Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

WATER FOR INJECTION, STERILE INJECTION SOLUTION FOR SOLID FORM MIXTURES

Facility

$18.12

Service Code	NDC 63323018510
Hospital Charge Code	301772
Hospital Revenue Code	250
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$16.31
Rate for Payer: Aetna Commercial	$15.40
Rate for Payer: Aetna New Business (MI Preferred)	$11.78
Rate for Payer: Cash Price	$14.50
Rate for Payer: Cofinity Commercial	$12.68
Rate for Payer: Cofinity Commercial	$15.58
Rate for Payer: Cofinity Medicare Advantage	$12.68
Rate for Payer: Encore Health Key Benefits Commercial	$14.50
Rate for Payer: Healthscope Commercial	$16.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.40
Rate for Payer: PHP Commercial	$15.40
Rate for Payer: Priority Health Cigna Priority Health	$11.78
Rate for Payer: Priority Health SBD	$11.42

WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION

Facility

$47.85

Service Code	NDC 00338001304
Hospital Charge Code	28400
Hospital Revenue Code	250
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$43.06
Rate for Payer: Aetna Commercial	$40.67
Rate for Payer: Aetna New Business (MI Preferred)	$31.10
Rate for Payer: Cash Price	$38.28
Rate for Payer: Cofinity Commercial	$33.50
Rate for Payer: Cofinity Commercial	$41.15
Rate for Payer: Cofinity Medicare Advantage	$33.50
Rate for Payer: Encore Health Key Benefits Commercial	$38.28
Rate for Payer: Healthscope Commercial	$43.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.67
Rate for Payer: PHP Commercial	$40.67
Rate for Payer: Priority Health Cigna Priority Health	$31.10
Rate for Payer: Priority Health SBD	$30.15

WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION

Facility

$47.85

Service Code	NDC 00338001304
Hospital Charge Code	28400
Hospital Revenue Code	250
Min. Negotiated Rate	$19.14
Max. Negotiated Rate	$43.06
Rate for Payer: Aetna Commercial	$40.67
Rate for Payer: Aetna Medicare	$23.92
Rate for Payer: Aetna New Business (MI Preferred)	$31.10
Rate for Payer: BCBS Complete	$19.14
Rate for Payer: Cash Price	$38.28
Rate for Payer: Cofinity Commercial	$33.50
Rate for Payer: Cofinity Commercial	$41.15
Rate for Payer: Cofinity Medicare Advantage	$33.50
Rate for Payer: Encore Health Key Benefits Commercial	$38.28
Rate for Payer: Healthscope Commercial	$43.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.67
Rate for Payer: PHP Commercial	$40.67
Rate for Payer: Priority Health Cigna Priority Health	$31.10
Rate for Payer: Priority Health SBD	$30.15

WATER FOR IRRIGATION, STERILE SOLUTION

Facility

$63.80

Service Code	NDC 00338000404
Hospital Charge Code	7485
Hospital Revenue Code	250
Min. Negotiated Rate	$25.52
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna Medicare	$31.90
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: BCBS Complete	$25.52
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

WATER FOR IRRIGATION, STERILE SOLUTION

Facility

$95.70

Service Code	NDC 00338000347
Hospital Charge Code	7485
Hospital Revenue Code	250
Min. Negotiated Rate	$60.29
Max. Negotiated Rate	$86.13
Rate for Payer: Aetna Commercial	$81.34
Rate for Payer: Aetna New Business (MI Preferred)	$62.20
Rate for Payer: Cash Price	$76.56
Rate for Payer: Cofinity Commercial	$66.99
Rate for Payer: Cofinity Commercial	$82.30
Rate for Payer: Cofinity Medicare Advantage	$66.99
Rate for Payer: Encore Health Key Benefits Commercial	$76.56
Rate for Payer: Healthscope Commercial	$86.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.34
Rate for Payer: PHP Commercial	$81.34
Rate for Payer: Priority Health Cigna Priority Health	$62.20
Rate for Payer: Priority Health SBD	$60.29

