Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

VILAZODONE 20 MG TABLET

Facility

$1,317.46

Service Code	NDC 00456112030
Hospital Charge Code	152700
Hospital Revenue Code	637
Min. Negotiated Rate	$830.00
Max. Negotiated Rate	$1,185.71
Rate for Payer: Aetna Commercial	$1,119.84
Rate for Payer: Aetna New Business (MI Preferred)	$856.35
Rate for Payer: Cash Price	$1,053.97
Rate for Payer: Cofinity Advantage	$922.22
Rate for Payer: Cofinity Commercial	$1,133.02
Rate for Payer: Encore Health Key Benefits Commercial	$1,053.97
Rate for Payer: Healthscope Commercial	$1,185.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,119.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$988.10
Rate for Payer: PHP Commercial	$1,119.84
Rate for Payer: Priority Health SBD	$830.00

VILAZODONE 20 MG TABLET

Facility

$542.24

Service Code	NDC 62332023330
Hospital Charge Code	152700
Hospital Revenue Code	637
Min. Negotiated Rate	$341.61
Max. Negotiated Rate	$488.02
Rate for Payer: Aetna Commercial	$460.90
Rate for Payer: Aetna New Business (MI Preferred)	$352.46
Rate for Payer: Cash Price	$433.79
Rate for Payer: Cofinity Advantage	$379.57
Rate for Payer: Cofinity Commercial	$466.33
Rate for Payer: Encore Health Key Benefits Commercial	$433.79
Rate for Payer: Healthscope Commercial	$488.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$460.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$406.68
Rate for Payer: PHP Commercial	$460.90
Rate for Payer: Priority Health SBD	$341.61

VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$507.28

Service Code	HCPCS J9360
Hospital Charge Code	8594
Hospital Revenue Code	636
Min. Negotiated Rate	$319.59
Max. Negotiated Rate	$456.55
Rate for Payer: Aetna Commercial	$431.19
Rate for Payer: Aetna New Business (MI Preferred)	$329.73
Rate for Payer: Cash Price	$405.82
Rate for Payer: Cofinity Advantage	$355.10
Rate for Payer: Cofinity Commercial	$436.26
Rate for Payer: Encore Health Key Benefits Commercial	$405.82
Rate for Payer: Healthscope Commercial	$456.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$380.46
Rate for Payer: PHP Commercial	$431.19
Rate for Payer: Priority Health SBD	$319.59

VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$507.28

Service Code	HCPCS J9360
Hospital Charge Code	8594
Hospital Revenue Code	636
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$456.55
Rate for Payer: Aetna Commercial	$431.19
Rate for Payer: Aetna Medicare	$253.64
Rate for Payer: Aetna New Business (MI Preferred)	$329.73
Rate for Payer: BCBS Complete	$202.91
Rate for Payer: BCBS Trust/PPO	$13.00
Rate for Payer: BCN Commercial	$13.00
Rate for Payer: Cash Price	$405.82
Rate for Payer: Cash Price	$405.82
Rate for Payer: Cofinity Advantage	$355.10
Rate for Payer: Cofinity Commercial	$436.26
Rate for Payer: Encore Health Key Benefits Commercial	$405.82
Rate for Payer: Healthscope Commercial	$456.55
Rate for Payer: MI Amish Medical Board Commercial	$405.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$431.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$380.46
Rate for Payer: PHP Commercial	$431.19
Rate for Payer: Priority Health SBD	$319.59
Rate for Payer: UHC All Payor (Choice/PPO)	$8.55
Rate for Payer: UHC Core	$8.55
Rate for Payer: UHC Exchange	$8.55

VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$109.27

Service Code	HCPCS J9370
Hospital Charge Code	8597
Hospital Revenue Code	636
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$98.34
Rate for Payer: Aetna Commercial	$92.88
Rate for Payer: Aetna Medicare	$54.63
Rate for Payer: Aetna New Business (MI Preferred)	$71.03
Rate for Payer: BCBS Complete	$43.71
Rate for Payer: BCBS Trust/PPO	$20.07
Rate for Payer: BCN Commercial	$20.07
Rate for Payer: Cash Price	$87.42
Rate for Payer: Cash Price	$87.42
Rate for Payer: Cofinity Advantage	$76.49
Rate for Payer: Cofinity Commercial	$93.97
Rate for Payer: Encore Health Key Benefits Commercial	$87.42
Rate for Payer: Healthscope Commercial	$98.34
Rate for Payer: MI Amish Medical Board Commercial	$87.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.95
Rate for Payer: PHP Commercial	$92.88
Rate for Payer: Priority Health SBD	$68.84
Rate for Payer: UHC All Payor (Choice/PPO)	$13.45
Rate for Payer: UHC Core	$13.45
Rate for Payer: UHC Exchange	$13.45

VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION

Facility

$203.16

Service Code	HCPCS J9370
Hospital Charge Code	118463
Hospital Revenue Code	636
Min. Negotiated Rate	$127.99
Max. Negotiated Rate	$182.84
Rate for Payer: Aetna Commercial	$172.69
Rate for Payer: Aetna New Business (MI Preferred)	$132.05
Rate for Payer: Cash Price	$162.53
Rate for Payer: Cofinity Advantage	$142.21
Rate for Payer: Cofinity Commercial	$174.72
Rate for Payer: Encore Health Key Benefits Commercial	$162.53
Rate for Payer: Healthscope Commercial	$182.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$152.37
Rate for Payer: PHP Commercial	$172.69
Rate for Payer: Priority Health SBD	$127.99

VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION

Facility

$203.16

Service Code	HCPCS J9370
Hospital Charge Code	118463
Hospital Revenue Code	636
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$182.84
Rate for Payer: Aetna Commercial	$172.69
Rate for Payer: Aetna Commercial	$170.25
Rate for Payer: Aetna Medicare	$100.14
Rate for Payer: Aetna Medicare	$101.58
Rate for Payer: Aetna New Business (MI Preferred)	$132.05
Rate for Payer: Aetna New Business (MI Preferred)	$130.19
Rate for Payer: BCBS Complete	$81.26
Rate for Payer: BCBS Complete	$80.12
Rate for Payer: BCBS Trust/PPO	$20.07
Rate for Payer: BCBS Trust/PPO	$20.07
Rate for Payer: BCN Commercial	$20.07
Rate for Payer: BCN Commercial	$20.07
Rate for Payer: Cash Price	$162.53
Rate for Payer: Cash Price	$160.23
Rate for Payer: Cash Price	$160.23
Rate for Payer: Cash Price	$162.53
Rate for Payer: Cofinity Advantage	$142.21
Rate for Payer: Cofinity Advantage	$140.20
Rate for Payer: Cofinity Commercial	$174.72
Rate for Payer: Cofinity Commercial	$172.25
Rate for Payer: Encore Health Key Benefits Commercial	$160.23
Rate for Payer: Encore Health Key Benefits Commercial	$162.53
Rate for Payer: Healthscope Commercial	$182.84
Rate for Payer: Healthscope Commercial	$180.26
Rate for Payer: MI Amish Medical Board Commercial	$162.53
Rate for Payer: MI Amish Medical Board Commercial	$160.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$152.37
Rate for Payer: PHP Commercial	$170.25
Rate for Payer: PHP Commercial	$172.69
Rate for Payer: Priority Health SBD	$127.99
Rate for Payer: Priority Health SBD	$126.18
Rate for Payer: UHC All Payor (Choice/PPO)	$13.45
Rate for Payer: UHC All Payor (Choice/PPO)	$13.45
Rate for Payer: UHC Core	$13.45
Rate for Payer: UHC Core	$13.45
Rate for Payer: UHC Exchange	$13.45
Rate for Payer: UHC Exchange	$13.45

VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$151.50

Service Code	HCPCS J9390
Hospital Charge Code	14203
Hospital Revenue Code	636
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$136.35
Rate for Payer: Aetna Commercial	$128.78
Rate for Payer: Aetna Medicare	$75.75
Rate for Payer: Aetna New Business (MI Preferred)	$98.47
Rate for Payer: BCBS Complete	$60.60
Rate for Payer: BCBS Trust/PPO	$13.64
Rate for Payer: BCN Commercial	$13.64
Rate for Payer: Cash Price	$121.20
Rate for Payer: Cash Price	$121.20
Rate for Payer: Cofinity Advantage	$106.05
Rate for Payer: Cofinity Commercial	$130.29
Rate for Payer: Encore Health Key Benefits Commercial	$121.20
Rate for Payer: Healthscope Commercial	$136.35
Rate for Payer: MI Amish Medical Board Commercial	$121.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$128.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$113.62
Rate for Payer: PHP Commercial	$128.78
Rate for Payer: Priority Health SBD	$95.44
Rate for Payer: UHC All Payor (Choice/PPO)	$8.98
Rate for Payer: UHC Core	$8.98
Rate for Payer: UHC Exchange	$8.98

VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$151.50

Service Code	HCPCS J9390
Hospital Charge Code	14203
Hospital Revenue Code	636
Min. Negotiated Rate	$95.44
Max. Negotiated Rate	$136.35
Rate for Payer: Aetna Commercial	$128.78
Rate for Payer: Aetna New Business (MI Preferred)	$98.47
Rate for Payer: Cash Price	$121.20
Rate for Payer: Cofinity Advantage	$106.05
Rate for Payer: Cofinity Commercial	$130.29
Rate for Payer: Encore Health Key Benefits Commercial	$121.20
Rate for Payer: Healthscope Commercial	$136.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$128.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$113.62
Rate for Payer: PHP Commercial	$128.78
Rate for Payer: Priority Health SBD	$95.44

VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION

Facility

$271.73

Service Code	HCPCS J9390
Hospital Charge Code	41673
Hospital Revenue Code	636
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$244.56
Rate for Payer: Aetna Commercial	$230.97
Rate for Payer: Aetna Medicare	$135.87
Rate for Payer: Aetna New Business (MI Preferred)	$176.62
Rate for Payer: BCBS Complete	$108.69
Rate for Payer: BCBS Trust/PPO	$13.64
Rate for Payer: BCN Commercial	$13.64
Rate for Payer: Cash Price	$217.38
Rate for Payer: Cash Price	$217.38
Rate for Payer: Cofinity Advantage	$190.21
Rate for Payer: Cofinity Commercial	$233.69
Rate for Payer: Encore Health Key Benefits Commercial	$217.38
Rate for Payer: Healthscope Commercial	$244.56
Rate for Payer: MI Amish Medical Board Commercial	$217.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$203.80
Rate for Payer: PHP Commercial	$230.97
Rate for Payer: Priority Health SBD	$171.19
Rate for Payer: UHC All Payor (Choice/PPO)	$8.98
Rate for Payer: UHC Core	$8.98
Rate for Payer: UHC Exchange	$8.98

VIRAL ILLNESS

Facility

$3,396.80

Service Code	APR-DRG 7232
Min. Negotiated Rate	$3,235.05
Max. Negotiated Rate	$3,396.80
Rate for Payer: BCBS Complete	$3,396.80
Rate for Payer: Mclaren Medicaid	$3,235.05
Rate for Payer: Meridian Medicaid	$3,396.80
Rate for Payer: Priority Health Choice Medicaid	$3,235.05
Rate for Payer: UHC Medicaid	$3,235.05
Rate for Payer: UHCCP Medicaid	$3,235.05

VIRAL ILLNESS

Facility

$5,996.72

Service Code	APR-DRG 7233
Min. Negotiated Rate	$5,711.16
Max. Negotiated Rate	$5,996.72
Rate for Payer: BCBS Complete	$5,996.72
Rate for Payer: Mclaren Medicaid	$5,711.16
Rate for Payer: Meridian Medicaid	$5,996.72
Rate for Payer: Priority Health Choice Medicaid	$5,711.16
Rate for Payer: UHC Medicaid	$5,711.16
Rate for Payer: UHCCP Medicaid	$5,711.16

