Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$113.40

Service Code	NDC 00409114405
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$102.06
Rate for Payer: Aetna Commercial	$96.39
Rate for Payer: Aetna New Business (MI Preferred)	$73.71
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$79.38
Rate for Payer: Cofinity Commercial	$97.52
Rate for Payer: Cofinity Medicare Advantage	$79.38
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$102.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: PHP Commercial	$96.39
Rate for Payer: Priority Health Cigna Priority Health	$73.71
Rate for Payer: Priority Health SBD	$71.44

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$113.40

Service Code	NDC 00409114405
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$102.06
Rate for Payer: Aetna Commercial	$96.39
Rate for Payer: Aetna Medicare	$56.70
Rate for Payer: Aetna New Business (MI Preferred)	$73.71
Rate for Payer: BCBS Complete	$45.36
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$79.38
Rate for Payer: Cofinity Commercial	$97.52
Rate for Payer: Cofinity Medicare Advantage	$79.38
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$102.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: PHP Commercial	$96.39
Rate for Payer: Priority Health Cigna Priority Health	$73.71
Rate for Payer: Priority Health SBD	$71.44

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION

Facility

$18.27

Service Code	NDC 70756060582
Hospital Charge Code	8527
Hospital Revenue Code	250
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$16.44
Rate for Payer: Aetna Commercial	$15.53
Rate for Payer: Aetna Medicare	$9.14
Rate for Payer: Aetna New Business (MI Preferred)	$11.88
Rate for Payer: BCBS Complete	$7.31
Rate for Payer: Cash Price	$14.62
Rate for Payer: Cofinity Commercial	$12.79
Rate for Payer: Cofinity Commercial	$15.71
Rate for Payer: Cofinity Medicare Advantage	$12.79
Rate for Payer: Encore Health Key Benefits Commercial	$14.62
Rate for Payer: Healthscope Commercial	$16.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.53
Rate for Payer: PHP Commercial	$15.53
Rate for Payer: Priority Health Cigna Priority Health	$11.88
Rate for Payer: Priority Health SBD	$11.51

VERAPAMIL 40 MG TABLET

Facility

$345.45

Service Code	NDC 00591040401
Hospital Charge Code	8529
Hospital Revenue Code	637
Min. Negotiated Rate	$138.18
Max. Negotiated Rate	$310.90
Rate for Payer: Aetna Commercial	$293.63
Rate for Payer: Aetna Medicare	$172.72
Rate for Payer: Aetna New Business (MI Preferred)	$224.54
Rate for Payer: BCBS Complete	$138.18
Rate for Payer: Cash Price	$276.36
Rate for Payer: Cofinity Commercial	$241.82
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.82
Rate for Payer: Encore Health Key Benefits Commercial	$276.36
Rate for Payer: Healthscope Commercial	$310.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.63
Rate for Payer: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

VERAPAMIL 40 MG TABLET

Facility

$310.20

Service Code	NDC 23155005901
Hospital Charge Code	8529
Hospital Revenue Code	637
Min. Negotiated Rate	$195.43
Max. Negotiated Rate	$279.18
Rate for Payer: Aetna Commercial	$263.67
Rate for Payer: Aetna New Business (MI Preferred)	$201.63
Rate for Payer: Cash Price	$248.16
Rate for Payer: Cofinity Commercial	$217.14
Rate for Payer: Cofinity Commercial	$266.77
Rate for Payer: Cofinity Medicare Advantage	$217.14
Rate for Payer: Encore Health Key Benefits Commercial	$248.16
Rate for Payer: Healthscope Commercial	$279.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.67
Rate for Payer: PHP Commercial	$263.67
Rate for Payer: Priority Health Cigna Priority Health	$201.63
Rate for Payer: Priority Health SBD	$195.43

