Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$3.40

Service Code	NDC 60687020611
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$3.06
Rate for Payer: Aetna Commercial	$2.89
Rate for Payer: Aetna New Business (MI Preferred)	$2.21
Rate for Payer: Cash Price	$2.72
Rate for Payer: Cofinity Advantage	$2.38
Rate for Payer: Cofinity Commercial	$2.92
Rate for Payer: Encore Health Key Benefits Commercial	$2.72
Rate for Payer: Healthscope Commercial	$3.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.55
Rate for Payer: PHP Commercial	$2.89
Rate for Payer: Priority Health SBD	$2.14

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$339.15

Service Code	NDC 60687020601
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$133.29
Max. Negotiated Rate	$305.24
Rate for Payer: Aetna Commercial	$288.28
Rate for Payer: Aetna Medicare	$169.57
Rate for Payer: Aetna New Business (MI Preferred)	$220.45
Rate for Payer: BCBS Complete	$135.66
Rate for Payer: Cash Price	$271.32
Rate for Payer: Cofinity Advantage	$237.41
Rate for Payer: Cofinity Commercial	$291.67
Rate for Payer: Encore Health Key Benefits Commercial	$271.32
Rate for Payer: Healthscope Commercial	$305.24
Rate for Payer: MI Amish Medical Board Commercial	$271.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$254.36
Rate for Payer: PHP Commercial	$288.28
Rate for Payer: Priority Health SBD	$213.66
Rate for Payer: UHC All Payor (Choice/PPO)	$220.45
Rate for Payer: UHC Core	$176.70
Rate for Payer: UHC Exchange	$133.29

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$172.71

Service Code	NDC 50742024990
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$108.81
Max. Negotiated Rate	$155.44
Rate for Payer: Aetna Commercial	$146.80
Rate for Payer: Aetna New Business (MI Preferred)	$112.26
Rate for Payer: Cash Price	$138.17
Rate for Payer: Cofinity Advantage	$120.90
Rate for Payer: Cofinity Commercial	$148.53
Rate for Payer: Encore Health Key Benefits Commercial	$138.17
Rate for Payer: Healthscope Commercial	$155.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$146.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.53
Rate for Payer: PHP Commercial	$146.80
Rate for Payer: Priority Health SBD	$108.81

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$129.03

Service Code	NDC 10370083011
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$81.29
Max. Negotiated Rate	$116.13
Rate for Payer: Aetna Commercial	$109.68
Rate for Payer: Aetna New Business (MI Preferred)	$83.87
Rate for Payer: Cash Price	$103.22
Rate for Payer: Cofinity Advantage	$90.32
Rate for Payer: Cofinity Commercial	$110.97
Rate for Payer: Encore Health Key Benefits Commercial	$103.22
Rate for Payer: Healthscope Commercial	$116.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.77
Rate for Payer: PHP Commercial	$109.68
Rate for Payer: Priority Health SBD	$81.29

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$173.57

Service Code	NDC 24979002707
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$68.21
Max. Negotiated Rate	$156.21
Rate for Payer: Aetna Commercial	$147.53
Rate for Payer: Aetna Medicare	$86.78
Rate for Payer: Aetna New Business (MI Preferred)	$112.82
Rate for Payer: BCBS Complete	$69.43
Rate for Payer: Cash Price	$138.86
Rate for Payer: Cofinity Advantage	$121.50
Rate for Payer: Cofinity Commercial	$149.27
Rate for Payer: Encore Health Key Benefits Commercial	$138.86
Rate for Payer: Healthscope Commercial	$156.21
Rate for Payer: MI Amish Medical Board Commercial	$138.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$130.18
Rate for Payer: PHP Commercial	$147.53
Rate for Payer: Priority Health SBD	$109.35
Rate for Payer: UHC All Payor (Choice/PPO)	$112.82
Rate for Payer: UHC Core	$90.43
Rate for Payer: UHC Exchange	$68.21

