Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$45.57

Service Code	NDC 61314065605
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$28.71
Max. Negotiated Rate	$41.01
Rate for Payer: Aetna Commercial	$38.73
Rate for Payer: Aetna New Business (MI Preferred)	$29.62
Rate for Payer: Cash Price	$36.46
Rate for Payer: Cofinity Commercial	$31.90
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Medicare Advantage	$31.90
Rate for Payer: Encore Health Key Benefits Commercial	$36.46
Rate for Payer: Healthscope Commercial	$41.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.73
Rate for Payer: PHP Commercial	$38.73
Rate for Payer: Priority Health Cigna Priority Health	$29.62
Rate for Payer: Priority Health SBD	$28.71

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$45.57

Service Code	NDC 61314065605
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$41.01
Rate for Payer: Aetna Commercial	$38.73
Rate for Payer: Aetna Medicare	$22.78
Rate for Payer: Aetna New Business (MI Preferred)	$29.62
Rate for Payer: BCBS Complete	$18.23
Rate for Payer: Cash Price	$36.46
Rate for Payer: Cofinity Commercial	$31.90
Rate for Payer: Cofinity Commercial	$39.19
Rate for Payer: Cofinity Medicare Advantage	$31.90
Rate for Payer: Encore Health Key Benefits Commercial	$36.46
Rate for Payer: Healthscope Commercial	$41.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.73
Rate for Payer: PHP Commercial	$38.73
Rate for Payer: Priority Health Cigna Priority Health	$29.62
Rate for Payer: Priority Health SBD	$28.71

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$395.85

Service Code	NDC 00065065605
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$158.34
Max. Negotiated Rate	$356.26
Rate for Payer: Aetna Commercial	$336.47
Rate for Payer: Aetna Medicare	$197.92
Rate for Payer: Aetna New Business (MI Preferred)	$257.30
Rate for Payer: BCBS Complete	$158.34
Rate for Payer: Cash Price	$316.68
Rate for Payer: Cofinity Commercial	$277.10
Rate for Payer: Cofinity Commercial	$340.43
Rate for Payer: Cofinity Medicare Advantage	$277.10
Rate for Payer: Encore Health Key Benefits Commercial	$316.68
Rate for Payer: Healthscope Commercial	$356.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.47
Rate for Payer: PHP Commercial	$336.47
Rate for Payer: Priority Health Cigna Priority Health	$257.30
Rate for Payer: Priority Health SBD	$249.39

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$395.85

Service Code	NDC 00065065605
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$249.39
Max. Negotiated Rate	$356.26
Rate for Payer: Aetna Commercial	$336.47
Rate for Payer: Aetna New Business (MI Preferred)	$257.30
Rate for Payer: Cash Price	$316.68
Rate for Payer: Cofinity Commercial	$277.10
Rate for Payer: Cofinity Commercial	$340.43
Rate for Payer: Cofinity Medicare Advantage	$277.10
Rate for Payer: Encore Health Key Benefits Commercial	$316.68
Rate for Payer: Healthscope Commercial	$356.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$336.47
Rate for Payer: PHP Commercial	$336.47
Rate for Payer: Priority Health Cigna Priority Health	$257.30
Rate for Payer: Priority Health SBD	$249.39

CIPROFLOXACIN 250 MG TABLET

Facility

$253.80

Service Code	NDC 55111012601
Hospital Charge Code	25118
Hospital Revenue Code	637
Min. Negotiated Rate	$101.52
Max. Negotiated Rate	$228.42
Rate for Payer: Aetna Commercial	$215.73
Rate for Payer: Aetna Medicare	$126.90
Rate for Payer: Aetna New Business (MI Preferred)	$164.97
Rate for Payer: BCBS Complete	$101.52
Rate for Payer: Cash Price	$203.04
Rate for Payer: Cofinity Commercial	$177.66
Rate for Payer: Cofinity Commercial	$218.27
Rate for Payer: Cofinity Medicare Advantage	$177.66
Rate for Payer: Encore Health Key Benefits Commercial	$203.04
Rate for Payer: Healthscope Commercial	$228.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.73
Rate for Payer: PHP Commercial	$215.73
Rate for Payer: Priority Health Cigna Priority Health	$164.97
Rate for Payer: Priority Health SBD	$159.89

