Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$257.48

Service Code	NDC 49884046565
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$102.99
Max. Negotiated Rate	$231.73
Rate for Payer: Aetna Commercial	$218.86
Rate for Payer: Aetna Medicare	$128.74
Rate for Payer: Aetna New Business (MI Preferred)	$167.36
Rate for Payer: BCBS Complete	$102.99
Rate for Payer: Cash Price	$205.98
Rate for Payer: Cofinity Commercial	$180.24
Rate for Payer: Cofinity Commercial	$221.43
Rate for Payer: Cofinity Medicare Advantage	$180.24
Rate for Payer: Encore Health Key Benefits Commercial	$205.98
Rate for Payer: Healthscope Commercial	$231.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$218.86
Rate for Payer: PHP Commercial	$218.86
Rate for Payer: Priority Health Cigna Priority Health	$167.36
Rate for Payer: Priority Health SBD	$162.21

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$257.48

Service Code	NDC 49884046565
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$162.21
Max. Negotiated Rate	$231.73
Rate for Payer: Aetna Commercial	$218.86
Rate for Payer: Aetna New Business (MI Preferred)	$167.36
Rate for Payer: Cash Price	$205.98
Rate for Payer: Cofinity Commercial	$180.24
Rate for Payer: Cofinity Commercial	$221.43
Rate for Payer: Cofinity Medicare Advantage	$180.24
Rate for Payer: Encore Health Key Benefits Commercial	$205.98
Rate for Payer: Healthscope Commercial	$231.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$218.86
Rate for Payer: PHP Commercial	$218.86
Rate for Payer: Priority Health Cigna Priority Health	$167.36
Rate for Payer: Priority Health SBD	$162.21

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$4.30

Service Code	NDC 49884046564
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.87
Rate for Payer: Aetna Commercial	$3.66
Rate for Payer: Aetna Medicare	$2.15
Rate for Payer: Aetna New Business (MI Preferred)	$2.80
Rate for Payer: BCBS Complete	$1.72
Rate for Payer: Cash Price	$3.44
Rate for Payer: Cofinity Commercial	$3.01
Rate for Payer: Cofinity Commercial	$3.70
Rate for Payer: Cofinity Medicare Advantage	$3.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.44
Rate for Payer: Healthscope Commercial	$3.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.66
Rate for Payer: PHP Commercial	$3.66
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: Priority Health SBD	$2.71

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$4.30

Service Code	NDC 49884046564
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$3.87
Rate for Payer: Aetna Commercial	$3.66
Rate for Payer: Aetna New Business (MI Preferred)	$2.80
Rate for Payer: Cash Price	$3.44
Rate for Payer: Cofinity Commercial	$3.01
Rate for Payer: Cofinity Commercial	$3.70
Rate for Payer: Cofinity Medicare Advantage	$3.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.44
Rate for Payer: Healthscope Commercial	$3.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.66
Rate for Payer: PHP Commercial	$3.66
Rate for Payer: Priority Health Cigna Priority Health	$2.80
Rate for Payer: Priority Health SBD	$2.71

CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION

Facility

$258.83

Service Code	NDC 00409409301
Hospital Charge Code	1685
Hospital Revenue Code	250
Min. Negotiated Rate	$103.53
Max. Negotiated Rate	$232.95
Rate for Payer: Aetna Commercial	$220.01
Rate for Payer: Aetna Medicare	$129.42
Rate for Payer: Aetna New Business (MI Preferred)	$168.24
Rate for Payer: BCBS Complete	$103.53
Rate for Payer: Cash Price	$207.06
Rate for Payer: Cofinity Commercial	$181.18
Rate for Payer: Cofinity Commercial	$222.59
Rate for Payer: Cofinity Medicare Advantage	$181.18
Rate for Payer: Encore Health Key Benefits Commercial	$207.06
Rate for Payer: Healthscope Commercial	$232.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$220.01
Rate for Payer: PHP Commercial	$220.01
Rate for Payer: Priority Health Cigna Priority Health	$168.24
Rate for Payer: Priority Health SBD	$163.06

CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION

Facility

$258.83

Service Code	NDC 00409409301
Hospital Charge Code	1685
Hospital Revenue Code	250
Min. Negotiated Rate	$163.06
Max. Negotiated Rate	$232.95
Rate for Payer: Aetna Commercial	$220.01
Rate for Payer: Aetna New Business (MI Preferred)	$168.24
Rate for Payer: Cash Price	$207.06
Rate for Payer: Cofinity Commercial	$181.18
Rate for Payer: Cofinity Commercial	$222.59
Rate for Payer: Cofinity Medicare Advantage	$181.18
Rate for Payer: Encore Health Key Benefits Commercial	$207.06
Rate for Payer: Healthscope Commercial	$232.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$220.01
Rate for Payer: PHP Commercial	$220.01
Rate for Payer: Priority Health Cigna Priority Health	$168.24
Rate for Payer: Priority Health SBD	$163.06

CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS

Facility

$15,201.47

Service Code	CPT 58350
Hospital Revenue Code	360
Min. Negotiated Rate	$1,482.18
Max. Negotiated Rate	$15,201.47
Rate for Payer: Aetna Medicare	$5,030.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,045.79
Rate for Payer: Amish Plain Church Group Commercial	$6,045.79
Rate for Payer: BCBS Complete	$2,722.06
Rate for Payer: BCBS MAPPO	$4,836.63
Rate for Payer: BCBS Trust/PPO	$1,482.18
Rate for Payer: BCN Commercial	$1,482.18
Rate for Payer: BCN Medicare Advantage	$4,836.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,836.63
Rate for Payer: Mclaren Medicaid	$2,592.43
Rate for Payer: Mclaren Medicare	$4,836.63
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,078.46
Rate for Payer: Meridian Medicaid	$2,722.06
Rate for Payer: MI Amish Medical Board Commercial	$5,562.12
Rate for Payer: Nomi Health Commercial	$10,156.92
Rate for Payer: PACE Medicare	$4,594.80
Rate for Payer: PACE SWMI	$4,836.63
Rate for Payer: PHP Medicare Advantage	$4,836.63
Rate for Payer: Priority Health Choice Medicaid	$2,592.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,201.47
Rate for Payer: Priority Health Medicare	$4,836.63
Rate for Payer: Priority Health Narrow Network	$12,161.18
Rate for Payer: Railroad Medicare Medicare	$4,836.63
Rate for Payer: UHC All Payor (Choice/PPO)	$13,614.63
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$4,836.63
Rate for Payer: UHC Exchange	$5,811.00
Rate for Payer: UHC Medicare Advantage	$4,836.63
Rate for Payer: UHCCP Medicaid	$2,723.02
Rate for Payer: VA VA	$4,836.63

CILOSTAZOL 100 MG TABLET

Facility

$165.84

Service Code	NDC 50268017715
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$104.48
Max. Negotiated Rate	$149.26
Rate for Payer: Aetna Commercial	$140.96
Rate for Payer: Aetna New Business (MI Preferred)	$107.80
Rate for Payer: Cash Price	$132.67
Rate for Payer: Cofinity Commercial	$116.09
Rate for Payer: Cofinity Commercial	$142.62
Rate for Payer: Cofinity Medicare Advantage	$116.09
Rate for Payer: Encore Health Key Benefits Commercial	$132.67
Rate for Payer: Healthscope Commercial	$149.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.96
Rate for Payer: PHP Commercial	$140.96
Rate for Payer: Priority Health Cigna Priority Health	$107.80
Rate for Payer: Priority Health SBD	$104.48

CILOSTAZOL 100 MG TABLET

Facility

$165.84

Service Code	NDC 50268017715
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$66.34
Max. Negotiated Rate	$149.26
Rate for Payer: Aetna Commercial	$140.96
Rate for Payer: Aetna Medicare	$82.92
Rate for Payer: Aetna New Business (MI Preferred)	$107.80
Rate for Payer: BCBS Complete	$66.34
Rate for Payer: Cash Price	$132.67
Rate for Payer: Cofinity Commercial	$116.09
Rate for Payer: Cofinity Commercial	$142.62
Rate for Payer: Cofinity Medicare Advantage	$116.09
Rate for Payer: Encore Health Key Benefits Commercial	$132.67
Rate for Payer: Healthscope Commercial	$149.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.96
Rate for Payer: PHP Commercial	$140.96
Rate for Payer: Priority Health Cigna Priority Health	$107.80
Rate for Payer: Priority Health SBD	$104.48

