Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SULFACETAMIDE SODIUM 10 % EYE DROPS

Facility

$139.71

Service Code	NDC 24208067004
Hospital Charge Code	7359
Hospital Revenue Code	637
Min. Negotiated Rate	$88.02
Max. Negotiated Rate	$125.74
Rate for Payer: Aetna Commercial	$118.75
Rate for Payer: Aetna New Business (MI Preferred)	$90.81
Rate for Payer: Cash Price	$111.77
Rate for Payer: Cofinity Commercial	$120.15
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Cofinity Medicare Advantage	$97.80
Rate for Payer: Encore Health Key Benefits Commercial	$111.77
Rate for Payer: Healthscope Commercial	$125.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.75
Rate for Payer: PHP Commercial	$118.75
Rate for Payer: Priority Health Cigna Priority Health	$90.81
Rate for Payer: Priority Health SBD	$88.02

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$12.88

Service Code	NDC 50383082421
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.59
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna New Business (MI Preferred)	$8.37
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Cofinity Medicare Advantage	$9.02
Rate for Payer: Encore Health Key Benefits Commercial	$10.30
Rate for Payer: Healthscope Commercial	$11.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.95
Rate for Payer: PHP Commercial	$10.95
Rate for Payer: Priority Health Cigna Priority Health	$8.37
Rate for Payer: Priority Health SBD	$8.11

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$52.69

Service Code	NDC 00121085320
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$47.42
Rate for Payer: Aetna Commercial	$44.79
Rate for Payer: Aetna New Business (MI Preferred)	$34.25
Rate for Payer: Cash Price	$42.15
Rate for Payer: Cofinity Commercial	$36.88
Rate for Payer: Cofinity Commercial	$45.31
Rate for Payer: Cofinity Medicare Advantage	$36.88
Rate for Payer: Encore Health Key Benefits Commercial	$42.15
Rate for Payer: Healthscope Commercial	$47.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.79
Rate for Payer: PHP Commercial	$44.79
Rate for Payer: Priority Health Cigna Priority Health	$34.25
Rate for Payer: Priority Health SBD	$33.19

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$12.88

Service Code	NDC 50383082420
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$11.59
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna Medicare	$6.44
Rate for Payer: Aetna New Business (MI Preferred)	$8.37
Rate for Payer: BCBS Complete	$5.15
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Cofinity Medicare Advantage	$9.02
Rate for Payer: Encore Health Key Benefits Commercial	$10.30
Rate for Payer: Healthscope Commercial	$11.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.95
Rate for Payer: PHP Commercial	$10.95
Rate for Payer: Priority Health Cigna Priority Health	$8.37
Rate for Payer: Priority Health SBD	$8.11

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$52.69

Service Code	NDC 00121085340
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$47.42
Rate for Payer: Aetna Commercial	$44.79
Rate for Payer: Aetna Medicare	$26.34
Rate for Payer: Aetna New Business (MI Preferred)	$34.25
Rate for Payer: BCBS Complete	$21.08
Rate for Payer: Cash Price	$42.15
Rate for Payer: Cofinity Commercial	$36.88
Rate for Payer: Cofinity Commercial	$45.31
Rate for Payer: Cofinity Medicare Advantage	$36.88
Rate for Payer: Encore Health Key Benefits Commercial	$42.15
Rate for Payer: Healthscope Commercial	$47.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.79
Rate for Payer: PHP Commercial	$44.79
Rate for Payer: Priority Health Cigna Priority Health	$34.25
Rate for Payer: Priority Health SBD	$33.19

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$52.69

Service Code	NDC 00121085340
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$47.42
Rate for Payer: Aetna Commercial	$44.79
Rate for Payer: Aetna New Business (MI Preferred)	$34.25
Rate for Payer: Cash Price	$42.15
Rate for Payer: Cofinity Commercial	$36.88
Rate for Payer: Cofinity Commercial	$45.31
Rate for Payer: Cofinity Medicare Advantage	$36.88
Rate for Payer: Encore Health Key Benefits Commercial	$42.15
Rate for Payer: Healthscope Commercial	$47.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.79
Rate for Payer: PHP Commercial	$44.79
Rate for Payer: Priority Health Cigna Priority Health	$34.25
Rate for Payer: Priority Health SBD	$33.19

