Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CELECOXIB 100 MG CAPSULE

Facility

$807.71

Service Code	NDC 51079019920
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$508.86
Max. Negotiated Rate	$726.94
Rate for Payer: Aetna Commercial	$686.55
Rate for Payer: Aetna New Business (MI Preferred)	$525.01
Rate for Payer: Cash Price	$646.17
Rate for Payer: Cofinity Commercial	$565.40
Rate for Payer: Cofinity Commercial	$694.63
Rate for Payer: Cofinity Medicare Advantage	$565.40
Rate for Payer: Encore Health Key Benefits Commercial	$646.17
Rate for Payer: Healthscope Commercial	$726.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$686.55
Rate for Payer: PHP Commercial	$686.55
Rate for Payer: Priority Health Cigna Priority Health	$525.01
Rate for Payer: Priority Health SBD	$508.86

CELECOXIB 100 MG CAPSULE

Facility

$3,464.31

Service Code	NDC 00025152031
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$1,385.72
Max. Negotiated Rate	$3,117.88
Rate for Payer: Aetna Commercial	$2,944.66
Rate for Payer: Aetna Medicare	$1,732.15
Rate for Payer: Aetna New Business (MI Preferred)	$2,251.80
Rate for Payer: BCBS Complete	$1,385.72
Rate for Payer: Cash Price	$2,771.45
Rate for Payer: Cofinity Commercial	$2,425.02
Rate for Payer: Cofinity Commercial	$2,979.31
Rate for Payer: Cofinity Medicare Advantage	$2,425.02
Rate for Payer: Encore Health Key Benefits Commercial	$2,771.45
Rate for Payer: Healthscope Commercial	$3,117.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,944.66
Rate for Payer: PHP Commercial	$2,944.66
Rate for Payer: Priority Health Cigna Priority Health	$2,251.80
Rate for Payer: Priority Health SBD	$2,182.52

CELECOXIB 200 MG CAPSULE

Facility

$5.58

Service Code	NDC 60687044711
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$5.02
Rate for Payer: Aetna Commercial	$4.74
Rate for Payer: Aetna New Business (MI Preferred)	$3.63
Rate for Payer: Cash Price	$4.46
Rate for Payer: Cofinity Commercial	$3.91
Rate for Payer: Cofinity Commercial	$4.80
Rate for Payer: Cofinity Medicare Advantage	$3.91
Rate for Payer: Encore Health Key Benefits Commercial	$4.46
Rate for Payer: Healthscope Commercial	$5.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.74
Rate for Payer: PHP Commercial	$4.74
Rate for Payer: Priority Health Cigna Priority Health	$3.63
Rate for Payer: Priority Health SBD	$3.52

CELECOXIB 200 MG CAPSULE

Facility

$202.10

Service Code	NDC 33342015711
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$80.84
Max. Negotiated Rate	$181.89
Rate for Payer: Aetna Commercial	$171.78
Rate for Payer: Aetna Medicare	$101.05
Rate for Payer: Aetna New Business (MI Preferred)	$131.37
Rate for Payer: BCBS Complete	$80.84
Rate for Payer: Cash Price	$161.68
Rate for Payer: Cofinity Commercial	$141.47
Rate for Payer: Cofinity Commercial	$173.81
Rate for Payer: Cofinity Medicare Advantage	$141.47
Rate for Payer: Encore Health Key Benefits Commercial	$161.68
Rate for Payer: Healthscope Commercial	$181.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$171.78
Rate for Payer: PHP Commercial	$171.78
Rate for Payer: Priority Health Cigna Priority Health	$131.37
Rate for Payer: Priority Health SBD	$127.32

