Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CYANOCOBALAMIN (VIT B-12) 250 MCG TABLET

Facility

$3.55

Service Code	NDC 50268085311
Hospital Charge Code	2010
Hospital Revenue Code	637
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$3.19
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna New Business (MI Preferred)	$2.31
Rate for Payer: Cash Price	$2.84
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Cofinity Commercial	$3.05
Rate for Payer: Cofinity Medicare Advantage	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.84
Rate for Payer: Healthscope Commercial	$3.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.02
Rate for Payer: PHP Commercial	$3.02
Rate for Payer: Priority Health Cigna Priority Health	$2.31
Rate for Payer: Priority Health SBD	$2.24

CYANOCOBALAMIN (VIT B-12) 250 MCG TABLET

Facility

$42.77

Service Code	NDC 80681016500
Hospital Charge Code	2010
Hospital Revenue Code	637
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$38.49
Rate for Payer: Aetna Commercial	$36.35
Rate for Payer: Aetna Medicare	$21.39
Rate for Payer: Aetna New Business (MI Preferred)	$27.80
Rate for Payer: BCBS Complete	$17.11
Rate for Payer: Cash Price	$34.22
Rate for Payer: Cofinity Commercial	$29.94
Rate for Payer: Cofinity Commercial	$36.78
Rate for Payer: Cofinity Medicare Advantage	$29.94
Rate for Payer: Encore Health Key Benefits Commercial	$34.22
Rate for Payer: Healthscope Commercial	$38.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.35
Rate for Payer: PHP Commercial	$36.35
Rate for Payer: Priority Health Cigna Priority Health	$27.80
Rate for Payer: Priority Health SBD	$26.95

CYANOCOBALAMIN (VIT B-12) 250 MCG TABLET

Facility

$177.43

Service Code	NDC 50268085315
Hospital Charge Code	2010
Hospital Revenue Code	637
Min. Negotiated Rate	$111.78
Max. Negotiated Rate	$159.69
Rate for Payer: Aetna Commercial	$150.82
Rate for Payer: Aetna New Business (MI Preferred)	$115.33
Rate for Payer: Cash Price	$141.94
Rate for Payer: Cofinity Commercial	$124.20
Rate for Payer: Cofinity Commercial	$152.59
Rate for Payer: Cofinity Medicare Advantage	$124.20
Rate for Payer: Encore Health Key Benefits Commercial	$141.94
Rate for Payer: Healthscope Commercial	$159.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$150.82
Rate for Payer: PHP Commercial	$150.82
Rate for Payer: Priority Health Cigna Priority Health	$115.33
Rate for Payer: Priority Health SBD	$111.78

CYANOCOBALAMIN (VIT B-12) 250 MCG TABLET

Facility

$42.77

Service Code	NDC 80681016500
Hospital Charge Code	2010
Hospital Revenue Code	637
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$38.49
Rate for Payer: Aetna Commercial	$36.35
Rate for Payer: Aetna New Business (MI Preferred)	$27.80
Rate for Payer: Cash Price	$34.22
Rate for Payer: Cofinity Commercial	$29.94
Rate for Payer: Cofinity Commercial	$36.78
Rate for Payer: Cofinity Medicare Advantage	$29.94
Rate for Payer: Encore Health Key Benefits Commercial	$34.22
Rate for Payer: Healthscope Commercial	$38.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.35
Rate for Payer: PHP Commercial	$36.35
Rate for Payer: Priority Health Cigna Priority Health	$27.80
Rate for Payer: Priority Health SBD	$26.95

CYCLOPENTOLATE 1 % EYE DROPS

Facility

$99.37

Service Code	NDC 00065039602
Hospital Charge Code	2025
Hospital Revenue Code	637
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$89.43
Rate for Payer: Aetna Commercial	$84.46
Rate for Payer: Aetna Medicare	$49.69
Rate for Payer: Aetna New Business (MI Preferred)	$64.59
Rate for Payer: BCBS Complete	$39.75
Rate for Payer: Cash Price	$79.50
Rate for Payer: Cofinity Commercial	$69.56
Rate for Payer: Cofinity Commercial	$85.46
Rate for Payer: Cofinity Medicare Advantage	$69.56
Rate for Payer: Encore Health Key Benefits Commercial	$79.50
Rate for Payer: Healthscope Commercial	$89.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.46
Rate for Payer: PHP Commercial	$84.46
Rate for Payer: Priority Health Cigna Priority Health	$64.59
Rate for Payer: Priority Health SBD	$62.60