CIPROFLOXACIN 250 MG TABLET

Facility

$361.90

Service Code	NDC 65862007601
Hospital Charge Code	25118
Hospital Revenue Code	637
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Commercial	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Cofinity Medicare Advantage	$253.33
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health Cigna Priority Health	$235.24
Rate for Payer: Priority Health SBD	$228.00

CIPROFLOXACIN 250 MG TABLET

Facility

$317.25

Service Code	NDC 00143992701
Hospital Charge Code	25118
Hospital Revenue Code	637
Min. Negotiated Rate	$126.90
Max. Negotiated Rate	$285.52
Rate for Payer: Aetna Commercial	$269.66
Rate for Payer: Aetna Medicare	$158.62
Rate for Payer: Aetna New Business (MI Preferred)	$206.21
Rate for Payer: BCBS Complete	$126.90
Rate for Payer: Cash Price	$253.80
Rate for Payer: Cofinity Commercial	$222.08
Rate for Payer: Cofinity Commercial	$272.84
Rate for Payer: Cofinity Medicare Advantage	$222.08
Rate for Payer: Encore Health Key Benefits Commercial	$253.80
Rate for Payer: Healthscope Commercial	$285.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.66
Rate for Payer: PHP Commercial	$269.66
Rate for Payer: Priority Health Cigna Priority Health	$206.21
Rate for Payer: Priority Health SBD	$199.87

CIPROFLOXACIN 250 MG TABLET

Facility

$253.80

Service Code	NDC 55111012601
Hospital Charge Code	25118
Hospital Revenue Code	637
Min. Negotiated Rate	$159.89
Max. Negotiated Rate	$228.42
Rate for Payer: Aetna Commercial	$215.73
Rate for Payer: Aetna New Business (MI Preferred)	$164.97
Rate for Payer: Cash Price	$203.04
Rate for Payer: Cofinity Commercial	$177.66
Rate for Payer: Cofinity Commercial	$218.27
Rate for Payer: Cofinity Medicare Advantage	$177.66
Rate for Payer: Encore Health Key Benefits Commercial	$203.04
Rate for Payer: Healthscope Commercial	$228.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.73
Rate for Payer: PHP Commercial	$215.73
Rate for Payer: Priority Health Cigna Priority Health	$164.97
Rate for Payer: Priority Health SBD	$159.89

CIPROFLOXACIN 250 MG TABLET

Facility

$317.25

Service Code	NDC 00143992701
Hospital Charge Code	25118
Hospital Revenue Code	637
Min. Negotiated Rate	$199.87
Max. Negotiated Rate	$285.52
Rate for Payer: Aetna Commercial	$269.66
Rate for Payer: Aetna New Business (MI Preferred)	$206.21
Rate for Payer: Cash Price	$253.80
Rate for Payer: Cofinity Commercial	$222.08
Rate for Payer: Cofinity Commercial	$272.84
Rate for Payer: Cofinity Medicare Advantage	$222.08
Rate for Payer: Encore Health Key Benefits Commercial	$253.80
Rate for Payer: Healthscope Commercial	$285.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.66
Rate for Payer: PHP Commercial	$269.66
Rate for Payer: Priority Health Cigna Priority Health	$206.21
Rate for Payer: Priority Health SBD	$199.87

CIPROFLOXACIN 250 MG TABLET

Facility

$361.90

Service Code	NDC 65862007601
Hospital Charge Code	25118
Hospital Revenue Code	637
Min. Negotiated Rate	$144.76
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna Medicare	$180.95
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: BCBS Complete	$144.76
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Commercial	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Cofinity Medicare Advantage	$253.33
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health Cigna Priority Health	$235.24
Rate for Payer: Priority Health SBD	$228.00

CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$41.47

Service Code	HCPCS J0744
Hospital Charge Code	9611
Hospital Revenue Code	636
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$37.32
Rate for Payer: Aetna Commercial	$35.25
Rate for Payer: Aetna Commercial	$43.38
Rate for Payer: Aetna New Business (MI Preferred)	$26.96
Rate for Payer: Aetna New Business (MI Preferred)	$33.18
Rate for Payer: Cash Price	$33.18
Rate for Payer: Cash Price	$40.83
Rate for Payer: Cofinity Commercial	$29.03
Rate for Payer: Cofinity Commercial	$35.73
Rate for Payer: Cofinity Commercial	$43.89
Rate for Payer: Cofinity Commercial	$35.66
Rate for Payer: Cofinity Medicare Advantage	$35.73
Rate for Payer: Cofinity Medicare Advantage	$29.03
Rate for Payer: Encore Health Key Benefits Commercial	$33.18
Rate for Payer: Encore Health Key Benefits Commercial	$40.83
Rate for Payer: Healthscope Commercial	$37.32
Rate for Payer: Healthscope Commercial	$45.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.38
Rate for Payer: PHP Commercial	$35.25
Rate for Payer: PHP Commercial	$43.38
Rate for Payer: Priority Health Cigna Priority Health	$33.18
Rate for Payer: Priority Health Cigna Priority Health	$26.96
Rate for Payer: Priority Health SBD	$32.16
Rate for Payer: Priority Health SBD	$26.13

CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK

Facility

$41.47

Service Code	HCPCS J0744
Hospital Charge Code	9611
Hospital Revenue Code	636
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$37.32
Rate for Payer: Aetna Commercial	$35.25
Rate for Payer: Aetna Commercial	$43.38
Rate for Payer: Aetna Medicare	$25.52
Rate for Payer: Aetna Medicare	$20.74
Rate for Payer: Aetna New Business (MI Preferred)	$26.96
Rate for Payer: Aetna New Business (MI Preferred)	$33.18
Rate for Payer: BCBS Complete	$20.42
Rate for Payer: BCBS Complete	$16.59
Rate for Payer: BCBS Trust/PPO	$5.24
Rate for Payer: BCBS Trust/PPO	$5.24
Rate for Payer: BCN Commercial	$5.24
Rate for Payer: BCN Commercial	$5.24
Rate for Payer: Cash Price	$40.83
Rate for Payer: Cash Price	$40.83
Rate for Payer: Cash Price	$33.18
Rate for Payer: Cash Price	$33.18
Rate for Payer: Cofinity Commercial	$29.03
Rate for Payer: Cofinity Commercial	$43.89
Rate for Payer: Cofinity Commercial	$35.73
Rate for Payer: Cofinity Commercial	$35.66
Rate for Payer: Cofinity Medicare Advantage	$35.73
Rate for Payer: Cofinity Medicare Advantage	$29.03
Rate for Payer: Encore Health Key Benefits Commercial	$33.18
Rate for Payer: Encore Health Key Benefits Commercial	$40.83
Rate for Payer: Healthscope Commercial	$37.32
Rate for Payer: Healthscope Commercial	$45.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.25
Rate for Payer: PHP Commercial	$43.38
Rate for Payer: PHP Commercial	$35.25
Rate for Payer: Priority Health Cigna Priority Health	$26.96
Rate for Payer: Priority Health Cigna Priority Health	$33.18
Rate for Payer: Priority Health SBD	$32.16
Rate for Payer: Priority Health SBD	$26.13

CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; NEONATE (28 DAYS OF AGE OR LESS)

Facility

$4,450.00

Service Code	CPT 54160
Hospital Revenue Code	360
Min. Negotiated Rate	$154.10
Max. Negotiated Rate	$4,450.00
Rate for Payer: Aetna Medicare	$680.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$817.46
Rate for Payer: Amish Plain Church Group Commercial	$817.46
Rate for Payer: BCBS Complete	$368.05
Rate for Payer: BCBS MAPPO	$653.97
Rate for Payer: BCBS Trust/PPO	$855.81
Rate for Payer: BCN Commercial	$855.81
Rate for Payer: BCN Medicare Advantage	$653.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$653.97
Rate for Payer: Mclaren Medicaid	$350.53
Rate for Payer: Mclaren Medicare	$653.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$686.67
Rate for Payer: Meridian Medicaid	$368.05
Rate for Payer: MI Amish Medical Board Commercial	$752.07
Rate for Payer: Nomi Health Commercial	$1,373.34
Rate for Payer: PACE Medicare	$621.27
Rate for Payer: PACE SWMI	$653.97
Rate for Payer: PHP Medicare Advantage	$653.97
Rate for Payer: Priority Health Choice Medicaid	$350.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,055.42
Rate for Payer: Priority Health Medicare	$653.97
Rate for Payer: Priority Health Narrow Network	$1,644.34
Rate for Payer: Railroad Medicare Medicare	$653.97
Rate for Payer: UHC All Payor (Choice/PPO)	$154.10
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$653.97
Rate for Payer: UHC Exchange	$4,450.00
Rate for Payer: UHC Medicare Advantage	$653.97
Rate for Payer: UHCCP Medicaid	$368.19
Rate for Payer: VA VA	$653.97

CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE

Facility

$6,308.24

Service Code	CPT 54161
Hospital Revenue Code	360
Min. Negotiated Rate	$208.67
Max. Negotiated Rate	$6,308.24
Rate for Payer: Aetna Medicare	$2,087.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,508.86
Rate for Payer: Amish Plain Church Group Commercial	$2,508.86
Rate for Payer: BCBS Complete	$1,129.59
Rate for Payer: BCBS MAPPO	$2,007.09
Rate for Payer: BCBS Trust/PPO	$1,709.92
Rate for Payer: BCN Commercial	$1,709.92
Rate for Payer: BCN Medicare Advantage	$2,007.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,007.09
Rate for Payer: Mclaren Medicaid	$1,075.80
Rate for Payer: Mclaren Medicare	$2,007.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,107.44
Rate for Payer: Meridian Medicaid	$1,129.59
Rate for Payer: MI Amish Medical Board Commercial	$2,308.15
Rate for Payer: Nomi Health Commercial	$4,214.89
Rate for Payer: PACE Medicare	$1,906.74
Rate for Payer: PACE SWMI	$2,007.09
Rate for Payer: PHP Medicare Advantage	$2,007.09
Rate for Payer: Priority Health Choice Medicaid	$1,075.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6,308.24
Rate for Payer: Priority Health Medicare	$2,007.09
Rate for Payer: Priority Health Narrow Network	$5,046.59
Rate for Payer: Railroad Medicare Medicare	$2,007.09
Rate for Payer: UHC All Payor (Choice/PPO)	$208.67
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,007.09
Rate for Payer: UHC Exchange	$4,450.00
Rate for Payer: UHC Medicare Advantage	$2,007.09
Rate for Payer: UHCCP Medicaid	$1,129.99
Rate for Payer: VA VA	$2,007.09

CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK

Facility

$6,308.24

Service Code	CPT 54150
Hospital Revenue Code	360
Min. Negotiated Rate	$620.52
Max. Negotiated Rate	$6,308.24
Rate for Payer: Aetna Medicare	$2,087.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,508.86
Rate for Payer: Amish Plain Church Group Commercial	$2,508.86
Rate for Payer: BCBS Complete	$1,129.59
Rate for Payer: BCBS MAPPO	$2,007.09
Rate for Payer: BCBS Trust/PPO	$620.52
Rate for Payer: BCN Commercial	$620.52
Rate for Payer: BCN Medicare Advantage	$2,007.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,007.09
Rate for Payer: Mclaren Medicaid	$1,075.80
Rate for Payer: Mclaren Medicare	$2,007.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,107.44
Rate for Payer: Meridian Medicaid	$1,129.59
Rate for Payer: MI Amish Medical Board Commercial	$2,308.15
Rate for Payer: Nomi Health Commercial	$4,214.89
Rate for Payer: PACE Medicare	$1,906.74
Rate for Payer: PACE SWMI	$2,007.09
Rate for Payer: PHP Medicare Advantage	$2,007.09
Rate for Payer: Priority Health Choice Medicaid	$1,075.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6,308.24
Rate for Payer: Priority Health Medicare	$2,007.09
Rate for Payer: Priority Health Narrow Network	$5,046.59
Rate for Payer: Railroad Medicare Medicare	$2,007.09
Rate for Payer: UHC All Payor (Choice/PPO)	$5,649.76
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,007.09
Rate for Payer: UHC Exchange	$4,450.00
Rate for Payer: UHC Medicare Advantage	$2,007.09
Rate for Payer: UHCCP Medicaid	$1,129.99
Rate for Payer: VA VA	$2,007.09