CILOSTAZOL 100 MG TABLET

Facility

$3.32

Service Code	NDC 50268017711
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna Medicare	$1.66
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: BCBS Complete	$1.33
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Cofinity Medicare Advantage	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health Cigna Priority Health	$2.16
Rate for Payer: Priority Health SBD	$2.09

CILOSTAZOL 100 MG TABLET

Facility

$3.32

Service Code	NDC 50268017711
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Cofinity Medicare Advantage	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health Cigna Priority Health	$2.16
Rate for Payer: Priority Health SBD	$2.09

CILOSTAZOL 100 MG TABLET

Facility

$136.77

Service Code	NDC 60505252201
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$86.17
Max. Negotiated Rate	$123.09
Rate for Payer: Aetna Commercial	$116.25
Rate for Payer: Aetna New Business (MI Preferred)	$88.90
Rate for Payer: Cash Price	$109.42
Rate for Payer: Cofinity Commercial	$117.62
Rate for Payer: Cofinity Commercial	$95.74
Rate for Payer: Cofinity Medicare Advantage	$95.74
Rate for Payer: Encore Health Key Benefits Commercial	$109.42
Rate for Payer: Healthscope Commercial	$123.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.25
Rate for Payer: PHP Commercial	$116.25
Rate for Payer: Priority Health Cigna Priority Health	$88.90
Rate for Payer: Priority Health SBD	$86.17

CILOSTAZOL 100 MG TABLET

Facility

$136.77

Service Code	NDC 60505252201
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$54.71
Max. Negotiated Rate	$123.09
Rate for Payer: Aetna Commercial	$116.25
Rate for Payer: Aetna Medicare	$68.38
Rate for Payer: Aetna New Business (MI Preferred)	$88.90
Rate for Payer: BCBS Complete	$54.71
Rate for Payer: Cash Price	$109.42
Rate for Payer: Cofinity Commercial	$117.62
Rate for Payer: Cofinity Commercial	$95.74
Rate for Payer: Cofinity Medicare Advantage	$95.74
Rate for Payer: Encore Health Key Benefits Commercial	$109.42
Rate for Payer: Healthscope Commercial	$123.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.25
Rate for Payer: PHP Commercial	$116.25
Rate for Payer: Priority Health Cigna Priority Health	$88.90
Rate for Payer: Priority Health SBD	$86.17

CIMETIDINE 200 MG TABLET

Facility

$276.45

Service Code	NDC 00378005301
Hospital Charge Code	9604
Hospital Revenue Code	637
Min. Negotiated Rate	$174.16
Max. Negotiated Rate	$248.80
Rate for Payer: Aetna Commercial	$234.98
Rate for Payer: Aetna New Business (MI Preferred)	$179.69
Rate for Payer: Cash Price	$221.16
Rate for Payer: Cofinity Commercial	$193.52
Rate for Payer: Cofinity Commercial	$237.75
Rate for Payer: Cofinity Medicare Advantage	$193.52
Rate for Payer: Encore Health Key Benefits Commercial	$221.16
Rate for Payer: Healthscope Commercial	$248.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.98
Rate for Payer: PHP Commercial	$234.98
Rate for Payer: Priority Health Cigna Priority Health	$179.69
Rate for Payer: Priority Health SBD	$174.16