VIRAL ILLNESS

Facility

$8,541.02

Service Code	APR-DRG 7234
Min. Negotiated Rate	$8,134.31
Max. Negotiated Rate	$8,541.02
Rate for Payer: BCBS Complete	$8,541.02
Rate for Payer: Mclaren Medicaid	$8,134.31
Rate for Payer: Meridian Medicaid	$8,541.02
Rate for Payer: Priority Health Choice Medicaid	$8,134.31
Rate for Payer: UHC Medicaid	$8,134.31
Rate for Payer: UHCCP Medicaid	$8,134.31

VIRAL ILLNESS

Facility

$2,709.99

Service Code	APR-DRG 7231
Min. Negotiated Rate	$2,580.94
Max. Negotiated Rate	$2,709.99
Rate for Payer: BCBS Complete	$2,709.99
Rate for Payer: Mclaren Medicaid	$2,580.94
Rate for Payer: Meridian Medicaid	$2,709.99
Rate for Payer: Priority Health Choice Medicaid	$2,580.94
Rate for Payer: UHC Medicaid	$2,580.94
Rate for Payer: UHCCP Medicaid	$2,580.94

VIRAL ILLNESS WITH MCC

Facility

$24,422.29

Service Code	MSDRG 865
Min. Negotiated Rate	$11,550.30
Max. Negotiated Rate	$24,422.29
Rate for Payer: Aetna Medicare	$12,644.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,197.76
Rate for Payer: Amish Plain Church Group Commercial	$15,197.76
Rate for Payer: BCBS MAPPO	$12,158.21
Rate for Payer: BCBS Trust/PPO	$23,798.91
Rate for Payer: BCN Commercial	$23,798.91
Rate for Payer: BCN Medicare Advantage	$12,158.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,158.21
Rate for Payer: Mclaren Medicare	$12,158.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,766.12
Rate for Payer: MI Amish Medical Board Commercial	$13,981.94
Rate for Payer: Molina Medicare/Medicaid	$13,374.03
Rate for Payer: Nomi Health Commercial	$19,328.07
Rate for Payer: PACE Medicare	$11,550.30
Rate for Payer: PACE SWMI	$12,158.21
Rate for Payer: PHP Medicare Advantage	$12,158.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$24,155.80
Rate for Payer: Priority Health Medicare	$12,158.21
Rate for Payer: Priority Health Tiered Network	$19,324.64
Rate for Payer: Railroad Medicare Medicare	$12,158.21
Rate for Payer: UHC All Payor (Choice/PPO)	$24,422.29
Rate for Payer: UHC Core	$20,432.32
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,158.21
Rate for Payer: UHC Exchange	$16,686.57
Rate for Payer: VA VA	$12,158.21

VIRAL ILLNESS WITHOUT MCC

Facility

$14,174.48

Service Code	MSDRG 866
Min. Negotiated Rate	$6,934.48
Max. Negotiated Rate	$14,174.48
Rate for Payer: Aetna Medicare	$7,591.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,124.31
Rate for Payer: Amish Plain Church Group Commercial	$9,124.31
Rate for Payer: BCBS MAPPO	$7,299.45
Rate for Payer: BCBS Trust/PPO	$10,723.20
Rate for Payer: BCN Commercial	$10,723.20
Rate for Payer: BCN Medicare Advantage	$7,299.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,299.45
Rate for Payer: Mclaren Medicare	$7,299.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,664.42
Rate for Payer: MI Amish Medical Board Commercial	$8,394.37
Rate for Payer: Molina Medicare/Medicaid	$8,029.40
Rate for Payer: Nomi Health Commercial	$11,217.84
Rate for Payer: PACE Medicare	$6,934.48
Rate for Payer: PACE SWMI	$7,299.45
Rate for Payer: PHP Medicare Advantage	$7,299.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$14,019.81
Rate for Payer: Priority Health Medicare	$7,299.45
Rate for Payer: Priority Health Tiered Network	$11,215.85
Rate for Payer: Railroad Medicare Medicare	$7,299.45
Rate for Payer: UHC All Payor (Choice/PPO)	$14,174.48
Rate for Payer: UHC Core	$11,858.74
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,299.45
Rate for Payer: UHC Exchange	$9,684.74
Rate for Payer: VA VA	$7,299.45

