Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$189.00

Service Code	NDC 63739047810
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna Commercial	$160.65
Rate for Payer: Aetna New Business (MI Preferred)	$122.85
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cofinity Commercial	$132.30
Rate for Payer: Cofinity Commercial	$162.54
Rate for Payer: Cofinity Medicare Advantage	$132.30
Rate for Payer: Encore Health Key Benefits Commercial	$151.20
Rate for Payer: Healthscope Commercial	$170.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$160.65
Rate for Payer: PHP Commercial	$160.65
Rate for Payer: Priority Health Cigna Priority Health	$122.85
Rate for Payer: Priority Health SBD	$119.07

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$180.00

Service Code	NDC 00904718361
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$126.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Cofinity Medicare Advantage	$126.00
Rate for Payer: Encore Health Key Benefits Commercial	$144.00
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health Cigna Priority Health	$117.00
Rate for Payer: Priority Health SBD	$113.40

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$14.00

Service Code	NDC 63739047802
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$11.90
Rate for Payer: Aetna New Business (MI Preferred)	$9.10
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cofinity Commercial	$12.04
Rate for Payer: Cofinity Commercial	$9.80
Rate for Payer: Cofinity Medicare Advantage	$9.80
Rate for Payer: Encore Health Key Benefits Commercial	$11.20
Rate for Payer: Healthscope Commercial	$12.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.90
Rate for Payer: PHP Commercial	$11.90
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: Priority Health SBD	$8.82

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$100.80

Service Code	NDC 00904699860
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$90.72
Rate for Payer: Aetna Commercial	$85.68
Rate for Payer: Aetna Medicare	$50.40
Rate for Payer: Aetna New Business (MI Preferred)	$65.52
Rate for Payer: BCBS Complete	$40.32
Rate for Payer: Cash Price	$80.64
Rate for Payer: Cofinity Commercial	$70.56
Rate for Payer: Cofinity Commercial	$86.69
Rate for Payer: Cofinity Medicare Advantage	$70.56
Rate for Payer: Encore Health Key Benefits Commercial	$80.64
Rate for Payer: Healthscope Commercial	$90.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.68
Rate for Payer: PHP Commercial	$85.68
Rate for Payer: Priority Health Cigna Priority Health	$65.52
Rate for Payer: Priority Health SBD	$63.50

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$14.00

Service Code	NDC 63739047802
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$11.90
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: Aetna New Business (MI Preferred)	$9.10
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cofinity Commercial	$12.04
Rate for Payer: Cofinity Commercial	$9.80
Rate for Payer: Cofinity Medicare Advantage	$9.80
Rate for Payer: Encore Health Key Benefits Commercial	$11.20
Rate for Payer: Healthscope Commercial	$12.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.90
Rate for Payer: PHP Commercial	$11.90
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: Priority Health SBD	$8.82

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$8.45

Service Code	NDC 00121187000
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna Commercial	$7.18
Rate for Payer: Aetna Medicare	$4.22
Rate for Payer: Aetna New Business (MI Preferred)	$5.49
Rate for Payer: BCBS Complete	$3.38
Rate for Payer: Cash Price	$6.76
Rate for Payer: Cofinity Commercial	$5.92
Rate for Payer: Cofinity Commercial	$7.27
Rate for Payer: Cofinity Medicare Advantage	$5.92
Rate for Payer: Encore Health Key Benefits Commercial	$6.76
Rate for Payer: Healthscope Commercial	$7.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.18
Rate for Payer: PHP Commercial	$7.18
Rate for Payer: Priority Health Cigna Priority Health	$5.49
Rate for Payer: Priority Health SBD	$5.32

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$8.45

Service Code	NDC 00121187010
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna Commercial	$7.18
Rate for Payer: Aetna Medicare	$4.22
Rate for Payer: Aetna New Business (MI Preferred)	$5.49
Rate for Payer: BCBS Complete	$3.38
Rate for Payer: Cash Price	$6.76
Rate for Payer: Cofinity Commercial	$5.92
Rate for Payer: Cofinity Commercial	$7.27
Rate for Payer: Cofinity Medicare Advantage	$5.92
Rate for Payer: Encore Health Key Benefits Commercial	$6.76
Rate for Payer: Healthscope Commercial	$7.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.18
Rate for Payer: PHP Commercial	$7.18
Rate for Payer: Priority Health Cigna Priority Health	$5.49
Rate for Payer: Priority Health SBD	$5.32

