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	$39.85
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.76
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: Cash Price	$50.60
Rate for Payer: Cofinity Commercial	$44.28
Rate for Payer: Cofinity Commercial	$54.40
Rate for Payer: Cofinity Medicare Advantage	$44.28
Rate for Payer: Encore Health Key Benefits Commercial	$50.60
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.76
Rate for Payer: PHP Commercial	$53.76
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.85

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	$27.60
Max. Negotiated Rate	$39.43
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna New Business (MI Preferred)	$28.48
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

$632.41

Service Code	NDC 00378647097
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$398.42
Max. Negotiated Rate	$569.17
Rate for Payer: Aetna Commercial	$537.55
Rate for Payer: Aetna New Business (MI Preferred)	$411.07
Rate for Payer: Cash Price	$505.93
Rate for Payer: Cofinity Commercial	$442.69
Rate for Payer: Cofinity Commercial	$543.87
Rate for Payer: Cofinity Medicare Advantage	$442.69
Rate for Payer: Encore Health Key Benefits Commercial	$505.93
Rate for Payer: Healthscope Commercial	$569.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$537.55
Rate for Payer: PHP Commercial	$537.55
Rate for Payer: Priority Health Cigna Priority Health	$411.07
Rate for Payer: Priority Health SBD	$398.42

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

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

$24.23

Service Code	NDC 50742050501
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$21.81
Rate for Payer: Aetna Commercial	$20.60
Rate for Payer: Aetna New Business (MI Preferred)	$15.75
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

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	$25.30
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 Commercial	$44.28
Rate for Payer: Cofinity Commercial	$54.40
Rate for Payer: Cofinity Medicare Advantage	$44.28
Rate for Payer: Encore Health Key Benefits Commercial	$50.60
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.76
Rate for Payer: PHP Commercial	$53.76
Rate for Payer: Priority Health Cigna Priority Health	$41.11
Rate for Payer: Priority Health SBD	$39.85

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	$205.95
Max. Negotiated Rate	$294.21
Rate for Payer: Aetna Commercial	$277.86
Rate for Payer: Aetna New Business (MI Preferred)	$212.48
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

$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

$245.35

Service Code	NDC 50742050510
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$154.57
Max. Negotiated Rate	$220.82
Rate for Payer: Aetna Commercial	$208.55
Rate for Payer: Aetna New Business (MI Preferred)	$159.48
Rate for Payer: Cash Price	$196.28
Rate for Payer: Cofinity Commercial	$171.74
Rate for Payer: Cofinity Commercial	$211.00
Rate for Payer: Cofinity Medicare Advantage	$171.74
Rate for Payer: Encore Health Key Benefits Commercial	$196.28
Rate for Payer: Healthscope Commercial	$220.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.55
Rate for Payer: PHP Commercial	$208.55
Rate for Payer: Priority Health Cigna Priority Health	$159.48
Rate for Payer: Priority Health SBD	$154.57

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	$369.63
Max. Negotiated Rate	$528.04
Rate for Payer: Aetna Commercial	$498.70
Rate for Payer: Aetna New Business (MI Preferred)	$381.36
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

$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 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

SCREENING OF A PATIENT

Professional

Both

$15.00

Service Code	HCPCS D0190
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$2,519.00
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	$2,519.00
Rate for Payer: Priority Health Choice Medicaid	$19.20
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: UHCCP Medicaid	$19.20