CELECOXIB 200 MG CAPSULE

Facility

$5,682.09

Service Code	NDC 00025152534
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$3,579.72
Max. Negotiated Rate	$5,113.88
Rate for Payer: Aetna Commercial	$4,829.78
Rate for Payer: Aetna New Business (MI Preferred)	$3,693.36
Rate for Payer: Cash Price	$4,545.67
Rate for Payer: Cofinity Commercial	$3,977.46
Rate for Payer: Cofinity Commercial	$4,886.60
Rate for Payer: Cofinity Medicare Advantage	$3,977.46
Rate for Payer: Encore Health Key Benefits Commercial	$4,545.67
Rate for Payer: Healthscope Commercial	$5,113.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,829.78
Rate for Payer: PHP Commercial	$4,829.78
Rate for Payer: Priority Health Cigna Priority Health	$3,693.36
Rate for Payer: Priority Health SBD	$3,579.72

CELECOXIB 200 MG CAPSULE

Facility

$5.05

Service Code	NDC 50268016911
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$4.54
Rate for Payer: Aetna Commercial	$4.29
Rate for Payer: Aetna New Business (MI Preferred)	$3.28
Rate for Payer: Cash Price	$4.04
Rate for Payer: Cofinity Commercial	$3.54
Rate for Payer: Cofinity Commercial	$4.34
Rate for Payer: Cofinity Medicare Advantage	$3.54
Rate for Payer: Encore Health Key Benefits Commercial	$4.04
Rate for Payer: Healthscope Commercial	$4.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.29
Rate for Payer: PHP Commercial	$4.29
Rate for Payer: Priority Health Cigna Priority Health	$3.28
Rate for Payer: Priority Health SBD	$3.18

CELECOXIB 200 MG CAPSULE

Facility

$5.58

Service Code	NDC 60687044711
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$5.02
Rate for Payer: Aetna Commercial	$4.74
Rate for Payer: Aetna Medicare	$2.79
Rate for Payer: Aetna New Business (MI Preferred)	$3.63
Rate for Payer: BCBS Complete	$2.23
Rate for Payer: Cash Price	$4.46
Rate for Payer: Cofinity Commercial	$3.91
Rate for Payer: Cofinity Commercial	$4.80
Rate for Payer: Cofinity Medicare Advantage	$3.91
Rate for Payer: Encore Health Key Benefits Commercial	$4.46
Rate for Payer: Healthscope Commercial	$5.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.74
Rate for Payer: PHP Commercial	$4.74
Rate for Payer: Priority Health Cigna Priority Health	$3.63
Rate for Payer: Priority Health SBD	$3.52

CELECOXIB 200 MG CAPSULE

Facility

$202.10

Service Code	NDC 33342015711
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$127.32
Max. Negotiated Rate	$181.89
Rate for Payer: Aetna Commercial	$171.78
Rate for Payer: Aetna New Business (MI Preferred)	$131.37
Rate for Payer: Cash Price	$161.68
Rate for Payer: Cofinity Commercial	$141.47
Rate for Payer: Cofinity Commercial	$173.81
Rate for Payer: Cofinity Medicare Advantage	$141.47
Rate for Payer: Encore Health Key Benefits Commercial	$161.68
Rate for Payer: Healthscope Commercial	$181.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$171.78
Rate for Payer: PHP Commercial	$171.78
Rate for Payer: Priority Health Cigna Priority Health	$131.37
Rate for Payer: Priority Health SBD	$127.32

CELECOXIB 200 MG CAPSULE

Facility

$252.48

Service Code	NDC 50268016915
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$100.99
Max. Negotiated Rate	$227.23
Rate for Payer: Aetna Commercial	$214.61
Rate for Payer: Aetna Medicare	$126.24
Rate for Payer: Aetna New Business (MI Preferred)	$164.11
Rate for Payer: BCBS Complete	$100.99
Rate for Payer: Cash Price	$201.98
Rate for Payer: Cofinity Commercial	$176.74
Rate for Payer: Cofinity Commercial	$217.13
Rate for Payer: Cofinity Medicare Advantage	$176.74
Rate for Payer: Encore Health Key Benefits Commercial	$201.98
Rate for Payer: Healthscope Commercial	$227.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.61
Rate for Payer: PHP Commercial	$214.61
Rate for Payer: Priority Health Cigna Priority Health	$164.11
Rate for Payer: Priority Health SBD	$159.06