WATER FOR IRRIGATION, STERILE SOLUTION

Facility

$79.75

Service Code	NDC 00338000403
Hospital Charge Code	7485
Hospital Revenue Code	250
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$71.78
Rate for Payer: Aetna Commercial	$67.79
Rate for Payer: Aetna New Business (MI Preferred)	$51.84
Rate for Payer: Cash Price	$63.80
Rate for Payer: Cofinity Commercial	$55.82
Rate for Payer: Cofinity Commercial	$68.58
Rate for Payer: Cofinity Medicare Advantage	$55.82
Rate for Payer: Encore Health Key Benefits Commercial	$63.80
Rate for Payer: Healthscope Commercial	$71.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.79
Rate for Payer: PHP Commercial	$67.79
Rate for Payer: Priority Health Cigna Priority Health	$51.84
Rate for Payer: Priority Health SBD	$50.24

WATER FOR IRRIGATION, STERILE SOLUTION

Facility

$79.75

Service Code	NDC 00338000403
Hospital Charge Code	7485
Hospital Revenue Code	250
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$71.78
Rate for Payer: Aetna Commercial	$67.79
Rate for Payer: Aetna Medicare	$39.88
Rate for Payer: Aetna New Business (MI Preferred)	$51.84
Rate for Payer: BCBS Complete	$31.90
Rate for Payer: Cash Price	$63.80
Rate for Payer: Cofinity Commercial	$55.82
Rate for Payer: Cofinity Commercial	$68.58
Rate for Payer: Cofinity Medicare Advantage	$55.82
Rate for Payer: Encore Health Key Benefits Commercial	$63.80
Rate for Payer: Healthscope Commercial	$71.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.79
Rate for Payer: PHP Commercial	$67.79
Rate for Payer: Priority Health Cigna Priority Health	$51.84
Rate for Payer: Priority Health SBD	$50.24

WATER FOR IRRIGATION, STERILE SOLUTION

Facility

$47.85

Service Code	NDC 00338000405
Hospital Charge Code	7485
Hospital Revenue Code	250
Min. Negotiated Rate	$19.14
Max. Negotiated Rate	$43.06
Rate for Payer: Aetna Commercial	$40.67
Rate for Payer: Aetna Medicare	$23.92
Rate for Payer: Aetna New Business (MI Preferred)	$31.10
Rate for Payer: BCBS Complete	$19.14
Rate for Payer: Cash Price	$38.28
Rate for Payer: Cofinity Commercial	$33.50
Rate for Payer: Cofinity Commercial	$41.15
Rate for Payer: Cofinity Medicare Advantage	$33.50
Rate for Payer: Encore Health Key Benefits Commercial	$38.28
Rate for Payer: Healthscope Commercial	$43.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.67
Rate for Payer: PHP Commercial	$40.67
Rate for Payer: Priority Health Cigna Priority Health	$31.10
Rate for Payer: Priority Health SBD	$30.15

WATER FOR IRRIGATION, STERILE SOLUTION

Facility

$63.80

Service Code	NDC 00338000404
Hospital Charge Code	7485
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Cofinity Medicare Advantage	$44.66
Rate for Payer: Encore Health Key Benefits Commercial	$51.04
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$41.47
Rate for Payer: Priority Health SBD	$40.19

WATER FOR IRRIGATION, STERILE SOLUTION

Facility

$47.85

Service Code	NDC 00338000405
Hospital Charge Code	7485
Hospital Revenue Code	250
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$43.06
Rate for Payer: Aetna Commercial	$40.67
Rate for Payer: Aetna New Business (MI Preferred)	$31.10
Rate for Payer: Cash Price	$38.28
Rate for Payer: Cofinity Commercial	$33.50
Rate for Payer: Cofinity Commercial	$41.15
Rate for Payer: Cofinity Medicare Advantage	$33.50
Rate for Payer: Encore Health Key Benefits Commercial	$38.28
Rate for Payer: Healthscope Commercial	$43.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.67
Rate for Payer: PHP Commercial	$40.67
Rate for Payer: Priority Health Cigna Priority Health	$31.10
Rate for Payer: Priority Health SBD	$30.15