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$12.88

Service Code	NDC 50383082420
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.59
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna New Business (MI Preferred)	$8.37
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Cofinity Medicare Advantage	$9.02
Rate for Payer: Encore Health Key Benefits Commercial	$10.30
Rate for Payer: Healthscope Commercial	$11.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.95
Rate for Payer: PHP Commercial	$10.95
Rate for Payer: Priority Health Cigna Priority Health	$8.37
Rate for Payer: Priority Health SBD	$8.11

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$52.69

Service Code	NDC 00121085320
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$47.42
Rate for Payer: Aetna Commercial	$44.79
Rate for Payer: Aetna Medicare	$26.34
Rate for Payer: Aetna New Business (MI Preferred)	$34.25
Rate for Payer: BCBS Complete	$21.08
Rate for Payer: Cash Price	$42.15
Rate for Payer: Cofinity Commercial	$36.88
Rate for Payer: Cofinity Commercial	$45.31
Rate for Payer: Cofinity Medicare Advantage	$36.88
Rate for Payer: Encore Health Key Benefits Commercial	$42.15
Rate for Payer: Healthscope Commercial	$47.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.79
Rate for Payer: PHP Commercial	$44.79
Rate for Payer: Priority Health Cigna Priority Health	$34.25
Rate for Payer: Priority Health SBD	$33.19

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$12.88

Service Code	NDC 50383082421
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$11.59
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna Medicare	$6.44
Rate for Payer: Aetna New Business (MI Preferred)	$8.37
Rate for Payer: BCBS Complete	$5.15
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Cofinity Medicare Advantage	$9.02
Rate for Payer: Encore Health Key Benefits Commercial	$10.30
Rate for Payer: Healthscope Commercial	$11.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.95
Rate for Payer: PHP Commercial	$10.95
Rate for Payer: Priority Health Cigna Priority Health	$8.37
Rate for Payer: Priority Health SBD	$8.11

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$19.63

Service Code	NDC 00703951491
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$12.37
Max. Negotiated Rate	$17.67
Rate for Payer: Aetna Commercial	$16.69
Rate for Payer: Aetna New Business (MI Preferred)	$12.76
Rate for Payer: Cash Price	$15.70
Rate for Payer: Cofinity Commercial	$13.74
Rate for Payer: Cofinity Commercial	$16.88
Rate for Payer: Cofinity Medicare Advantage	$13.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.70
Rate for Payer: Healthscope Commercial	$17.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.69
Rate for Payer: PHP Commercial	$16.69
Rate for Payer: Priority Health Cigna Priority Health	$12.76
Rate for Payer: Priority Health SBD	$12.37

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$19.63

Service Code	NDC 00703951493
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$12.37
Max. Negotiated Rate	$17.67
Rate for Payer: Aetna Commercial	$16.69
Rate for Payer: Aetna New Business (MI Preferred)	$12.76
Rate for Payer: Cash Price	$15.70
Rate for Payer: Cofinity Commercial	$13.74
Rate for Payer: Cofinity Commercial	$16.88
Rate for Payer: Cofinity Medicare Advantage	$13.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.70
Rate for Payer: Healthscope Commercial	$17.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.69
Rate for Payer: PHP Commercial	$16.69
Rate for Payer: Priority Health Cigna Priority Health	$12.76
Rate for Payer: Priority Health SBD	$12.37

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$26.20

Service Code	NDC 70069036201
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$23.58
Rate for Payer: Aetna Commercial	$22.27
Rate for Payer: Aetna Medicare	$13.10
Rate for Payer: Aetna New Business (MI Preferred)	$17.03
Rate for Payer: BCBS Complete	$10.48
Rate for Payer: Cash Price	$20.96
Rate for Payer: Cofinity Commercial	$18.34
Rate for Payer: Cofinity Commercial	$22.53
Rate for Payer: Cofinity Medicare Advantage	$18.34
Rate for Payer: Encore Health Key Benefits Commercial	$20.96
Rate for Payer: Healthscope Commercial	$23.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.27
Rate for Payer: PHP Commercial	$22.27
Rate for Payer: Priority Health Cigna Priority Health	$17.03
Rate for Payer: Priority Health SBD	$16.51