CELECOXIB 200 MG CAPSULE

Facility

$506.40

Service Code	NDC 00904650361
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$319.03
Max. Negotiated Rate	$455.76
Rate for Payer: Aetna Commercial	$430.44
Rate for Payer: Aetna New Business (MI Preferred)	$329.16
Rate for Payer: Cash Price	$405.12
Rate for Payer: Cofinity Commercial	$354.48
Rate for Payer: Cofinity Commercial	$435.50
Rate for Payer: Cofinity Medicare Advantage	$354.48
Rate for Payer: Encore Health Key Benefits Commercial	$405.12
Rate for Payer: Healthscope Commercial	$455.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$430.44
Rate for Payer: PHP Commercial	$430.44
Rate for Payer: Priority Health Cigna Priority Health	$329.16
Rate for Payer: Priority Health SBD	$319.03

CELECOXIB 200 MG CAPSULE

Facility

$506.40

Service Code	NDC 00904650361
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$202.56
Max. Negotiated Rate	$455.76
Rate for Payer: Aetna Commercial	$430.44
Rate for Payer: Aetna Medicare	$253.20
Rate for Payer: Aetna New Business (MI Preferred)	$329.16
Rate for Payer: BCBS Complete	$202.56
Rate for Payer: Cash Price	$405.12
Rate for Payer: Cofinity Commercial	$354.48
Rate for Payer: Cofinity Commercial	$435.50
Rate for Payer: Cofinity Medicare Advantage	$354.48
Rate for Payer: Encore Health Key Benefits Commercial	$405.12
Rate for Payer: Healthscope Commercial	$455.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$430.44
Rate for Payer: PHP Commercial	$430.44
Rate for Payer: Priority Health Cigna Priority Health	$329.16
Rate for Payer: Priority Health SBD	$319.03

CELECOXIB 200 MG CAPSULE

Facility

$5,682.09

Service Code	NDC 00025152534
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$2,272.84
Max. Negotiated Rate	$5,113.88
Rate for Payer: Aetna Commercial	$4,829.78
Rate for Payer: Aetna Medicare	$2,841.05
Rate for Payer: Aetna New Business (MI Preferred)	$3,693.36
Rate for Payer: BCBS Complete	$2,272.84
Rate for Payer: Cash Price	$4,545.67
Rate for Payer: Cofinity Commercial	$3,977.46
Rate for Payer: Cofinity Commercial	$4,886.60
Rate for Payer: Cofinity Medicare Advantage	$3,977.46
Rate for Payer: Encore Health Key Benefits Commercial	$4,545.67
Rate for Payer: Healthscope Commercial	$5,113.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,829.78
Rate for Payer: PHP Commercial	$4,829.78
Rate for Payer: Priority Health Cigna Priority Health	$3,693.36
Rate for Payer: Priority Health SBD	$3,579.72

CELECOXIB 200 MG CAPSULE

Facility

$5.05

Service Code	NDC 50268016911
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$4.54
Rate for Payer: Aetna Commercial	$4.29
Rate for Payer: Aetna Medicare	$2.52
Rate for Payer: Aetna New Business (MI Preferred)	$3.28
Rate for Payer: BCBS Complete	$2.02
Rate for Payer: Cash Price	$4.04
Rate for Payer: Cofinity Commercial	$3.54
Rate for Payer: Cofinity Commercial	$4.34
Rate for Payer: Cofinity Medicare Advantage	$3.54
Rate for Payer: Encore Health Key Benefits Commercial	$4.04
Rate for Payer: Healthscope Commercial	$4.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.29
Rate for Payer: PHP Commercial	$4.29
Rate for Payer: Priority Health Cigna Priority Health	$3.28
Rate for Payer: Priority Health SBD	$3.18