SCROTAL EXPLORATION

Facility

$10,620.87

Service Code	CPT 55110
Hospital Revenue Code	360
Min. Negotiated Rate	$411.52
Max. Negotiated Rate	$10,620.87
Rate for Payer: Aetna Medicare	$3,514.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,224.04
Rate for Payer: Amish Plain Church Group Commercial	$4,224.04
Rate for Payer: BCBS Complete	$1,901.83
Rate for Payer: BCBS MAPPO	$3,379.23
Rate for Payer: BCBS Trust/PPO	$914.83
Rate for Payer: BCN Commercial	$914.83
Rate for Payer: BCN Medicare Advantage	$3,379.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,379.23
Rate for Payer: Mclaren Medicaid	$1,811.27
Rate for Payer: Mclaren Medicare	$3,379.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,548.19
Rate for Payer: Meridian Medicaid	$1,901.83
Rate for Payer: MI Amish Medical Board Commercial	$3,886.11
Rate for Payer: Nomi Health Commercial	$7,096.38
Rate for Payer: PACE Medicare	$3,210.27
Rate for Payer: PACE SWMI	$3,379.23
Rate for Payer: PHP Medicare Advantage	$3,379.23
Rate for Payer: Priority Health Choice Medicaid	$1,811.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,620.87
Rate for Payer: Priority Health Medicare	$3,379.23
Rate for Payer: Priority Health Narrow Network	$8,496.70
Rate for Payer: Railroad Medicare Medicare	$3,379.23
Rate for Payer: UHC All Payor (Choice/PPO)	$411.52
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,379.23
Rate for Payer: UHC Exchange	$4,450.00
Rate for Payer: UHC Medicare Advantage	$3,379.23
Rate for Payer: UHCCP Medicaid	$1,902.51
Rate for Payer: VA VA	$3,379.23

SCROTOPLASTY; SIMPLE

Facility

$10,620.87

Service Code	CPT 55175
Hospital Revenue Code	360
Min. Negotiated Rate	$386.74
Max. Negotiated Rate	$10,620.87
Rate for Payer: Aetna Medicare	$3,514.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,224.04
Rate for Payer: Amish Plain Church Group Commercial	$4,224.04
Rate for Payer: BCBS Complete	$1,901.83
Rate for Payer: BCBS MAPPO	$3,379.23
Rate for Payer: BCBS Trust/PPO	$1,319.44
Rate for Payer: BCN Commercial	$1,319.44
Rate for Payer: BCN Medicare Advantage	$3,379.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,379.23
Rate for Payer: Mclaren Medicaid	$1,811.27
Rate for Payer: Mclaren Medicare	$3,379.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,548.19
Rate for Payer: Meridian Medicaid	$1,901.83
Rate for Payer: MI Amish Medical Board Commercial	$3,886.11
Rate for Payer: Nomi Health Commercial	$7,096.38
Rate for Payer: PACE Medicare	$3,210.27
Rate for Payer: PACE SWMI	$3,379.23
Rate for Payer: PHP Medicare Advantage	$3,379.23
Rate for Payer: Priority Health Choice Medicaid	$1,811.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,620.87
Rate for Payer: Priority Health Medicare	$3,379.23
Rate for Payer: Priority Health Narrow Network	$8,496.70
Rate for Payer: Railroad Medicare Medicare	$3,379.23
Rate for Payer: UHC All Payor (Choice/PPO)	$386.74
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$3,379.23
Rate for Payer: UHC Exchange	$7,322.00
Rate for Payer: UHC Medicare Advantage	$3,379.23
Rate for Payer: UHCCP Medicaid	$1,902.51
Rate for Payer: VA VA	$3,379.23

SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED

Facility

$5,632.99

Service Code	CPT 13160
Hospital Revenue Code	360
Min. Negotiated Rate	$842.03
Max. Negotiated Rate	$5,632.99
Rate for Payer: Aetna Medicare	$1,863.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,240.30
Rate for Payer: Amish Plain Church Group Commercial	$2,240.30
Rate for Payer: BCBS Complete	$1,008.67
Rate for Payer: BCBS MAPPO	$1,792.24
Rate for Payer: BCBS Trust/PPO	$2,124.91
Rate for Payer: BCN Commercial	$2,124.91
Rate for Payer: BCN Medicare Advantage	$1,792.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,792.24
Rate for Payer: Mclaren Medicaid	$960.64
Rate for Payer: Mclaren Medicare	$1,792.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,881.85
Rate for Payer: Meridian Medicaid	$1,008.67
Rate for Payer: MI Amish Medical Board Commercial	$2,061.08
Rate for Payer: Nomi Health Commercial	$3,763.70
Rate for Payer: PACE Medicare	$1,702.63
Rate for Payer: PACE SWMI	$1,792.24
Rate for Payer: PHP Medicare Advantage	$1,792.24
Rate for Payer: Priority Health Choice Medicaid	$960.64
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,632.99
Rate for Payer: Priority Health Medicare	$1,792.24
Rate for Payer: Priority Health Narrow Network	$4,506.39
Rate for Payer: Railroad Medicare Medicare	$1,792.24
Rate for Payer: UHC All Payor (Choice/PPO)	$842.03
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,792.24
Rate for Payer: UHC Exchange	$3,362.00
Rate for Payer: UHC Medicare Advantage	$1,792.24
Rate for Payer: UHCCP Medicaid	$1,009.03
Rate for Payer: VA VA	$1,792.24