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$26.20

Service Code	NDC 70069036210
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$23.58
Rate for Payer: Aetna Commercial	$22.27
Rate for Payer: Aetna New Business (MI Preferred)	$17.03
Rate for Payer: Cash Price	$20.96
Rate for Payer: Cofinity Commercial	$18.34
Rate for Payer: Cofinity Commercial	$22.53
Rate for Payer: Cofinity Medicare Advantage	$18.34
Rate for Payer: Encore Health Key Benefits Commercial	$20.96
Rate for Payer: Healthscope Commercial	$23.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.27
Rate for Payer: PHP Commercial	$22.27
Rate for Payer: Priority Health Cigna Priority Health	$17.03
Rate for Payer: Priority Health SBD	$16.51

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$19.63

Service Code	NDC 00703951491
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$17.67
Rate for Payer: Aetna Commercial	$16.69
Rate for Payer: Aetna Medicare	$9.82
Rate for Payer: Aetna New Business (MI Preferred)	$12.76
Rate for Payer: BCBS Complete	$7.85
Rate for Payer: Cash Price	$15.70
Rate for Payer: Cofinity Commercial	$13.74
Rate for Payer: Cofinity Commercial	$16.88
Rate for Payer: Cofinity Medicare Advantage	$13.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.70
Rate for Payer: Healthscope Commercial	$17.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.69
Rate for Payer: PHP Commercial	$16.69
Rate for Payer: Priority Health Cigna Priority Health	$12.76
Rate for Payer: Priority Health SBD	$12.37

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$26.20

Service Code	NDC 70069036201
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$23.58
Rate for Payer: Aetna Commercial	$22.27
Rate for Payer: Aetna New Business (MI Preferred)	$17.03
Rate for Payer: Cash Price	$20.96
Rate for Payer: Cofinity Commercial	$18.34
Rate for Payer: Cofinity Commercial	$22.53
Rate for Payer: Cofinity Medicare Advantage	$18.34
Rate for Payer: Encore Health Key Benefits Commercial	$20.96
Rate for Payer: Healthscope Commercial	$23.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.27
Rate for Payer: PHP Commercial	$22.27
Rate for Payer: Priority Health Cigna Priority Health	$17.03
Rate for Payer: Priority Health SBD	$16.51

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$26.20

Service Code	NDC 70069036210
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$23.58
Rate for Payer: Aetna Commercial	$22.27
Rate for Payer: Aetna Medicare	$13.10
Rate for Payer: Aetna New Business (MI Preferred)	$17.03
Rate for Payer: BCBS Complete	$10.48
Rate for Payer: Cash Price	$20.96
Rate for Payer: Cofinity Commercial	$18.34
Rate for Payer: Cofinity Commercial	$22.53
Rate for Payer: Cofinity Medicare Advantage	$18.34
Rate for Payer: Encore Health Key Benefits Commercial	$20.96
Rate for Payer: Healthscope Commercial	$23.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.27
Rate for Payer: PHP Commercial	$22.27
Rate for Payer: Priority Health Cigna Priority Health	$17.03
Rate for Payer: Priority Health SBD	$16.51

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$19.63

Service Code	NDC 00703951493
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$17.67
Rate for Payer: Aetna Commercial	$16.69
Rate for Payer: Aetna Medicare	$9.82
Rate for Payer: Aetna New Business (MI Preferred)	$12.76
Rate for Payer: BCBS Complete	$7.85
Rate for Payer: Cash Price	$15.70
Rate for Payer: Cofinity Commercial	$13.74
Rate for Payer: Cofinity Commercial	$16.88
Rate for Payer: Cofinity Medicare Advantage	$13.74
Rate for Payer: Encore Health Key Benefits Commercial	$15.70
Rate for Payer: Healthscope Commercial	$17.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.69
Rate for Payer: PHP Commercial	$16.69
Rate for Payer: Priority Health Cigna Priority Health	$12.76
Rate for Payer: Priority Health SBD	$12.37

SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET

Facility

$291.40

Service Code	NDC 00904272561
Hospital Charge Code	7555
Hospital Revenue Code	637
Min. Negotiated Rate	$183.58
Max. Negotiated Rate	$262.26
Rate for Payer: Aetna Commercial	$247.69
Rate for Payer: Aetna New Business (MI Preferred)	$189.41
Rate for Payer: Cash Price	$233.12
Rate for Payer: Cofinity Commercial	$203.98
Rate for Payer: Cofinity Commercial	$250.60
Rate for Payer: Cofinity Medicare Advantage	$203.98
Rate for Payer: Encore Health Key Benefits Commercial	$233.12
Rate for Payer: Healthscope Commercial	$262.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.69
Rate for Payer: PHP Commercial	$247.69
Rate for Payer: Priority Health Cigna Priority Health	$189.41
Rate for Payer: Priority Health SBD	$183.58

SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET

Facility

$291.40

Service Code	NDC 00904272561
Hospital Charge Code	7555
Hospital Revenue Code	637
Min. Negotiated Rate	$116.56
Max. Negotiated Rate	$262.26
Rate for Payer: Aetna Commercial	$247.69
Rate for Payer: Aetna Medicare	$145.70
Rate for Payer: Aetna New Business (MI Preferred)	$189.41
Rate for Payer: BCBS Complete	$116.56
Rate for Payer: Cash Price	$233.12
Rate for Payer: Cofinity Commercial	$203.98
Rate for Payer: Cofinity Commercial	$250.60
Rate for Payer: Cofinity Medicare Advantage	$203.98
Rate for Payer: Encore Health Key Benefits Commercial	$233.12
Rate for Payer: Healthscope Commercial	$262.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.69
Rate for Payer: PHP Commercial	$247.69
Rate for Payer: Priority Health Cigna Priority Health	$189.41
Rate for Payer: Priority Health SBD	$183.58

SULFASALAZINE 500 MG TABLET

Facility

$892.80

Service Code	NDC 62135096001
Hospital Charge Code	7562
Hospital Revenue Code	637
Min. Negotiated Rate	$562.46
Max. Negotiated Rate	$803.52
Rate for Payer: Aetna Commercial	$758.88
Rate for Payer: Aetna New Business (MI Preferred)	$580.32
Rate for Payer: Cash Price	$714.24
Rate for Payer: Cofinity Commercial	$624.96
Rate for Payer: Cofinity Commercial	$767.81
Rate for Payer: Cofinity Medicare Advantage	$624.96
Rate for Payer: Encore Health Key Benefits Commercial	$714.24
Rate for Payer: Healthscope Commercial	$803.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$758.88
Rate for Payer: PHP Commercial	$758.88
Rate for Payer: Priority Health Cigna Priority Health	$580.32
Rate for Payer: Priority Health SBD	$562.46

SULFASALAZINE 500 MG TABLET

Facility

$423.00

Service Code	NDC 59762500005
Hospital Charge Code	7562
Hospital Revenue Code	637
Min. Negotiated Rate	$169.20
Max. Negotiated Rate	$380.70
Rate for Payer: Aetna Commercial	$359.55
Rate for Payer: Aetna Medicare	$211.50
Rate for Payer: Aetna New Business (MI Preferred)	$274.95
Rate for Payer: BCBS Complete	$169.20
Rate for Payer: Cash Price	$338.40
Rate for Payer: Cofinity Commercial	$296.10
Rate for Payer: Cofinity Commercial	$363.78
Rate for Payer: Cofinity Medicare Advantage	$296.10
Rate for Payer: Encore Health Key Benefits Commercial	$338.40
Rate for Payer: Healthscope Commercial	$380.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.55
Rate for Payer: PHP Commercial	$359.55
Rate for Payer: Priority Health Cigna Priority Health	$274.95
Rate for Payer: Priority Health SBD	$266.49