CELECOXIB 200 MG CAPSULE

Facility

$465.30

Service Code	NDC 69097042107
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$186.12
Max. Negotiated Rate	$418.77
Rate for Payer: Aetna Commercial	$395.50
Rate for Payer: Aetna Medicare	$232.65
Rate for Payer: Aetna New Business (MI Preferred)	$302.44
Rate for Payer: BCBS Complete	$186.12
Rate for Payer: Cash Price	$372.24
Rate for Payer: Cofinity Commercial	$325.71
Rate for Payer: Cofinity Commercial	$400.16
Rate for Payer: Cofinity Medicare Advantage	$325.71
Rate for Payer: Encore Health Key Benefits Commercial	$372.24
Rate for Payer: Healthscope Commercial	$418.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$395.50
Rate for Payer: PHP Commercial	$395.50
Rate for Payer: Priority Health Cigna Priority Health	$302.44
Rate for Payer: Priority Health SBD	$293.14

CELECOXIB 200 MG CAPSULE

Facility

$465.30

Service Code	NDC 69097042107
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$293.14
Max. Negotiated Rate	$418.77
Rate for Payer: Aetna Commercial	$395.50
Rate for Payer: Aetna New Business (MI Preferred)	$302.44
Rate for Payer: Cash Price	$372.24
Rate for Payer: Cofinity Commercial	$325.71
Rate for Payer: Cofinity Commercial	$400.16
Rate for Payer: Cofinity Medicare Advantage	$325.71
Rate for Payer: Encore Health Key Benefits Commercial	$372.24
Rate for Payer: Healthscope Commercial	$418.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$395.50
Rate for Payer: PHP Commercial	$395.50
Rate for Payer: Priority Health Cigna Priority Health	$302.44
Rate for Payer: Priority Health SBD	$293.14

CELECOXIB 200 MG CAPSULE

Facility

$557.76

Service Code	NDC 60687044701
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$223.10
Max. Negotiated Rate	$501.98
Rate for Payer: Aetna Commercial	$474.10
Rate for Payer: Aetna Medicare	$278.88
Rate for Payer: Aetna New Business (MI Preferred)	$362.54
Rate for Payer: BCBS Complete	$223.10
Rate for Payer: Cash Price	$446.21
Rate for Payer: Cofinity Commercial	$390.43
Rate for Payer: Cofinity Commercial	$479.67
Rate for Payer: Cofinity Medicare Advantage	$390.43
Rate for Payer: Encore Health Key Benefits Commercial	$446.21
Rate for Payer: Healthscope Commercial	$501.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$474.10
Rate for Payer: PHP Commercial	$474.10
Rate for Payer: Priority Health Cigna Priority Health	$362.54
Rate for Payer: Priority Health SBD	$351.39

CELECOXIB 200 MG CAPSULE

Facility

$557.76

Service Code	NDC 60687044701
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$351.39
Max. Negotiated Rate	$501.98
Rate for Payer: Aetna Commercial	$474.10
Rate for Payer: Aetna New Business (MI Preferred)	$362.54
Rate for Payer: Cash Price	$446.21
Rate for Payer: Cofinity Commercial	$390.43
Rate for Payer: Cofinity Commercial	$479.67
Rate for Payer: Cofinity Medicare Advantage	$390.43
Rate for Payer: Encore Health Key Benefits Commercial	$446.21
Rate for Payer: Healthscope Commercial	$501.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$474.10
Rate for Payer: PHP Commercial	$474.10
Rate for Payer: Priority Health Cigna Priority Health	$362.54
Rate for Payer: Priority Health SBD	$351.39

