Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$130.80

Service Code	NDC 50268071715
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$82.40
Max. Negotiated Rate	$117.72
Rate for Payer: Aetna Commercial	$111.18
Rate for Payer: Aetna New Business (MI Preferred)	$85.02
Rate for Payer: Cash Price	$104.64
Rate for Payer: Cofinity Commercial	$112.49
Rate for Payer: Cofinity Commercial	$91.56
Rate for Payer: Cofinity Medicare Advantage	$91.56
Rate for Payer: Encore Health Key Benefits Commercial	$104.64
Rate for Payer: Healthscope Commercial	$117.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.18
Rate for Payer: PHP Commercial	$111.18
Rate for Payer: Priority Health Cigna Priority Health	$85.02
Rate for Payer: Priority Health SBD	$82.40

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$235.60

Service Code	NDC 00904667106
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$148.43
Max. Negotiated Rate	$212.04
Rate for Payer: Aetna Commercial	$200.26
Rate for Payer: Aetna New Business (MI Preferred)	$153.14
Rate for Payer: Cash Price	$188.48
Rate for Payer: Cofinity Commercial	$164.92
Rate for Payer: Cofinity Commercial	$202.62
Rate for Payer: Cofinity Medicare Advantage	$164.92
Rate for Payer: Encore Health Key Benefits Commercial	$188.48
Rate for Payer: Healthscope Commercial	$212.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.26
Rate for Payer: PHP Commercial	$200.26
Rate for Payer: Priority Health Cigna Priority Health	$153.14
Rate for Payer: Priority Health SBD	$148.43

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$2.62

Service Code	NDC 50268071711
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare	$1.31
Rate for Payer: Aetna New Business (MI Preferred)	$1.70
Rate for Payer: BCBS Complete	$1.05
Rate for Payer: Cash Price	$2.10
Rate for Payer: Cofinity Commercial	$1.83
Rate for Payer: Cofinity Commercial	$2.25
Rate for Payer: Cofinity Medicare Advantage	$1.83
Rate for Payer: Encore Health Key Benefits Commercial	$2.10
Rate for Payer: Healthscope Commercial	$2.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.23
Rate for Payer: PHP Commercial	$2.23
Rate for Payer: Priority Health Cigna Priority Health	$1.70
Rate for Payer: Priority Health SBD	$1.65

SILDENAFIL (REVATIO) 20 MG TABLET

Facility

$130.80

Service Code	NDC 50268071715
Hospital Charge Code	41832
Hospital Revenue Code	637
Min. Negotiated Rate	$52.32
Max. Negotiated Rate	$117.72
Rate for Payer: Aetna Commercial	$111.18
Rate for Payer: Aetna Medicare	$65.40
Rate for Payer: Aetna New Business (MI Preferred)	$85.02
Rate for Payer: BCBS Complete	$52.32
Rate for Payer: Cash Price	$104.64
Rate for Payer: Cofinity Commercial	$112.49
Rate for Payer: Cofinity Commercial	$91.56
Rate for Payer: Cofinity Medicare Advantage	$91.56
Rate for Payer: Encore Health Key Benefits Commercial	$104.64
Rate for Payer: Healthscope Commercial	$117.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.18
Rate for Payer: PHP Commercial	$111.18
Rate for Payer: Priority Health Cigna Priority Health	$85.02
Rate for Payer: Priority Health SBD	$82.40

SILVER ER TOPICAL GEL,EXTENDED RELEASE

Facility

$72.54

Service Code	NDC 80196029660
Hospital Charge Code	115249
Hospital Revenue Code	637
Min. Negotiated Rate	$29.02
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 Commercial	$50.78
Rate for Payer: Cofinity Commercial	$62.38
Rate for Payer: Cofinity Medicare Advantage	$50.78
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: PHP Commercial	$61.66
Rate for Payer: Priority Health Cigna Priority Health	$47.15
Rate for Payer: Priority Health SBD	$45.70

