Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ALLOPURINOL 100 MG TABLET

Facility

$77.55

Service Code	NDC 16729013401
Hospital Charge Code	310
Hospital Revenue Code	637
Min. Negotiated Rate	$48.86
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna New Business (MI Preferred)	$50.41
Rate for Payer: Cash Price	$62.04
Rate for Payer: Cofinity Advantage	$54.28
Rate for Payer: Cofinity Commercial	$66.69
Rate for Payer: Encore Health Key Benefits Commercial	$62.04
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.16
Rate for Payer: PHP Commercial	$65.92
Rate for Payer: Priority Health SBD	$48.86

ALLOPURINOL 100 MG TABLET

Facility

$277.40

Service Code	NDC 00591554301
Hospital Charge Code	310
Hospital Revenue Code	637
Min. Negotiated Rate	$174.76
Max. Negotiated Rate	$249.66
Rate for Payer: Aetna Commercial	$235.79
Rate for Payer: Aetna New Business (MI Preferred)	$180.31
Rate for Payer: Cash Price	$221.92
Rate for Payer: Cofinity Advantage	$194.18
Rate for Payer: Cofinity Commercial	$238.56
Rate for Payer: Encore Health Key Benefits Commercial	$221.92
Rate for Payer: Healthscope Commercial	$249.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.05
Rate for Payer: PHP Commercial	$235.79
Rate for Payer: Priority Health SBD	$174.76

ALLOPURINOL 100 MG TABLET

Facility

$277.40

Service Code	NDC 00591554301
Hospital Charge Code	310
Hospital Revenue Code	637
Min. Negotiated Rate	$109.02
Max. Negotiated Rate	$249.66
Rate for Payer: Aetna Commercial	$235.79
Rate for Payer: Aetna Medicare	$138.70
Rate for Payer: Aetna New Business (MI Preferred)	$180.31
Rate for Payer: BCBS Complete	$110.96
Rate for Payer: Cash Price	$221.92
Rate for Payer: Cofinity Advantage	$194.18
Rate for Payer: Cofinity Commercial	$238.56
Rate for Payer: Encore Health Key Benefits Commercial	$221.92
Rate for Payer: Healthscope Commercial	$249.66
Rate for Payer: MI Amish Medical Board Commercial	$221.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.05
Rate for Payer: PHP Commercial	$235.79
Rate for Payer: Priority Health SBD	$174.76
Rate for Payer: UHC All Payor (Choice/PPO)	$180.31
Rate for Payer: UHC Core	$144.53
Rate for Payer: UHC Exchange	$109.02

ALLOPURINOL 100 MG TABLET

Facility

$255.55

Service Code	NDC 51079020520
Hospital Charge Code	310
Hospital Revenue Code	637
Min. Negotiated Rate	$161.00
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$217.22
Rate for Payer: Aetna New Business (MI Preferred)	$166.11
Rate for Payer: Cash Price	$204.44
Rate for Payer: Cofinity Advantage	$178.88
Rate for Payer: Cofinity Commercial	$219.77
Rate for Payer: Encore Health Key Benefits Commercial	$204.44
Rate for Payer: Healthscope Commercial	$230.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$217.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$191.66
Rate for Payer: PHP Commercial	$217.22
Rate for Payer: Priority Health SBD	$161.00

ALLOPURINOL 100 MG TABLET

Facility

$2.56

Service Code	NDC 51079020501
Hospital Charge Code	310
Hospital Revenue Code	637
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.30
Rate for Payer: Aetna Commercial	$2.18
Rate for Payer: Aetna New Business (MI Preferred)	$1.66
Rate for Payer: Cash Price	$2.05
Rate for Payer: Cofinity Advantage	$1.79
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.05
Rate for Payer: Healthscope Commercial	$2.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.92
Rate for Payer: PHP Commercial	$2.18
Rate for Payer: Priority Health SBD	$1.61