WATER FOR IRRIGATION, STERILE SOLUTION

Facility

$95.70

Service Code	NDC 00338000347
Hospital Charge Code	7485
Hospital Revenue Code	250
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$86.13
Rate for Payer: Aetna Commercial	$81.34
Rate for Payer: Aetna Medicare	$47.85
Rate for Payer: Aetna New Business (MI Preferred)	$62.20
Rate for Payer: BCBS Complete	$38.28
Rate for Payer: Cash Price	$76.56
Rate for Payer: Cofinity Commercial	$66.99
Rate for Payer: Cofinity Commercial	$82.30
Rate for Payer: Cofinity Medicare Advantage	$66.99
Rate for Payer: Encore Health Key Benefits Commercial	$76.56
Rate for Payer: Healthscope Commercial	$86.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.34
Rate for Payer: PHP Commercial	$81.34
Rate for Payer: Priority Health Cigna Priority Health	$62.20
Rate for Payer: Priority Health SBD	$60.29

WHITE PETROLATUM 57.7 %-MINERAL OIL 31.9 % EYE OINTMENT

Facility

$27.80

Service Code	NDC 63736014308
Hospital Charge Code	175688
Hospital Revenue Code	637
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$25.02
Rate for Payer: Aetna Commercial	$23.63
Rate for Payer: Aetna New Business (MI Preferred)	$18.07
Rate for Payer: Cash Price	$22.24
Rate for Payer: Cofinity Commercial	$19.46
Rate for Payer: Cofinity Commercial	$23.91
Rate for Payer: Cofinity Medicare Advantage	$19.46
Rate for Payer: Encore Health Key Benefits Commercial	$22.24
Rate for Payer: Healthscope Commercial	$25.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.63
Rate for Payer: PHP Commercial	$23.63
Rate for Payer: Priority Health Cigna Priority Health	$18.07
Rate for Payer: Priority Health SBD	$17.51

WHITE PETROLATUM 57.7 %-MINERAL OIL 31.9 % EYE OINTMENT

Facility

$27.80

Service Code	NDC 63736014308
Hospital Charge Code	175688
Hospital Revenue Code	637
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$25.02
Rate for Payer: Aetna Commercial	$23.63
Rate for Payer: Aetna Medicare	$13.90
Rate for Payer: Aetna New Business (MI Preferred)	$18.07
Rate for Payer: BCBS Complete	$11.12
Rate for Payer: Cash Price	$22.24
Rate for Payer: Cofinity Commercial	$19.46
Rate for Payer: Cofinity Commercial	$23.91
Rate for Payer: Cofinity Medicare Advantage	$19.46
Rate for Payer: Encore Health Key Benefits Commercial	$22.24
Rate for Payer: Healthscope Commercial	$25.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.63
Rate for Payer: PHP Commercial	$23.63
Rate for Payer: Priority Health Cigna Priority Health	$18.07
Rate for Payer: Priority Health SBD	$17.51

WHITE PETROLATUM EYE OINTMENT WRAPPER

Facility

$27.80

Service Code	NDC 63736014308
Hospital Charge Code	301577
Hospital Revenue Code	637
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$25.02
Rate for Payer: Aetna Commercial	$23.63
Rate for Payer: Aetna New Business (MI Preferred)	$18.07
Rate for Payer: Cash Price	$22.24
Rate for Payer: Cofinity Commercial	$19.46
Rate for Payer: Cofinity Commercial	$23.91
Rate for Payer: Cofinity Medicare Advantage	$19.46
Rate for Payer: Encore Health Key Benefits Commercial	$22.24
Rate for Payer: Healthscope Commercial	$25.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.63
Rate for Payer: PHP Commercial	$23.63
Rate for Payer: Priority Health Cigna Priority Health	$18.07
Rate for Payer: Priority Health SBD	$17.51

WHITE PETROLATUM EYE OINTMENT WRAPPER

Facility

$27.80

Service Code	NDC 63736014308
Hospital Charge Code	301577
Hospital Revenue Code	637
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$25.02
Rate for Payer: Aetna Commercial	$23.63
Rate for Payer: Aetna Medicare	$13.90
Rate for Payer: Aetna New Business (MI Preferred)	$18.07
Rate for Payer: BCBS Complete	$11.12
Rate for Payer: Cash Price	$22.24
Rate for Payer: Cofinity Commercial	$19.46
Rate for Payer: Cofinity Commercial	$23.91
Rate for Payer: Cofinity Medicare Advantage	$19.46
Rate for Payer: Encore Health Key Benefits Commercial	$22.24
Rate for Payer: Healthscope Commercial	$25.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.63
Rate for Payer: PHP Commercial	$23.63
Rate for Payer: Priority Health Cigna Priority Health	$18.07
Rate for Payer: Priority Health SBD	$17.51

WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM

Facility

$12.88

Service Code	NDC 61924017804
Hospital Charge Code	11371
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	$9.02
Rate for Payer: Cofinity Commercial	$11.08
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

WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM

Facility

$12.88

Service Code	NDC 61924017804
Hospital Charge Code	11371
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

ZIDOVUDINE 100 MG CAPSULE

Facility

$676.32

Service Code	NDC 65862010701
Hospital Charge Code	11692
Hospital Revenue Code	637
Min. Negotiated Rate	$270.53
Max. Negotiated Rate	$608.69
Rate for Payer: Aetna Commercial	$574.87
Rate for Payer: Aetna Medicare	$338.16
Rate for Payer: Aetna New Business (MI Preferred)	$439.61
Rate for Payer: BCBS Complete	$270.53
Rate for Payer: Cash Price	$541.06
Rate for Payer: Cofinity Commercial	$473.42
Rate for Payer: Cofinity Commercial	$581.64
Rate for Payer: Cofinity Medicare Advantage	$473.42
Rate for Payer: Encore Health Key Benefits Commercial	$541.06
Rate for Payer: Healthscope Commercial	$608.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$574.87
Rate for Payer: PHP Commercial	$574.87
Rate for Payer: Priority Health Cigna Priority Health	$439.61
Rate for Payer: Priority Health SBD	$426.08

ZIDOVUDINE 100 MG CAPSULE

Facility

$676.32

Service Code	NDC 65862010701
Hospital Charge Code	11692
Hospital Revenue Code	637
Min. Negotiated Rate	$426.08
Max. Negotiated Rate	$608.69
Rate for Payer: Aetna Commercial	$574.87
Rate for Payer: Aetna New Business (MI Preferred)	$439.61
Rate for Payer: Cash Price	$541.06
Rate for Payer: Cofinity Commercial	$473.42
Rate for Payer: Cofinity Commercial	$581.64
Rate for Payer: Cofinity Medicare Advantage	$473.42
Rate for Payer: Encore Health Key Benefits Commercial	$541.06
Rate for Payer: Healthscope Commercial	$608.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$574.87
Rate for Payer: PHP Commercial	$574.87
Rate for Payer: Priority Health Cigna Priority Health	$439.61
Rate for Payer: Priority Health SBD	$426.08

ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$126.65

Service Code	HCPCS J3485
Hospital Charge Code	11691
Hospital Revenue Code	636
Min. Negotiated Rate	$79.79
Max. Negotiated Rate	$113.98
Rate for Payer: Aetna Commercial	$107.65
Rate for Payer: Aetna New Business (MI Preferred)	$82.32
Rate for Payer: Cash Price	$101.32
Rate for Payer: Cofinity Commercial	$108.92
Rate for Payer: Cofinity Commercial	$88.66
Rate for Payer: Cofinity Medicare Advantage	$88.66
Rate for Payer: Encore Health Key Benefits Commercial	$101.32
Rate for Payer: Healthscope Commercial	$113.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.65
Rate for Payer: PHP Commercial	$107.65
Rate for Payer: Priority Health Cigna Priority Health	$82.32
Rate for Payer: Priority Health SBD	$79.79

ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$126.65

Service Code	HCPCS J3485
Hospital Charge Code	11691
Hospital Revenue Code	636
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$113.98
Rate for Payer: Aetna Commercial	$107.65
Rate for Payer: Aetna Medicare	$63.32
Rate for Payer: Aetna New Business (MI Preferred)	$82.32
Rate for Payer: BCBS Complete	$50.66
Rate for Payer: BCBS Trust/PPO	$4.27
Rate for Payer: BCN Commercial	$4.27
Rate for Payer: Cash Price	$101.32
Rate for Payer: Cash Price	$101.32
Rate for Payer: Cofinity Commercial	$108.92
Rate for Payer: Cofinity Commercial	$88.66
Rate for Payer: Cofinity Medicare Advantage	$88.66
Rate for Payer: Encore Health Key Benefits Commercial	$101.32
Rate for Payer: Healthscope Commercial	$113.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.65
Rate for Payer: PHP Commercial	$107.65
Rate for Payer: Priority Health Cigna Priority Health	$82.32
Rate for Payer: Priority Health SBD	$79.79

