Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SOTALOL 80 MG TABLET

Facility

$4.44

Service Code	NDC 00245001289
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.77
Rate for Payer: Aetna New Business (MI Preferred)	$2.89
Rate for Payer: Cash Price	$3.55
Rate for Payer: Cofinity Commercial	$3.11
Rate for Payer: Cofinity Commercial	$3.82
Rate for Payer: Cofinity Medicare Advantage	$3.11
Rate for Payer: Encore Health Key Benefits Commercial	$3.55
Rate for Payer: Healthscope Commercial	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.77
Rate for Payer: PHP Commercial	$3.77
Rate for Payer: Priority Health Cigna Priority Health	$2.89
Rate for Payer: Priority Health SBD	$2.80

SOTALOL 80 MG TABLET

Facility

$499.68

Service Code	NDC 68084065401
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$199.87
Max. Negotiated Rate	$449.71
Rate for Payer: Aetna Commercial	$424.73
Rate for Payer: Aetna Medicare	$249.84
Rate for Payer: Aetna New Business (MI Preferred)	$324.79
Rate for Payer: BCBS Complete	$199.87
Rate for Payer: Cash Price	$399.74
Rate for Payer: Cofinity Commercial	$349.78
Rate for Payer: Cofinity Commercial	$429.72
Rate for Payer: Cofinity Medicare Advantage	$349.78
Rate for Payer: Encore Health Key Benefits Commercial	$399.74
Rate for Payer: Healthscope Commercial	$449.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$424.73
Rate for Payer: PHP Commercial	$424.73
Rate for Payer: Priority Health Cigna Priority Health	$324.79
Rate for Payer: Priority Health SBD	$314.80

SOTALOL 80 MG TABLET

Facility

$4.44

Service Code	NDC 00245001289
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.77
Rate for Payer: Aetna Medicare	$2.22
Rate for Payer: Aetna New Business (MI Preferred)	$2.89
Rate for Payer: BCBS Complete	$1.78
Rate for Payer: Cash Price	$3.55
Rate for Payer: Cofinity Commercial	$3.11
Rate for Payer: Cofinity Commercial	$3.82
Rate for Payer: Cofinity Medicare Advantage	$3.11
Rate for Payer: Encore Health Key Benefits Commercial	$3.55
Rate for Payer: Healthscope Commercial	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.77
Rate for Payer: PHP Commercial	$3.77
Rate for Payer: Priority Health Cigna Priority Health	$2.89
Rate for Payer: Priority Health SBD	$2.80

SOTALOL 80 MG TABLET

Facility

$122.20

Service Code	NDC 60505008000
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$76.99
Max. Negotiated Rate	$109.98
Rate for Payer: Aetna Commercial	$103.87
Rate for Payer: Aetna New Business (MI Preferred)	$79.43
Rate for Payer: Cash Price	$97.76
Rate for Payer: Cofinity Commercial	$105.09
Rate for Payer: Cofinity Commercial	$85.54
Rate for Payer: Cofinity Medicare Advantage	$85.54
Rate for Payer: Encore Health Key Benefits Commercial	$97.76
Rate for Payer: Healthscope Commercial	$109.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.87
Rate for Payer: PHP Commercial	$103.87
Rate for Payer: Priority Health Cigna Priority Health	$79.43
Rate for Payer: Priority Health SBD	$76.99

SOTALOL 80 MG TABLET

Facility

$444.00

Service Code	NDC 00245001201
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$279.72
Max. Negotiated Rate	$399.60
Rate for Payer: Aetna Commercial	$377.40
Rate for Payer: Aetna New Business (MI Preferred)	$288.60
Rate for Payer: Cash Price	$355.20
Rate for Payer: Cofinity Commercial	$310.80
Rate for Payer: Cofinity Commercial	$381.84
Rate for Payer: Cofinity Medicare Advantage	$310.80
Rate for Payer: Encore Health Key Benefits Commercial	$355.20
Rate for Payer: Healthscope Commercial	$399.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$377.40
Rate for Payer: PHP Commercial	$377.40
Rate for Payer: Priority Health Cigna Priority Health	$288.60
Rate for Payer: Priority Health SBD	$279.72

SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER (SEPARATE PROCEDURE)

Facility

$7,528.73

Service Code	CPT 46080
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;

Facility

$1,901.18

Service Code	CPT 62270
Hospital Revenue Code	361
Min. Negotiated Rate	$362.01
Max. Negotiated Rate	$1,901.18
Rate for Payer: Aetna Medicare	$702.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$844.25
Rate for Payer: Amish Plain Church Group Commercial	$844.25
Rate for Payer: BCBS Complete	$380.12
Rate for Payer: BCBS MAPPO	$675.40
Rate for Payer: BCN Medicare Advantage	$675.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$675.40
Rate for Payer: Mclaren Medicaid	$362.01
Rate for Payer: Mclaren Medicare	$675.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$709.17
Rate for Payer: Meridian Medicaid	$380.12
Rate for Payer: MI Amish Medical Board Commercial	$776.71
Rate for Payer: PACE Medicare	$641.63
Rate for Payer: PACE SWMI	$675.40
Rate for Payer: PHP Medicare Advantage	$675.40
Rate for Payer: Priority Health Choice Medicaid	$362.01
Rate for Payer: Priority Health Medicare	$675.40
Rate for Payer: Railroad Medicare Medicare	$675.40
Rate for Payer: UHC All Payor (Choice/PPO)	$1,901.18
Rate for Payer: UHC Dual Complete DSNP	$675.40
Rate for Payer: UHC Medicare Advantage	$675.40
Rate for Payer: UHCCP Medicaid	$380.25
Rate for Payer: VA VA	$675.40

SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER);

Facility

$1,901.18

Service Code	CPT 62272
Hospital Revenue Code	361
Min. Negotiated Rate	$362.01
Max. Negotiated Rate	$1,901.18
Rate for Payer: Aetna Medicare	$702.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$844.25
Rate for Payer: Amish Plain Church Group Commercial	$844.25
Rate for Payer: BCBS Complete	$380.12
Rate for Payer: BCBS MAPPO	$675.40
Rate for Payer: BCN Medicare Advantage	$675.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$675.40
Rate for Payer: Mclaren Medicaid	$362.01
Rate for Payer: Mclaren Medicare	$675.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$709.17
Rate for Payer: Meridian Medicaid	$380.12
Rate for Payer: MI Amish Medical Board Commercial	$776.71
Rate for Payer: PACE Medicare	$641.63
Rate for Payer: PACE SWMI	$675.40
Rate for Payer: PHP Medicare Advantage	$675.40
Rate for Payer: Priority Health Choice Medicaid	$362.01
Rate for Payer: Priority Health Medicare	$675.40
Rate for Payer: Railroad Medicare Medicare	$675.40
Rate for Payer: UHC All Payor (Choice/PPO)	$1,901.18
Rate for Payer: UHC Dual Complete DSNP	$675.40
Rate for Payer: UHC Medicare Advantage	$675.40
Rate for Payer: UHCCP Medicaid	$380.25
Rate for Payer: VA VA	$675.40

SPIRONOLACTONE 25 MG TABLET

Facility

$162.15

Service Code	NDC 68382066001
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$64.86
Max. Negotiated Rate	$145.94
Rate for Payer: Aetna Commercial	$137.83
Rate for Payer: Aetna Medicare	$81.08
Rate for Payer: Aetna New Business (MI Preferred)	$105.40
Rate for Payer: BCBS Complete	$64.86
Rate for Payer: Cash Price	$129.72
Rate for Payer: Cofinity Commercial	$113.50
Rate for Payer: Cofinity Commercial	$139.45
Rate for Payer: Cofinity Medicare Advantage	$113.50
Rate for Payer: Encore Health Key Benefits Commercial	$129.72
Rate for Payer: Healthscope Commercial	$145.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.83
Rate for Payer: PHP Commercial	$137.83
Rate for Payer: Priority Health Cigna Priority Health	$105.40
Rate for Payer: Priority Health SBD	$102.15