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$8.45

Service Code	NDC 00121187000
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna Commercial	$7.18
Rate for Payer: Aetna New Business (MI Preferred)	$5.49
Rate for Payer: Cash Price	$6.76
Rate for Payer: Cofinity Commercial	$5.92
Rate for Payer: Cofinity Commercial	$7.27
Rate for Payer: Cofinity Medicare Advantage	$5.92
Rate for Payer: Encore Health Key Benefits Commercial	$6.76
Rate for Payer: Healthscope Commercial	$7.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.18
Rate for Payer: PHP Commercial	$7.18
Rate for Payer: Priority Health Cigna Priority Health	$5.49
Rate for Payer: Priority Health SBD	$5.32

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$8.45

Service Code	NDC 00121187010
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna Commercial	$7.18
Rate for Payer: Aetna New Business (MI Preferred)	$5.49
Rate for Payer: Cash Price	$6.76
Rate for Payer: Cofinity Commercial	$5.92
Rate for Payer: Cofinity Commercial	$7.27
Rate for Payer: Cofinity Medicare Advantage	$5.92
Rate for Payer: Encore Health Key Benefits Commercial	$6.76
Rate for Payer: Healthscope Commercial	$7.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.18
Rate for Payer: PHP Commercial	$7.18
Rate for Payer: Priority Health Cigna Priority Health	$5.49
Rate for Payer: Priority Health SBD	$5.32

DOFETILIDE 125 MCG CAPSULE

Facility

$2,310.80

Service Code	NDC 00069580060
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$924.32
Max. Negotiated Rate	$2,079.72
Rate for Payer: Aetna Commercial	$1,964.18
Rate for Payer: Aetna Medicare	$1,155.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,502.02
Rate for Payer: BCBS Complete	$924.32
Rate for Payer: Cash Price	$1,848.64
Rate for Payer: Cofinity Commercial	$1,617.56
Rate for Payer: Cofinity Commercial	$1,987.29
Rate for Payer: Cofinity Medicare Advantage	$1,617.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,848.64
Rate for Payer: Healthscope Commercial	$2,079.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,964.18
Rate for Payer: PHP Commercial	$1,964.18
Rate for Payer: Priority Health Cigna Priority Health	$1,502.02
Rate for Payer: Priority Health SBD	$1,455.80

DOFETILIDE 125 MCG CAPSULE

Facility

$627.08

Service Code	NDC 00904668108
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$395.06
Max. Negotiated Rate	$564.37
Rate for Payer: Aetna Commercial	$533.02
Rate for Payer: Aetna New Business (MI Preferred)	$407.60
Rate for Payer: Cash Price	$501.66
Rate for Payer: Cofinity Commercial	$438.96
Rate for Payer: Cofinity Commercial	$539.29
Rate for Payer: Cofinity Medicare Advantage	$438.96
Rate for Payer: Encore Health Key Benefits Commercial	$501.66
Rate for Payer: Healthscope Commercial	$564.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$533.02
Rate for Payer: PHP Commercial	$533.02
Rate for Payer: Priority Health Cigna Priority Health	$407.60
Rate for Payer: Priority Health SBD	$395.06

DOFETILIDE 125 MCG CAPSULE

Facility

$203.91

Service Code	NDC 69452013117
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$81.56
Max. Negotiated Rate	$183.52
Rate for Payer: Aetna Commercial	$173.32
Rate for Payer: Aetna Medicare	$101.96
Rate for Payer: Aetna New Business (MI Preferred)	$132.54
Rate for Payer: BCBS Complete	$81.56
Rate for Payer: Cash Price	$163.13
Rate for Payer: Cofinity Commercial	$142.74
Rate for Payer: Cofinity Commercial	$175.36
Rate for Payer: Cofinity Medicare Advantage	$142.74
Rate for Payer: Encore Health Key Benefits Commercial	$163.13
Rate for Payer: Healthscope Commercial	$183.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.32
Rate for Payer: PHP Commercial	$173.32
Rate for Payer: Priority Health Cigna Priority Health	$132.54
Rate for Payer: Priority Health SBD	$128.46

