Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DONEPEZIL 5 MG TABLET

Facility

$260.85

Service Code	NDC 00904647761
Hospital Charge Code	18786
Hospital Revenue Code	637
Min. Negotiated Rate	$164.34
Max. Negotiated Rate	$234.76
Rate for Payer: Aetna Commercial	$221.72
Rate for Payer: Aetna New Business (MI Preferred)	$169.55
Rate for Payer: Cash Price	$208.68
Rate for Payer: Cofinity Advantage	$182.59
Rate for Payer: Cofinity Commercial	$224.33
Rate for Payer: Encore Health Key Benefits Commercial	$208.68
Rate for Payer: Healthscope Commercial	$234.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.64
Rate for Payer: PHP Commercial	$221.72
Rate for Payer: Priority Health SBD	$164.34

DONEPEZIL 5 MG TABLET

Facility

$43.71

Service Code	NDC 43547027503
Hospital Charge Code	18786
Hospital Revenue Code	637
Min. Negotiated Rate	$27.54
Max. Negotiated Rate	$39.34
Rate for Payer: Aetna Commercial	$37.15
Rate for Payer: Aetna New Business (MI Preferred)	$28.41
Rate for Payer: Cash Price	$34.97
Rate for Payer: Cofinity Advantage	$30.60
Rate for Payer: Cofinity Commercial	$37.59
Rate for Payer: Encore Health Key Benefits Commercial	$34.97
Rate for Payer: Healthscope Commercial	$39.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.78
Rate for Payer: PHP Commercial	$37.15
Rate for Payer: Priority Health SBD	$27.54

DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION

Facility

$20.02

Service Code	HCPCS J1265
Hospital Charge Code	2595
Hospital Revenue Code	636
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$18.02
Rate for Payer: Aetna Commercial	$17.02
Rate for Payer: Aetna Commercial	$16.26
Rate for Payer: Aetna New Business (MI Preferred)	$13.01
Rate for Payer: Aetna New Business (MI Preferred)	$12.43
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$16.02
Rate for Payer: Cofinity Advantage	$14.01
Rate for Payer: Cofinity Advantage	$13.39
Rate for Payer: Cofinity Commercial	$16.45
Rate for Payer: Cofinity Commercial	$17.22
Rate for Payer: Encore Health Key Benefits Commercial	$16.02
Rate for Payer: Encore Health Key Benefits Commercial	$15.30
Rate for Payer: Healthscope Commercial	$18.02
Rate for Payer: Healthscope Commercial	$17.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.02
Rate for Payer: PHP Commercial	$16.26
Rate for Payer: PHP Commercial	$17.02
Rate for Payer: Priority Health SBD	$12.61
Rate for Payer: Priority Health SBD	$12.05

DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION

Facility

$20.02

Service Code	HCPCS J1265
Hospital Charge Code	2595
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$18.02
Rate for Payer: Aetna Commercial	$17.02
Rate for Payer: Aetna Commercial	$16.26
Rate for Payer: Aetna Medicare	$9.56
Rate for Payer: Aetna Medicare	$10.01
Rate for Payer: Aetna New Business (MI Preferred)	$13.01
Rate for Payer: Aetna New Business (MI Preferred)	$12.43
Rate for Payer: BCBS Complete	$7.65
Rate for Payer: BCBS Complete	$8.01
Rate for Payer: BCBS Trust/PPO	$1.99
Rate for Payer: BCBS Trust/PPO	$1.99
Rate for Payer: BCN Commercial	$1.99
Rate for Payer: BCN Commercial	$1.99
Rate for Payer: Cash Price	$16.02
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$16.02
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cofinity Advantage	$14.01
Rate for Payer: Cofinity Advantage	$13.39
Rate for Payer: Cofinity Commercial	$17.22
Rate for Payer: Cofinity Commercial	$16.45
Rate for Payer: Encore Health Key Benefits Commercial	$15.30
Rate for Payer: Encore Health Key Benefits Commercial	$16.02
Rate for Payer: Healthscope Commercial	$17.22
Rate for Payer: Healthscope Commercial	$18.02
Rate for Payer: MI Amish Medical Board Commercial	$15.30
Rate for Payer: MI Amish Medical Board Commercial	$16.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.35
Rate for Payer: PHP Commercial	$17.02
Rate for Payer: PHP Commercial	$16.26
Rate for Payer: Priority Health SBD	$12.61
Rate for Payer: Priority Health SBD	$12.05
Rate for Payer: UHC All Payor (Choice/PPO)	$1.32
Rate for Payer: UHC All Payor (Choice/PPO)	$1.32
Rate for Payer: UHC Core	$1.32
Rate for Payer: UHC Core	$1.32
Rate for Payer: UHC Exchange	$1.32
Rate for Payer: UHC Exchange	$1.32

DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN

Facility

$98.31

Service Code	HCPCS J1265
Hospital Charge Code	14845
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$88.48
Rate for Payer: Aetna Commercial	$83.56
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna Medicare	$49.16
Rate for Payer: Aetna Medicare	$36.72
Rate for Payer: Aetna New Business (MI Preferred)	$47.74
Rate for Payer: Aetna New Business (MI Preferred)	$63.90
Rate for Payer: BCBS Complete	$39.32
Rate for Payer: BCBS Complete	$29.38
Rate for Payer: BCBS Trust/PPO	$1.99
Rate for Payer: BCBS Trust/PPO	$1.99
Rate for Payer: BCN Commercial	$1.99
Rate for Payer: BCN Commercial	$1.99
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cofinity Advantage	$51.41
Rate for Payer: Cofinity Advantage	$68.82
Rate for Payer: Cofinity Commercial	$84.55
Rate for Payer: Cofinity Commercial	$63.16
Rate for Payer: Encore Health Key Benefits Commercial	$78.65
Rate for Payer: Encore Health Key Benefits Commercial	$58.75
Rate for Payer: Healthscope Commercial	$66.10
Rate for Payer: Healthscope Commercial	$88.48
Rate for Payer: MI Amish Medical Board Commercial	$78.65
Rate for Payer: MI Amish Medical Board Commercial	$58.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$73.73
Rate for Payer: PHP Commercial	$83.56
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: Priority Health SBD	$46.27
Rate for Payer: Priority Health SBD	$61.94
Rate for Payer: UHC All Payor (Choice/PPO)	$1.32
Rate for Payer: UHC All Payor (Choice/PPO)	$1.32
Rate for Payer: UHC Core	$1.32
Rate for Payer: UHC Core	$1.32
Rate for Payer: UHC Exchange	$1.32
Rate for Payer: UHC Exchange	$1.32

DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN

Facility

$73.44

Service Code	HCPCS J1265
Hospital Charge Code	14845
Hospital Revenue Code	636
Min. Negotiated Rate	$46.27
Max. Negotiated Rate	$66.10
Rate for Payer: Aetna Commercial	$62.42
Rate for Payer: Aetna Commercial	$83.56
Rate for Payer: Aetna New Business (MI Preferred)	$47.74
Rate for Payer: Aetna New Business (MI Preferred)	$63.90
Rate for Payer: Cash Price	$58.75
Rate for Payer: Cash Price	$78.65
Rate for Payer: Cofinity Advantage	$51.41
Rate for Payer: Cofinity Advantage	$68.82
Rate for Payer: Cofinity Commercial	$63.16
Rate for Payer: Cofinity Commercial	$84.55
Rate for Payer: Encore Health Key Benefits Commercial	$78.65
Rate for Payer: Encore Health Key Benefits Commercial	$58.75
Rate for Payer: Healthscope Commercial	$88.48
Rate for Payer: Healthscope Commercial	$66.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$73.73
Rate for Payer: PHP Commercial	$62.42
Rate for Payer: PHP Commercial	$83.56
Rate for Payer: Priority Health SBD	$46.27
Rate for Payer: Priority Health SBD	$61.94

DOPAMINE 400 MG/5 ML (80 MG/ML) INTRAVENOUS SOLUTION

Facility

$22.65

Service Code	HCPCS J1265
Hospital Charge Code	118602
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$20.39
Rate for Payer: Aetna Commercial	$19.25
Rate for Payer: Aetna Medicare	$11.32
Rate for Payer: Aetna New Business (MI Preferred)	$14.72
Rate for Payer: BCBS Complete	$9.06
Rate for Payer: BCBS Trust/PPO	$1.99
Rate for Payer: BCN Commercial	$1.99
Rate for Payer: Cash Price	$18.12
Rate for Payer: Cash Price	$18.12
Rate for Payer: Cofinity Advantage	$15.86
Rate for Payer: Cofinity Commercial	$19.48
Rate for Payer: Encore Health Key Benefits Commercial	$18.12
Rate for Payer: Healthscope Commercial	$20.39
Rate for Payer: MI Amish Medical Board Commercial	$18.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.99
Rate for Payer: PHP Commercial	$19.25
Rate for Payer: Priority Health SBD	$14.27
Rate for Payer: UHC All Payor (Choice/PPO)	$1.32
Rate for Payer: UHC Core	$1.32
Rate for Payer: UHC Exchange	$1.32