SPIRONOLACTONE 25 MG TABLET

Facility

$282.00

Service Code	NDC 63739054410
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$112.80
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna Commercial	$239.70
Rate for Payer: Aetna Medicare	$141.00
Rate for Payer: Aetna New Business (MI Preferred)	$183.30
Rate for Payer: BCBS Complete	$112.80
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cofinity Commercial	$197.40
Rate for Payer: Cofinity Commercial	$242.52
Rate for Payer: Cofinity Medicare Advantage	$197.40
Rate for Payer: Encore Health Key Benefits Commercial	$225.60
Rate for Payer: Healthscope Commercial	$253.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.70
Rate for Payer: PHP Commercial	$239.70
Rate for Payer: Priority Health Cigna Priority Health	$183.30
Rate for Payer: Priority Health SBD	$177.66

SPIRONOLACTONE 25 MG TABLET

Facility

$162.15

Service Code	NDC 68382066001
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$145.94
Rate for Payer: Aetna Commercial	$137.83
Rate for Payer: Aetna New Business (MI Preferred)	$105.40
Rate for Payer: Cash Price	$129.72
Rate for Payer: Cofinity Commercial	$113.50
Rate for Payer: Cofinity Commercial	$139.45
Rate for Payer: Cofinity Medicare Advantage	$113.50
Rate for Payer: Encore Health Key Benefits Commercial	$129.72
Rate for Payer: Healthscope Commercial	$145.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.83
Rate for Payer: PHP Commercial	$137.83
Rate for Payer: Priority Health Cigna Priority Health	$105.40
Rate for Payer: Priority Health SBD	$102.15

SPIRONOLACTONE 25 MG TABLET

Facility

$274.95

Service Code	NDC 53746051101
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$173.22
Max. Negotiated Rate	$247.46
Rate for Payer: Aetna Commercial	$233.71
Rate for Payer: Aetna New Business (MI Preferred)	$178.72
Rate for Payer: Cash Price	$219.96
Rate for Payer: Cofinity Commercial	$192.47
Rate for Payer: Cofinity Commercial	$236.46
Rate for Payer: Cofinity Medicare Advantage	$192.47
Rate for Payer: Encore Health Key Benefits Commercial	$219.96
Rate for Payer: Healthscope Commercial	$247.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$233.71
Rate for Payer: PHP Commercial	$233.71
Rate for Payer: Priority Health Cigna Priority Health	$178.72
Rate for Payer: Priority Health SBD	$173.22

SPIRONOLACTONE 25 MG TABLET

Facility

$3.37

Service Code	NDC 60687046511
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna Commercial	$2.86
Rate for Payer: Aetna Medicare	$1.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.19
Rate for Payer: BCBS Complete	$1.35
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Cofinity Medicare Advantage	$2.36
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.86
Rate for Payer: PHP Commercial	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$2.19
Rate for Payer: Priority Health SBD	$2.12

SPIRONOLACTONE 25 MG TABLET

Facility

$387.75

Service Code	NDC 51079010320
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$155.10
Max. Negotiated Rate	$348.98
Rate for Payer: Aetna Commercial	$329.59
Rate for Payer: Aetna Medicare	$193.88
Rate for Payer: Aetna New Business (MI Preferred)	$252.04
Rate for Payer: BCBS Complete	$155.10
Rate for Payer: Cash Price	$310.20
Rate for Payer: Cofinity Commercial	$271.43
Rate for Payer: Cofinity Commercial	$333.46
Rate for Payer: Cofinity Medicare Advantage	$271.43
Rate for Payer: Encore Health Key Benefits Commercial	$310.20
Rate for Payer: Healthscope Commercial	$348.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.59
Rate for Payer: PHP Commercial	$329.59
Rate for Payer: Priority Health Cigna Priority Health	$252.04
Rate for Payer: Priority Health SBD	$244.28