ALLOPURINOL 100 MG TABLET

Facility

$215.65

Service Code	NDC 60687067701
Hospital Charge Code	310
Hospital Revenue Code	637
Min. Negotiated Rate	$84.75
Max. Negotiated Rate	$194.09
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna Medicare	$107.83
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
Rate for Payer: BCBS Complete	$86.26
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Advantage	$150.96
Rate for Payer: Cofinity Commercial	$185.46
Rate for Payer: Encore Health Key Benefits Commercial	$172.52
Rate for Payer: Healthscope Commercial	$194.09
Rate for Payer: MI Amish Medical Board Commercial	$172.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$161.74
Rate for Payer: PHP Commercial	$183.30
Rate for Payer: Priority Health SBD	$135.86
Rate for Payer: UHC All Payor (Choice/PPO)	$140.17
Rate for Payer: UHC Core	$112.35
Rate for Payer: UHC Exchange	$84.75

ALLOPURINOL 300 MG TABLET

Facility

$371.30

Service Code	NDC 00603211621
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$145.92
Max. Negotiated Rate	$334.17
Rate for Payer: Aetna Commercial	$315.61
Rate for Payer: Aetna Medicare	$185.65
Rate for Payer: Aetna New Business (MI Preferred)	$241.34
Rate for Payer: BCBS Complete	$148.52
Rate for Payer: Cash Price	$297.04
Rate for Payer: Cofinity Advantage	$259.91
Rate for Payer: Cofinity Commercial	$319.32
Rate for Payer: Encore Health Key Benefits Commercial	$297.04
Rate for Payer: Healthscope Commercial	$334.17
Rate for Payer: MI Amish Medical Board Commercial	$297.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$278.48
Rate for Payer: PHP Commercial	$315.61
Rate for Payer: Priority Health SBD	$233.92
Rate for Payer: UHC All Payor (Choice/PPO)	$241.34
Rate for Payer: UHC Core	$193.45
Rate for Payer: UHC Exchange	$145.92

ALLOPURINOL 300 MG TABLET

Facility

$377.15

Service Code	NDC 00904657261
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$339.44
Rate for Payer: Aetna Commercial	$320.58
Rate for Payer: Aetna New Business (MI Preferred)	$245.15
Rate for Payer: Cash Price	$301.72
Rate for Payer: Cofinity Advantage	$264.00
Rate for Payer: Cofinity Commercial	$324.35
Rate for Payer: Encore Health Key Benefits Commercial	$301.72
Rate for Payer: Healthscope Commercial	$339.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$320.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$282.86
Rate for Payer: PHP Commercial	$320.58
Rate for Payer: Priority Health SBD	$237.60

ALLOPURINOL 300 MG TABLET

Facility

$371.30

Service Code	NDC 00603211621
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$233.92
Max. Negotiated Rate	$334.17
Rate for Payer: Aetna Commercial	$315.61
Rate for Payer: Aetna New Business (MI Preferred)	$241.34
Rate for Payer: Cash Price	$297.04
Rate for Payer: Cofinity Advantage	$259.91
Rate for Payer: Cofinity Commercial	$319.32
Rate for Payer: Encore Health Key Benefits Commercial	$297.04
Rate for Payer: Healthscope Commercial	$334.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$278.48
Rate for Payer: PHP Commercial	$315.61
Rate for Payer: Priority Health SBD	$233.92

ALLOPURINOL 300 MG TABLET

Facility

$377.15

Service Code	NDC 00904657261
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$148.22
Max. Negotiated Rate	$339.44
Rate for Payer: Aetna Commercial	$320.58
Rate for Payer: Aetna Medicare	$188.57
Rate for Payer: Aetna New Business (MI Preferred)	$245.15
Rate for Payer: BCBS Complete	$150.86
Rate for Payer: Cash Price	$301.72
Rate for Payer: Cofinity Advantage	$264.00
Rate for Payer: Cofinity Commercial	$324.35
Rate for Payer: Encore Health Key Benefits Commercial	$301.72
Rate for Payer: Healthscope Commercial	$339.44
Rate for Payer: MI Amish Medical Board Commercial	$301.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$320.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$282.86
Rate for Payer: PHP Commercial	$320.58
Rate for Payer: Priority Health SBD	$237.60
Rate for Payer: UHC All Payor (Choice/PPO)	$245.15
Rate for Payer: UHC Core	$196.50
Rate for Payer: UHC Exchange	$148.22