DOFETILIDE 125 MCG CAPSULE

Facility

$627.08

Service Code	NDC 00904668108
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$250.83
Max. Negotiated Rate	$564.37
Rate for Payer: Aetna Commercial	$533.02
Rate for Payer: Aetna Medicare	$313.54
Rate for Payer: Aetna New Business (MI Preferred)	$407.60
Rate for Payer: BCBS Complete	$250.83
Rate for Payer: Cash Price	$501.66
Rate for Payer: Cofinity Commercial	$438.96
Rate for Payer: Cofinity Commercial	$539.29
Rate for Payer: Cofinity Medicare Advantage	$438.96
Rate for Payer: Encore Health Key Benefits Commercial	$501.66
Rate for Payer: Healthscope Commercial	$564.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$533.02
Rate for Payer: PHP Commercial	$533.02
Rate for Payer: Priority Health Cigna Priority Health	$407.60
Rate for Payer: Priority Health SBD	$395.06

DOFETILIDE 125 MCG CAPSULE

Facility

$203.91

Service Code	NDC 69452013117
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$128.46
Max. Negotiated Rate	$183.52
Rate for Payer: Aetna Commercial	$173.32
Rate for Payer: Aetna New Business (MI Preferred)	$132.54
Rate for Payer: Cash Price	$163.13
Rate for Payer: Cofinity Commercial	$142.74
Rate for Payer: Cofinity Commercial	$175.36
Rate for Payer: Cofinity Medicare Advantage	$142.74
Rate for Payer: Encore Health Key Benefits Commercial	$163.13
Rate for Payer: Healthscope Commercial	$183.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.32
Rate for Payer: PHP Commercial	$173.32
Rate for Payer: Priority Health Cigna Priority Health	$132.54
Rate for Payer: Priority Health SBD	$128.46

DOFETILIDE 125 MCG CAPSULE

Facility

$2,310.80

Service Code	NDC 00069580060
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$1,455.80
Max. Negotiated Rate	$2,079.72
Rate for Payer: Aetna Commercial	$1,964.18
Rate for Payer: Aetna New Business (MI Preferred)	$1,502.02
Rate for Payer: Cash Price	$1,848.64
Rate for Payer: Cofinity Commercial	$1,617.56
Rate for Payer: Cofinity Commercial	$1,987.29
Rate for Payer: Cofinity Medicare Advantage	$1,617.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,848.64
Rate for Payer: Healthscope Commercial	$2,079.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,964.18
Rate for Payer: PHP Commercial	$1,964.18
Rate for Payer: Priority Health Cigna Priority Health	$1,502.02
Rate for Payer: Priority Health SBD	$1,455.80

DOFETILIDE 250 MCG CAPSULE

Facility

$203.91

Service Code	NDC 69452013217
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$128.46
Max. Negotiated Rate	$183.52
Rate for Payer: Aetna Commercial	$173.32
Rate for Payer: Aetna New Business (MI Preferred)	$132.54
Rate for Payer: Cash Price	$163.13
Rate for Payer: Cofinity Commercial	$142.74
Rate for Payer: Cofinity Commercial	$175.36
Rate for Payer: Cofinity Medicare Advantage	$142.74
Rate for Payer: Encore Health Key Benefits Commercial	$163.13
Rate for Payer: Healthscope Commercial	$183.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.32
Rate for Payer: PHP Commercial	$173.32
Rate for Payer: Priority Health Cigna Priority Health	$132.54
Rate for Payer: Priority Health SBD	$128.46

