Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$7.61
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	$7.61
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	$7.61
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	$7.61
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

$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	$101.95
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	$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

$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

$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

$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 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 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

$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

$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	$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	$0.59
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	$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

$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

$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	$101.95
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	$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

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

DONEPEZIL 10 MG TABLET

Facility

$225.60

Service Code	NDC 00904647861
Hospital Charge Code	18787
Hospital Revenue Code	637
Min. Negotiated Rate	$90.24
Max. Negotiated Rate	$203.04
Rate for Payer: Aetna Commercial	$191.76
Rate for Payer: Aetna Medicare	$112.80
Rate for Payer: Aetna New Business (MI Preferred)	$146.64
Rate for Payer: BCBS Complete	$90.24
Rate for Payer: Cash Price	$180.48
Rate for Payer: Cofinity Commercial	$157.92
Rate for Payer: Cofinity Commercial	$194.02
Rate for Payer: Cofinity Medicare Advantage	$157.92
Rate for Payer: Encore Health Key Benefits Commercial	$180.48
Rate for Payer: Healthscope Commercial	$203.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.76
Rate for Payer: PHP Commercial	$191.76
Rate for Payer: Priority Health Cigna Priority Health	$146.64
Rate for Payer: Priority Health SBD	$142.13

DONEPEZIL 10 MG TABLET

Facility

$225.60

Service Code	NDC 00904647861
Hospital Charge Code	18787
Hospital Revenue Code	637
Min. Negotiated Rate	$142.13
Max. Negotiated Rate	$203.04
Rate for Payer: Aetna Commercial	$191.76
Rate for Payer: Aetna New Business (MI Preferred)	$146.64
Rate for Payer: Cash Price	$180.48
Rate for Payer: Cofinity Commercial	$157.92
Rate for Payer: Cofinity Commercial	$194.02
Rate for Payer: Cofinity Medicare Advantage	$157.92
Rate for Payer: Encore Health Key Benefits Commercial	$180.48
Rate for Payer: Healthscope Commercial	$203.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.76
Rate for Payer: PHP Commercial	$191.76
Rate for Payer: Priority Health Cigna Priority Health	$146.64
Rate for Payer: Priority Health SBD	$142.13

DONEPEZIL 5 MG TABLET

Facility

$263.20

Service Code	NDC 00904647761
Hospital Charge Code	18786
Hospital Revenue Code	637
Min. Negotiated Rate	$105.28
Max. Negotiated Rate	$236.88
Rate for Payer: Aetna Commercial	$223.72
Rate for Payer: Aetna Medicare	$131.60
Rate for Payer: Aetna New Business (MI Preferred)	$171.08
Rate for Payer: BCBS Complete	$105.28
Rate for Payer: Cash Price	$210.56
Rate for Payer: Cofinity Commercial	$184.24
Rate for Payer: Cofinity Commercial	$226.35
Rate for Payer: Cofinity Medicare Advantage	$184.24
Rate for Payer: Encore Health Key Benefits Commercial	$210.56
Rate for Payer: Healthscope Commercial	$236.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.72
Rate for Payer: PHP Commercial	$223.72
Rate for Payer: Priority Health Cigna Priority Health	$171.08
Rate for Payer: Priority Health SBD	$165.82

DONEPEZIL 5 MG TABLET

Facility

$43.01

Service Code	NDC 43547027503
Hospital Charge Code	18786
Hospital Revenue Code	637
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$38.71
Rate for Payer: Aetna Commercial	$36.56
Rate for Payer: Aetna Medicare	$21.50
Rate for Payer: Aetna New Business (MI Preferred)	$27.96
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: Cash Price	$34.41
Rate for Payer: Cofinity Commercial	$30.11
Rate for Payer: Cofinity Commercial	$36.99
Rate for Payer: Cofinity Medicare Advantage	$30.11
Rate for Payer: Encore Health Key Benefits Commercial	$34.41
Rate for Payer: Healthscope Commercial	$38.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.56
Rate for Payer: PHP Commercial	$36.56
Rate for Payer: Priority Health Cigna Priority Health	$27.96
Rate for Payer: Priority Health SBD	$27.10

DONEPEZIL 5 MG TABLET

Facility

$263.20

Service Code	NDC 00904647761
Hospital Charge Code	18786
Hospital Revenue Code	637
Min. Negotiated Rate	$165.82
Max. Negotiated Rate	$236.88
Rate for Payer: Aetna Commercial	$223.72
Rate for Payer: Aetna New Business (MI Preferred)	$171.08
Rate for Payer: Cash Price	$210.56
Rate for Payer: Cofinity Commercial	$184.24
Rate for Payer: Cofinity Commercial	$226.35
Rate for Payer: Cofinity Medicare Advantage	$184.24
Rate for Payer: Encore Health Key Benefits Commercial	$210.56
Rate for Payer: Healthscope Commercial	$236.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$223.72
Rate for Payer: PHP Commercial	$223.72
Rate for Payer: Priority Health Cigna Priority Health	$171.08
Rate for Payer: Priority Health SBD	$165.82

DONEPEZIL 5 MG TABLET

Facility

$43.01

Service Code	NDC 43547027503
Hospital Charge Code	18786
Hospital Revenue Code	637
Min. Negotiated Rate	$27.10
Max. Negotiated Rate	$38.71
Rate for Payer: Aetna Commercial	$36.56
Rate for Payer: Aetna New Business (MI Preferred)	$27.96
Rate for Payer: Cash Price	$34.41
Rate for Payer: Cofinity Commercial	$30.11
Rate for Payer: Cofinity Commercial	$36.99
Rate for Payer: Cofinity Medicare Advantage	$30.11
Rate for Payer: Encore Health Key Benefits Commercial	$34.41
Rate for Payer: Healthscope Commercial	$38.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.56
Rate for Payer: PHP Commercial	$36.56
Rate for Payer: Priority Health Cigna Priority Health	$27.96
Rate for Payer: Priority Health SBD	$27.10

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

Facility

$19.13

Service Code	HCPCS J1265
Hospital Charge Code	2595
Hospital Revenue Code	636
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$17.22
Rate for Payer: Aetna Commercial	$16.26
Rate for Payer: Aetna Commercial	$16.77
Rate for Payer: Aetna New Business (MI Preferred)	$12.43
Rate for Payer: Aetna New Business (MI Preferred)	$12.82
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cash Price	$15.78
Rate for Payer: Cofinity Commercial	$13.39
Rate for Payer: Cofinity Commercial	$13.81
Rate for Payer: Cofinity Commercial	$16.97
Rate for Payer: Cofinity Commercial	$16.45
Rate for Payer: Cofinity Medicare Advantage	$13.81
Rate for Payer: Cofinity Medicare Advantage	$13.39
Rate for Payer: Encore Health Key Benefits Commercial	$15.30
Rate for Payer: Encore Health Key Benefits Commercial	$15.78
Rate for Payer: Healthscope Commercial	$17.22
Rate for Payer: Healthscope Commercial	$17.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.77
Rate for Payer: PHP Commercial	$16.26
Rate for Payer: PHP Commercial	$16.77
Rate for Payer: Priority Health Cigna Priority Health	$12.82
Rate for Payer: Priority Health Cigna Priority Health	$12.43
Rate for Payer: Priority Health SBD	$12.43
Rate for Payer: Priority Health SBD	$12.05

Know your out-of-pocket cost for care.

All Charges