CIMETIDINE 200 MG TABLET

Facility

$276.45

Service Code	NDC 00378005301
Hospital Charge Code	9604
Hospital Revenue Code	637
Min. Negotiated Rate	$110.58
Max. Negotiated Rate	$248.80
Rate for Payer: Aetna Commercial	$234.98
Rate for Payer: Aetna Medicare	$138.22
Rate for Payer: Aetna New Business (MI Preferred)	$179.69
Rate for Payer: BCBS Complete	$110.58
Rate for Payer: Cash Price	$221.16
Rate for Payer: Cofinity Commercial	$193.52
Rate for Payer: Cofinity Commercial	$237.75
Rate for Payer: Cofinity Medicare Advantage	$193.52
Rate for Payer: Encore Health Key Benefits Commercial	$221.16
Rate for Payer: Healthscope Commercial	$248.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.98
Rate for Payer: PHP Commercial	$234.98
Rate for Payer: Priority Health Cigna Priority Health	$179.69
Rate for Payer: Priority Health SBD	$174.16

CINACALCET 30 MG TABLET

Facility

$132.53

Service Code	HCPCS J8499
Hospital Charge Code	38100
Hospital Revenue Code	637
Min. Negotiated Rate	$83.49
Max. Negotiated Rate	$119.28
Rate for Payer: Aetna Commercial	$112.65
Rate for Payer: Aetna Commercial	$1,536.68
Rate for Payer: Aetna Commercial	$80.19
Rate for Payer: Aetna New Business (MI Preferred)	$1,175.11
Rate for Payer: Aetna New Business (MI Preferred)	$86.14
Rate for Payer: Aetna New Business (MI Preferred)	$61.32
Rate for Payer: Cash Price	$106.02
Rate for Payer: Cash Price	$1,446.29
Rate for Payer: Cash Price	$75.47
Rate for Payer: Cofinity Commercial	$66.04
Rate for Payer: Cofinity Commercial	$113.98
Rate for Payer: Cofinity Commercial	$92.77
Rate for Payer: Cofinity Commercial	$81.13
Rate for Payer: Cofinity Commercial	$1,265.50
Rate for Payer: Cofinity Commercial	$1,554.76
Rate for Payer: Cofinity Medicare Advantage	$1,265.50
Rate for Payer: Cofinity Medicare Advantage	$66.04
Rate for Payer: Cofinity Medicare Advantage	$92.77
Rate for Payer: Encore Health Key Benefits Commercial	$1,446.29
Rate for Payer: Encore Health Key Benefits Commercial	$106.02
Rate for Payer: Encore Health Key Benefits Commercial	$75.47
Rate for Payer: Healthscope Commercial	$1,627.07
Rate for Payer: Healthscope Commercial	$84.91
Rate for Payer: Healthscope Commercial	$119.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,536.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.19
Rate for Payer: PHP Commercial	$80.19
Rate for Payer: PHP Commercial	$112.65
Rate for Payer: PHP Commercial	$1,536.68
Rate for Payer: Priority Health Cigna Priority Health	$86.14
Rate for Payer: Priority Health Cigna Priority Health	$61.32
Rate for Payer: Priority Health Cigna Priority Health	$1,175.11
Rate for Payer: Priority Health SBD	$59.43
Rate for Payer: Priority Health SBD	$83.49
Rate for Payer: Priority Health SBD	$1,138.95