DOFETILIDE 250 MCG CAPSULE

Facility

$2,310.80

Service Code	NDC 00069581060
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$1,455.80
Max. Negotiated Rate	$2,079.72
Rate for Payer: Aetna Commercial	$1,964.18
Rate for Payer: Aetna New Business (MI Preferred)	$1,502.02
Rate for Payer: Cash Price	$1,848.64
Rate for Payer: Cofinity Commercial	$1,617.56
Rate for Payer: Cofinity Commercial	$1,987.29
Rate for Payer: Cofinity Medicare Advantage	$1,617.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,848.64
Rate for Payer: Healthscope Commercial	$2,079.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,964.18
Rate for Payer: PHP Commercial	$1,964.18
Rate for Payer: Priority Health Cigna Priority Health	$1,502.02
Rate for Payer: Priority Health SBD	$1,455.80

DOFETILIDE 250 MCG CAPSULE

Facility

$0.94

Service Code	NDC 00069581043
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna Commercial	$0.80
Rate for Payer: Aetna Medicare	$0.47
Rate for Payer: Aetna New Business (MI Preferred)	$0.61
Rate for Payer: BCBS Complete	$0.38
Rate for Payer: Cash Price	$0.75
Rate for Payer: Cofinity Commercial	$0.66
Rate for Payer: Cofinity Commercial	$0.81
Rate for Payer: Cofinity Medicare Advantage	$0.66
Rate for Payer: Encore Health Key Benefits Commercial	$0.75
Rate for Payer: Healthscope Commercial	$0.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.80
Rate for Payer: PHP Commercial	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.61
Rate for Payer: Priority Health SBD	$0.59

DOFETILIDE 250 MCG CAPSULE

Facility

$0.94

Service Code	NDC 00069581043
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna Commercial	$0.80
Rate for Payer: Aetna New Business (MI Preferred)	$0.61
Rate for Payer: Cash Price	$0.75
Rate for Payer: Cofinity Commercial	$0.66
Rate for Payer: Cofinity Commercial	$0.81
Rate for Payer: Cofinity Medicare Advantage	$0.66
Rate for Payer: Encore Health Key Benefits Commercial	$0.75
Rate for Payer: Healthscope Commercial	$0.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.80
Rate for Payer: PHP Commercial	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.61
Rate for Payer: Priority Health SBD	$0.59

DOFETILIDE 250 MCG CAPSULE

Facility

$619.98

Service Code	NDC 00904668208
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$390.59
Max. Negotiated Rate	$557.98
Rate for Payer: Aetna Commercial	$526.98
Rate for Payer: Aetna New Business (MI Preferred)	$402.99
Rate for Payer: Cash Price	$495.98
Rate for Payer: Cofinity Commercial	$433.99
Rate for Payer: Cofinity Commercial	$533.18
Rate for Payer: Cofinity Medicare Advantage	$433.99
Rate for Payer: Encore Health Key Benefits Commercial	$495.98
Rate for Payer: Healthscope Commercial	$557.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$526.98
Rate for Payer: PHP Commercial	$526.98
Rate for Payer: Priority Health Cigna Priority Health	$402.99
Rate for Payer: Priority Health SBD	$390.59

DOFETILIDE 250 MCG CAPSULE

Facility

$2,310.80

Service Code	NDC 00069581060
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$924.32
Max. Negotiated Rate	$2,079.72
Rate for Payer: Aetna Commercial	$1,964.18
Rate for Payer: Aetna Medicare	$1,155.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,502.02
Rate for Payer: BCBS Complete	$924.32
Rate for Payer: Cash Price	$1,848.64
Rate for Payer: Cofinity Commercial	$1,617.56
Rate for Payer: Cofinity Commercial	$1,987.29
Rate for Payer: Cofinity Medicare Advantage	$1,617.56
Rate for Payer: Encore Health Key Benefits Commercial	$1,848.64
Rate for Payer: Healthscope Commercial	$2,079.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,964.18
Rate for Payer: PHP Commercial	$1,964.18
Rate for Payer: Priority Health Cigna Priority Health	$1,502.02
Rate for Payer: Priority Health SBD	$1,455.80