CYCLOPENTOLATE 1 % EYE DROPS

Facility

$99.37

Service Code	NDC 00065039602
Hospital Charge Code	2025
Hospital Revenue Code	637
Min. Negotiated Rate	$62.60
Max. Negotiated Rate	$89.43
Rate for Payer: Aetna Commercial	$84.46
Rate for Payer: Aetna New Business (MI Preferred)	$64.59
Rate for Payer: Cash Price	$79.50
Rate for Payer: Cofinity Commercial	$69.56
Rate for Payer: Cofinity Commercial	$85.46
Rate for Payer: Cofinity Medicare Advantage	$69.56
Rate for Payer: Encore Health Key Benefits Commercial	$79.50
Rate for Payer: Healthscope Commercial	$89.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.46
Rate for Payer: PHP Commercial	$84.46
Rate for Payer: Priority Health Cigna Priority Health	$64.59
Rate for Payer: Priority Health SBD	$62.60

CYCLOPENTOLATE 1 % EYE DROPS

Facility

$40.25

Service Code	NDC 24208073501
Hospital Charge Code	2025
Hospital Revenue Code	637
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$36.23
Rate for Payer: Aetna Commercial	$34.21
Rate for Payer: Aetna Medicare	$20.12
Rate for Payer: Aetna New Business (MI Preferred)	$26.16
Rate for Payer: BCBS Complete	$16.10
Rate for Payer: Cash Price	$32.20
Rate for Payer: Cofinity Commercial	$28.18
Rate for Payer: Cofinity Commercial	$34.62
Rate for Payer: Cofinity Medicare Advantage	$28.18
Rate for Payer: Encore Health Key Benefits Commercial	$32.20
Rate for Payer: Healthscope Commercial	$36.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.21
Rate for Payer: PHP Commercial	$34.21
Rate for Payer: Priority Health Cigna Priority Health	$26.16
Rate for Payer: Priority Health SBD	$25.36

CYCLOPENTOLATE 1 % EYE DROPS

Facility

$18.86

Service Code	NDC 17478010002
Hospital Charge Code	2025
Hospital Revenue Code	637
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$16.97
Rate for Payer: Aetna Commercial	$16.03
Rate for Payer: Aetna Medicare	$9.43
Rate for Payer: Aetna New Business (MI Preferred)	$12.26
Rate for Payer: BCBS Complete	$7.54
Rate for Payer: Cash Price	$15.09
Rate for Payer: Cofinity Commercial	$13.20
Rate for Payer: Cofinity Commercial	$16.22
Rate for Payer: Cofinity Medicare Advantage	$13.20
Rate for Payer: Encore Health Key Benefits Commercial	$15.09
Rate for Payer: Healthscope Commercial	$16.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.03
Rate for Payer: PHP Commercial	$16.03
Rate for Payer: Priority Health Cigna Priority Health	$12.26
Rate for Payer: Priority Health SBD	$11.88

CYCLOPENTOLATE 1 % EYE DROPS

Facility

$40.25

Service Code	NDC 24208073501
Hospital Charge Code	2025
Hospital Revenue Code	637
Min. Negotiated Rate	$25.36
Max. Negotiated Rate	$36.23
Rate for Payer: Aetna Commercial	$34.21
Rate for Payer: Aetna New Business (MI Preferred)	$26.16
Rate for Payer: Cash Price	$32.20
Rate for Payer: Cofinity Commercial	$28.18
Rate for Payer: Cofinity Commercial	$34.62
Rate for Payer: Cofinity Medicare Advantage	$28.18
Rate for Payer: Encore Health Key Benefits Commercial	$32.20
Rate for Payer: Healthscope Commercial	$36.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.21
Rate for Payer: PHP Commercial	$34.21
Rate for Payer: Priority Health Cigna Priority Health	$26.16
Rate for Payer: Priority Health SBD	$25.36