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$172.71

Service Code	NDC 50742024990
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$67.88
Max. Negotiated Rate	$155.44
Rate for Payer: Aetna Commercial	$146.80
Rate for Payer: Aetna Medicare	$86.36
Rate for Payer: Aetna New Business (MI Preferred)	$112.26
Rate for Payer: BCBS Complete	$69.08
Rate for Payer: Cash Price	$138.17
Rate for Payer: Cofinity Advantage	$120.90
Rate for Payer: Cofinity Commercial	$148.53
Rate for Payer: Encore Health Key Benefits Commercial	$138.17
Rate for Payer: Healthscope Commercial	$155.44
Rate for Payer: MI Amish Medical Board Commercial	$138.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$146.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.53
Rate for Payer: PHP Commercial	$146.80
Rate for Payer: Priority Health SBD	$108.81
Rate for Payer: UHC All Payor (Choice/PPO)	$112.26
Rate for Payer: UHC Core	$89.98
Rate for Payer: UHC Exchange	$67.88

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$173.57

Service Code	NDC 24979002707
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$109.35
Max. Negotiated Rate	$156.21
Rate for Payer: Aetna Commercial	$147.53
Rate for Payer: Aetna New Business (MI Preferred)	$112.82
Rate for Payer: Cash Price	$138.86
Rate for Payer: Cofinity Advantage	$121.50
Rate for Payer: Cofinity Commercial	$149.27
Rate for Payer: Encore Health Key Benefits Commercial	$138.86
Rate for Payer: Healthscope Commercial	$156.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$130.18
Rate for Payer: PHP Commercial	$147.53
Rate for Payer: Priority Health SBD	$109.35

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$339.15

Service Code	NDC 60687020601
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$213.66
Max. Negotiated Rate	$305.24
Rate for Payer: Aetna Commercial	$288.28
Rate for Payer: Aetna New Business (MI Preferred)	$220.45
Rate for Payer: Cash Price	$271.32
Rate for Payer: Cofinity Advantage	$237.41
Rate for Payer: Cofinity Commercial	$291.67
Rate for Payer: Encore Health Key Benefits Commercial	$271.32
Rate for Payer: Healthscope Commercial	$305.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$254.36
Rate for Payer: PHP Commercial	$288.28
Rate for Payer: Priority Health SBD	$213.66

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$3.40

Service Code	NDC 60687020611
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.06
Rate for Payer: Aetna Commercial	$2.89
Rate for Payer: Aetna Medicare	$1.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.21
Rate for Payer: BCBS Complete	$1.36
Rate for Payer: Cash Price	$2.72
Rate for Payer: Cofinity Advantage	$2.38
Rate for Payer: Cofinity Commercial	$2.92
Rate for Payer: Encore Health Key Benefits Commercial	$2.72
Rate for Payer: Healthscope Commercial	$3.06
Rate for Payer: MI Amish Medical Board Commercial	$2.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.55
Rate for Payer: PHP Commercial	$2.89
Rate for Payer: Priority Health SBD	$2.14
Rate for Payer: UHC All Payor (Choice/PPO)	$2.21
Rate for Payer: UHC Core	$1.77
Rate for Payer: UHC Exchange	$1.34

DILTIAZEM CD 180 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$129.03

Service Code	NDC 10370083011
Hospital Charge Code	29272
Hospital Revenue Code	637
Min. Negotiated Rate	$50.71
Max. Negotiated Rate	$116.13
Rate for Payer: Aetna Commercial	$109.68
Rate for Payer: Aetna Medicare	$64.52
Rate for Payer: Aetna New Business (MI Preferred)	$83.87
Rate for Payer: BCBS Complete	$51.61
Rate for Payer: Cash Price	$103.22
Rate for Payer: Cofinity Advantage	$90.32
Rate for Payer: Cofinity Commercial	$110.97
Rate for Payer: Encore Health Key Benefits Commercial	$103.22
Rate for Payer: Healthscope Commercial	$116.13
Rate for Payer: MI Amish Medical Board Commercial	$103.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.77
Rate for Payer: PHP Commercial	$109.68
Rate for Payer: Priority Health SBD	$81.29
Rate for Payer: UHC All Payor (Choice/PPO)	$83.87
Rate for Payer: UHC Core	$67.22
Rate for Payer: UHC Exchange	$50.71

DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$374.30

Service Code	NDC 00904721961
Hospital Charge Code	29274
Hospital Revenue Code	637
Min. Negotiated Rate	$147.10
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna Medicare	$187.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: BCBS Complete	$149.72
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Advantage	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: MI Amish Medical Board Commercial	$299.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.73
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health SBD	$235.81
Rate for Payer: UHC All Payor (Choice/PPO)	$243.29
Rate for Payer: UHC Core	$195.01
Rate for Payer: UHC Exchange	$147.10

DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$532.66

Service Code	NDC 68682099798
Hospital Charge Code	29274
Hospital Revenue Code	637
Min. Negotiated Rate	$335.58
Max. Negotiated Rate	$479.39
Rate for Payer: Aetna Commercial	$452.76
Rate for Payer: Aetna New Business (MI Preferred)	$346.23
Rate for Payer: Cash Price	$426.13
Rate for Payer: Cofinity Advantage	$372.86
Rate for Payer: Cofinity Commercial	$458.09
Rate for Payer: Encore Health Key Benefits Commercial	$426.13
Rate for Payer: Healthscope Commercial	$479.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$452.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.50
Rate for Payer: PHP Commercial	$452.76
Rate for Payer: Priority Health SBD	$335.58

DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$532.66

Service Code	NDC 68682099798
Hospital Charge Code	29274
Hospital Revenue Code	637
Min. Negotiated Rate	$209.34
Max. Negotiated Rate	$479.39
Rate for Payer: Aetna Commercial	$452.76
Rate for Payer: Aetna Medicare	$266.33
Rate for Payer: Aetna New Business (MI Preferred)	$346.23
Rate for Payer: BCBS Complete	$213.06
Rate for Payer: Cash Price	$426.13
Rate for Payer: Cofinity Advantage	$372.86
Rate for Payer: Cofinity Commercial	$458.09
Rate for Payer: Encore Health Key Benefits Commercial	$426.13
Rate for Payer: Healthscope Commercial	$479.39
Rate for Payer: MI Amish Medical Board Commercial	$426.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$452.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.50
Rate for Payer: PHP Commercial	$452.76
Rate for Payer: Priority Health SBD	$335.58
Rate for Payer: UHC All Payor (Choice/PPO)	$346.23
Rate for Payer: UHC Core	$277.52
Rate for Payer: UHC Exchange	$209.34

DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$4.13

Service Code	NDC 60687021711
Hospital Charge Code	29274
Hospital Revenue Code	637
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.72
Rate for Payer: Aetna Commercial	$3.51
Rate for Payer: Aetna Medicare	$2.06
Rate for Payer: Aetna New Business (MI Preferred)	$2.68
Rate for Payer: BCBS Complete	$1.65
Rate for Payer: Cash Price	$3.30
Rate for Payer: Cofinity Advantage	$2.89
Rate for Payer: Cofinity Commercial	$3.55
Rate for Payer: Encore Health Key Benefits Commercial	$3.30
Rate for Payer: Healthscope Commercial	$3.72
Rate for Payer: MI Amish Medical Board Commercial	$3.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.10
Rate for Payer: PHP Commercial	$3.51
Rate for Payer: Priority Health SBD	$2.60
Rate for Payer: UHC All Payor (Choice/PPO)	$2.68
Rate for Payer: UHC Core	$2.15
Rate for Payer: UHC Exchange	$1.62

DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$4.13

Service Code	NDC 60687021711
Hospital Charge Code	29274
Hospital Revenue Code	637
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.72
Rate for Payer: Aetna Commercial	$3.51
Rate for Payer: Aetna New Business (MI Preferred)	$2.68
Rate for Payer: Cash Price	$3.30
Rate for Payer: Cofinity Advantage	$2.89
Rate for Payer: Cofinity Commercial	$3.55
Rate for Payer: Encore Health Key Benefits Commercial	$3.30
Rate for Payer: Healthscope Commercial	$3.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.10
Rate for Payer: PHP Commercial	$3.51
Rate for Payer: Priority Health SBD	$2.60

DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$374.30

Service Code	NDC 00904721961
Hospital Charge Code	29274
Hospital Revenue Code	637
Min. Negotiated Rate	$235.81
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Advantage	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.73
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health SBD	$235.81

DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$412.30

Service Code	NDC 60687021701
Hospital Charge Code	29274
Hospital Revenue Code	637
Min. Negotiated Rate	$162.03
Max. Negotiated Rate	$371.07
Rate for Payer: Aetna Commercial	$350.45
Rate for Payer: Aetna Medicare	$206.15
Rate for Payer: Aetna New Business (MI Preferred)	$268.00
Rate for Payer: BCBS Complete	$164.92
Rate for Payer: Cash Price	$329.84
Rate for Payer: Cofinity Advantage	$288.61
Rate for Payer: Cofinity Commercial	$354.58
Rate for Payer: Encore Health Key Benefits Commercial	$329.84
Rate for Payer: Healthscope Commercial	$371.07
Rate for Payer: MI Amish Medical Board Commercial	$329.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$350.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$309.23
Rate for Payer: PHP Commercial	$350.45
Rate for Payer: Priority Health SBD	$259.75
Rate for Payer: UHC All Payor (Choice/PPO)	$268.00
Rate for Payer: UHC Core	$214.81
Rate for Payer: UHC Exchange	$162.03

DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR

Facility

$412.30

Service Code	NDC 60687021701
Hospital Charge Code	29274
Hospital Revenue Code	637
Min. Negotiated Rate	$259.75
Max. Negotiated Rate	$371.07
Rate for Payer: Aetna Commercial	$350.45
Rate for Payer: Aetna New Business (MI Preferred)	$268.00
Rate for Payer: Cash Price	$329.84
Rate for Payer: Cofinity Advantage	$288.61
Rate for Payer: Cofinity Commercial	$354.58
Rate for Payer: Encore Health Key Benefits Commercial	$329.84
Rate for Payer: Healthscope Commercial	$371.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$350.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$309.23
Rate for Payer: PHP Commercial	$350.45
Rate for Payer: Priority Health SBD	$259.75

DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION

Facility

$24.01

Service Code	HCPCS J1240
Hospital Charge Code	2483
Hospital Revenue Code	636
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$21.61
Rate for Payer: Aetna Commercial	$20.41
Rate for Payer: Aetna Medicare	$12.01
Rate for Payer: Aetna New Business (MI Preferred)	$15.61
Rate for Payer: BCBS Complete	$9.60
Rate for Payer: BCBS Trust/PPO	$15.39
Rate for Payer: BCN Commercial	$15.39
Rate for Payer: Cash Price	$19.21
Rate for Payer: Cash Price	$19.21
Rate for Payer: Cofinity Advantage	$16.81
Rate for Payer: Cofinity Commercial	$20.65
Rate for Payer: Encore Health Key Benefits Commercial	$19.21
Rate for Payer: Healthscope Commercial	$21.61
Rate for Payer: MI Amish Medical Board Commercial	$19.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.01
Rate for Payer: PHP Commercial	$20.41
Rate for Payer: Priority Health SBD	$15.13
Rate for Payer: UHC All Payor (Choice/PPO)	$1.52
Rate for Payer: UHC Core	$1.52
Rate for Payer: UHC Exchange	$1.52

DIMENHYDRINATE 50 MG/ML INJECTION SOLUTION

Facility

$24.01

Service Code	HCPCS J1240
Hospital Charge Code	2483
Hospital Revenue Code	636
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$21.61
Rate for Payer: Aetna Commercial	$20.41
Rate for Payer: Aetna New Business (MI Preferred)	$15.61
Rate for Payer: Cash Price	$19.21
Rate for Payer: Cofinity Advantage	$16.81
Rate for Payer: Cofinity Commercial	$20.65
Rate for Payer: Encore Health Key Benefits Commercial	$19.21
Rate for Payer: Healthscope Commercial	$21.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.01
Rate for Payer: PHP Commercial	$20.41
Rate for Payer: Priority Health SBD	$15.13

