Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIVALPROEX 500 MG TABLET,DELAYED RELEASE

Facility

$380.70

Service Code	NDC 00904686161
Hospital Charge Code	2553
Hospital Revenue Code	637
Min. Negotiated Rate	$239.84
Max. Negotiated Rate	$342.63
Rate for Payer: Aetna Commercial	$323.60
Rate for Payer: Aetna New Business (MI Preferred)	$247.46
Rate for Payer: Cash Price	$304.56
Rate for Payer: Cofinity Advantage	$266.49
Rate for Payer: Cofinity Commercial	$327.40
Rate for Payer: Encore Health Key Benefits Commercial	$304.56
Rate for Payer: Healthscope Commercial	$342.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$323.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$285.52
Rate for Payer: PHP Commercial	$323.60
Rate for Payer: Priority Health SBD	$239.84

DIVALPROEX 500 MG TABLET,DELAYED RELEASE

Facility

$380.70

Service Code	NDC 00904686161
Hospital Charge Code	2553
Hospital Revenue Code	637
Min. Negotiated Rate	$149.62
Max. Negotiated Rate	$342.63
Rate for Payer: Aetna Commercial	$323.60
Rate for Payer: Aetna Medicare	$190.35
Rate for Payer: Aetna New Business (MI Preferred)	$247.46
Rate for Payer: BCBS Complete	$152.28
Rate for Payer: Cash Price	$304.56
Rate for Payer: Cofinity Advantage	$266.49
Rate for Payer: Cofinity Commercial	$327.40
Rate for Payer: Encore Health Key Benefits Commercial	$304.56
Rate for Payer: Healthscope Commercial	$342.63
Rate for Payer: MI Amish Medical Board Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$323.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$285.52
Rate for Payer: PHP Commercial	$323.60
Rate for Payer: Priority Health SBD	$239.84
Rate for Payer: UHC All Payor (Choice/PPO)	$247.46
Rate for Payer: UHC Core	$198.34
Rate for Payer: UHC Exchange	$149.62

DIVALPROEX 500 MG TABLET,DELAYED RELEASE

Facility

$236.84

Service Code	NDC 68084078261
Hospital Charge Code	2553
Hospital Revenue Code	637
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$213.16
Rate for Payer: Aetna Commercial	$201.31
Rate for Payer: Aetna Medicare	$118.42
Rate for Payer: Aetna New Business (MI Preferred)	$153.95
Rate for Payer: BCBS Complete	$94.74
Rate for Payer: Cash Price	$189.47
Rate for Payer: Cofinity Advantage	$165.79
Rate for Payer: Cofinity Commercial	$203.68
Rate for Payer: Encore Health Key Benefits Commercial	$189.47
Rate for Payer: Healthscope Commercial	$213.16
Rate for Payer: MI Amish Medical Board Commercial	$189.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$201.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$177.63
Rate for Payer: PHP Commercial	$201.31
Rate for Payer: Priority Health SBD	$149.21
Rate for Payer: UHC All Payor (Choice/PPO)	$153.95
Rate for Payer: UHC Core	$123.39
Rate for Payer: UHC Exchange	$93.08

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$388.80

Service Code	NDC 00904636361
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$244.94
Max. Negotiated Rate	$349.92
Rate for Payer: Aetna Commercial	$330.48
Rate for Payer: Aetna New Business (MI Preferred)	$252.72
Rate for Payer: Cash Price	$311.04
Rate for Payer: Cofinity Advantage	$272.16
Rate for Payer: Cofinity Commercial	$334.37
Rate for Payer: Encore Health Key Benefits Commercial	$311.04
Rate for Payer: Healthscope Commercial	$349.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$291.60
Rate for Payer: PHP Commercial	$330.48
Rate for Payer: Priority Health SBD	$244.94