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY

Facility

$2,641.38

Service Code	CPT 36247
Hospital Revenue Code	360
Min. Negotiated Rate	$314.23
Max. Negotiated Rate	$2,641.38
Rate for Payer: BCBS Trust/PPO	$2,641.38
Rate for Payer: BCN Commercial	$2,641.38
Rate for Payer: UHC All Payor (Choice/PPO)	$314.23
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; FIRST ORDER BRANCH (EG, RENAL VEIN, JUGULAR VEIN)

Facility

$2,074.18

Service Code	CPT 36011
Hospital Revenue Code	360
Min. Negotiated Rate	$164.27
Max. Negotiated Rate	$2,074.18
Rate for Payer: BCBS Trust/PPO	$2,074.18
Rate for Payer: BCN Commercial	$2,074.18
Rate for Payer: UHC All Payor (Choice/PPO)	$164.27
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND ORDER, OR MORE SELECTIVE, BRANCH (EG, LEFT ADRENAL VEIN, PETROSAL SINUS)

Facility

$2,114.95

Service Code	CPT 36012
Hospital Revenue Code	360
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$2,114.95
Rate for Payer: BCBS Trust/PPO	$2,114.95
Rate for Payer: BCN Commercial	$2,114.95
Rate for Payer: UHC All Payor (Choice/PPO)	$183.00
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$940.00

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 Commercial	$607.01
Rate for Payer: Cofinity Commercial	$494.07
Rate for Payer: Cofinity Medicare Advantage	$494.07
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: PHP Commercial	$599.95
Rate for Payer: Priority Health Cigna Priority Health	$458.78
Rate for Payer: Priority Health SBD	$444.67

SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION

Facility

$705.82

Service Code	NDC 00517656025
Hospital Charge Code	190643
Hospital Revenue Code	250
Min. Negotiated Rate	$282.33
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 Commercial	$494.07
Rate for Payer: Cofinity Commercial	$607.01
Rate for Payer: Cofinity Medicare Advantage	$494.07
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: PHP Commercial	$599.95
Rate for Payer: Priority Health Cigna Priority Health	$458.78
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	$41.45
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 Commercial	$72.53
Rate for Payer: Cofinity Commercial	$89.11
Rate for Payer: Cofinity Medicare Advantage	$72.53
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: PHP Commercial	$88.08
Rate for Payer: Priority Health Cigna Priority Health	$67.35
Rate for Payer: Priority Health SBD	$65.28

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$159.50

Service Code	NDC 60687062201
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$100.48
Max. Negotiated Rate	$143.55
Rate for Payer: Aetna Commercial	$135.58
Rate for Payer: Aetna New Business (MI Preferred)	$103.68
Rate for Payer: Cash Price	$127.60
Rate for Payer: Cofinity Commercial	$111.65
Rate for Payer: Cofinity Commercial	$137.17
Rate for Payer: Cofinity Medicare Advantage	$111.65
Rate for Payer: Encore Health Key Benefits Commercial	$127.60
Rate for Payer: Healthscope Commercial	$143.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.58
Rate for Payer: PHP Commercial	$135.58
Rate for Payer: Priority Health Cigna Priority Health	$103.68
Rate for Payer: Priority Health SBD	$100.48

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	$59.54
Max. Negotiated Rate	$85.05
Rate for Payer: Aetna Commercial	$80.32
Rate for Payer: Aetna New Business (MI Preferred)	$61.42
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cofinity Commercial	$66.15
Rate for Payer: Cofinity Commercial	$81.27
Rate for Payer: Cofinity Medicare Advantage	$66.15
Rate for Payer: Encore Health Key Benefits Commercial	$75.60
Rate for Payer: Healthscope Commercial	$85.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.32
Rate for Payer: PHP Commercial	$80.32
Rate for Payer: Priority Health Cigna Priority Health	$61.42
Rate for Payer: Priority Health SBD	$59.54

Know your out-of-pocket cost for care.

All Charges