VIRAL MENINGITIS

Facility

$3,230.55

Service Code	APR-DRG 0511
Min. Negotiated Rate	$3,076.71
Max. Negotiated Rate	$3,230.55
Rate for Payer: BCBS Complete	$3,230.55
Rate for Payer: Mclaren Medicaid	$3,076.71
Rate for Payer: Meridian Medicaid	$3,230.55
Rate for Payer: Priority Health Choice Medicaid	$3,076.71
Rate for Payer: UHC Medicaid	$3,076.71
Rate for Payer: UHCCP Medicaid	$3,076.71

VIRAL MENINGITIS

Facility

$4,339.88

Service Code	APR-DRG 0512
Min. Negotiated Rate	$4,133.22
Max. Negotiated Rate	$4,339.88
Rate for Payer: BCBS Complete	$4,339.88
Rate for Payer: Mclaren Medicaid	$4,133.22
Rate for Payer: Meridian Medicaid	$4,339.88
Rate for Payer: Priority Health Choice Medicaid	$4,133.22
Rate for Payer: UHC Medicaid	$4,133.22
Rate for Payer: UHCCP Medicaid	$4,133.22

VIRAL MENINGITIS

Facility

$11,346.18

Service Code	APR-DRG 0514
Min. Negotiated Rate	$10,805.89
Max. Negotiated Rate	$11,346.18
Rate for Payer: BCBS Complete	$11,346.18
Rate for Payer: Mclaren Medicaid	$10,805.89
Rate for Payer: Meridian Medicaid	$11,346.18
Rate for Payer: Priority Health Choice Medicaid	$10,805.89
Rate for Payer: UHC Medicaid	$10,805.89
Rate for Payer: UHCCP Medicaid	$10,805.89

VIRAL MENINGITIS

Facility

$7,163.96

Service Code	APR-DRG 0513
Min. Negotiated Rate	$6,822.82
Max. Negotiated Rate	$7,163.96
Rate for Payer: BCBS Complete	$7,163.96
Rate for Payer: Mclaren Medicaid	$6,822.82
Rate for Payer: Meridian Medicaid	$7,163.96
Rate for Payer: Priority Health Choice Medicaid	$6,822.82
Rate for Payer: UHC Medicaid	$6,822.82
Rate for Payer: UHCCP Medicaid	$6,822.82

VIRAL MENINGITIS WITH CC/MCC

Facility

$31,255.25

Service Code	MSDRG 075
Min. Negotiated Rate	$14,628.00
Max. Negotiated Rate	$31,255.25
Rate for Payer: Aetna Medicare	$16,013.82
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,247.38
Rate for Payer: Amish Plain Church Group Commercial	$19,247.38
Rate for Payer: BCBS MAPPO	$15,397.90
Rate for Payer: BCBS Trust/PPO	$17,956.28
Rate for Payer: BCN Commercial	$17,956.28
Rate for Payer: BCN Medicare Advantage	$15,397.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,397.90
Rate for Payer: Mclaren Medicare	$15,397.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,167.80
Rate for Payer: MI Amish Medical Board Commercial	$17,707.58
Rate for Payer: Molina Medicare/Medicaid	$16,937.69
Rate for Payer: Nomi Health Commercial	$24,735.75
Rate for Payer: PACE Medicare	$14,628.00
Rate for Payer: PACE SWMI	$15,397.90
Rate for Payer: PHP Medicare Advantage	$15,397.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$30,914.20
Rate for Payer: Priority Health Medicare	$15,397.90
Rate for Payer: Priority Health Tiered Network	$24,731.36
Rate for Payer: Railroad Medicare Medicare	$15,397.90
Rate for Payer: UHC All Payor (Choice/PPO)	$31,255.25
Rate for Payer: UHC Core	$26,148.95
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,397.90
Rate for Payer: UHC Exchange	$21,355.20
Rate for Payer: VA VA	$15,397.90