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$4.28

Service Code	NDC 68084031011
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: Aetna Medicare	$2.14
Rate for Payer: Aetna New Business (MI Preferred)	$2.78
Rate for Payer: BCBS Complete	$1.71
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cofinity Advantage	$3.00
Rate for Payer: Cofinity Commercial	$3.68
Rate for Payer: Encore Health Key Benefits Commercial	$3.42
Rate for Payer: Healthscope Commercial	$3.85
Rate for Payer: MI Amish Medical Board Commercial	$3.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.21
Rate for Payer: PHP Commercial	$3.64
Rate for Payer: Priority Health SBD	$2.70
Rate for Payer: UHC All Payor (Choice/PPO)	$2.78
Rate for Payer: UHC Core	$2.23
Rate for Payer: UHC Exchange	$1.68

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$388.80

Service Code	NDC 00904636361
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$152.80
Max. Negotiated Rate	$349.92
Rate for Payer: Aetna Commercial	$330.48
Rate for Payer: Aetna Medicare	$194.40
Rate for Payer: Aetna New Business (MI Preferred)	$252.72
Rate for Payer: BCBS Complete	$155.52
Rate for Payer: Cash Price	$311.04
Rate for Payer: Cofinity Advantage	$272.16
Rate for Payer: Cofinity Commercial	$334.37
Rate for Payer: Encore Health Key Benefits Commercial	$311.04
Rate for Payer: Healthscope Commercial	$349.92
Rate for Payer: MI Amish Medical Board Commercial	$311.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$291.60
Rate for Payer: PHP Commercial	$330.48
Rate for Payer: Priority Health SBD	$244.94
Rate for Payer: UHC All Payor (Choice/PPO)	$252.72
Rate for Payer: UHC Core	$202.56
Rate for Payer: UHC Exchange	$152.80

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$4.28

Service Code	NDC 68084031011
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: Aetna New Business (MI Preferred)	$2.78
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cofinity Advantage	$3.00
Rate for Payer: Cofinity Commercial	$3.68
Rate for Payer: Encore Health Key Benefits Commercial	$3.42
Rate for Payer: Healthscope Commercial	$3.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.21
Rate for Payer: PHP Commercial	$3.64
Rate for Payer: Priority Health SBD	$2.70

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$427.20

Service Code	NDC 68084031001
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$167.89
Max. Negotiated Rate	$384.48
Rate for Payer: Aetna Commercial	$363.12
Rate for Payer: Aetna Medicare	$213.60
Rate for Payer: Aetna New Business (MI Preferred)	$277.68
Rate for Payer: BCBS Complete	$170.88
Rate for Payer: Cash Price	$341.76
Rate for Payer: Cofinity Advantage	$299.04
Rate for Payer: Cofinity Commercial	$367.39
Rate for Payer: Encore Health Key Benefits Commercial	$341.76
Rate for Payer: Healthscope Commercial	$384.48
Rate for Payer: MI Amish Medical Board Commercial	$341.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$320.40
Rate for Payer: PHP Commercial	$363.12
Rate for Payer: Priority Health SBD	$269.14
Rate for Payer: UHC All Payor (Choice/PPO)	$277.68
Rate for Payer: UHC Core	$222.57
Rate for Payer: UHC Exchange	$167.89

DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$427.20

Service Code	NDC 68084031001
Hospital Charge Code	34418
Hospital Revenue Code	637
Min. Negotiated Rate	$269.14
Max. Negotiated Rate	$384.48
Rate for Payer: Aetna Commercial	$363.12
Rate for Payer: Aetna New Business (MI Preferred)	$277.68
Rate for Payer: Cash Price	$341.76
Rate for Payer: Cofinity Advantage	$299.04
Rate for Payer: Cofinity Commercial	$367.39
Rate for Payer: Encore Health Key Benefits Commercial	$341.76
Rate for Payer: Healthscope Commercial	$384.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$320.40
Rate for Payer: PHP Commercial	$363.12
Rate for Payer: Priority Health SBD	$269.14