ALLOPURINOL 300 MG TABLET

Facility

$458.25

Service Code	NDC 70710121001
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$180.09
Max. Negotiated Rate	$412.43
Rate for Payer: Aetna Commercial	$389.51
Rate for Payer: Aetna Medicare	$229.12
Rate for Payer: Aetna New Business (MI Preferred)	$297.86
Rate for Payer: BCBS Complete	$183.30
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Advantage	$320.77
Rate for Payer: Cofinity Commercial	$394.10
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$412.43
Rate for Payer: MI Amish Medical Board Commercial	$366.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$343.69
Rate for Payer: PHP Commercial	$389.51
Rate for Payer: Priority Health SBD	$288.70
Rate for Payer: UHC All Payor (Choice/PPO)	$297.86
Rate for Payer: UHC Core	$238.75
Rate for Payer: UHC Exchange	$180.09

ALLOPURINOL 300 MG TABLET

Facility

$458.25

Service Code	NDC 70710121001
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$288.70
Max. Negotiated Rate	$412.43
Rate for Payer: Aetna Commercial	$389.51
Rate for Payer: Aetna New Business (MI Preferred)	$297.86
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Advantage	$320.77
Rate for Payer: Cofinity Commercial	$394.10
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$412.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$343.69
Rate for Payer: PHP Commercial	$389.51
Rate for Payer: Priority Health SBD	$288.70

ALOE VERA-COLLAGEN TOPICAL FOAM

Facility

$28.09

Service Code	NDC 68455010841
Hospital Charge Code	108259
Hospital Revenue Code	637
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$25.28
Rate for Payer: Aetna Commercial	$23.88
Rate for Payer: Aetna New Business (MI Preferred)	$18.26
Rate for Payer: Cash Price	$22.47
Rate for Payer: Cofinity Advantage	$19.66
Rate for Payer: Cofinity Commercial	$24.16
Rate for Payer: Encore Health Key Benefits Commercial	$22.47
Rate for Payer: Healthscope Commercial	$25.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.07
Rate for Payer: PHP Commercial	$23.88
Rate for Payer: Priority Health SBD	$17.70

ALOE VERA-COLLAGEN TOPICAL FOAM

Facility

$28.09

Service Code	NDC 68455010841
Hospital Charge Code	108259
Hospital Revenue Code	637
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$25.28
Rate for Payer: Aetna Commercial	$23.88
Rate for Payer: Aetna Medicare	$14.04
Rate for Payer: Aetna New Business (MI Preferred)	$18.26
Rate for Payer: BCBS Complete	$11.24
Rate for Payer: Cash Price	$22.47
Rate for Payer: Cofinity Advantage	$19.66
Rate for Payer: Cofinity Commercial	$24.16
Rate for Payer: Encore Health Key Benefits Commercial	$22.47
Rate for Payer: Healthscope Commercial	$25.28
Rate for Payer: MI Amish Medical Board Commercial	$22.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.07
Rate for Payer: PHP Commercial	$23.88
Rate for Payer: Priority Health SBD	$17.70
Rate for Payer: UHC All Payor (Choice/PPO)	$18.26
Rate for Payer: UHC Core	$14.63
Rate for Payer: UHC Exchange	$11.04

ALOE VERA-SOAP

Facility

$9.21

Service Code	NDC 68455010835
Hospital Charge Code	114141
Hospital Revenue Code	637
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$8.29
Rate for Payer: Aetna Commercial	$7.83
Rate for Payer: Aetna New Business (MI Preferred)	$5.99
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cofinity Advantage	$6.45
Rate for Payer: Cofinity Commercial	$7.92
Rate for Payer: Encore Health Key Benefits Commercial	$7.37
Rate for Payer: Healthscope Commercial	$8.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.91
Rate for Payer: PHP Commercial	$7.83
Rate for Payer: Priority Health SBD	$5.80