VERAPAMIL 40 MG TABLET

Facility

$310.20

Service Code	NDC 23155005901
Hospital Charge Code	8529
Hospital Revenue Code	637
Min. Negotiated Rate	$124.08
Max. Negotiated Rate	$279.18
Rate for Payer: Aetna Commercial	$263.67
Rate for Payer: Aetna Medicare	$155.10
Rate for Payer: Aetna New Business (MI Preferred)	$201.63
Rate for Payer: BCBS Complete	$124.08
Rate for Payer: Cash Price	$248.16
Rate for Payer: Cofinity Commercial	$217.14
Rate for Payer: Cofinity Commercial	$266.77
Rate for Payer: Cofinity Medicare Advantage	$217.14
Rate for Payer: Encore Health Key Benefits Commercial	$248.16
Rate for Payer: Healthscope Commercial	$279.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.67
Rate for Payer: PHP Commercial	$263.67
Rate for Payer: Priority Health Cigna Priority Health	$201.63
Rate for Payer: Priority Health SBD	$195.43

VERAPAMIL 40 MG TABLET

Facility

$345.45

Service Code	NDC 00591040401
Hospital Charge Code	8529
Hospital Revenue Code	637
Min. Negotiated Rate	$217.63
Max. Negotiated Rate	$310.90
Rate for Payer: Aetna Commercial	$293.63
Rate for Payer: Aetna New Business (MI Preferred)	$224.54
Rate for Payer: Cash Price	$276.36
Rate for Payer: Cofinity Commercial	$241.82
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.82
Rate for Payer: Encore Health Key Benefits Commercial	$276.36
Rate for Payer: Healthscope Commercial	$310.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.63
Rate for Payer: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE

Facility

$5.25

Service Code	NDC 60687049311
Hospital Charge Code	11639
Hospital Revenue Code	637
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.72
Rate for Payer: Aetna Commercial	$4.46
Rate for Payer: Aetna Medicare	$2.62
Rate for Payer: Aetna New Business (MI Preferred)	$3.41
Rate for Payer: BCBS Complete	$2.10
Rate for Payer: Cash Price	$4.20
Rate for Payer: Cofinity Commercial	$3.68
Rate for Payer: Cofinity Commercial	$4.52
Rate for Payer: Cofinity Medicare Advantage	$3.68
Rate for Payer: Encore Health Key Benefits Commercial	$4.20
Rate for Payer: Healthscope Commercial	$4.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.46
Rate for Payer: PHP Commercial	$4.46
Rate for Payer: Priority Health Cigna Priority Health	$3.41
Rate for Payer: Priority Health SBD	$3.31

VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE

Facility

$524.64

Service Code	NDC 60687049301
Hospital Charge Code	11639
Hospital Revenue Code	637
Min. Negotiated Rate	$209.86
Max. Negotiated Rate	$472.18
Rate for Payer: Aetna Commercial	$445.94
Rate for Payer: Aetna Medicare	$262.32
Rate for Payer: Aetna New Business (MI Preferred)	$341.02
Rate for Payer: BCBS Complete	$209.86
Rate for Payer: Cash Price	$419.71
Rate for Payer: Cofinity Commercial	$367.25
Rate for Payer: Cofinity Commercial	$451.19
Rate for Payer: Cofinity Medicare Advantage	$367.25
Rate for Payer: Encore Health Key Benefits Commercial	$419.71
Rate for Payer: Healthscope Commercial	$472.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$445.94
Rate for Payer: PHP Commercial	$445.94
Rate for Payer: Priority Health Cigna Priority Health	$341.02
Rate for Payer: Priority Health SBD	$330.52

VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE

Facility

$5.25

Service Code	NDC 60687049311
Hospital Charge Code	11639
Hospital Revenue Code	637
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$4.72
Rate for Payer: Aetna Commercial	$4.46
Rate for Payer: Aetna New Business (MI Preferred)	$3.41
Rate for Payer: Cash Price	$4.20
Rate for Payer: Cofinity Commercial	$3.68
Rate for Payer: Cofinity Commercial	$4.52
Rate for Payer: Cofinity Medicare Advantage	$3.68
Rate for Payer: Encore Health Key Benefits Commercial	$4.20
Rate for Payer: Healthscope Commercial	$4.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.46
Rate for Payer: PHP Commercial	$4.46
Rate for Payer: Priority Health Cigna Priority Health	$3.41
Rate for Payer: Priority Health SBD	$3.31

VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE

Facility

$200.45

Service Code	NDC 68462029201
Hospital Charge Code	11639
Hospital Revenue Code	637
Min. Negotiated Rate	$126.28
Max. Negotiated Rate	$180.40
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.32
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Cofinity Medicare Advantage	$140.32
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$130.29
Rate for Payer: Priority Health SBD	$126.28

VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE

Facility

$200.45

Service Code	NDC 68462029201
Hospital Charge Code	11639
Hospital Revenue Code	637
Min. Negotiated Rate	$80.18
Max. Negotiated Rate	$180.40
Rate for Payer: Aetna Commercial	$170.38
Rate for Payer: Aetna Medicare	$100.22
Rate for Payer: Aetna New Business (MI Preferred)	$130.29
Rate for Payer: BCBS Complete	$80.18
Rate for Payer: Cash Price	$160.36
Rate for Payer: Cofinity Commercial	$140.32
Rate for Payer: Cofinity Commercial	$172.39
Rate for Payer: Cofinity Medicare Advantage	$140.32
Rate for Payer: Encore Health Key Benefits Commercial	$160.36
Rate for Payer: Healthscope Commercial	$180.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.38
Rate for Payer: PHP Commercial	$170.38
Rate for Payer: Priority Health Cigna Priority Health	$130.29
Rate for Payer: Priority Health SBD	$126.28

VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE

Facility

$524.64

Service Code	NDC 60687049301
Hospital Charge Code	11639
Hospital Revenue Code	637
Min. Negotiated Rate	$330.52
Max. Negotiated Rate	$472.18
Rate for Payer: Aetna Commercial	$445.94
Rate for Payer: Aetna New Business (MI Preferred)	$341.02
Rate for Payer: Cash Price	$419.71
Rate for Payer: Cofinity Commercial	$451.19
Rate for Payer: Cofinity Commercial	$367.25
Rate for Payer: Cofinity Medicare Advantage	$367.25
Rate for Payer: Encore Health Key Benefits Commercial	$419.71
Rate for Payer: Healthscope Commercial	$472.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$445.94
Rate for Payer: PHP Commercial	$445.94
Rate for Payer: Priority Health Cigna Priority Health	$341.02
Rate for Payer: Priority Health SBD	$330.52

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE

Facility

$5.62

Service Code	NDC 60687050411
Hospital Charge Code	11640
Hospital Revenue Code	637
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna Commercial	$4.78
Rate for Payer: Aetna Medicare	$2.81
Rate for Payer: Aetna New Business (MI Preferred)	$3.65
Rate for Payer: BCBS Complete	$2.25
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cofinity Commercial	$3.93
Rate for Payer: Cofinity Commercial	$4.83
Rate for Payer: Cofinity Medicare Advantage	$3.93
Rate for Payer: Encore Health Key Benefits Commercial	$4.50
Rate for Payer: Healthscope Commercial	$5.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.78
Rate for Payer: PHP Commercial	$4.78
Rate for Payer: Priority Health Cigna Priority Health	$3.65
Rate for Payer: Priority Health SBD	$3.54

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE

Facility

$5.62

Service Code	NDC 60687050411
Hospital Charge Code	11640
Hospital Revenue Code	637
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna Commercial	$4.78
Rate for Payer: Aetna New Business (MI Preferred)	$3.65
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cofinity Commercial	$3.93
Rate for Payer: Cofinity Commercial	$4.83
Rate for Payer: Cofinity Medicare Advantage	$3.93
Rate for Payer: Encore Health Key Benefits Commercial	$4.50
Rate for Payer: Healthscope Commercial	$5.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.78
Rate for Payer: PHP Commercial	$4.78
Rate for Payer: Priority Health Cigna Priority Health	$3.65
Rate for Payer: Priority Health SBD	$3.54

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE

Facility

$561.60

Service Code	NDC 60687050401
Hospital Charge Code	11640
Hospital Revenue Code	637
Min. Negotiated Rate	$224.64
Max. Negotiated Rate	$505.44
Rate for Payer: Aetna Commercial	$477.36
Rate for Payer: Aetna Medicare	$280.80
Rate for Payer: Aetna New Business (MI Preferred)	$365.04
Rate for Payer: BCBS Complete	$224.64
Rate for Payer: Cash Price	$449.28
Rate for Payer: Cofinity Commercial	$393.12
Rate for Payer: Cofinity Commercial	$482.98
Rate for Payer: Cofinity Medicare Advantage	$393.12
Rate for Payer: Encore Health Key Benefits Commercial	$449.28
Rate for Payer: Healthscope Commercial	$505.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$477.36
Rate for Payer: PHP Commercial	$477.36
Rate for Payer: Priority Health Cigna Priority Health	$365.04
Rate for Payer: Priority Health SBD	$353.81