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$214.70

Service Code	NDC 65162075710
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$84.38
Max. Negotiated Rate	$193.23
Rate for Payer: Aetna Commercial	$182.50
Rate for Payer: Aetna Medicare	$107.35
Rate for Payer: Aetna New Business (MI Preferred)	$139.56
Rate for Payer: BCBS Complete	$85.88
Rate for Payer: Cash Price	$171.76
Rate for Payer: Cofinity Advantage	$150.29
Rate for Payer: Cofinity Commercial	$184.64
Rate for Payer: Encore Health Key Benefits Commercial	$171.76
Rate for Payer: Healthscope Commercial	$193.23
Rate for Payer: MI Amish Medical Board Commercial	$171.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$182.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$161.03
Rate for Payer: PHP Commercial	$182.50
Rate for Payer: Priority Health SBD	$135.26
Rate for Payer: UHC All Payor (Choice/PPO)	$139.56
Rate for Payer: UHC Core	$111.86
Rate for Payer: UHC Exchange	$84.38

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$799.20

Service Code	NDC 68084041501
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$314.09
Max. Negotiated Rate	$719.28
Rate for Payer: Aetna Commercial	$679.32
Rate for Payer: Aetna Medicare	$399.60
Rate for Payer: Aetna New Business (MI Preferred)	$519.48
Rate for Payer: BCBS Complete	$319.68
Rate for Payer: Cash Price	$639.36
Rate for Payer: Cofinity Advantage	$559.44
Rate for Payer: Cofinity Commercial	$687.31
Rate for Payer: Encore Health Key Benefits Commercial	$639.36
Rate for Payer: Healthscope Commercial	$719.28
Rate for Payer: MI Amish Medical Board Commercial	$639.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$679.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$599.40
Rate for Payer: PHP Commercial	$679.32
Rate for Payer: Priority Health SBD	$503.50
Rate for Payer: UHC All Payor (Choice/PPO)	$519.48
Rate for Payer: UHC Core	$416.38
Rate for Payer: UHC Exchange	$314.09

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$2,007.25

Service Code	NDC 00074712611
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$1,264.57
Max. Negotiated Rate	$1,806.53
Rate for Payer: Aetna Commercial	$1,706.16
Rate for Payer: Aetna New Business (MI Preferred)	$1,304.71
Rate for Payer: Cash Price	$1,605.80
Rate for Payer: Cofinity Advantage	$1,405.08
Rate for Payer: Cofinity Commercial	$1,726.23
Rate for Payer: Encore Health Key Benefits Commercial	$1,605.80
Rate for Payer: Healthscope Commercial	$1,806.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,706.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,505.44
Rate for Payer: PHP Commercial	$1,706.16
Rate for Payer: Priority Health SBD	$1,264.57

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$799.20

Service Code	NDC 68084041501
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$503.50
Max. Negotiated Rate	$719.28
Rate for Payer: Aetna Commercial	$679.32
Rate for Payer: Aetna New Business (MI Preferred)	$519.48
Rate for Payer: Cash Price	$639.36
Rate for Payer: Cofinity Advantage	$559.44
Rate for Payer: Cofinity Commercial	$687.31
Rate for Payer: Encore Health Key Benefits Commercial	$639.36
Rate for Payer: Healthscope Commercial	$719.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$679.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$599.40
Rate for Payer: PHP Commercial	$679.32
Rate for Payer: Priority Health SBD	$503.50