DOPAMINE 400 MG/5 ML (80 MG/ML) INTRAVENOUS SOLUTION

Facility

$22.65

Service Code	HCPCS J1265
Hospital Charge Code	118602
Hospital Revenue Code	636
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$20.39
Rate for Payer: Aetna Commercial	$19.25
Rate for Payer: Aetna New Business (MI Preferred)	$14.72
Rate for Payer: Cash Price	$18.12
Rate for Payer: Cofinity Advantage	$15.86
Rate for Payer: Cofinity Commercial	$19.48
Rate for Payer: Encore Health Key Benefits Commercial	$18.12
Rate for Payer: Healthscope Commercial	$20.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.99
Rate for Payer: PHP Commercial	$19.25
Rate for Payer: Priority Health SBD	$14.27

DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION

Facility

$474.13

Service Code	HCPCS J7639
Hospital Charge Code	12211
Hospital Revenue Code	250
Min. Negotiated Rate	$44.13
Max. Negotiated Rate	$426.72
Rate for Payer: Aetna Commercial	$403.01
Rate for Payer: Aetna Medicare	$237.06
Rate for Payer: Aetna New Business (MI Preferred)	$308.18
Rate for Payer: BCBS Complete	$189.65
Rate for Payer: Cash Price	$379.30
Rate for Payer: Cash Price	$379.30
Rate for Payer: Cofinity Advantage	$331.89
Rate for Payer: Cofinity Commercial	$407.75
Rate for Payer: Encore Health Key Benefits Commercial	$379.30
Rate for Payer: Healthscope Commercial	$426.72
Rate for Payer: MI Amish Medical Board Commercial	$379.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$355.60
Rate for Payer: PHP Commercial	$403.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$55.16
Rate for Payer: Priority Health SBD	$298.70
Rate for Payer: Priority Health Tiered Network	$44.13
Rate for Payer: UHC All Payor (Choice/PPO)	$308.18
Rate for Payer: UHC Core	$247.02
Rate for Payer: UHC Exchange	$186.33

DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION

Facility

$474.13

Service Code	HCPCS J7639
Hospital Charge Code	12211
Hospital Revenue Code	250
Min. Negotiated Rate	$298.70
Max. Negotiated Rate	$426.72
Rate for Payer: Aetna Commercial	$403.01
Rate for Payer: Aetna New Business (MI Preferred)	$308.18
Rate for Payer: Cash Price	$379.30
Rate for Payer: Cofinity Advantage	$331.89
Rate for Payer: Cofinity Commercial	$407.75
Rate for Payer: Encore Health Key Benefits Commercial	$379.30
Rate for Payer: Healthscope Commercial	$426.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$355.60
Rate for Payer: PHP Commercial	$403.01
Rate for Payer: Priority Health SBD	$298.70

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$17,396.22

Service Code	APR-DRG 3042
Min. Negotiated Rate	$16,567.82
Max. Negotiated Rate	$17,396.22
Rate for Payer: BCBS Complete	$17,396.22
Rate for Payer: Mclaren Medicaid	$16,567.82
Rate for Payer: Meridian Medicaid	$17,396.22
Rate for Payer: Priority Health Choice Medicaid	$16,567.82
Rate for Payer: UHC Medicaid	$16,567.82
Rate for Payer: UHCCP Medicaid	$16,567.82

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$13,653.71

Service Code	APR-DRG 3041
Min. Negotiated Rate	$13,003.54
Max. Negotiated Rate	$13,653.71
Rate for Payer: BCBS Complete	$13,653.71
Rate for Payer: Mclaren Medicaid	$13,003.54
Rate for Payer: Meridian Medicaid	$13,653.71
Rate for Payer: Priority Health Choice Medicaid	$13,003.54
Rate for Payer: UHC Medicaid	$13,003.54
Rate for Payer: UHCCP Medicaid	$13,003.54

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$25,466.56

Service Code	APR-DRG 3043
Min. Negotiated Rate	$24,253.87
Max. Negotiated Rate	$25,466.56
Rate for Payer: BCBS Complete	$25,466.56
Rate for Payer: Mclaren Medicaid	$24,253.87
Rate for Payer: Meridian Medicaid	$25,466.56
Rate for Payer: Priority Health Choice Medicaid	$24,253.87
Rate for Payer: UHC Medicaid	$24,253.87
Rate for Payer: UHCCP Medicaid	$24,253.87