CYCLOPENTOLATE 1 % EYE DROPS

Facility

$18.86

Service Code	NDC 17478010002
Hospital Charge Code	2025
Hospital Revenue Code	637
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$16.97
Rate for Payer: Aetna Commercial	$16.03
Rate for Payer: Aetna New Business (MI Preferred)	$12.26
Rate for Payer: Cash Price	$15.09
Rate for Payer: Cofinity Commercial	$13.20
Rate for Payer: Cofinity Commercial	$16.22
Rate for Payer: Cofinity Medicare Advantage	$13.20
Rate for Payer: Encore Health Key Benefits Commercial	$15.09
Rate for Payer: Healthscope Commercial	$16.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.03
Rate for Payer: PHP Commercial	$16.03
Rate for Payer: Priority Health Cigna Priority Health	$12.26
Rate for Payer: Priority Health SBD	$11.88

CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION

Facility

$1,136.88

Service Code	HCPCS J9075
Hospital Charge Code	194691
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1,023.19
Rate for Payer: Aetna Commercial	$966.35
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: Aetna New Business (MI Preferred)	$738.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.60
Rate for Payer: Amish Plain Church Group Commercial	$0.60
Rate for Payer: BCBS Complete	$0.27
Rate for Payer: BCBS MAPPO	$0.48
Rate for Payer: BCN Medicare Advantage	$0.48
Rate for Payer: Cash Price	$909.50
Rate for Payer: Cash Price	$909.50
Rate for Payer: Cofinity Commercial	$977.72
Rate for Payer: Cofinity Commercial	$795.82
Rate for Payer: Cofinity Medicare Advantage	$795.82
Rate for Payer: Encore Health Key Benefits Commercial	$909.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.48
Rate for Payer: Healthscope Commercial	$1,023.19
Rate for Payer: Mclaren Medicaid	$0.26
Rate for Payer: Mclaren Medicare	$0.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.50
Rate for Payer: Meridian Medicaid	$0.27
Rate for Payer: MI Amish Medical Board Commercial	$0.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$966.35
Rate for Payer: PACE Medicare	$0.46
Rate for Payer: PACE SWMI	$0.48
Rate for Payer: PHP Commercial	$966.35
Rate for Payer: PHP Medicare Advantage	$0.48
Rate for Payer: Priority Health Choice Medicaid	$0.26
Rate for Payer: Priority Health Cigna Priority Health	$738.97
Rate for Payer: Priority Health Medicare	$0.48
Rate for Payer: Priority Health SBD	$716.23
Rate for Payer: Railroad Medicare Medicare	$0.48
Rate for Payer: UHC All Payor (Choice/PPO)	$1.35
Rate for Payer: UHC Dual Complete DSNP	$0.48
Rate for Payer: UHC Medicare Advantage	$0.48
Rate for Payer: UHCCP Medicaid	$0.27
Rate for Payer: VA VA	$0.48

CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION

Facility

$1,136.88

Service Code	HCPCS J9075
Hospital Charge Code	194691
Hospital Revenue Code	636
Min. Negotiated Rate	$716.23
Max. Negotiated Rate	$1,023.19
Rate for Payer: Aetna Commercial	$966.35
Rate for Payer: Aetna New Business (MI Preferred)	$738.97
Rate for Payer: Cash Price	$909.50
Rate for Payer: Cofinity Commercial	$795.82
Rate for Payer: Cofinity Commercial	$977.72
Rate for Payer: Cofinity Medicare Advantage	$795.82
Rate for Payer: Encore Health Key Benefits Commercial	$909.50
Rate for Payer: Healthscope Commercial	$1,023.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$966.35
Rate for Payer: PHP Commercial	$966.35
Rate for Payer: Priority Health Cigna Priority Health	$738.97
Rate for Payer: Priority Health SBD	$716.23

CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION

Facility

$2,149.02

Service Code	HCPCS J9073
Hospital Charge Code	194691
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1,934.12
Rate for Payer: Aetna Commercial	$1,826.67
Rate for Payer: Aetna Medicare	$0.81
Rate for Payer: Aetna New Business (MI Preferred)	$1,396.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.98
Rate for Payer: Amish Plain Church Group Commercial	$0.98
Rate for Payer: BCBS Complete	$0.44
Rate for Payer: BCBS MAPPO	$0.78
Rate for Payer: BCN Medicare Advantage	$0.78
Rate for Payer: Cash Price	$1,719.22
Rate for Payer: Cash Price	$1,719.22
Rate for Payer: Cofinity Commercial	$1,504.31
Rate for Payer: Cofinity Commercial	$1,848.16
Rate for Payer: Cofinity Medicare Advantage	$1,504.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,719.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.78
Rate for Payer: Healthscope Commercial	$1,934.12
Rate for Payer: Mclaren Medicaid	$0.42
Rate for Payer: Mclaren Medicare	$0.78
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.82
Rate for Payer: Meridian Medicaid	$0.44
Rate for Payer: MI Amish Medical Board Commercial	$0.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,826.67
Rate for Payer: PACE Medicare	$0.74
Rate for Payer: PACE SWMI	$0.78
Rate for Payer: PHP Commercial	$1,826.67
Rate for Payer: PHP Medicare Advantage	$0.78
Rate for Payer: Priority Health Choice Medicaid	$0.42
Rate for Payer: Priority Health Cigna Priority Health	$1,396.86
Rate for Payer: Priority Health Medicare	$0.78
Rate for Payer: Priority Health SBD	$1,353.88
Rate for Payer: Railroad Medicare Medicare	$0.78
Rate for Payer: UHC All Payor (Choice/PPO)	$2.20
Rate for Payer: UHC Dual Complete DSNP	$0.78
Rate for Payer: UHC Medicare Advantage	$0.78
Rate for Payer: UHCCP Medicaid	$0.44
Rate for Payer: VA VA	$0.78

CYCLOPHOSPHAMIDE 200 MG/ML INTRAVENOUS SOLUTION

Facility

$2,929.38

Service Code	HCPCS J9071
Hospital Charge Code	194691
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$2,636.44
Rate for Payer: Aetna Commercial	$2,489.97
Rate for Payer: Aetna Commercial	$1,176.61
Rate for Payer: Aetna Medicare	$0.66
Rate for Payer: Aetna Medicare	$0.66
Rate for Payer: Aetna New Business (MI Preferred)	$899.76
Rate for Payer: Aetna New Business (MI Preferred)	$1,904.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.79
Rate for Payer: Amish Plain Church Group Commercial	$0.79
Rate for Payer: Amish Plain Church Group Commercial	$0.79
Rate for Payer: BCBS Complete	$0.35
Rate for Payer: BCBS Complete	$0.35
Rate for Payer: BCBS MAPPO	$0.63
Rate for Payer: BCBS MAPPO	$0.63
Rate for Payer: BCN Medicare Advantage	$0.63
Rate for Payer: BCN Medicare Advantage	$0.63
Rate for Payer: Cash Price	$1,107.40
Rate for Payer: Cash Price	$2,343.50
Rate for Payer: Cash Price	$1,107.40
Rate for Payer: Cash Price	$2,343.50
Rate for Payer: Cofinity Commercial	$2,050.57
Rate for Payer: Cofinity Commercial	$968.98
Rate for Payer: Cofinity Commercial	$1,190.45
Rate for Payer: Cofinity Commercial	$2,519.27
Rate for Payer: Cofinity Medicare Advantage	$968.98
Rate for Payer: Cofinity Medicare Advantage	$2,050.57
Rate for Payer: Encore Health Key Benefits Commercial	$1,107.40
Rate for Payer: Encore Health Key Benefits Commercial	$2,343.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.63
Rate for Payer: Healthscope Commercial	$1,245.83
Rate for Payer: Healthscope Commercial	$2,636.44
Rate for Payer: Mclaren Medicaid	$0.34
Rate for Payer: Mclaren Medicaid	$0.34
Rate for Payer: Mclaren Medicare	$0.63
Rate for Payer: Mclaren Medicare	$0.63
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.66
Rate for Payer: Meridian Medicaid	$0.35
Rate for Payer: Meridian Medicaid	$0.35
Rate for Payer: MI Amish Medical Board Commercial	$0.72
Rate for Payer: MI Amish Medical Board Commercial	$0.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,489.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,176.61
Rate for Payer: PACE Medicare	$0.60
Rate for Payer: PACE Medicare	$0.60
Rate for Payer: PACE SWMI	$0.63
Rate for Payer: PACE SWMI	$0.63
Rate for Payer: PHP Commercial	$1,176.61
Rate for Payer: PHP Commercial	$2,489.97
Rate for Payer: PHP Medicare Advantage	$0.63
Rate for Payer: PHP Medicare Advantage	$0.63
Rate for Payer: Priority Health Choice Medicaid	$0.34
Rate for Payer: Priority Health Choice Medicaid	$0.34
Rate for Payer: Priority Health Cigna Priority Health	$899.76
Rate for Payer: Priority Health Cigna Priority Health	$1,904.10
Rate for Payer: Priority Health Medicare	$0.63
Rate for Payer: Priority Health Medicare	$0.63
Rate for Payer: Priority Health SBD	$872.08
Rate for Payer: Priority Health SBD	$1,845.51
Rate for Payer: Railroad Medicare Medicare	$0.63
Rate for Payer: Railroad Medicare Medicare	$0.63
Rate for Payer: UHC All Payor (Choice/PPO)	$1.77
Rate for Payer: UHC All Payor (Choice/PPO)	$1.77
Rate for Payer: UHC Dual Complete DSNP	$0.63
Rate for Payer: UHC Dual Complete DSNP	$0.63
Rate for Payer: UHC Medicare Advantage	$0.63
Rate for Payer: UHC Medicare Advantage	$0.63
Rate for Payer: UHCCP Medicaid	$0.35
Rate for Payer: UHCCP Medicaid	$0.35
Rate for Payer: VA VA	$0.63
Rate for Payer: VA VA	$0.63