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$2,007.25

Service Code	NDC 00074712611
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$788.85
Max. Negotiated Rate	$1,806.53
Rate for Payer: Aetna Commercial	$1,706.16
Rate for Payer: Aetna Medicare	$1,003.62
Rate for Payer: Aetna New Business (MI Preferred)	$1,304.71
Rate for Payer: BCBS Complete	$802.90
Rate for Payer: Cash Price	$1,605.80
Rate for Payer: Cofinity Advantage	$1,405.08
Rate for Payer: Cofinity Commercial	$1,726.23
Rate for Payer: Encore Health Key Benefits Commercial	$1,605.80
Rate for Payer: Healthscope Commercial	$1,806.53
Rate for Payer: MI Amish Medical Board Commercial	$1,605.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,706.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,505.44
Rate for Payer: PHP Commercial	$1,706.16
Rate for Payer: Priority Health SBD	$1,264.57
Rate for Payer: UHC All Payor (Choice/PPO)	$1,304.71
Rate for Payer: UHC Core	$1,045.78
Rate for Payer: UHC Exchange	$788.85

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$8.00

Service Code	NDC 68084041511
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: Aetna New Business (MI Preferred)	$5.20
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cofinity Advantage	$5.60
Rate for Payer: Cofinity Commercial	$6.88
Rate for Payer: Encore Health Key Benefits Commercial	$6.40
Rate for Payer: Healthscope Commercial	$7.20
Rate for Payer: MI Amish Medical Board Commercial	$6.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00
Rate for Payer: PHP Commercial	$6.80
Rate for Payer: Priority Health SBD	$5.04
Rate for Payer: UHC All Payor (Choice/PPO)	$5.20
Rate for Payer: UHC Core	$4.17
Rate for Payer: UHC Exchange	$3.14

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$8.00

Service Code	NDC 68084041511
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna New Business (MI Preferred)	$5.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cofinity Advantage	$5.60
Rate for Payer: Cofinity Commercial	$6.88
Rate for Payer: Encore Health Key Benefits Commercial	$6.40
Rate for Payer: Healthscope Commercial	$7.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00
Rate for Payer: PHP Commercial	$6.80
Rate for Payer: Priority Health SBD	$5.04

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$214.70

Service Code	NDC 65162075710
Hospital Charge Code	81426
Hospital Revenue Code	637
Min. Negotiated Rate	$135.26
Max. Negotiated Rate	$193.23
Rate for Payer: Aetna Commercial	$182.50
Rate for Payer: Aetna New Business (MI Preferred)	$139.56
Rate for Payer: Cash Price	$171.76
Rate for Payer: Cofinity Advantage	$150.29
Rate for Payer: Cofinity Commercial	$184.64
Rate for Payer: Encore Health Key Benefits Commercial	$171.76
Rate for Payer: Healthscope Commercial	$193.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$182.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$161.03
Rate for Payer: PHP Commercial	$182.50
Rate for Payer: Priority Health SBD	$135.26

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$7,101.47

Service Code	APR-DRG 2443
Min. Negotiated Rate	$6,763.30
Max. Negotiated Rate	$7,101.47
Rate for Payer: BCBS Complete	$7,101.47
Rate for Payer: Mclaren Medicaid	$6,763.30
Rate for Payer: Meridian Medicaid	$7,101.47
Rate for Payer: Priority Health Choice Medicaid	$6,763.30
Rate for Payer: UHC Medicaid	$6,763.30
Rate for Payer: UHCCP Medicaid	$6,763.30

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$3,274.69

Service Code	APR-DRG 2441
Min. Negotiated Rate	$3,118.75
Max. Negotiated Rate	$3,274.69
Rate for Payer: BCBS Complete	$3,274.69
Rate for Payer: Mclaren Medicaid	$3,118.75
Rate for Payer: Meridian Medicaid	$3,274.69
Rate for Payer: Priority Health Choice Medicaid	$3,118.75
Rate for Payer: UHC Medicaid	$3,118.75
Rate for Payer: UHCCP Medicaid	$3,118.75

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$4,342.75

Service Code	APR-DRG 2442
Min. Negotiated Rate	$4,135.95
Max. Negotiated Rate	$4,342.75
Rate for Payer: BCBS Complete	$4,342.75
Rate for Payer: Mclaren Medicaid	$4,135.95
Rate for Payer: Meridian Medicaid	$4,342.75
Rate for Payer: Priority Health Choice Medicaid	$4,135.95
Rate for Payer: UHC Medicaid	$4,135.95
Rate for Payer: UHCCP Medicaid	$4,135.95