CINACALCET 30 MG TABLET

Facility

$132.53

Service Code	HCPCS J8499
Hospital Charge Code	38100
Hospital Revenue Code	637
Min. Negotiated Rate	$53.01
Max. Negotiated Rate	$119.28
Rate for Payer: Aetna Commercial	$112.65
Rate for Payer: Aetna Commercial	$80.19
Rate for Payer: Aetna Commercial	$1,536.68
Rate for Payer: Aetna Medicare	$47.17
Rate for Payer: Aetna Medicare	$66.26
Rate for Payer: Aetna Medicare	$903.93
Rate for Payer: Aetna New Business (MI Preferred)	$61.32
Rate for Payer: Aetna New Business (MI Preferred)	$86.14
Rate for Payer: Aetna New Business (MI Preferred)	$1,175.11
Rate for Payer: BCBS Complete	$723.14
Rate for Payer: BCBS Complete	$53.01
Rate for Payer: BCBS Complete	$37.74
Rate for Payer: Cash Price	$75.47
Rate for Payer: Cash Price	$106.02
Rate for Payer: Cash Price	$1,446.29
Rate for Payer: Cofinity Commercial	$81.13
Rate for Payer: Cofinity Commercial	$92.77
Rate for Payer: Cofinity Commercial	$113.98
Rate for Payer: Cofinity Commercial	$1,554.76
Rate for Payer: Cofinity Commercial	$1,265.50
Rate for Payer: Cofinity Commercial	$66.04
Rate for Payer: Cofinity Medicare Advantage	$1,265.50
Rate for Payer: Cofinity Medicare Advantage	$92.77
Rate for Payer: Cofinity Medicare Advantage	$66.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,446.29
Rate for Payer: Encore Health Key Benefits Commercial	$75.47
Rate for Payer: Encore Health Key Benefits Commercial	$106.02
Rate for Payer: Healthscope Commercial	$1,627.07
Rate for Payer: Healthscope Commercial	$119.28
Rate for Payer: Healthscope Commercial	$84.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,536.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.65
Rate for Payer: PHP Commercial	$1,536.68
Rate for Payer: PHP Commercial	$112.65
Rate for Payer: PHP Commercial	$80.19
Rate for Payer: Priority Health Cigna Priority Health	$86.14
Rate for Payer: Priority Health Cigna Priority Health	$61.32
Rate for Payer: Priority Health Cigna Priority Health	$1,175.11
Rate for Payer: Priority Health SBD	$59.43
Rate for Payer: Priority Health SBD	$1,138.95
Rate for Payer: Priority Health SBD	$83.49

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$729.73

Service Code	NDC 62756042790
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$291.89
Max. Negotiated Rate	$656.76
Rate for Payer: Aetna Commercial	$620.27
Rate for Payer: Aetna Medicare	$364.86
Rate for Payer: Aetna New Business (MI Preferred)	$474.32
Rate for Payer: BCBS Complete	$291.89
Rate for Payer: Cash Price	$583.78
Rate for Payer: Cofinity Commercial	$510.81
Rate for Payer: Cofinity Commercial	$627.57
Rate for Payer: Cofinity Medicare Advantage	$510.81
Rate for Payer: Encore Health Key Benefits Commercial	$583.78
Rate for Payer: Healthscope Commercial	$656.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$620.27
Rate for Payer: PHP Commercial	$620.27
Rate for Payer: Priority Health Cigna Priority Health	$474.32
Rate for Payer: Priority Health SBD	$459.73

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$302.72

Service Code	NDC 72485062513
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$190.71
Max. Negotiated Rate	$272.45
Rate for Payer: Aetna Commercial	$257.31
Rate for Payer: Aetna New Business (MI Preferred)	$196.77
Rate for Payer: Cash Price	$242.18
Rate for Payer: Cofinity Commercial	$211.90
Rate for Payer: Cofinity Commercial	$260.34
Rate for Payer: Cofinity Medicare Advantage	$211.90
Rate for Payer: Encore Health Key Benefits Commercial	$242.18
Rate for Payer: Healthscope Commercial	$272.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.31
Rate for Payer: PHP Commercial	$257.31
Rate for Payer: Priority Health Cigna Priority Health	$196.77
Rate for Payer: Priority Health SBD	$190.71

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$399.95

Service Code	NDC 43598032675
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$251.97
Max. Negotiated Rate	$359.96
Rate for Payer: Aetna Commercial	$339.96
Rate for Payer: Aetna New Business (MI Preferred)	$259.97
Rate for Payer: Cash Price	$319.96
Rate for Payer: Cofinity Commercial	$279.96
Rate for Payer: Cofinity Commercial	$343.96
Rate for Payer: Cofinity Medicare Advantage	$279.96
Rate for Payer: Encore Health Key Benefits Commercial	$319.96
Rate for Payer: Healthscope Commercial	$359.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.96
Rate for Payer: PHP Commercial	$339.96
Rate for Payer: Priority Health Cigna Priority Health	$259.97
Rate for Payer: Priority Health SBD	$251.97