CELECOXIB 200 MG CAPSULE

Facility

$252.48

Service Code	NDC 50268016915
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$159.06
Max. Negotiated Rate	$227.23
Rate for Payer: Aetna Commercial	$214.61
Rate for Payer: Aetna New Business (MI Preferred)	$164.11
Rate for Payer: Cash Price	$201.98
Rate for Payer: Cofinity Commercial	$176.74
Rate for Payer: Cofinity Commercial	$217.13
Rate for Payer: Cofinity Medicare Advantage	$176.74
Rate for Payer: Encore Health Key Benefits Commercial	$201.98
Rate for Payer: Healthscope Commercial	$227.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.61
Rate for Payer: PHP Commercial	$214.61
Rate for Payer: Priority Health Cigna Priority Health	$164.11
Rate for Payer: Priority Health SBD	$159.06

CELECOXIB 400 MG CAPSULE

Facility

$185.25

Service Code	NDC 65862091060
Hospital Charge Code	33653
Hospital Revenue Code	637
Min. Negotiated Rate	$74.10
Max. Negotiated Rate	$166.72
Rate for Payer: Aetna Commercial	$157.46
Rate for Payer: Aetna Medicare	$92.62
Rate for Payer: Aetna New Business (MI Preferred)	$120.41
Rate for Payer: BCBS Complete	$74.10
Rate for Payer: Cash Price	$148.20
Rate for Payer: Cofinity Commercial	$129.68
Rate for Payer: Cofinity Commercial	$159.31
Rate for Payer: Cofinity Medicare Advantage	$129.68
Rate for Payer: Encore Health Key Benefits Commercial	$148.20
Rate for Payer: Healthscope Commercial	$166.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.46
Rate for Payer: PHP Commercial	$157.46
Rate for Payer: Priority Health Cigna Priority Health	$120.41
Rate for Payer: Priority Health SBD	$116.71

CELECOXIB 400 MG CAPSULE

Facility

$185.25

Service Code	NDC 65862091060
Hospital Charge Code	33653
Hospital Revenue Code	637
Min. Negotiated Rate	$116.71
Max. Negotiated Rate	$166.72
Rate for Payer: Aetna Commercial	$157.46
Rate for Payer: Aetna New Business (MI Preferred)	$120.41
Rate for Payer: Cash Price	$148.20
Rate for Payer: Cofinity Commercial	$129.68
Rate for Payer: Cofinity Commercial	$159.31
Rate for Payer: Cofinity Medicare Advantage	$129.68
Rate for Payer: Encore Health Key Benefits Commercial	$148.20
Rate for Payer: Healthscope Commercial	$166.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.46
Rate for Payer: PHP Commercial	$157.46
Rate for Payer: Priority Health Cigna Priority Health	$120.41
Rate for Payer: Priority Health SBD	$116.71

CELECOXIB 400 MG CAPSULE

Facility

$312.48

Service Code	NDC 13668031060
Hospital Charge Code	33653
Hospital Revenue Code	637
Min. Negotiated Rate	$196.86
Max. Negotiated Rate	$281.23
Rate for Payer: Aetna Commercial	$265.61
Rate for Payer: Aetna New Business (MI Preferred)	$203.11
Rate for Payer: Cash Price	$249.98
Rate for Payer: Cofinity Commercial	$218.74
Rate for Payer: Cofinity Commercial	$268.73
Rate for Payer: Cofinity Medicare Advantage	$218.74
Rate for Payer: Encore Health Key Benefits Commercial	$249.98
Rate for Payer: Healthscope Commercial	$281.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$265.61
Rate for Payer: PHP Commercial	$265.61
Rate for Payer: Priority Health Cigna Priority Health	$203.11
Rate for Payer: Priority Health SBD	$196.86