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE

Facility

$561.60

Service Code	NDC 60687050401
Hospital Charge Code	11640
Hospital Revenue Code	637
Min. Negotiated Rate	$353.81
Max. Negotiated Rate	$505.44
Rate for Payer: Aetna Commercial	$477.36
Rate for Payer: Aetna New Business (MI Preferred)	$365.04
Rate for Payer: Cash Price	$449.28
Rate for Payer: Cofinity Commercial	$393.12
Rate for Payer: Cofinity Commercial	$482.98
Rate for Payer: Cofinity Medicare Advantage	$393.12
Rate for Payer: Encore Health Key Benefits Commercial	$449.28
Rate for Payer: Healthscope Commercial	$505.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$477.36
Rate for Payer: PHP Commercial	$477.36
Rate for Payer: Priority Health Cigna Priority Health	$365.04
Rate for Payer: Priority Health SBD	$353.81

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE

Facility

$1,974.00

Service Code	NDC 68462029305
Hospital Charge Code	11640
Hospital Revenue Code	637
Min. Negotiated Rate	$789.60
Max. Negotiated Rate	$1,776.60
Rate for Payer: Aetna Commercial	$1,677.90
Rate for Payer: Aetna Medicare	$987.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,283.10
Rate for Payer: BCBS Complete	$789.60
Rate for Payer: Cash Price	$1,579.20
Rate for Payer: Cofinity Commercial	$1,381.80
Rate for Payer: Cofinity Commercial	$1,697.64
Rate for Payer: Cofinity Medicare Advantage	$1,381.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,579.20
Rate for Payer: Healthscope Commercial	$1,776.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,677.90
Rate for Payer: PHP Commercial	$1,677.90
Rate for Payer: Priority Health Cigna Priority Health	$1,283.10
Rate for Payer: Priority Health SBD	$1,243.62

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE

Facility

$1,974.00

Service Code	NDC 68462029305
Hospital Charge Code	11640
Hospital Revenue Code	637
Min. Negotiated Rate	$1,243.62
Max. Negotiated Rate	$1,776.60
Rate for Payer: Aetna Commercial	$1,677.90
Rate for Payer: Aetna New Business (MI Preferred)	$1,283.10
Rate for Payer: Cash Price	$1,579.20
Rate for Payer: Cofinity Commercial	$1,381.80
Rate for Payer: Cofinity Commercial	$1,697.64
Rate for Payer: Cofinity Medicare Advantage	$1,381.80
Rate for Payer: Encore Health Key Benefits Commercial	$1,579.20
Rate for Payer: Healthscope Commercial	$1,776.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,677.90
Rate for Payer: PHP Commercial	$1,677.90
Rate for Payer: Priority Health Cigna Priority Health	$1,283.10
Rate for Payer: Priority Health SBD	$1,243.62

VILAZODONE 20 MG TABLET

Facility

$1,254.75

Service Code	NDC 00456112030
Hospital Charge Code	152700
Hospital Revenue Code	637
Min. Negotiated Rate	$790.49
Max. Negotiated Rate	$1,129.28
Rate for Payer: Aetna Commercial	$1,066.54
Rate for Payer: Aetna New Business (MI Preferred)	$815.59
Rate for Payer: Cash Price	$1,003.80
Rate for Payer: Cofinity Commercial	$1,079.08
Rate for Payer: Cofinity Commercial	$878.32
Rate for Payer: Cofinity Medicare Advantage	$878.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,003.80
Rate for Payer: Healthscope Commercial	$1,129.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,066.54
Rate for Payer: PHP Commercial	$1,066.54
Rate for Payer: Priority Health Cigna Priority Health	$815.59
Rate for Payer: Priority Health SBD	$790.49

