Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GENDER RELATED PROCEDURES

Facility

$55,723.04

Service Code	APR-DRG 8514
Min. Negotiated Rate	$53,069.56
Max. Negotiated Rate	$55,723.04
Rate for Payer: BCBS Complete	$55,723.04
Rate for Payer: Mclaren Medicaid	$53,069.56
Rate for Payer: Meridian Medicaid	$55,723.04
Rate for Payer: Priority Health Choice Medicaid	$53,069.56
Rate for Payer: UHC Medicaid	$53,069.56
Rate for Payer: UHCCP Medicaid	$53,069.56

GENDER RELATED PROCEDURES

Facility

$55,723.04

Service Code	APR-DRG 8513
Min. Negotiated Rate	$53,069.56
Max. Negotiated Rate	$55,723.04
Rate for Payer: BCBS Complete	$55,723.04
Rate for Payer: Mclaren Medicaid	$53,069.56
Rate for Payer: Meridian Medicaid	$55,723.04
Rate for Payer: Priority Health Choice Medicaid	$53,069.56
Rate for Payer: UHC Medicaid	$53,069.56
Rate for Payer: UHCCP Medicaid	$53,069.56

GENETIC DISORDERS

Facility

$6,756.91

Service Code	APR-DRG 4282
Min. Negotiated Rate	$6,435.16
Max. Negotiated Rate	$6,756.91
Rate for Payer: BCBS Complete	$6,756.91
Rate for Payer: Mclaren Medicaid	$6,435.16
Rate for Payer: Meridian Medicaid	$6,756.91
Rate for Payer: Priority Health Choice Medicaid	$6,435.16
Rate for Payer: UHC Medicaid	$6,435.16
Rate for Payer: UHCCP Medicaid	$6,435.16

GENETIC DISORDERS

Facility

$14,718.33

Service Code	APR-DRG 4283
Min. Negotiated Rate	$14,017.46
Max. Negotiated Rate	$14,718.33
Rate for Payer: BCBS Complete	$14,718.33
Rate for Payer: Mclaren Medicaid	$14,017.46
Rate for Payer: Meridian Medicaid	$14,718.33
Rate for Payer: Priority Health Choice Medicaid	$14,017.46
Rate for Payer: UHC Medicaid	$14,017.46
Rate for Payer: UHCCP Medicaid	$14,017.46

GENETIC DISORDERS

Facility

$24,962.06

Service Code	APR-DRG 4284
Min. Negotiated Rate	$23,773.39
Max. Negotiated Rate	$24,962.06
Rate for Payer: BCBS Complete	$24,962.06
Rate for Payer: Mclaren Medicaid	$23,773.39
Rate for Payer: Meridian Medicaid	$24,962.06
Rate for Payer: Priority Health Choice Medicaid	$23,773.39
Rate for Payer: UHC Medicaid	$23,773.39
Rate for Payer: UHCCP Medicaid	$23,773.39

GENETIC DISORDERS

Facility

$3,600.32

Service Code	APR-DRG 4281
Min. Negotiated Rate	$3,428.88
Max. Negotiated Rate	$3,600.32
Rate for Payer: BCBS Complete	$3,600.32
Rate for Payer: Mclaren Medicaid	$3,428.88
Rate for Payer: Meridian Medicaid	$3,600.32
Rate for Payer: Priority Health Choice Medicaid	$3,428.88
Rate for Payer: UHC Medicaid	$3,428.88
Rate for Payer: UHCCP Medicaid	$3,428.88

GENTAMICIN 0.1 % TOPICAL CREAM

Facility

$128.58

Service Code	NDC 45802005635
Hospital Charge Code	3423
Hospital Revenue Code	637
Min. Negotiated Rate	$50.53
Max. Negotiated Rate	$115.72
Rate for Payer: Aetna Commercial	$109.29
Rate for Payer: Aetna Medicare	$64.29
Rate for Payer: Aetna New Business (MI Preferred)	$83.58
Rate for Payer: BCBS Complete	$51.43
Rate for Payer: Cash Price	$102.86
Rate for Payer: Cofinity Advantage	$90.01
Rate for Payer: Cofinity Commercial	$110.58
Rate for Payer: Encore Health Key Benefits Commercial	$102.86
Rate for Payer: Healthscope Commercial	$115.72
Rate for Payer: MI Amish Medical Board Commercial	$102.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.44
Rate for Payer: PHP Commercial	$109.29
Rate for Payer: Priority Health SBD	$81.01
Rate for Payer: UHC All Payor (Choice/PPO)	$83.58
Rate for Payer: UHC Core	$66.99
Rate for Payer: UHC Exchange	$50.53