SILVER ER TOPICAL GEL,EXTENDED RELEASE

Facility

$70.71

Service Code	NDC 08327030909
Hospital Charge Code	115249
Hospital Revenue Code	637
Min. Negotiated Rate	$28.28
Max. Negotiated Rate	$63.64
Rate for Payer: Aetna Commercial	$60.10
Rate for Payer: Aetna Medicare	$35.35
Rate for Payer: Aetna New Business (MI Preferred)	$45.96
Rate for Payer: BCBS Complete	$28.28
Rate for Payer: Cash Price	$56.57
Rate for Payer: Cofinity Commercial	$49.50
Rate for Payer: Cofinity Commercial	$60.81
Rate for Payer: Cofinity Medicare Advantage	$49.50
Rate for Payer: Encore Health Key Benefits Commercial	$56.57
Rate for Payer: Healthscope Commercial	$63.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.10
Rate for Payer: PHP Commercial	$60.10
Rate for Payer: Priority Health Cigna Priority Health	$45.96
Rate for Payer: Priority Health SBD	$44.55

SILVER ER TOPICAL GEL,EXTENDED RELEASE

Facility

$70.71

Service Code	NDC 08327030909
Hospital Charge Code	115249
Hospital Revenue Code	637
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$63.64
Rate for Payer: Aetna Commercial	$60.10
Rate for Payer: Aetna New Business (MI Preferred)	$45.96
Rate for Payer: Cash Price	$56.57
Rate for Payer: Cofinity Commercial	$49.50
Rate for Payer: Cofinity Commercial	$60.81
Rate for Payer: Cofinity Medicare Advantage	$49.50
Rate for Payer: Encore Health Key Benefits Commercial	$56.57
Rate for Payer: Healthscope Commercial	$63.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.10
Rate for Payer: PHP Commercial	$60.10
Rate for Payer: Priority Health Cigna Priority Health	$45.96
Rate for Payer: Priority Health SBD	$44.55

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 Commercial	$50.78
Rate for Payer: Cofinity Commercial	$62.38
Rate for Payer: Cofinity Medicare Advantage	$50.78
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: PHP Commercial	$61.66
Rate for Payer: Priority Health Cigna Priority Health	$47.15
Rate for Payer: Priority Health SBD	$45.70

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 Commercial	$3.61
Rate for Payer: Cofinity Commercial	$4.44
Rate for Payer: Cofinity Medicare Advantage	$3.61
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: PHP Commercial	$4.39
Rate for Payer: Priority Health Cigna Priority Health	$3.35
Rate for Payer: Priority Health SBD	$3.25

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$81.90

Service Code	NDC 12165010003
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$73.71
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: Aetna New Business (MI Preferred)	$53.23
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cofinity Commercial	$57.33
Rate for Payer: Cofinity Commercial	$70.43
Rate for Payer: Cofinity Medicare Advantage	$57.33
Rate for Payer: Encore Health Key Benefits Commercial	$65.52
Rate for Payer: Healthscope Commercial	$73.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.61
Rate for Payer: PHP Commercial	$69.61
Rate for Payer: Priority Health Cigna Priority Health	$53.23
Rate for Payer: Priority Health SBD	$51.60

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	$2.06
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 Commercial	$3.61
Rate for Payer: Cofinity Commercial	$4.44
Rate for Payer: Cofinity Medicare Advantage	$3.61
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: PHP Commercial	$4.39
Rate for Payer: Priority Health Cigna Priority Health	$3.35
Rate for Payer: Priority Health SBD	$3.25

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$81.90

Service Code	NDC 12165010001
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$73.71
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: Aetna New Business (MI Preferred)	$53.23
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cofinity Commercial	$57.33
Rate for Payer: Cofinity Commercial	$70.43
Rate for Payer: Cofinity Medicare Advantage	$57.33
Rate for Payer: Encore Health Key Benefits Commercial	$65.52
Rate for Payer: Healthscope Commercial	$73.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.61
Rate for Payer: PHP Commercial	$69.61
Rate for Payer: Priority Health Cigna Priority Health	$53.23
Rate for Payer: Priority Health SBD	$51.60

