	$469.37
Rate for Payer: Cofinity Commercial	$410.70
Rate for Payer: Cofinity Commercial	$504.57
Rate for Payer: Cofinity Medicare Advantage	$410.70
Rate for Payer: Encore Health Key Benefits Commercial	$469.37
Rate for Payer: Healthscope Commercial	$528.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$498.70
Rate for Payer: PHP Commercial	$498.70
Rate for Payer: Priority Health Cigna Priority Health	$381.36
Rate for Payer: Priority Health SBD	$369.63

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$326.90

Service Code	NDC 45802058046
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$130.76
Max. Negotiated Rate	$294.21
Rate for Payer: Aetna Commercial	$277.86
Rate for Payer: Aetna Medicare	$163.45
Rate for Payer: Aetna New Business (MI Preferred)	$212.48
Rate for Payer: BCBS Complete	$130.76
Rate for Payer: Cash Price	$261.52
Rate for Payer: Cofinity Commercial	$228.83
Rate for Payer: Cofinity Commercial	$281.13
Rate for Payer: Cofinity Medicare Advantage	$228.83
Rate for Payer: Encore Health Key Benefits Commercial	$261.52
Rate for Payer: Healthscope Commercial	$294.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.86
Rate for Payer: PHP Commercial	$277.86
Rate for Payer: Priority Health Cigna Priority Health	$212.48
Rate for Payer: Priority Health SBD	$205.95

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	$420.52
Max. Negotiated Rate	$946.18
Rate for Payer: Aetna Commercial	$893.61
Rate for Payer: Aetna Medicare	$525.66
Rate for Payer: Aetna New Business (MI Preferred)	$683.35
Rate for Payer: BCBS Complete	$420.52
Rate for Payer: Cash Price	$841.05
Rate for Payer: Cofinity Commercial	$735.92
Rate for Payer: Cofinity Commercial	$904.13
Rate for Payer: Cofinity Medicare Advantage	$735.92
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: PHP Commercial	$893.61
Rate for Payer: Priority Health Cigna Priority Health	$683.35
Rate for Payer: Priority Health SBD	$662.33

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$43.81

Service Code	NDC 10019055390
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$17.52
Max. Negotiated Rate	$39.43
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare	$21.90
Rate for Payer: Aetna New Business (MI Preferred)	$28.48
Rate for Payer: BCBS Complete	$17.52
Rate for Payer: Cash Price	$35.05
Rate for Payer: Cofinity Commercial	$30.67
Rate for Payer: Cofinity Commercial	$37.68
Rate for Payer: Cofinity Medicare Advantage	$30.67
Rate for Payer: Encore Health Key Benefits Commercial	$35.05
Rate for Payer: Healthscope Commercial	$39.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.24
Rate for Payer: PHP Commercial	$37.24
Rate for Payer: Priority Health Cigna Priority Health	$28.48
Rate for Payer: Priority Health SBD	$27.60

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	$175.22
Max. Negotiated Rate	$394.24
Rate for Payer: Aetna Commercial	$372.34
Rate for Payer: Aetna Medicare	$219.02
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 Commercial	$306.64
Rate for Payer: Cofinity Commercial	$376.72
Rate for Payer: Cofinity Medicare Advantage	$306.64
Rate for Payer: Encore Health Key Benefits Commercial	$350.44
Rate for Payer: Healthscope Commercial	$394.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$372.34
Rate for Payer: PHP Commercial	$372.34
Rate for Payer: Priority Health Cigna Priority Health	$284.73
Rate for Payer: Priority Health SBD	$275.97

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$24.23

Service Code	NDC 50742050501
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$21.81
Rate for Payer: Aetna Commercial	$20.60
Rate for Payer: Aetna Medicare	$12.12
Rate for Payer: Aetna New Business (MI Preferred)	$15.75
Rate for Payer: BCBS Complete	$9.69
Rate for Payer: Cash Price	$19.38
Rate for Payer: Cofinity Commercial	$16.96
Rate for Payer: Cofinity Commercial	$20.84
Rate for Payer: Cofinity Medicare Advantage	$16.96
Rate for Payer: Encore Health Key Benefits Commercial	$19.38
Rate for Payer: Healthscope Commercial	$21.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.60
Rate for Payer: PHP Commercial	$20.60
Rate for Payer: Priority Health Cigna Priority Health	$15.75
Rate for Payer: Priority Health SBD	$15.26

Know your out-of-pocket cost for care.

All Charges