GENTAMICIN 0.1 % TOPICAL CREAM

Facility

$128.58

Service Code	NDC 45802005635
Hospital Charge Code	3423
Hospital Revenue Code	637
Min. Negotiated Rate	$81.01
Max. Negotiated Rate	$115.72
Rate for Payer: Aetna Commercial	$109.29
Rate for Payer: Aetna New Business (MI Preferred)	$83.58
Rate for Payer: Cash Price	$102.86
Rate for Payer: Cofinity Advantage	$90.01
Rate for Payer: Cofinity Commercial	$110.58
Rate for Payer: Encore Health Key Benefits Commercial	$102.86
Rate for Payer: Healthscope Commercial	$115.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.44
Rate for Payer: PHP Commercial	$109.29
Rate for Payer: Priority Health SBD	$81.01

GENTAMICIN 0.3 % EYE DROPS

Facility

$17.82

Service Code	NDC 61314063305
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$16.04
Rate for Payer: Aetna Commercial	$15.15
Rate for Payer: Aetna New Business (MI Preferred)	$11.58
Rate for Payer: Cash Price	$14.26
Rate for Payer: Cofinity Advantage	$12.47
Rate for Payer: Cofinity Commercial	$15.33
Rate for Payer: Encore Health Key Benefits Commercial	$14.26
Rate for Payer: Healthscope Commercial	$16.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.37
Rate for Payer: PHP Commercial	$15.15
Rate for Payer: Priority Health SBD	$11.23

GENTAMICIN 0.3 % EYE DROPS

Facility

$17.82

Service Code	NDC 61314063305
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$16.04
Rate for Payer: Aetna Commercial	$15.15
Rate for Payer: Aetna Medicare	$8.91
Rate for Payer: Aetna New Business (MI Preferred)	$11.58
Rate for Payer: BCBS Complete	$7.13
Rate for Payer: Cash Price	$14.26
Rate for Payer: Cofinity Advantage	$12.47
Rate for Payer: Cofinity Commercial	$15.33
Rate for Payer: Encore Health Key Benefits Commercial	$14.26
Rate for Payer: Healthscope Commercial	$16.04
Rate for Payer: MI Amish Medical Board Commercial	$14.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.37
Rate for Payer: PHP Commercial	$15.15
Rate for Payer: Priority Health SBD	$11.23
Rate for Payer: UHC All Payor (Choice/PPO)	$11.58
Rate for Payer: UHC Core	$9.28
Rate for Payer: UHC Exchange	$7.00

GENTAMICIN 0.3 % EYE DROPS

Facility

$116.24

Service Code	NDC 24208058060
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$73.23
Max. Negotiated Rate	$104.62
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna New Business (MI Preferred)	$75.56
Rate for Payer: Cash Price	$92.99
Rate for Payer: Cofinity Advantage	$81.37
Rate for Payer: Cofinity Commercial	$99.97
Rate for Payer: Encore Health Key Benefits Commercial	$92.99
Rate for Payer: Healthscope Commercial	$104.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.18
Rate for Payer: PHP Commercial	$98.80
Rate for Payer: Priority Health SBD	$73.23

GENTAMICIN 0.3 % EYE DROPS

Facility

$116.24

Service Code	NDC 24208058060
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$45.68
Max. Negotiated Rate	$104.62
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare	$58.12
Rate for Payer: Aetna New Business (MI Preferred)	$75.56
Rate for Payer: BCBS Complete	$46.50
Rate for Payer: Cash Price	$92.99
Rate for Payer: Cofinity Advantage	$81.37
Rate for Payer: Cofinity Commercial	$99.97
Rate for Payer: Encore Health Key Benefits Commercial	$92.99
Rate for Payer: Healthscope Commercial	$104.62
Rate for Payer: MI Amish Medical Board Commercial	$92.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.18
Rate for Payer: PHP Commercial	$98.80
Rate for Payer: Priority Health SBD	$73.23
Rate for Payer: UHC All Payor (Choice/PPO)	$75.56
Rate for Payer: UHC Core	$60.56
Rate for Payer: UHC Exchange	$45.68

GENTAMICIN 120 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK

Facility

$80.41

Service Code	HCPCS J1580
Hospital Charge Code	114156
Hospital Revenue Code	636
Min. Negotiated Rate	$50.66
Max. Negotiated Rate	$72.37
Rate for Payer: Aetna Commercial	$68.35
Rate for Payer: Aetna New Business (MI Preferred)	$52.27
Rate for Payer: Cash Price	$64.33
Rate for Payer: Cofinity Advantage	$56.29
Rate for Payer: Cofinity Commercial	$69.15
Rate for Payer: Encore Health Key Benefits Commercial	$64.33
Rate for Payer: Healthscope Commercial	$72.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.31
Rate for Payer: PHP Commercial	$68.35
Rate for Payer: Priority Health SBD	$50.66