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$81.90

Service Code	NDC 12165010003
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$73.71
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: Aetna Medicare	$40.95
Rate for Payer: Aetna New Business (MI Preferred)	$53.23
Rate for Payer: BCBS Complete	$32.76
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cofinity Commercial	$57.33
Rate for Payer: Cofinity Commercial	$70.43
Rate for Payer: Cofinity Medicare Advantage	$57.33
Rate for Payer: Encore Health Key Benefits Commercial	$65.52
Rate for Payer: Healthscope Commercial	$73.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.61
Rate for Payer: PHP Commercial	$69.61
Rate for Payer: Priority Health Cigna Priority Health	$53.23
Rate for Payer: Priority Health SBD	$51.60

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$81.90

Service Code	NDC 12165010001
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$73.71
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: Aetna Medicare	$40.95
Rate for Payer: Aetna New Business (MI Preferred)	$53.23
Rate for Payer: BCBS Complete	$32.76
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cofinity Commercial	$57.33
Rate for Payer: Cofinity Commercial	$70.43
Rate for Payer: Cofinity Medicare Advantage	$57.33
Rate for Payer: Encore Health Key Benefits Commercial	$65.52
Rate for Payer: Healthscope Commercial	$73.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.61
Rate for Payer: PHP Commercial	$69.61
Rate for Payer: Priority Health Cigna Priority Health	$53.23
Rate for Payer: Priority Health SBD	$51.60

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$18.90

Service Code	NDC 67877012405
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$17.01
Rate for Payer: Aetna Commercial	$16.07
Rate for Payer: Aetna Medicare	$9.45
Rate for Payer: Aetna New Business (MI Preferred)	$12.29
Rate for Payer: BCBS Complete	$7.56
Rate for Payer: Cash Price	$15.12
Rate for Payer: Cofinity Commercial	$13.23
Rate for Payer: Cofinity Commercial	$16.25
Rate for Payer: Cofinity Medicare Advantage	$13.23
Rate for Payer: Encore Health Key Benefits Commercial	$15.12
Rate for Payer: Healthscope Commercial	$17.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.07
Rate for Payer: PHP Commercial	$16.07
Rate for Payer: Priority Health Cigna Priority Health	$12.29
Rate for Payer: Priority Health SBD	$11.91

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 Commercial	$16.91
Rate for Payer: Cofinity Commercial	$20.77
Rate for Payer: Cofinity Medicare Advantage	$16.91
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: PHP Commercial	$20.53
Rate for Payer: Priority Health Cigna Priority Health	$15.70
Rate for Payer: Priority Health SBD	$15.21

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$88.20

Service Code	NDC 67877012440
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: BCBS Complete	$35.28
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
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: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$18.90

Service Code	NDC 67877012405
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$17.01
Rate for Payer: Aetna Commercial	$16.07
Rate for Payer: Aetna New Business (MI Preferred)	$12.29
Rate for Payer: Cash Price	$15.12
Rate for Payer: Cofinity Commercial	$13.23
Rate for Payer: Cofinity Commercial	$16.25
Rate for Payer: Cofinity Medicare Advantage	$13.23
Rate for Payer: Encore Health Key Benefits Commercial	$15.12
Rate for Payer: Healthscope Commercial	$17.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.07
Rate for Payer: PHP Commercial	$16.07
Rate for Payer: Priority Health Cigna Priority Health	$12.29
Rate for Payer: Priority Health SBD	$11.91

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$24.15

Service Code	NDC 43598021025
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$9.66
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 Commercial	$16.91
Rate for Payer: Cofinity Commercial	$20.77
Rate for Payer: Cofinity Medicare Advantage	$16.91
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: PHP Commercial	$20.53
Rate for Payer: Priority Health Cigna Priority Health	$15.70
Rate for Payer: Priority Health SBD	$15.21