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION

Facility

$21.99

Service Code	NDC 00781315270
Hospital Charge Code	16168
Hospital Revenue Code	250
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$19.79
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna New Business (MI Preferred)	$14.29
Rate for Payer: Cash Price	$17.59
Rate for Payer: Cofinity Commercial	$15.39
Rate for Payer: Cofinity Commercial	$18.91
Rate for Payer: Cofinity Medicare Advantage	$15.39
Rate for Payer: Encore Health Key Benefits Commercial	$17.59
Rate for Payer: Healthscope Commercial	$19.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.69
Rate for Payer: PHP Commercial	$18.69
Rate for Payer: Priority Health Cigna Priority Health	$14.29
Rate for Payer: Priority Health SBD	$13.85

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION

Facility

$21.99

Service Code	NDC 00781315295
Hospital Charge Code	16168
Hospital Revenue Code	250
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$19.79
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare	$11.00
Rate for Payer: Aetna New Business (MI Preferred)	$14.29
Rate for Payer: BCBS Complete	$8.80
Rate for Payer: Cash Price	$17.59
Rate for Payer: Cofinity Commercial	$15.39
Rate for Payer: Cofinity Commercial	$18.91
Rate for Payer: Cofinity Medicare Advantage	$15.39
Rate for Payer: Encore Health Key Benefits Commercial	$17.59
Rate for Payer: Healthscope Commercial	$19.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.69
Rate for Payer: PHP Commercial	$18.69
Rate for Payer: Priority Health Cigna Priority Health	$14.29
Rate for Payer: Priority Health SBD	$13.85

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION

Facility

$21.99

Service Code	NDC 00781315295
Hospital Charge Code	16168
Hospital Revenue Code	250
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$19.79
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna New Business (MI Preferred)	$14.29
Rate for Payer: Cash Price	$17.59
Rate for Payer: Cofinity Commercial	$15.39
Rate for Payer: Cofinity Commercial	$18.91
Rate for Payer: Cofinity Medicare Advantage	$15.39
Rate for Payer: Encore Health Key Benefits Commercial	$17.59
Rate for Payer: Healthscope Commercial	$19.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.69
Rate for Payer: PHP Commercial	$18.69
Rate for Payer: Priority Health Cigna Priority Health	$14.29
Rate for Payer: Priority Health SBD	$13.85

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION

Facility

$114.50

Service Code	NDC 00074438010
Hospital Charge Code	16168
Hospital Revenue Code	250
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$103.05
Rate for Payer: Aetna Commercial	$97.32
Rate for Payer: Aetna Medicare	$57.25
Rate for Payer: Aetna New Business (MI Preferred)	$74.42
Rate for Payer: BCBS Complete	$45.80
Rate for Payer: Cash Price	$91.60
Rate for Payer: Cofinity Commercial	$80.15
Rate for Payer: Cofinity Commercial	$98.47
Rate for Payer: Cofinity Medicare Advantage	$80.15
Rate for Payer: Encore Health Key Benefits Commercial	$91.60
Rate for Payer: Healthscope Commercial	$103.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.32
Rate for Payer: PHP Commercial	$97.32
Rate for Payer: Priority Health Cigna Priority Health	$74.42
Rate for Payer: Priority Health SBD	$72.14

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION

Facility

$21.99

Service Code	NDC 00781315270
Hospital Charge Code	16168
Hospital Revenue Code	250
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$19.79
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare	$11.00
Rate for Payer: Aetna New Business (MI Preferred)	$14.29
Rate for Payer: BCBS Complete	$8.80
Rate for Payer: Cash Price	$17.59
Rate for Payer: Cofinity Commercial	$15.39
Rate for Payer: Cofinity Commercial	$18.91
Rate for Payer: Cofinity Medicare Advantage	$15.39
Rate for Payer: Encore Health Key Benefits Commercial	$17.59
Rate for Payer: Healthscope Commercial	$19.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.69
Rate for Payer: PHP Commercial	$18.69
Rate for Payer: Priority Health Cigna Priority Health	$14.29
Rate for Payer: Priority Health SBD	$13.85

CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION

Facility

$114.50

Service Code	NDC 00074438010
Hospital Charge Code	16168
Hospital Revenue Code	250
Min. Negotiated Rate	$72.14
Max. Negotiated Rate	$103.05
Rate for Payer: Aetna Commercial	$97.32
Rate for Payer: Aetna New Business (MI Preferred)	$74.42
Rate for Payer: Cash Price	$91.60
Rate for Payer: Cofinity Commercial	$80.15
Rate for Payer: Cofinity Commercial	$98.47
Rate for Payer: Cofinity Medicare Advantage	$80.15
Rate for Payer: Encore Health Key Benefits Commercial	$91.60
Rate for Payer: Healthscope Commercial	$103.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.32
Rate for Payer: PHP Commercial	$97.32
Rate for Payer: Priority Health Cigna Priority Health	$74.42
Rate for Payer: Priority Health SBD	$72.14

CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION

Facility

$190.38

Service Code	NDC 70069015101
Hospital Charge Code	16169
Hospital Revenue Code	250
Min. Negotiated Rate	$119.94
Max. Negotiated Rate	$171.34
Rate for Payer: Aetna Commercial	$161.82
Rate for Payer: Aetna New Business (MI Preferred)	$123.75
Rate for Payer: Cash Price	$152.30
Rate for Payer: Cofinity Commercial	$133.27
Rate for Payer: Cofinity Commercial	$163.73
Rate for Payer: Cofinity Medicare Advantage	$133.27
Rate for Payer: Encore Health Key Benefits Commercial	$152.30
Rate for Payer: Healthscope Commercial	$171.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.82
Rate for Payer: PHP Commercial	$161.82
Rate for Payer: Priority Health Cigna Priority Health	$123.75
Rate for Payer: Priority Health SBD	$119.94

CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION

Facility

$192.33

Service Code	NDC 00781315395
Hospital Charge Code	16169
Hospital Revenue Code	250
Min. Negotiated Rate	$76.93
Max. Negotiated Rate	$173.10
Rate for Payer: Aetna Commercial	$163.48
Rate for Payer: Aetna Medicare	$96.16
Rate for Payer: Aetna New Business (MI Preferred)	$125.01
Rate for Payer: BCBS Complete	$76.93
Rate for Payer: Cash Price	$153.86
Rate for Payer: Cofinity Commercial	$134.63
Rate for Payer: Cofinity Commercial	$165.40
Rate for Payer: Cofinity Medicare Advantage	$134.63
Rate for Payer: Encore Health Key Benefits Commercial	$153.86
Rate for Payer: Healthscope Commercial	$173.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.48
Rate for Payer: PHP Commercial	$163.48
Rate for Payer: Priority Health Cigna Priority Health	$125.01
Rate for Payer: Priority Health SBD	$121.17

CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION

Facility

$190.38

Service Code	NDC 70069015101
Hospital Charge Code	16169
Hospital Revenue Code	250
Min. Negotiated Rate	$76.15
Max. Negotiated Rate	$171.34
Rate for Payer: Aetna Commercial	$161.82
Rate for Payer: Aetna Medicare	$95.19
Rate for Payer: Aetna New Business (MI Preferred)	$123.75
Rate for Payer: BCBS Complete	$76.15
Rate for Payer: Cash Price	$152.30
Rate for Payer: Cofinity Commercial	$133.27
Rate for Payer: Cofinity Commercial	$163.73
Rate for Payer: Cofinity Medicare Advantage	$133.27
Rate for Payer: Encore Health Key Benefits Commercial	$152.30
Rate for Payer: Healthscope Commercial	$171.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.82
Rate for Payer: PHP Commercial	$161.82
Rate for Payer: Priority Health Cigna Priority Health	$123.75
Rate for Payer: Priority Health SBD	$119.94

CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION

Facility

$190.38

Service Code	NDC 70069015110
Hospital Charge Code	16169
Hospital Revenue Code	250
Min. Negotiated Rate	$76.15
Max. Negotiated Rate	$171.34
Rate for Payer: Aetna Commercial	$161.82
Rate for Payer: Aetna Medicare	$95.19
Rate for Payer: Aetna New Business (MI Preferred)	$123.75
Rate for Payer: BCBS Complete	$76.15
Rate for Payer: Cash Price	$152.30
Rate for Payer: Cofinity Commercial	$133.27
Rate for Payer: Cofinity Commercial	$163.73
Rate for Payer: Cofinity Medicare Advantage	$133.27
Rate for Payer: Encore Health Key Benefits Commercial	$152.30
Rate for Payer: Healthscope Commercial	$171.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.82
Rate for Payer: PHP Commercial	$161.82
Rate for Payer: Priority Health Cigna Priority Health	$123.75
Rate for Payer: Priority Health SBD	$119.94

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