ALOE VERA-SOAP

Facility

$9.21

Service Code	NDC 68455010835
Hospital Charge Code	114141
Hospital Revenue Code	637
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$8.29
Rate for Payer: Aetna Commercial	$7.83
Rate for Payer: Aetna Medicare	$4.61
Rate for Payer: Aetna New Business (MI Preferred)	$5.99
Rate for Payer: BCBS Complete	$3.68
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cofinity Advantage	$6.45
Rate for Payer: Cofinity Commercial	$7.92
Rate for Payer: Encore Health Key Benefits Commercial	$7.37
Rate for Payer: Healthscope Commercial	$8.29
Rate for Payer: MI Amish Medical Board Commercial	$7.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.91
Rate for Payer: PHP Commercial	$7.83
Rate for Payer: Priority Health SBD	$5.80
Rate for Payer: UHC All Payor (Choice/PPO)	$5.99
Rate for Payer: UHC Core	$4.80
Rate for Payer: UHC Exchange	$3.62

ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION

Facility

$1.48

Service Code	HCPCS J0256
Hospital Charge Code	185673
Hospital Revenue Code	636
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.33
Rate for Payer: Aetna Commercial	$1.26
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Advantage	$1.04
Rate for Payer: Cofinity Commercial	$1.27
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Healthscope Commercial	$1.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.11
Rate for Payer: PHP Commercial	$1.26
Rate for Payer: Priority Health SBD	$0.93

ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION

Facility

$1.48

Service Code	HCPCS J0256
Hospital Charge Code	185673
Hospital Revenue Code	636
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$17.21
Rate for Payer: Aetna Commercial	$1.26
Rate for Payer: Aetna Medicare	$5.35
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.42
Rate for Payer: Amish Plain Church Group Commercial	$6.42
Rate for Payer: BCBS Complete	$2.82
Rate for Payer: BCBS MAPPO	$5.14
Rate for Payer: BCBS Trust/PPO	$13.47
Rate for Payer: BCN Commercial	$13.47
Rate for Payer: BCN Medicare Advantage	$5.14
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Advantage	$1.04
Rate for Payer: Cofinity Commercial	$1.27
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.14
Rate for Payer: Healthscope Commercial	$1.33
Rate for Payer: Mclaren Medicaid	$2.69
Rate for Payer: Mclaren Medicare	$5.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.40
Rate for Payer: Meridian Medicaid	$5.40
Rate for Payer: MI Amish Medical Board Commercial	$5.91
Rate for Payer: Molina Medicare/Medicaid	$5.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.26
Rate for Payer: Nomi Health Commercial	$15.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.11
Rate for Payer: PACE Medicare	$4.88
Rate for Payer: PACE SWMI	$5.14
Rate for Payer: PHP Commercial	$1.26
Rate for Payer: PHP Medicare Advantage	$5.14
Rate for Payer: Priority Health Choice Medicaid	$2.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$17.21
Rate for Payer: Priority Health Medicare	$5.14
Rate for Payer: Priority Health SBD	$0.93
Rate for Payer: Priority Health Tiered Network	$13.77
Rate for Payer: Railroad Medicare Medicare	$5.14
Rate for Payer: UHC All Payor (Choice/PPO)	$8.86
Rate for Payer: UHC Core	$8.86
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5.14
Rate for Payer: UHC Exchange	$8.86
Rate for Payer: UHC Medicaid	$2.69
Rate for Payer: UHCCP Medicaid	$2.69
Rate for Payer: VA VA	$5.14

ALPRAZOLAM 0.25 MG TABLET

Facility

$4.85

Service Code	NDC 60687037711
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.37
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna Medicare	$2.42
Rate for Payer: Aetna New Business (MI Preferred)	$3.15
Rate for Payer: BCBS Complete	$1.94
Rate for Payer: Cash Price	$3.88
Rate for Payer: Cofinity Advantage	$3.40
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Encore Health Key Benefits Commercial	$3.88
Rate for Payer: Healthscope Commercial	$4.37
Rate for Payer: MI Amish Medical Board Commercial	$3.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.64
Rate for Payer: PHP Commercial	$4.12
Rate for Payer: Priority Health SBD	$3.06
Rate for Payer: UHC All Payor (Choice/PPO)	$3.15
Rate for Payer: UHC Core	$2.53
Rate for Payer: UHC Exchange	$1.91