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$32,832.32

Service Code	APR-DRG 3044
Min. Negotiated Rate	$31,268.87
Max. Negotiated Rate	$32,832.32
Rate for Payer: BCBS Complete	$32,832.32
Rate for Payer: Mclaren Medicaid	$31,268.87
Rate for Payer: Meridian Medicaid	$32,832.32
Rate for Payer: Priority Health Choice Medicaid	$31,268.87
Rate for Payer: UHC Medicaid	$31,268.87
Rate for Payer: UHCCP Medicaid	$31,268.87

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$38,010.94

Service Code	APR-DRG 3033
Min. Negotiated Rate	$36,200.89
Max. Negotiated Rate	$38,010.94
Rate for Payer: BCBS Complete	$38,010.94
Rate for Payer: Mclaren Medicaid	$36,200.89
Rate for Payer: Meridian Medicaid	$38,010.94
Rate for Payer: Priority Health Choice Medicaid	$36,200.89
Rate for Payer: UHC Medicaid	$36,200.89
Rate for Payer: UHCCP Medicaid	$36,200.89

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$23,665.25

Service Code	APR-DRG 3031
Min. Negotiated Rate	$22,538.33
Max. Negotiated Rate	$23,665.25
Rate for Payer: BCBS Complete	$23,665.25
Rate for Payer: Mclaren Medicaid	$22,538.33
Rate for Payer: Meridian Medicaid	$23,665.25
Rate for Payer: Priority Health Choice Medicaid	$22,538.33
Rate for Payer: UHC Medicaid	$22,538.33
Rate for Payer: UHCCP Medicaid	$22,538.33

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$59,644.41

Service Code	APR-DRG 3034
Min. Negotiated Rate	$56,804.20
Max. Negotiated Rate	$59,644.41
Rate for Payer: BCBS Complete	$59,644.41
Rate for Payer: Mclaren Medicaid	$56,804.20
Rate for Payer: Meridian Medicaid	$59,644.41
Rate for Payer: Priority Health Choice Medicaid	$56,804.20
Rate for Payer: UHC Medicaid	$56,804.20
Rate for Payer: UHCCP Medicaid	$56,804.20

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$26,336.83

Service Code	APR-DRG 3032
Min. Negotiated Rate	$25,082.69
Max. Negotiated Rate	$26,336.83
Rate for Payer: BCBS Complete	$26,336.83
Rate for Payer: Mclaren Medicaid	$25,082.69
Rate for Payer: Meridian Medicaid	$26,336.83
Rate for Payer: Priority Health Choice Medicaid	$25,082.69
Rate for Payer: UHC Medicaid	$25,082.69
Rate for Payer: UHCCP Medicaid	$25,082.69

DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS

Facility

$30.49

Service Code	NDC 24208048610
Hospital Charge Code	22982
Hospital Revenue Code	637
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$27.44
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Aetna Medicare	$15.24
Rate for Payer: Aetna New Business (MI Preferred)	$19.82
Rate for Payer: BCBS Complete	$12.20
Rate for Payer: Cash Price	$24.39
Rate for Payer: Cofinity Advantage	$21.34
Rate for Payer: Cofinity Commercial	$26.22
Rate for Payer: Encore Health Key Benefits Commercial	$24.39
Rate for Payer: Healthscope Commercial	$27.44
Rate for Payer: MI Amish Medical Board Commercial	$24.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.87
Rate for Payer: PHP Commercial	$25.92
Rate for Payer: Priority Health SBD	$19.21
Rate for Payer: UHC All Payor (Choice/PPO)	$19.82
Rate for Payer: UHC Core	$15.89
Rate for Payer: UHC Exchange	$11.98

DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS

Facility

$162.75

Service Code	NDC 50383023310
Hospital Charge Code	22982
Hospital Revenue Code	637
Min. Negotiated Rate	$102.53
Max. Negotiated Rate	$146.47
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna New Business (MI Preferred)	$105.79
Rate for Payer: Cash Price	$130.20
Rate for Payer: Cofinity Advantage	$113.92
Rate for Payer: Cofinity Commercial	$139.97
Rate for Payer: Encore Health Key Benefits Commercial	$130.20
Rate for Payer: Healthscope Commercial	$146.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$122.06
Rate for Payer: PHP Commercial	$138.34
Rate for Payer: Priority Health SBD	$102.53

DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS

Facility

$162.75

Service Code	NDC 50383023310
Hospital Charge Code	22982
Hospital Revenue Code	637
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$146.47
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna Medicare	$81.38
Rate for Payer: Aetna New Business (MI Preferred)	$105.79
Rate for Payer: BCBS Complete	$65.10
Rate for Payer: Cash Price	$130.20
Rate for Payer: Cofinity Advantage	$113.92
Rate for Payer: Cofinity Commercial	$139.97
Rate for Payer: Encore Health Key Benefits Commercial	$130.20
Rate for Payer: Healthscope Commercial	$146.47
Rate for Payer: MI Amish Medical Board Commercial	$130.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$138.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$122.06
Rate for Payer: PHP Commercial	$138.34
Rate for Payer: Priority Health SBD	$102.53
Rate for Payer: UHC All Payor (Choice/PPO)	$105.79
Rate for Payer: UHC Core	$84.79
Rate for Payer: UHC Exchange	$63.96

DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS

Facility

$65.10

Service Code	NDC 61314003002
Hospital Charge Code	22982
Hospital Revenue Code	637
Min. Negotiated Rate	$41.01
Max. Negotiated Rate	$58.59
Rate for Payer: Aetna Commercial	$55.34
Rate for Payer: Aetna New Business (MI Preferred)	$42.31
Rate for Payer: Cash Price	$52.08
Rate for Payer: Cofinity Advantage	$45.57
Rate for Payer: Cofinity Commercial	$55.99
Rate for Payer: Encore Health Key Benefits Commercial	$52.08
Rate for Payer: Healthscope Commercial	$58.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.83
Rate for Payer: PHP Commercial	$55.34
Rate for Payer: Priority Health SBD	$41.01

DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS

Facility

$65.10

Service Code	NDC 61314003002
Hospital Charge Code	22982
Hospital Revenue Code	637
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$58.59
Rate for Payer: Aetna Commercial	$55.34
Rate for Payer: Aetna Medicare	$32.55
Rate for Payer: Aetna New Business (MI Preferred)	$42.31
Rate for Payer: BCBS Complete	$26.04
Rate for Payer: Cash Price	$52.08
Rate for Payer: Cofinity Advantage	$45.57
Rate for Payer: Cofinity Commercial	$55.99
Rate for Payer: Encore Health Key Benefits Commercial	$52.08
Rate for Payer: Healthscope Commercial	$58.59
Rate for Payer: MI Amish Medical Board Commercial	$52.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.83
Rate for Payer: PHP Commercial	$55.34
Rate for Payer: Priority Health SBD	$41.01
Rate for Payer: UHC All Payor (Choice/PPO)	$42.31
Rate for Payer: UHC Core	$33.92
Rate for Payer: UHC Exchange	$25.58

DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS

Facility

$30.49

Service Code	NDC 24208048610
Hospital Charge Code	22982
Hospital Revenue Code	637
Min. Negotiated Rate	$19.21
Max. Negotiated Rate	$27.44
Rate for Payer: Aetna Commercial	$25.92
Rate for Payer: Aetna New Business (MI Preferred)	$19.82
Rate for Payer: Cash Price	$24.39
Rate for Payer: Cofinity Advantage	$21.34
Rate for Payer: Cofinity Commercial	$26.22
Rate for Payer: Encore Health Key Benefits Commercial	$24.39
Rate for Payer: Healthscope Commercial	$27.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.87
Rate for Payer: PHP Commercial	$25.92
Rate for Payer: Priority Health SBD	$19.21

DORZOLAMIDE 2 % EYE DROPS

Facility

$29.27

Service Code	NDC 70069050101
Hospital Charge Code	14471
Hospital Revenue Code	637
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$26.34
Rate for Payer: Aetna Commercial	$24.88
Rate for Payer: Aetna Medicare	$14.63
Rate for Payer: Aetna New Business (MI Preferred)	$19.03
Rate for Payer: BCBS Complete	$11.71
Rate for Payer: Cash Price	$23.42
Rate for Payer: Cofinity Advantage	$20.49
Rate for Payer: Cofinity Commercial	$25.17
Rate for Payer: Encore Health Key Benefits Commercial	$23.42
Rate for Payer: Healthscope Commercial	$26.34
Rate for Payer: MI Amish Medical Board Commercial	$23.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.95
Rate for Payer: PHP Commercial	$24.88
Rate for Payer: Priority Health SBD	$18.44
Rate for Payer: UHC All Payor (Choice/PPO)	$19.03
Rate for Payer: UHC Core	$15.25
Rate for Payer: UHC Exchange	$11.50

Know your out-of-pocket cost for care.

All Charges