CYCLOSPORINE 25 MG CAPSULE

Facility

$453.99

Service Code	HCPCS J7515
Hospital Charge Code	9707
Hospital Revenue Code	636
Min. Negotiated Rate	$181.60
Max. Negotiated Rate	$408.59
Rate for Payer: Aetna Commercial	$385.89
Rate for Payer: Aetna Medicare	$227.00
Rate for Payer: Aetna New Business (MI Preferred)	$295.09
Rate for Payer: BCBS Complete	$181.60
Rate for Payer: Cash Price	$363.19
Rate for Payer: Cofinity Commercial	$317.79
Rate for Payer: Cofinity Commercial	$390.43
Rate for Payer: Cofinity Medicare Advantage	$317.79
Rate for Payer: Encore Health Key Benefits Commercial	$363.19
Rate for Payer: Healthscope Commercial	$408.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.89
Rate for Payer: PHP Commercial	$385.89
Rate for Payer: Priority Health Cigna Priority Health	$295.09
Rate for Payer: Priority Health SBD	$286.01

CYCLOSPORINE 25 MG CAPSULE

Facility

$453.99

Service Code	HCPCS J7515
Hospital Charge Code	9707
Hospital Revenue Code	636
Min. Negotiated Rate	$286.01
Max. Negotiated Rate	$408.59
Rate for Payer: Aetna Commercial	$385.89
Rate for Payer: Aetna New Business (MI Preferred)	$295.09
Rate for Payer: Cash Price	$363.19
Rate for Payer: Cofinity Commercial	$317.79
Rate for Payer: Cofinity Commercial	$390.43
Rate for Payer: Cofinity Medicare Advantage	$317.79
Rate for Payer: Encore Health Key Benefits Commercial	$363.19
Rate for Payer: Healthscope Commercial	$408.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.89
Rate for Payer: PHP Commercial	$385.89
Rate for Payer: Priority Health Cigna Priority Health	$295.09
Rate for Payer: Priority Health SBD	$286.01

CYCLOSPORINE MODIFIED 100 MG CAPSULE

Facility

$36.82

Service Code	HCPCS J7502
Hospital Charge Code	28843
Hospital Revenue Code	636
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$33.14
Rate for Payer: Aetna Commercial	$31.30
Rate for Payer: Aetna Commercial	$938.88
Rate for Payer: Aetna New Business (MI Preferred)	$717.97
Rate for Payer: Aetna New Business (MI Preferred)	$23.93
Rate for Payer: Cash Price	$883.66
Rate for Payer: Cash Price	$29.46
Rate for Payer: Cofinity Commercial	$31.67
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Cofinity Commercial	$773.20
Rate for Payer: Cofinity Commercial	$949.93
Rate for Payer: Cofinity Medicare Advantage	$773.20
Rate for Payer: Cofinity Medicare Advantage	$25.77
Rate for Payer: Encore Health Key Benefits Commercial	$883.66
Rate for Payer: Encore Health Key Benefits Commercial	$29.46
Rate for Payer: Healthscope Commercial	$33.14
Rate for Payer: Healthscope Commercial	$994.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$938.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.30
Rate for Payer: PHP Commercial	$31.30
Rate for Payer: PHP Commercial	$938.88
Rate for Payer: Priority Health Cigna Priority Health	$717.97
Rate for Payer: Priority Health Cigna Priority Health	$23.93
Rate for Payer: Priority Health SBD	$695.88
Rate for Payer: Priority Health SBD	$23.20