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$11,910.31

Service Code	APR-DRG 2444
Min. Negotiated Rate	$11,343.15
Max. Negotiated Rate	$11,910.31
Rate for Payer: BCBS Complete	$11,910.31
Rate for Payer: Mclaren Medicaid	$11,343.15
Rate for Payer: Meridian Medicaid	$11,910.31
Rate for Payer: Priority Health Choice Medicaid	$11,343.15
Rate for Payer: UHC Medicaid	$11,343.15
Rate for Payer: UHCCP Medicaid	$11,343.15

DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION

Facility

$33.56

Service Code	HCPCS J1250
Hospital Charge Code	9892
Hospital Revenue Code	636
Min. Negotiated Rate	$13.23
Max. Negotiated Rate	$30.20
Rate for Payer: Aetna Commercial	$28.53
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare	$10.51
Rate for Payer: Aetna Medicare	$16.78
Rate for Payer: Aetna New Business (MI Preferred)	$21.81
Rate for Payer: Aetna New Business (MI Preferred)	$13.66
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS Complete	$13.42
Rate for Payer: BCBS Trust/PPO	$20.12
Rate for Payer: BCBS Trust/PPO	$20.12
Rate for Payer: BCN Commercial	$20.12
Rate for Payer: BCN Commercial	$20.12
Rate for Payer: Cash Price	$26.85
Rate for Payer: Cash Price	$16.81
Rate for Payer: Cash Price	$26.85
Rate for Payer: Cash Price	$16.81
Rate for Payer: Cofinity Advantage	$23.49
Rate for Payer: Cofinity Advantage	$14.71
Rate for Payer: Cofinity Commercial	$28.86
Rate for Payer: Cofinity Commercial	$18.07
Rate for Payer: Encore Health Key Benefits Commercial	$16.81
Rate for Payer: Encore Health Key Benefits Commercial	$26.85
Rate for Payer: Healthscope Commercial	$18.91
Rate for Payer: Healthscope Commercial	$30.20
Rate for Payer: MI Amish Medical Board Commercial	$16.81
Rate for Payer: MI Amish Medical Board Commercial	$26.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.76
Rate for Payer: PHP Commercial	$28.53
Rate for Payer: PHP Commercial	$17.86
Rate for Payer: Priority Health SBD	$21.14
Rate for Payer: Priority Health SBD	$13.24
Rate for Payer: UHC All Payor (Choice/PPO)	$13.23
Rate for Payer: UHC All Payor (Choice/PPO)	$13.23
Rate for Payer: UHC Core	$13.23
Rate for Payer: UHC Core	$13.23
Rate for Payer: UHC Exchange	$13.23
Rate for Payer: UHC Exchange	$13.23

DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION

Facility

$33.56

Service Code	HCPCS J1250
Hospital Charge Code	9892
Hospital Revenue Code	636
Min. Negotiated Rate	$21.14
Max. Negotiated Rate	$30.20
Rate for Payer: Aetna Commercial	$28.53
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna New Business (MI Preferred)	$21.81
Rate for Payer: Aetna New Business (MI Preferred)	$13.66
Rate for Payer: Cash Price	$16.81
Rate for Payer: Cash Price	$26.85
Rate for Payer: Cofinity Advantage	$23.49
Rate for Payer: Cofinity Advantage	$14.71
Rate for Payer: Cofinity Commercial	$18.07
Rate for Payer: Cofinity Commercial	$28.86
Rate for Payer: Encore Health Key Benefits Commercial	$26.85
Rate for Payer: Encore Health Key Benefits Commercial	$16.81
Rate for Payer: Healthscope Commercial	$30.20
Rate for Payer: Healthscope Commercial	$18.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.17
Rate for Payer: PHP Commercial	$17.86
Rate for Payer: PHP Commercial	$28.53
Rate for Payer: Priority Health SBD	$21.14
Rate for Payer: Priority Health SBD	$13.24

DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV

Facility

$82.62

Service Code	HCPCS J1250
Hospital Charge Code	18315
Hospital Revenue Code	636
Min. Negotiated Rate	$13.23
Max. Negotiated Rate	$74.36
Rate for Payer: Aetna Commercial	$70.23
Rate for Payer: Aetna Commercial	$142.97
Rate for Payer: Aetna Medicare	$84.10
Rate for Payer: Aetna Medicare	$41.31
Rate for Payer: Aetna New Business (MI Preferred)	$53.70
Rate for Payer: Aetna New Business (MI Preferred)	$109.33
Rate for Payer: BCBS Complete	$67.28
Rate for Payer: BCBS Complete	$33.05
Rate for Payer: BCBS Trust/PPO	$20.12
Rate for Payer: BCBS Trust/PPO	$20.12
Rate for Payer: BCN Commercial	$20.12
Rate for Payer: BCN Commercial	$20.12
Rate for Payer: Cash Price	$66.10
Rate for Payer: Cash Price	$134.56
Rate for Payer: Cash Price	$66.10
Rate for Payer: Cash Price	$134.56
Rate for Payer: Cofinity Advantage	$57.83
Rate for Payer: Cofinity Advantage	$117.74
Rate for Payer: Cofinity Commercial	$71.05
Rate for Payer: Cofinity Commercial	$144.65
Rate for Payer: Encore Health Key Benefits Commercial	$134.56
Rate for Payer: Encore Health Key Benefits Commercial	$66.10
Rate for Payer: Healthscope Commercial	$151.38
Rate for Payer: Healthscope Commercial	$74.36
Rate for Payer: MI Amish Medical Board Commercial	$134.56
Rate for Payer: MI Amish Medical Board Commercial	$66.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$126.15
Rate for Payer: PHP Commercial	$70.23
Rate for Payer: PHP Commercial	$142.97
Rate for Payer: Priority Health SBD	$52.05
Rate for Payer: Priority Health SBD	$105.97
Rate for Payer: UHC All Payor (Choice/PPO)	$13.23
Rate for Payer: UHC All Payor (Choice/PPO)	$13.23
Rate for Payer: UHC Core	$13.23
Rate for Payer: UHC Core	$13.23
Rate for Payer: UHC Exchange	$13.23
Rate for Payer: UHC Exchange	$13.23

DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV

Facility

$82.62

Service Code	HCPCS J1250
Hospital Charge Code	18315
Hospital Revenue Code	636
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$74.36
Rate for Payer: Aetna Commercial	$70.23
Rate for Payer: Aetna Commercial	$142.97
Rate for Payer: Aetna New Business (MI Preferred)	$53.70
Rate for Payer: Aetna New Business (MI Preferred)	$109.33
Rate for Payer: Cash Price	$134.56
Rate for Payer: Cash Price	$66.10
Rate for Payer: Cofinity Advantage	$57.83
Rate for Payer: Cofinity Advantage	$117.74
Rate for Payer: Cofinity Commercial	$144.65
Rate for Payer: Cofinity Commercial	$71.05
Rate for Payer: Encore Health Key Benefits Commercial	$66.10
Rate for Payer: Encore Health Key Benefits Commercial	$134.56
Rate for Payer: Healthscope Commercial	$74.36
Rate for Payer: Healthscope Commercial	$151.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$126.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.97
Rate for Payer: PHP Commercial	$142.97
Rate for Payer: PHP Commercial	$70.23
Rate for Payer: Priority Health SBD	$52.05
Rate for Payer: Priority Health SBD	$105.97

Know your out-of-pocket cost for care.

All Charges