ZIDOVUDINE 10 MG/ML ORAL SYRUP

Facility

$789.60

Service Code	NDC 65862004824
Hospital Charge Code	11693
Hospital Revenue Code	637
Min. Negotiated Rate	$497.45
Max. Negotiated Rate	$710.64
Rate for Payer: Aetna Commercial	$671.16
Rate for Payer: Aetna New Business (MI Preferred)	$513.24
Rate for Payer: Cash Price	$631.68
Rate for Payer: Cofinity Commercial	$552.72
Rate for Payer: Cofinity Commercial	$679.06
Rate for Payer: Cofinity Medicare Advantage	$552.72
Rate for Payer: Encore Health Key Benefits Commercial	$631.68
Rate for Payer: Healthscope Commercial	$710.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$671.16
Rate for Payer: PHP Commercial	$671.16
Rate for Payer: Priority Health Cigna Priority Health	$513.24
Rate for Payer: Priority Health SBD	$497.45

ZIDOVUDINE 10 MG/ML ORAL SYRUP

Facility

$789.60

Service Code	NDC 65862004824
Hospital Charge Code	11693
Hospital Revenue Code	637
Min. Negotiated Rate	$315.84
Max. Negotiated Rate	$710.64
Rate for Payer: Aetna Commercial	$671.16
Rate for Payer: Aetna Medicare	$394.80
Rate for Payer: Aetna New Business (MI Preferred)	$513.24
Rate for Payer: BCBS Complete	$315.84
Rate for Payer: Cash Price	$631.68
Rate for Payer: Cofinity Commercial	$552.72
Rate for Payer: Cofinity Commercial	$679.06
Rate for Payer: Cofinity Medicare Advantage	$552.72
Rate for Payer: Encore Health Key Benefits Commercial	$631.68
Rate for Payer: Healthscope Commercial	$710.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$671.16
Rate for Payer: PHP Commercial	$671.16
Rate for Payer: Priority Health Cigna Priority Health	$513.24
Rate for Payer: Priority Health SBD	$497.45

ZINC OXIDE 20 % TOPICAL OINTMENT

Facility

$23.32

Service Code	NDC 75834017001
Hospital Charge Code	8874
Hospital Revenue Code	637
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$20.99
Rate for Payer: Aetna Commercial	$19.82
Rate for Payer: Aetna New Business (MI Preferred)	$15.16
Rate for Payer: Cash Price	$18.66
Rate for Payer: Cofinity Commercial	$16.32
Rate for Payer: Cofinity Commercial	$20.06
Rate for Payer: Cofinity Medicare Advantage	$16.32
Rate for Payer: Encore Health Key Benefits Commercial	$18.66
Rate for Payer: Healthscope Commercial	$20.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.82
Rate for Payer: PHP Commercial	$19.82
Rate for Payer: Priority Health Cigna Priority Health	$15.16
Rate for Payer: Priority Health SBD	$14.69

ZINC OXIDE 20 % TOPICAL OINTMENT

Facility

$23.32

Service Code	NDC 75834017001
Hospital Charge Code	8874
Hospital Revenue Code	637
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$20.99
Rate for Payer: Aetna Commercial	$19.82
Rate for Payer: Aetna Medicare	$11.66
Rate for Payer: Aetna New Business (MI Preferred)	$15.16
Rate for Payer: BCBS Complete	$9.33
Rate for Payer: Cash Price	$18.66
Rate for Payer: Cofinity Commercial	$16.32
Rate for Payer: Cofinity Commercial	$20.06
Rate for Payer: Cofinity Medicare Advantage	$16.32
Rate for Payer: Encore Health Key Benefits Commercial	$18.66
Rate for Payer: Healthscope Commercial	$20.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.82
Rate for Payer: PHP Commercial	$19.82
Rate for Payer: Priority Health Cigna Priority Health	$15.16
Rate for Payer: Priority Health SBD	$14.69

Know your out-of-pocket cost for care.

All Charges