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$15.08

Service Code	NDC 67877012425
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna Commercial	$12.82
Rate for Payer: Aetna Medicare	$7.54
Rate for Payer: Aetna New Business (MI Preferred)	$9.80
Rate for Payer: BCBS Complete	$6.03
Rate for Payer: Cash Price	$12.06
Rate for Payer: Cofinity Commercial	$10.56
Rate for Payer: Cofinity Commercial	$12.97
Rate for Payer: Cofinity Medicare Advantage	$10.56
Rate for Payer: Encore Health Key Benefits Commercial	$12.06
Rate for Payer: Healthscope Commercial	$13.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.82
Rate for Payer: PHP Commercial	$12.82
Rate for Payer: Priority Health Cigna Priority Health	$9.80
Rate for Payer: Priority Health SBD	$9.50

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$88.20

Service Code	NDC 67877012440
Hospital Charge Code	7224
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 Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
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: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$15.08

Service Code	NDC 67877012425
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna Commercial	$12.82
Rate for Payer: Aetna New Business (MI Preferred)	$9.80
Rate for Payer: Cash Price	$12.06
Rate for Payer: Cofinity Commercial	$10.56
Rate for Payer: Cofinity Commercial	$12.97
Rate for Payer: Cofinity Medicare Advantage	$10.56
Rate for Payer: Encore Health Key Benefits Commercial	$12.06
Rate for Payer: Healthscope Commercial	$13.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.82
Rate for Payer: PHP Commercial	$12.82
Rate for Payer: Priority Health Cigna Priority Health	$9.80
Rate for Payer: Priority Health SBD	$9.50

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$24.84

Service Code	NDC 62372063015
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$22.36
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna New Business (MI Preferred)	$16.15
Rate for Payer: Cash Price	$19.87
Rate for Payer: Cofinity Commercial	$17.39
Rate for Payer: Cofinity Commercial	$21.36
Rate for Payer: Cofinity Medicare Advantage	$17.39
Rate for Payer: Encore Health Key Benefits Commercial	$19.87
Rate for Payer: Healthscope Commercial	$22.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.11
Rate for Payer: PHP Commercial	$21.11
Rate for Payer: Priority Health Cigna Priority Health	$16.15
Rate for Payer: Priority Health SBD	$15.65

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$9.05

Service Code	NDC 00536130375
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$8.14
Rate for Payer: Aetna Commercial	$7.69
Rate for Payer: Aetna Medicare	$4.53
Rate for Payer: Aetna New Business (MI Preferred)	$5.88
Rate for Payer: BCBS Complete	$3.62
Rate for Payer: Cash Price	$7.24
Rate for Payer: Cofinity Commercial	$6.33
Rate for Payer: Cofinity Commercial	$7.78
Rate for Payer: Cofinity Medicare Advantage	$6.33
Rate for Payer: Encore Health Key Benefits Commercial	$7.24
Rate for Payer: Healthscope Commercial	$8.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.69
Rate for Payer: PHP Commercial	$7.69
Rate for Payer: Priority Health Cigna Priority Health	$5.88
Rate for Payer: Priority Health SBD	$5.70

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$9.05

Service Code	NDC 00536130375
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$8.14
Rate for Payer: Aetna Commercial	$7.69
Rate for Payer: Aetna New Business (MI Preferred)	$5.88
Rate for Payer: Cash Price	$7.24
Rate for Payer: Cofinity Commercial	$6.33
Rate for Payer: Cofinity Commercial	$7.78
Rate for Payer: Cofinity Medicare Advantage	$6.33
Rate for Payer: Encore Health Key Benefits Commercial	$7.24
Rate for Payer: Healthscope Commercial	$8.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.69
Rate for Payer: PHP Commercial	$7.69
Rate for Payer: Priority Health Cigna Priority Health	$5.88
Rate for Payer: Priority Health SBD	$5.70

Know your out-of-pocket cost for care.

All Charges