SULFASALAZINE 500 MG TABLET

Facility

$725.76

Service Code	NDC 00013010110
Hospital Charge Code	7562
Hospital Revenue Code	637
Min. Negotiated Rate	$457.23
Max. Negotiated Rate	$653.18
Rate for Payer: Aetna Commercial	$616.90
Rate for Payer: Aetna New Business (MI Preferred)	$471.74
Rate for Payer: Cash Price	$580.61
Rate for Payer: Cofinity Commercial	$508.03
Rate for Payer: Cofinity Commercial	$624.15
Rate for Payer: Cofinity Medicare Advantage	$508.03
Rate for Payer: Encore Health Key Benefits Commercial	$580.61
Rate for Payer: Healthscope Commercial	$653.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$616.90
Rate for Payer: PHP Commercial	$616.90
Rate for Payer: Priority Health Cigna Priority Health	$471.74
Rate for Payer: Priority Health SBD	$457.23

SULFASALAZINE 500 MG TABLET

Facility

$725.76

Service Code	NDC 00013010110
Hospital Charge Code	7562
Hospital Revenue Code	637
Min. Negotiated Rate	$290.30
Max. Negotiated Rate	$653.18
Rate for Payer: Aetna Commercial	$616.90
Rate for Payer: Aetna Medicare	$362.88
Rate for Payer: Aetna New Business (MI Preferred)	$471.74
Rate for Payer: BCBS Complete	$290.30
Rate for Payer: Cash Price	$580.61
Rate for Payer: Cofinity Commercial	$508.03
Rate for Payer: Cofinity Commercial	$624.15
Rate for Payer: Cofinity Medicare Advantage	$508.03
Rate for Payer: Encore Health Key Benefits Commercial	$580.61
Rate for Payer: Healthscope Commercial	$653.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$616.90
Rate for Payer: PHP Commercial	$616.90
Rate for Payer: Priority Health Cigna Priority Health	$471.74
Rate for Payer: Priority Health SBD	$457.23

SULFASALAZINE 500 MG TABLET

Facility

$892.80

Service Code	NDC 62135096001
Hospital Charge Code	7562
Hospital Revenue Code	637
Min. Negotiated Rate	$357.12
Max. Negotiated Rate	$803.52
Rate for Payer: Aetna Commercial	$758.88
Rate for Payer: Aetna Medicare	$446.40
Rate for Payer: Aetna New Business (MI Preferred)	$580.32
Rate for Payer: BCBS Complete	$357.12
Rate for Payer: Cash Price	$714.24
Rate for Payer: Cofinity Commercial	$624.96
Rate for Payer: Cofinity Commercial	$767.81
Rate for Payer: Cofinity Medicare Advantage	$624.96
Rate for Payer: Encore Health Key Benefits Commercial	$714.24
Rate for Payer: Healthscope Commercial	$803.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$758.88
Rate for Payer: PHP Commercial	$758.88
Rate for Payer: Priority Health Cigna Priority Health	$580.32
Rate for Payer: Priority Health SBD	$562.46

SULFASALAZINE 500 MG TABLET

Facility

$423.00

Service Code	NDC 59762500005
Hospital Charge Code	7562
Hospital Revenue Code	637
Min. Negotiated Rate	$266.49
Max. Negotiated Rate	$380.70
Rate for Payer: Aetna Commercial	$359.55
Rate for Payer: Aetna New Business (MI Preferred)	$274.95
Rate for Payer: Cash Price	$338.40
Rate for Payer: Cofinity Commercial	$296.10
Rate for Payer: Cofinity Commercial	$363.78
Rate for Payer: Cofinity Medicare Advantage	$296.10
Rate for Payer: Encore Health Key Benefits Commercial	$338.40
Rate for Payer: Healthscope Commercial	$380.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.55
Rate for Payer: PHP Commercial	$359.55
Rate for Payer: Priority Health Cigna Priority Health	$274.95
Rate for Payer: Priority Health SBD	$266.49

Know your out-of-pocket cost for care.

All Charges