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$810.79

Service Code	NDC 00078079975
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$324.32
Max. Negotiated Rate	$729.71
Rate for Payer: Aetna Commercial	$689.17
Rate for Payer: Aetna Medicare	$405.40
Rate for Payer: Aetna New Business (MI Preferred)	$527.01
Rate for Payer: BCBS Complete	$324.32
Rate for Payer: Cash Price	$648.63
Rate for Payer: Cofinity Commercial	$567.55
Rate for Payer: Cofinity Commercial	$697.28
Rate for Payer: Cofinity Medicare Advantage	$567.55
Rate for Payer: Encore Health Key Benefits Commercial	$648.63
Rate for Payer: Healthscope Commercial	$729.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$689.17
Rate for Payer: PHP Commercial	$689.17
Rate for Payer: Priority Health Cigna Priority Health	$527.01
Rate for Payer: Priority Health SBD	$510.80

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$729.73

Service Code	NDC 62756042790
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$459.73
Max. Negotiated Rate	$656.76
Rate for Payer: Aetna Commercial	$620.27
Rate for Payer: Aetna New Business (MI Preferred)	$474.32
Rate for Payer: Cash Price	$583.78
Rate for Payer: Cofinity Commercial	$510.81
Rate for Payer: Cofinity Commercial	$627.57
Rate for Payer: Cofinity Medicare Advantage	$510.81
Rate for Payer: Encore Health Key Benefits Commercial	$583.78
Rate for Payer: Healthscope Commercial	$656.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$620.27
Rate for Payer: PHP Commercial	$620.27
Rate for Payer: Priority Health Cigna Priority Health	$474.32
Rate for Payer: Priority Health SBD	$459.73

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$302.72

Service Code	NDC 72485062513
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$121.09
Max. Negotiated Rate	$272.45
Rate for Payer: Aetna Commercial	$257.31
Rate for Payer: Aetna Medicare	$151.36
Rate for Payer: Aetna New Business (MI Preferred)	$196.77
Rate for Payer: BCBS Complete	$121.09
Rate for Payer: Cash Price	$242.18
Rate for Payer: Cofinity Commercial	$211.90
Rate for Payer: Cofinity Commercial	$260.34
Rate for Payer: Cofinity Medicare Advantage	$211.90
Rate for Payer: Encore Health Key Benefits Commercial	$242.18
Rate for Payer: Healthscope Commercial	$272.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.31
Rate for Payer: PHP Commercial	$257.31
Rate for Payer: Priority Health Cigna Priority Health	$196.77
Rate for Payer: Priority Health SBD	$190.71

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$810.79

Service Code	NDC 00078079975
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$510.80
Max. Negotiated Rate	$729.71
Rate for Payer: Aetna Commercial	$689.17
Rate for Payer: Aetna New Business (MI Preferred)	$527.01
Rate for Payer: Cash Price	$648.63
Rate for Payer: Cofinity Commercial	$567.55
Rate for Payer: Cofinity Commercial	$697.28
Rate for Payer: Cofinity Medicare Advantage	$567.55
Rate for Payer: Encore Health Key Benefits Commercial	$648.63
Rate for Payer: Healthscope Commercial	$729.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$689.17
Rate for Payer: PHP Commercial	$689.17
Rate for Payer: Priority Health Cigna Priority Health	$527.01
Rate for Payer: Priority Health SBD	$510.80

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$399.95

Service Code	NDC 43598032675
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$159.98
Max. Negotiated Rate	$359.96
Rate for Payer: Aetna Commercial	$339.96
Rate for Payer: Aetna Medicare	$199.98
Rate for Payer: Aetna New Business (MI Preferred)	$259.97
Rate for Payer: BCBS Complete	$159.98
Rate for Payer: Cash Price	$319.96
Rate for Payer: Cofinity Commercial	$279.96
Rate for Payer: Cofinity Commercial	$343.96
Rate for Payer: Cofinity Medicare Advantage	$279.96
Rate for Payer: Encore Health Key Benefits Commercial	$319.96
Rate for Payer: Healthscope Commercial	$359.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.96
Rate for Payer: PHP Commercial	$339.96
Rate for Payer: Priority Health Cigna Priority Health	$259.97
Rate for Payer: Priority Health SBD	$251.97

Know your out-of-pocket cost for care.

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