SPIRONOLACTONE 25 MG TABLET

Facility

$282.00

Service Code	NDC 63739054410
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$177.66
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna Commercial	$239.70
Rate for Payer: Aetna New Business (MI Preferred)	$183.30
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cofinity Commercial	$197.40
Rate for Payer: Cofinity Commercial	$242.52
Rate for Payer: Cofinity Medicare Advantage	$197.40
Rate for Payer: Encore Health Key Benefits Commercial	$225.60
Rate for Payer: Healthscope Commercial	$253.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.70
Rate for Payer: PHP Commercial	$239.70
Rate for Payer: Priority Health Cigna Priority Health	$183.30
Rate for Payer: Priority Health SBD	$177.66

SPIRONOLACTONE 25 MG TABLET

Facility

$3.37

Service Code	NDC 60687046511
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna Commercial	$2.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.19
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Cofinity Medicare Advantage	$2.36
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.86
Rate for Payer: PHP Commercial	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$2.19
Rate for Payer: Priority Health SBD	$2.12

SPIRONOLACTONE 25 MG TABLET

Facility

$3.88

Service Code	NDC 51079010301
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$3.49
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare	$1.94
Rate for Payer: Aetna New Business (MI Preferred)	$2.52
Rate for Payer: BCBS Complete	$1.55
Rate for Payer: Cash Price	$3.10
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Cofinity Commercial	$3.34
Rate for Payer: Cofinity Medicare Advantage	$2.72
Rate for Payer: Encore Health Key Benefits Commercial	$3.10
Rate for Payer: Healthscope Commercial	$3.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.30
Rate for Payer: PHP Commercial	$3.30
Rate for Payer: Priority Health Cigna Priority Health	$2.52
Rate for Payer: Priority Health SBD	$2.44

SPIRONOLACTONE 25 MG TABLET

Facility

$3.88

Service Code	NDC 51079010301
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$3.49
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna New Business (MI Preferred)	$2.52
Rate for Payer: Cash Price	$3.10
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Cofinity Commercial	$3.34
Rate for Payer: Cofinity Medicare Advantage	$2.72
Rate for Payer: Encore Health Key Benefits Commercial	$3.10
Rate for Payer: Healthscope Commercial	$3.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.30
Rate for Payer: PHP Commercial	$3.30
Rate for Payer: Priority Health Cigna Priority Health	$2.52
Rate for Payer: Priority Health SBD	$2.44

SPIRONOLACTONE 25 MG TABLET

Facility

$336.05

Service Code	NDC 60687046501
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$211.71
Max. Negotiated Rate	$302.44
Rate for Payer: Aetna Commercial	$285.64
Rate for Payer: Aetna New Business (MI Preferred)	$218.43
Rate for Payer: Cash Price	$268.84
Rate for Payer: Cofinity Commercial	$235.24
Rate for Payer: Cofinity Commercial	$289.00
Rate for Payer: Cofinity Medicare Advantage	$235.24
Rate for Payer: Encore Health Key Benefits Commercial	$268.84
Rate for Payer: Healthscope Commercial	$302.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.64
Rate for Payer: PHP Commercial	$285.64
Rate for Payer: Priority Health Cigna Priority Health	$218.43
Rate for Payer: Priority Health SBD	$211.71

SPIRONOLACTONE 25 MG TABLET

Facility

$336.05

Service Code	NDC 60687046501
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$134.42
Max. Negotiated Rate	$302.44
Rate for Payer: Aetna Commercial	$285.64
Rate for Payer: Aetna Medicare	$168.03
Rate for Payer: Aetna New Business (MI Preferred)	$218.43
Rate for Payer: BCBS Complete	$134.42
Rate for Payer: Cash Price	$268.84
Rate for Payer: Cofinity Commercial	$235.24
Rate for Payer: Cofinity Commercial	$289.00
Rate for Payer: Cofinity Medicare Advantage	$235.24
Rate for Payer: Encore Health Key Benefits Commercial	$268.84
Rate for Payer: Healthscope Commercial	$302.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.64
Rate for Payer: PHP Commercial	$285.64
Rate for Payer: Priority Health Cigna Priority Health	$218.43
Rate for Payer: Priority Health SBD	$211.71