VILAZODONE 20 MG TABLET

Facility

$1,254.75

Service Code	NDC 00456112030
Hospital Charge Code	152700
Hospital Revenue Code	637
Min. Negotiated Rate	$501.90
Max. Negotiated Rate	$1,129.28
Rate for Payer: Aetna Commercial	$1,066.54
Rate for Payer: Aetna Medicare	$627.38
Rate for Payer: Aetna New Business (MI Preferred)	$815.59
Rate for Payer: BCBS Complete	$501.90
Rate for Payer: Cash Price	$1,003.80
Rate for Payer: Cofinity Commercial	$1,079.08
Rate for Payer: Cofinity Commercial	$878.32
Rate for Payer: Cofinity Medicare Advantage	$878.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,003.80
Rate for Payer: Healthscope Commercial	$1,129.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,066.54
Rate for Payer: PHP Commercial	$1,066.54
Rate for Payer: Priority Health Cigna Priority Health	$815.59
Rate for Payer: Priority Health SBD	$790.49

VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$507.28

Service Code	HCPCS J9360
Hospital Charge Code	8594
Hospital Revenue Code	636
Min. Negotiated Rate	$13.64
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	$13.64
Rate for Payer: BCN Commercial	$13.64
Rate for Payer: Cash Price	$405.82
Rate for Payer: Cash Price	$405.82
Rate for Payer: Cofinity Commercial	$355.10
Rate for Payer: Cofinity Commercial	$436.26
Rate for Payer: Cofinity Medicare Advantage	$355.10
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: PHP Commercial	$431.19
Rate for Payer: Priority Health Cigna Priority Health	$329.73
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	$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 Commercial	$355.10
Rate for Payer: Cofinity Commercial	$436.26
Rate for Payer: Cofinity Medicare Advantage	$355.10
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: PHP Commercial	$431.19
Rate for Payer: Priority Health Cigna Priority Health	$329.73
Rate for Payer: Priority Health SBD	$319.59

VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$107.63

Service Code	HCPCS J9370
Hospital Charge Code	8597
Hospital Revenue Code	636
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$96.87
Rate for Payer: Aetna Commercial	$91.49
Rate for Payer: Aetna Medicare	$53.82
Rate for Payer: Aetna New Business (MI Preferred)	$69.96
Rate for Payer: BCBS Complete	$43.05
Rate for Payer: BCBS Trust/PPO	$22.76
Rate for Payer: BCN Commercial	$22.76
Rate for Payer: Cash Price	$86.10
Rate for Payer: Cash Price	$86.10
Rate for Payer: Cofinity Commercial	$75.34
Rate for Payer: Cofinity Commercial	$92.56
Rate for Payer: Cofinity Medicare Advantage	$75.34
Rate for Payer: Encore Health Key Benefits Commercial	$86.10
Rate for Payer: Healthscope Commercial	$96.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.49
Rate for Payer: PHP Commercial	$91.49
Rate for Payer: Priority Health Cigna Priority Health	$69.96
Rate for Payer: Priority Health SBD	$67.81

VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION

Facility

$200.29

Service Code	HCPCS J9370
Hospital Charge Code	118463
Hospital Revenue Code	636
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$180.26
Rate for Payer: Aetna Commercial	$170.25
Rate for Payer: Aetna Medicare	$100.14
Rate for Payer: Aetna New Business (MI Preferred)	$130.19
Rate for Payer: BCBS Complete	$80.12
Rate for Payer: BCBS Trust/PPO	$22.76
Rate for Payer: BCN Commercial	$22.76
Rate for Payer: Cash Price	$160.23
Rate for Payer: Cash Price	$160.23
Rate for Payer: Cofinity Commercial	$140.20
Rate for Payer: Cofinity Commercial	$172.25
Rate for Payer: Cofinity Medicare Advantage	$140.20
Rate for Payer: Encore Health Key Benefits Commercial	$160.23
Rate for Payer: Healthscope Commercial	$180.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.25
Rate for Payer: PHP Commercial	$170.25
Rate for Payer: Priority Health Cigna Priority Health	$130.19
Rate for Payer: Priority Health SBD	$126.18

Know your out-of-pocket cost for care.

All Charges