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$13,303.99

Service Code	MSDRG 076
Min. Negotiated Rate	$6,608.50
Max. Negotiated Rate	$13,303.99
Rate for Payer: Aetna Medicare	$7,234.57
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,695.40
Rate for Payer: Amish Plain Church Group Commercial	$8,695.40
Rate for Payer: BCBS MAPPO	$6,956.32
Rate for Payer: BCBS Trust/PPO	$10,388.47
Rate for Payer: BCN Commercial	$10,388.47
Rate for Payer: BCN Medicare Advantage	$6,956.32
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,956.32
Rate for Payer: Mclaren Medicare	$6,956.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,304.14
Rate for Payer: MI Amish Medical Board Commercial	$7,999.77
Rate for Payer: Molina Medicare/Medicaid	$7,651.95
Rate for Payer: Nomi Health Commercial	$9,659.52
Rate for Payer: PACE Medicare	$6,608.50
Rate for Payer: PACE SWMI	$6,956.32
Rate for Payer: PHP Medicare Advantage	$6,956.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$13,303.99
Rate for Payer: Priority Health Medicare	$6,956.32
Rate for Payer: Priority Health Tiered Network	$10,643.19
Rate for Payer: Railroad Medicare Medicare	$6,956.32
Rate for Payer: UHC All Payor (Choice/PPO)	$12,205.44
Rate for Payer: UHC Core	$10,211.39
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,956.32
Rate for Payer: UHC Exchange	$8,339.39
Rate for Payer: VA VA	$6,956.32

VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT

Facility

$15.30

Service Code	NDC 61924020404
Hospital Charge Code	115852
Hospital Revenue Code	637
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$13.77
Rate for Payer: Aetna Commercial	$13.01
Rate for Payer: Aetna Medicare	$7.65
Rate for Payer: Aetna New Business (MI Preferred)	$9.95
Rate for Payer: BCBS Complete	$6.12
Rate for Payer: Cash Price	$12.24
Rate for Payer: Cofinity Advantage	$10.71
Rate for Payer: Cofinity Commercial	$13.16
Rate for Payer: Encore Health Key Benefits Commercial	$12.24
Rate for Payer: Healthscope Commercial	$13.77
Rate for Payer: MI Amish Medical Board Commercial	$12.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.47
Rate for Payer: PHP Commercial	$13.01
Rate for Payer: Priority Health SBD	$9.64
Rate for Payer: UHC All Payor (Choice/PPO)	$9.95
Rate for Payer: UHC Core	$7.97
Rate for Payer: UHC Exchange	$6.01

VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT

Facility

$15.30

Service Code	NDC 61924020404
Hospital Charge Code	115852
Hospital Revenue Code	637
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$13.77
Rate for Payer: Aetna Commercial	$13.01
Rate for Payer: Aetna New Business (MI Preferred)	$9.95
Rate for Payer: Cash Price	$12.24
Rate for Payer: Cofinity Advantage	$10.71
Rate for Payer: Cofinity Commercial	$13.16
Rate for Payer: Encore Health Key Benefits Commercial	$12.24
Rate for Payer: Healthscope Commercial	$13.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.47
Rate for Payer: PHP Commercial	$13.01
Rate for Payer: Priority Health SBD	$9.64

VITAMIN B COMPLEX AND C NO.10-FOLIC ACID 900 MCG/5 ML ORAL LIQUID

Facility

$395.44

Service Code	NDC 54859051608
Hospital Charge Code	32716
Hospital Revenue Code	637
Min. Negotiated Rate	$249.13
Max. Negotiated Rate	$355.90
Rate for Payer: Aetna Commercial	$336.12
Rate for Payer: Aetna New Business (MI Preferred)	$257.04
Rate for Payer: Cash Price	$316.35
Rate for Payer: Cofinity Advantage	$276.81
Rate for Payer: Cofinity Commercial	$340.08
Rate for Payer: Encore Health Key Benefits Commercial	$316.35
Rate for Payer: Healthscope Commercial	$355.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$296.58
Rate for Payer: PHP Commercial	$336.12
Rate for Payer: Priority Health SBD	$249.13

Know your out-of-pocket cost for care.

All Charges