DIMENHYDRINATE 50 MG TABLET

Facility

$107.10

Service Code	NDC 00904205159
Hospital Charge Code	2485
Hospital Revenue Code	637
Min. Negotiated Rate	$42.09
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna Commercial	$91.03
Rate for Payer: Aetna Medicare	$53.55
Rate for Payer: Aetna New Business (MI Preferred)	$69.61
Rate for Payer: BCBS Complete	$42.84
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cofinity Advantage	$74.97
Rate for Payer: Cofinity Commercial	$92.11
Rate for Payer: Encore Health Key Benefits Commercial	$85.68
Rate for Payer: Healthscope Commercial	$96.39
Rate for Payer: MI Amish Medical Board Commercial	$85.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$80.33
Rate for Payer: PHP Commercial	$91.03
Rate for Payer: Priority Health SBD	$67.47
Rate for Payer: UHC All Payor (Choice/PPO)	$69.61
Rate for Payer: UHC Core	$55.80
Rate for Payer: UHC Exchange	$42.09

DIMENHYDRINATE 50 MG TABLET

Facility

$107.10

Service Code	NDC 00904205159
Hospital Charge Code	2485
Hospital Revenue Code	637
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna Commercial	$91.03
Rate for Payer: Aetna New Business (MI Preferred)	$69.61
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cofinity Advantage	$74.97
Rate for Payer: Cofinity Commercial	$92.11
Rate for Payer: Encore Health Key Benefits Commercial	$85.68
Rate for Payer: Healthscope Commercial	$96.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$80.33
Rate for Payer: PHP Commercial	$91.03
Rate for Payer: Priority Health SBD	$67.47

DIMETHICONE 3 % LOTION

Facility

$27.69

Service Code	NDC 00430310010
Hospital Charge Code	30105
Hospital Revenue Code	637
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$24.92
Rate for Payer: Aetna Commercial	$23.54
Rate for Payer: Aetna New Business (MI Preferred)	$18.00
Rate for Payer: Cash Price	$22.15
Rate for Payer: Cofinity Advantage	$19.38
Rate for Payer: Cofinity Commercial	$23.81
Rate for Payer: Encore Health Key Benefits Commercial	$22.15
Rate for Payer: Healthscope Commercial	$24.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.77
Rate for Payer: PHP Commercial	$23.54
Rate for Payer: Priority Health SBD	$17.44

DIMETHICONE 3 % LOTION

Facility

$27.69

Service Code	NDC 00430310010
Hospital Charge Code	30105
Hospital Revenue Code	637
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$24.92
Rate for Payer: Aetna Commercial	$23.54
Rate for Payer: Aetna Medicare	$13.85
Rate for Payer: Aetna New Business (MI Preferred)	$18.00
Rate for Payer: BCBS Complete	$11.08
Rate for Payer: Cash Price	$22.15
Rate for Payer: Cofinity Advantage	$19.38
Rate for Payer: Cofinity Commercial	$23.81
Rate for Payer: Encore Health Key Benefits Commercial	$22.15
Rate for Payer: Healthscope Commercial	$24.92
Rate for Payer: MI Amish Medical Board Commercial	$22.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.77
Rate for Payer: PHP Commercial	$23.54
Rate for Payer: Priority Health SBD	$17.44
Rate for Payer: UHC All Payor (Choice/PPO)	$18.00
Rate for Payer: UHC Core	$14.43
Rate for Payer: UHC Exchange	$10.88

DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED RELEASE

Facility

$1,893.18

Service Code	NDC 55566280001
Hospital Charge Code	27467
Hospital Revenue Code	637
Min. Negotiated Rate	$744.02
Max. Negotiated Rate	$1,703.86
Rate for Payer: Aetna Commercial	$1,609.20
Rate for Payer: Aetna Medicare	$946.59
Rate for Payer: Aetna New Business (MI Preferred)	$1,230.57
Rate for Payer: BCBS Complete	$757.27
Rate for Payer: Cash Price	$1,514.54
Rate for Payer: Cofinity Advantage	$1,325.23
Rate for Payer: Cofinity Commercial	$1,628.13
Rate for Payer: Encore Health Key Benefits Commercial	$1,514.54
Rate for Payer: Healthscope Commercial	$1,703.86
Rate for Payer: MI Amish Medical Board Commercial	$1,514.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,609.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,419.88
Rate for Payer: PHP Commercial	$1,609.20
Rate for Payer: Priority Health SBD	$1,192.70
Rate for Payer: UHC All Payor (Choice/PPO)	$1,230.57
Rate for Payer: UHC Core	$986.35
Rate for Payer: UHC Exchange	$744.02

Know your out-of-pocket cost for care.

All Charges