CYCLOSPORINE MODIFIED 100 MG CAPSULE

Facility

$36.82

Service Code	HCPCS J7502
Hospital Charge Code	28843
Hospital Revenue Code	636
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$33.14
Rate for Payer: Aetna Commercial	$31.30
Rate for Payer: Aetna Commercial	$938.88
Rate for Payer: Aetna Medicare	$552.28
Rate for Payer: Aetna Medicare	$18.41
Rate for Payer: Aetna New Business (MI Preferred)	$23.93
Rate for Payer: Aetna New Business (MI Preferred)	$717.97
Rate for Payer: BCBS Complete	$14.73
Rate for Payer: BCBS Complete	$441.83
Rate for Payer: Cash Price	$29.46
Rate for Payer: Cash Price	$883.66
Rate for Payer: Cofinity Commercial	$31.67
Rate for Payer: Cofinity Commercial	$773.20
Rate for Payer: Cofinity Commercial	$949.93
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Cofinity Medicare Advantage	$773.20
Rate for Payer: Cofinity Medicare Advantage	$25.77
Rate for Payer: Encore Health Key Benefits Commercial	$883.66
Rate for Payer: Encore Health Key Benefits Commercial	$29.46
Rate for Payer: Healthscope Commercial	$33.14
Rate for Payer: Healthscope Commercial	$994.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$938.88
Rate for Payer: PHP Commercial	$31.30
Rate for Payer: PHP Commercial	$938.88
Rate for Payer: Priority Health Cigna Priority Health	$717.97
Rate for Payer: Priority Health Cigna Priority Health	$23.93
Rate for Payer: Priority Health SBD	$695.88
Rate for Payer: Priority Health SBD	$23.20

CYCLOSPORINE MODIFIED 25 MG CAPSULE

Facility

$276.39

Service Code	HCPCS J7515
Hospital Charge Code	28842
Hospital Revenue Code	636
Min. Negotiated Rate	$174.13
Max. Negotiated Rate	$248.75
Rate for Payer: Aetna Commercial	$234.93
Rate for Payer: Aetna New Business (MI Preferred)	$179.65
Rate for Payer: Cash Price	$221.11
Rate for Payer: Cofinity Commercial	$193.47
Rate for Payer: Cofinity Commercial	$237.70
Rate for Payer: Cofinity Medicare Advantage	$193.47
Rate for Payer: Encore Health Key Benefits Commercial	$221.11
Rate for Payer: Healthscope Commercial	$248.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.93
Rate for Payer: PHP Commercial	$234.93
Rate for Payer: Priority Health Cigna Priority Health	$179.65
Rate for Payer: Priority Health SBD	$174.13

CYCLOSPORINE MODIFIED 25 MG CAPSULE

Facility

$276.39

Service Code	HCPCS J7515
Hospital Charge Code	28842
Hospital Revenue Code	636
Min. Negotiated Rate	$110.56
Max. Negotiated Rate	$248.75
Rate for Payer: Aetna Commercial	$234.93
Rate for Payer: Aetna Medicare	$138.19
Rate for Payer: Aetna New Business (MI Preferred)	$179.65
Rate for Payer: BCBS Complete	$110.56
Rate for Payer: Cash Price	$221.11
Rate for Payer: Cofinity Commercial	$193.47
Rate for Payer: Cofinity Commercial	$237.70
Rate for Payer: Cofinity Medicare Advantage	$193.47
Rate for Payer: Encore Health Key Benefits Commercial	$221.11
Rate for Payer: Healthscope Commercial	$248.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$234.93
Rate for Payer: PHP Commercial	$234.93
Rate for Payer: Priority Health Cigna Priority Health	$179.65
Rate for Payer: Priority Health SBD	$174.13