CELECOXIB 400 MG CAPSULE

Facility

$312.48

Service Code	NDC 13668031060
Hospital Charge Code	33653
Hospital Revenue Code	637
Min. Negotiated Rate	$124.99
Max. Negotiated Rate	$281.23
Rate for Payer: Aetna Commercial	$265.61
Rate for Payer: Aetna Medicare	$156.24
Rate for Payer: Aetna New Business (MI Preferred)	$203.11
Rate for Payer: BCBS Complete	$124.99
Rate for Payer: Cash Price	$249.98
Rate for Payer: Cofinity Commercial	$218.74
Rate for Payer: Cofinity Commercial	$268.73
Rate for Payer: Cofinity Medicare Advantage	$218.74
Rate for Payer: Encore Health Key Benefits Commercial	$249.98
Rate for Payer: Healthscope Commercial	$281.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$265.61
Rate for Payer: PHP Commercial	$265.61
Rate for Payer: Priority Health Cigna Priority Health	$203.11
Rate for Payer: Priority Health SBD	$196.86

CELECOXIB 400 MG CAPSULE

Facility

$502.56

Service Code	NDC 59762151802
Hospital Charge Code	33653
Hospital Revenue Code	637
Min. Negotiated Rate	$316.61
Max. Negotiated Rate	$452.30
Rate for Payer: Aetna Commercial	$427.18
Rate for Payer: Aetna New Business (MI Preferred)	$326.66
Rate for Payer: Cash Price	$402.05
Rate for Payer: Cofinity Commercial	$351.79
Rate for Payer: Cofinity Commercial	$432.20
Rate for Payer: Cofinity Medicare Advantage	$351.79
Rate for Payer: Encore Health Key Benefits Commercial	$402.05
Rate for Payer: Healthscope Commercial	$452.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$427.18
Rate for Payer: PHP Commercial	$427.18
Rate for Payer: Priority Health Cigna Priority Health	$326.66
Rate for Payer: Priority Health SBD	$316.61

CELECOXIB 400 MG CAPSULE

Facility

$502.56

Service Code	NDC 59762151802
Hospital Charge Code	33653
Hospital Revenue Code	637
Min. Negotiated Rate	$201.02
Max. Negotiated Rate	$452.30
Rate for Payer: Aetna Commercial	$427.18
Rate for Payer: Aetna Medicare	$251.28
Rate for Payer: Aetna New Business (MI Preferred)	$326.66
Rate for Payer: BCBS Complete	$201.02
Rate for Payer: Cash Price	$402.05
Rate for Payer: Cofinity Commercial	$351.79
Rate for Payer: Cofinity Commercial	$432.20
Rate for Payer: Cofinity Medicare Advantage	$351.79
Rate for Payer: Encore Health Key Benefits Commercial	$402.05
Rate for Payer: Healthscope Commercial	$452.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$427.18
Rate for Payer: PHP Commercial	$427.18
Rate for Payer: Priority Health Cigna Priority Health	$326.66
Rate for Payer: Priority Health SBD	$316.61

CELLULOSE, OXIDIZED 4" X 8" PADS

Facility

$279.50

Service Code	NDC 09900000604
Hospital Charge Code	169204
Hospital Revenue Code	250
Min. Negotiated Rate	$111.80
Max. Negotiated Rate	$251.55
Rate for Payer: Aetna Commercial	$237.57
Rate for Payer: Aetna Medicare	$139.75
Rate for Payer: Aetna New Business (MI Preferred)	$181.68
Rate for Payer: BCBS Complete	$111.80
Rate for Payer: Cash Price	$223.60
Rate for Payer: Cofinity Commercial	$195.65
Rate for Payer: Cofinity Commercial	$240.37
Rate for Payer: Cofinity Medicare Advantage	$195.65
Rate for Payer: Encore Health Key Benefits Commercial	$223.60
Rate for Payer: Healthscope Commercial	$251.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$237.57
Rate for Payer: PHP Commercial	$237.57
Rate for Payer: Priority Health Cigna Priority Health	$181.68
Rate for Payer: Priority Health SBD	$176.09

Know your out-of-pocket cost for care.

All Charges