ALPRAZOLAM 0.25 MG TABLET

Facility

$42.00

Service Code	NDC 00781106101
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Advantage	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.50
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health SBD	$26.46

ALPRAZOLAM 0.25 MG TABLET

Facility

$64.75

Service Code	NDC 65862067601
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$40.79
Max. Negotiated Rate	$58.27
Rate for Payer: Aetna Commercial	$55.04
Rate for Payer: Aetna New Business (MI Preferred)	$42.09
Rate for Payer: Cash Price	$51.80
Rate for Payer: Cofinity Advantage	$45.33
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Encore Health Key Benefits Commercial	$51.80
Rate for Payer: Healthscope Commercial	$58.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.56
Rate for Payer: PHP Commercial	$55.04
Rate for Payer: Priority Health SBD	$40.79

ALPRAZOLAM 0.25 MG TABLET

Facility

$78.75

Service Code	NDC 00228202710
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$30.95
Max. Negotiated Rate	$70.88
Rate for Payer: Aetna Commercial	$66.94
Rate for Payer: Aetna Medicare	$39.38
Rate for Payer: Aetna New Business (MI Preferred)	$51.19
Rate for Payer: BCBS Complete	$31.50
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cofinity Advantage	$55.12
Rate for Payer: Cofinity Commercial	$67.72
Rate for Payer: Encore Health Key Benefits Commercial	$63.00
Rate for Payer: Healthscope Commercial	$70.88
Rate for Payer: MI Amish Medical Board Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.06
Rate for Payer: PHP Commercial	$66.94
Rate for Payer: Priority Health SBD	$49.61
Rate for Payer: UHC All Payor (Choice/PPO)	$51.19
Rate for Payer: UHC Core	$41.03
Rate for Payer: UHC Exchange	$30.95

ALPRAZOLAM 0.25 MG TABLET

Facility

$4.85

Service Code	NDC 60687037711
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.37
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna New Business (MI Preferred)	$3.15
Rate for Payer: Cash Price	$3.88
Rate for Payer: Cofinity Advantage	$3.40
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Encore Health Key Benefits Commercial	$3.88
Rate for Payer: Healthscope Commercial	$4.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.64
Rate for Payer: PHP Commercial	$4.12
Rate for Payer: Priority Health SBD	$3.06

ALPRAZOLAM 0.25 MG TABLET

Facility

$54.25

Service Code	NDC 59762371901
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$48.83
Rate for Payer: Aetna Commercial	$46.11
Rate for Payer: Aetna New Business (MI Preferred)	$35.26
Rate for Payer: Cash Price	$43.40
Rate for Payer: Cofinity Advantage	$37.98
Rate for Payer: Cofinity Commercial	$46.66
Rate for Payer: Encore Health Key Benefits Commercial	$43.40
Rate for Payer: Healthscope Commercial	$48.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.69
Rate for Payer: PHP Commercial	$46.11
Rate for Payer: Priority Health SBD	$34.18

ALPRAZOLAM 0.25 MG TABLET

Facility

$54.25

Service Code	NDC 59762371901
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$48.83
Rate for Payer: Aetna Commercial	$46.11
Rate for Payer: Aetna Medicare	$27.12
Rate for Payer: Aetna New Business (MI Preferred)	$35.26
Rate for Payer: BCBS Complete	$21.70
Rate for Payer: Cash Price	$43.40
Rate for Payer: Cofinity Advantage	$37.98
Rate for Payer: Cofinity Commercial	$46.66
Rate for Payer: Encore Health Key Benefits Commercial	$43.40
Rate for Payer: Healthscope Commercial	$48.83
Rate for Payer: MI Amish Medical Board Commercial	$43.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.69
Rate for Payer: PHP Commercial	$46.11
Rate for Payer: Priority Health SBD	$34.18
Rate for Payer: UHC All Payor (Choice/PPO)	$35.26
Rate for Payer: UHC Core	$28.26
Rate for Payer: UHC Exchange	$21.32

Know your out-of-pocket cost for care.

All Charges