CYPROHEPTADINE 4 MG TABLET

Facility

$2.68

Service Code	NDC 50268018911
Hospital Charge Code	2033
Hospital Revenue Code	637
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna New Business (MI Preferred)	$1.74
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cofinity Commercial	$1.88
Rate for Payer: Cofinity Commercial	$2.30
Rate for Payer: Cofinity Medicare Advantage	$1.88
Rate for Payer: Encore Health Key Benefits Commercial	$2.14
Rate for Payer: Healthscope Commercial	$2.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.28
Rate for Payer: PHP Commercial	$2.28
Rate for Payer: Priority Health Cigna Priority Health	$1.74
Rate for Payer: Priority Health SBD	$1.69

CYPROHEPTADINE 4 MG TABLET

Facility

$133.68

Service Code	NDC 50268018915
Hospital Charge Code	2033
Hospital Revenue Code	637
Min. Negotiated Rate	$53.47
Max. Negotiated Rate	$120.31
Rate for Payer: Aetna Commercial	$113.63
Rate for Payer: Aetna Medicare	$66.84
Rate for Payer: Aetna New Business (MI Preferred)	$86.89
Rate for Payer: BCBS Complete	$53.47
Rate for Payer: Cash Price	$106.94
Rate for Payer: Cofinity Commercial	$114.96
Rate for Payer: Cofinity Commercial	$93.58
Rate for Payer: Cofinity Medicare Advantage	$93.58
Rate for Payer: Encore Health Key Benefits Commercial	$106.94
Rate for Payer: Healthscope Commercial	$120.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$113.63
Rate for Payer: PHP Commercial	$113.63
Rate for Payer: Priority Health Cigna Priority Health	$86.89
Rate for Payer: Priority Health SBD	$84.22

CYPROHEPTADINE 4 MG TABLET

Facility

$229.90

Service Code	NDC 52817021010
Hospital Charge Code	2033
Hospital Revenue Code	637
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$206.91
Rate for Payer: Aetna Commercial	$195.41
Rate for Payer: Aetna New Business (MI Preferred)	$149.44
Rate for Payer: Cash Price	$183.92
Rate for Payer: Cofinity Commercial	$160.93
Rate for Payer: Cofinity Commercial	$197.71
Rate for Payer: Cofinity Medicare Advantage	$160.93
Rate for Payer: Encore Health Key Benefits Commercial	$183.92
Rate for Payer: Healthscope Commercial	$206.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.41
Rate for Payer: PHP Commercial	$195.41
Rate for Payer: Priority Health Cigna Priority Health	$149.44
Rate for Payer: Priority Health SBD	$144.84

CYPROHEPTADINE 4 MG TABLET

Facility

$133.68

Service Code	NDC 50268018915
Hospital Charge Code	2033
Hospital Revenue Code	637
Min. Negotiated Rate	$84.22
Max. Negotiated Rate	$120.31
Rate for Payer: Aetna Commercial	$113.63
Rate for Payer: Aetna New Business (MI Preferred)	$86.89
Rate for Payer: Cash Price	$106.94
Rate for Payer: Cofinity Commercial	$114.96
Rate for Payer: Cofinity Commercial	$93.58
Rate for Payer: Cofinity Medicare Advantage	$93.58
Rate for Payer: Encore Health Key Benefits Commercial	$106.94
Rate for Payer: Healthscope Commercial	$120.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$113.63
Rate for Payer: PHP Commercial	$113.63
Rate for Payer: Priority Health Cigna Priority Health	$86.89
Rate for Payer: Priority Health SBD	$84.22

CYPROHEPTADINE 4 MG TABLET

Facility

$229.90

Service Code	NDC 52817021010
Hospital Charge Code	2033
Hospital Revenue Code	637
Min. Negotiated Rate	$91.96
Max. Negotiated Rate	$206.91
Rate for Payer: Aetna Commercial	$195.41
Rate for Payer: Aetna Medicare	$114.95
Rate for Payer: Aetna New Business (MI Preferred)	$149.44
Rate for Payer: BCBS Complete	$91.96
Rate for Payer: Cash Price	$183.92
Rate for Payer: Cofinity Commercial	$160.93
Rate for Payer: Cofinity Commercial	$197.71
Rate for Payer: Cofinity Medicare Advantage	$160.93
Rate for Payer: Encore Health Key Benefits Commercial	$183.92
Rate for Payer: Healthscope Commercial	$206.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.41
Rate for Payer: PHP Commercial	$195.41
Rate for Payer: Priority Health Cigna Priority Health	$149.44
Rate for Payer: Priority Health SBD	$144.84

Know your out-of-pocket cost for care.

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