SPIRONOLACTONE 25 MG TABLET

Facility

$274.95

Service Code	NDC 53746051101
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$109.98
Max. Negotiated Rate	$247.46
Rate for Payer: Aetna Commercial	$233.71
Rate for Payer: Aetna Medicare	$137.47
Rate for Payer: Aetna New Business (MI Preferred)	$178.72
Rate for Payer: BCBS Complete	$109.98
Rate for Payer: Cash Price	$219.96
Rate for Payer: Cofinity Commercial	$192.47
Rate for Payer: Cofinity Commercial	$236.46
Rate for Payer: Cofinity Medicare Advantage	$192.47
Rate for Payer: Encore Health Key Benefits Commercial	$219.96
Rate for Payer: Healthscope Commercial	$247.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$233.71
Rate for Payer: PHP Commercial	$233.71
Rate for Payer: Priority Health Cigna Priority Health	$178.72
Rate for Payer: Priority Health SBD	$173.22

SPIRONOLACTONE 25 MG TABLET

Facility

$387.75

Service Code	NDC 51079010320
Hospital Charge Code	7437
Hospital Revenue Code	637
Min. Negotiated Rate	$244.28
Max. Negotiated Rate	$348.98
Rate for Payer: Aetna Commercial	$329.59
Rate for Payer: Aetna New Business (MI Preferred)	$252.04
Rate for Payer: Cash Price	$310.20
Rate for Payer: Cofinity Commercial	$271.43
Rate for Payer: Cofinity Commercial	$333.46
Rate for Payer: Cofinity Medicare Advantage	$271.43
Rate for Payer: Encore Health Key Benefits Commercial	$310.20
Rate for Payer: Healthscope Commercial	$348.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.59
Rate for Payer: PHP Commercial	$329.59
Rate for Payer: Priority Health Cigna Priority Health	$252.04
Rate for Payer: Priority Health SBD	$244.28

SPIRONOLACTONE 50 MG TABLET

Facility

$262.20

Service Code	NDC 53746051401
Hospital Charge Code	11426
Hospital Revenue Code	637
Min. Negotiated Rate	$104.88
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna Medicare	$131.10
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: BCBS Complete	$104.88
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Commercial	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Cofinity Medicare Advantage	$183.54
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health Cigna Priority Health	$170.43
Rate for Payer: Priority Health SBD	$165.19

SPIRONOLACTONE 50 MG TABLET

Facility

$2.65

Service Code	NDC 60687047611
Hospital Charge Code	11426
Hospital Revenue Code	637
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna New Business (MI Preferred)	$1.72
Rate for Payer: Cash Price	$2.12
Rate for Payer: Cofinity Commercial	$1.85
Rate for Payer: Cofinity Commercial	$2.28
Rate for Payer: Cofinity Medicare Advantage	$1.85
Rate for Payer: Encore Health Key Benefits Commercial	$2.12
Rate for Payer: Healthscope Commercial	$2.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.25
Rate for Payer: PHP Commercial	$2.25
Rate for Payer: Priority Health Cigna Priority Health	$1.72
Rate for Payer: Priority Health SBD	$1.67

SPIRONOLACTONE 50 MG TABLET

Facility

$290.70

Service Code	NDC 63739054510
Hospital Charge Code	11426
Hospital Revenue Code	637
Min. Negotiated Rate	$183.14
Max. Negotiated Rate	$261.63
Rate for Payer: Aetna Commercial	$247.09
Rate for Payer: Aetna New Business (MI Preferred)	$188.96
Rate for Payer: Cash Price	$232.56
Rate for Payer: Cofinity Commercial	$203.49
Rate for Payer: Cofinity Commercial	$250.00
Rate for Payer: Cofinity Medicare Advantage	$203.49
Rate for Payer: Encore Health Key Benefits Commercial	$232.56
Rate for Payer: Healthscope Commercial	$261.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.09
Rate for Payer: PHP Commercial	$247.09
Rate for Payer: Priority Health Cigna Priority Health	$188.96
Rate for Payer: Priority Health SBD	$183.14

Know your out-of-pocket cost for care.

All Charges