DOFETILIDE 250 MCG CAPSULE

Facility

$619.98

Service Code	NDC 00904668208
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$247.99
Max. Negotiated Rate	$557.98
Rate for Payer: Aetna Commercial	$526.98
Rate for Payer: Aetna Medicare	$309.99
Rate for Payer: Aetna New Business (MI Preferred)	$402.99
Rate for Payer: BCBS Complete	$247.99
Rate for Payer: Cash Price	$495.98
Rate for Payer: Cofinity Commercial	$433.99
Rate for Payer: Cofinity Commercial	$533.18
Rate for Payer: Cofinity Medicare Advantage	$433.99
Rate for Payer: Encore Health Key Benefits Commercial	$495.98
Rate for Payer: Healthscope Commercial	$557.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$526.98
Rate for Payer: PHP Commercial	$526.98
Rate for Payer: Priority Health Cigna Priority Health	$402.99
Rate for Payer: Priority Health SBD	$390.59

DOFETILIDE 250 MCG CAPSULE

Facility

$203.91

Service Code	NDC 69452013217
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$81.56
Max. Negotiated Rate	$183.52
Rate for Payer: Aetna Commercial	$173.32
Rate for Payer: Aetna Medicare	$101.96
Rate for Payer: Aetna New Business (MI Preferred)	$132.54
Rate for Payer: BCBS Complete	$81.56
Rate for Payer: Cash Price	$163.13
Rate for Payer: Cofinity Commercial	$142.74
Rate for Payer: Cofinity Commercial	$175.36
Rate for Payer: Cofinity Medicare Advantage	$142.74
Rate for Payer: Encore Health Key Benefits Commercial	$163.13
Rate for Payer: Healthscope Commercial	$183.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.32
Rate for Payer: PHP Commercial	$173.32
Rate for Payer: Priority Health Cigna Priority Health	$132.54
Rate for Payer: Priority Health SBD	$128.46

DOLUTEGRAVIR 50 MG TABLET

Facility

$8,388.05

Service Code	NDC 49702022813
Hospital Charge Code	167672
Hospital Revenue Code	637
Min. Negotiated Rate	$5,284.47
Max. Negotiated Rate	$7,549.24
Rate for Payer: Aetna Commercial	$7,129.84
Rate for Payer: Aetna New Business (MI Preferred)	$5,452.23
Rate for Payer: Cash Price	$6,710.44
Rate for Payer: Cofinity Commercial	$5,871.64
Rate for Payer: Cofinity Commercial	$7,213.72
Rate for Payer: Cofinity Medicare Advantage	$5,871.64
Rate for Payer: Encore Health Key Benefits Commercial	$6,710.44
Rate for Payer: Healthscope Commercial	$7,549.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,129.84
Rate for Payer: PHP Commercial	$7,129.84
Rate for Payer: Priority Health Cigna Priority Health	$5,452.23
Rate for Payer: Priority Health SBD	$5,284.47

DOLUTEGRAVIR 50 MG TABLET

Facility

$8,388.05

Service Code	NDC 49702022813
Hospital Charge Code	167672
Hospital Revenue Code	637
Min. Negotiated Rate	$3,355.22
Max. Negotiated Rate	$7,549.24
Rate for Payer: Aetna Commercial	$7,129.84
Rate for Payer: Aetna Medicare	$4,194.02
Rate for Payer: Aetna New Business (MI Preferred)	$5,452.23
Rate for Payer: BCBS Complete	$3,355.22
Rate for Payer: Cash Price	$6,710.44
Rate for Payer: Cofinity Commercial	$5,871.64
Rate for Payer: Cofinity Commercial	$7,213.72
Rate for Payer: Cofinity Medicare Advantage	$5,871.64
Rate for Payer: Encore Health Key Benefits Commercial	$6,710.44
Rate for Payer: Healthscope Commercial	$7,549.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7,129.84
Rate for Payer: PHP Commercial	$7,129.84
Rate for Payer: Priority Health Cigna Priority Health	$5,452.23
Rate for Payer: Priority Health SBD	$5,284.47

Know your out-of-pocket cost for care.

All Charges