GENTAMICIN 120 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK

Facility

$80.41

Service Code	HCPCS J1580
Hospital Charge Code	114156
Hospital Revenue Code	636
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$72.37
Rate for Payer: Aetna Commercial	$68.35
Rate for Payer: Aetna Medicare	$40.20
Rate for Payer: Aetna New Business (MI Preferred)	$52.27
Rate for Payer: BCBS Complete	$32.16
Rate for Payer: BCBS Trust/PPO	$5.42
Rate for Payer: BCN Commercial	$5.42
Rate for Payer: Cash Price	$64.33
Rate for Payer: Cash Price	$64.33
Rate for Payer: Cofinity Advantage	$56.29
Rate for Payer: Cofinity Commercial	$69.15
Rate for Payer: Encore Health Key Benefits Commercial	$64.33
Rate for Payer: Healthscope Commercial	$72.37
Rate for Payer: MI Amish Medical Board Commercial	$64.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.31
Rate for Payer: PHP Commercial	$68.35
Rate for Payer: Priority Health SBD	$50.66
Rate for Payer: UHC All Payor (Choice/PPO)	$3.58
Rate for Payer: UHC Core	$3.58
Rate for Payer: UHC Exchange	$3.58

GENTAMICIN 40 MG/ML FOR INHALATION

Facility

$336.40

Service Code	HCPCS J1580
Hospital Charge Code	180596
Hospital Revenue Code	636
Min. Negotiated Rate	$211.93
Max. Negotiated Rate	$302.76
Rate for Payer: Aetna Commercial	$285.94
Rate for Payer: Aetna New Business (MI Preferred)	$218.66
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cofinity Advantage	$235.48
Rate for Payer: Cofinity Commercial	$289.30
Rate for Payer: Encore Health Key Benefits Commercial	$269.12
Rate for Payer: Healthscope Commercial	$302.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$252.30
Rate for Payer: PHP Commercial	$285.94
Rate for Payer: Priority Health SBD	$211.93

GENTAMICIN 40 MG/ML FOR INHALATION

Facility

$336.40

Service Code	HCPCS J1580
Hospital Charge Code	180596
Hospital Revenue Code	636
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$302.76
Rate for Payer: Aetna Commercial	$285.94
Rate for Payer: Aetna Medicare	$168.20
Rate for Payer: Aetna New Business (MI Preferred)	$218.66
Rate for Payer: BCBS Complete	$134.56
Rate for Payer: BCBS Trust/PPO	$5.42
Rate for Payer: BCN Commercial	$5.42
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cofinity Advantage	$235.48
Rate for Payer: Cofinity Commercial	$289.30
Rate for Payer: Encore Health Key Benefits Commercial	$269.12
Rate for Payer: Healthscope Commercial	$302.76
Rate for Payer: MI Amish Medical Board Commercial	$269.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$252.30
Rate for Payer: PHP Commercial	$285.94
Rate for Payer: Priority Health SBD	$211.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3.58
Rate for Payer: UHC Core	$3.58
Rate for Payer: UHC Exchange	$3.58

GENTAMICIN 40 MG/ML INJECTION SOLUTION

Facility

$336.40

Service Code	HCPCS J1580
Hospital Charge Code	3426
Hospital Revenue Code	636
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$302.76
Rate for Payer: Aetna Commercial	$285.94
Rate for Payer: Aetna Medicare	$168.20
Rate for Payer: Aetna New Business (MI Preferred)	$218.66
Rate for Payer: BCBS Complete	$134.56
Rate for Payer: BCBS Trust/PPO	$5.42
Rate for Payer: BCN Commercial	$5.42
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cofinity Advantage	$235.48
Rate for Payer: Cofinity Commercial	$289.30
Rate for Payer: Encore Health Key Benefits Commercial	$269.12
Rate for Payer: Healthscope Commercial	$302.76
Rate for Payer: MI Amish Medical Board Commercial	$269.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$252.30
Rate for Payer: PHP Commercial	$285.94
Rate for Payer: Priority Health SBD	$211.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3.58
Rate for Payer: UHC Core	$3.58
Rate for Payer: UHC Exchange	$3.58

GENTAMICIN 40 MG/ML INJECTION SOLUTION

Facility

$336.40

Service Code	HCPCS J1580
Hospital Charge Code	3426
Hospital Revenue Code	636
Min. Negotiated Rate	$211.93
Max. Negotiated Rate	$302.76
Rate for Payer: Aetna Commercial	$285.94
Rate for Payer: Aetna New Business (MI Preferred)	$218.66
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cofinity Advantage	$235.48
Rate for Payer: Cofinity Commercial	$289.30
Rate for Payer: Encore Health Key Benefits Commercial	$269.12
Rate for Payer: Healthscope Commercial	$302.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$252.30
Rate for Payer: PHP Commercial	$285.94
Rate for Payer: Priority Health SBD	$211.93

GENTAMICIN 80 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK

Facility

$66.43

Service Code	NDC 00338050941
Hospital Charge Code	15911
Hospital Revenue Code	250
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$59.79
Rate for Payer: Aetna Commercial	$56.47
Rate for Payer: Aetna Medicare	$33.22
Rate for Payer: Aetna New Business (MI Preferred)	$43.18
Rate for Payer: BCBS Complete	$26.57
Rate for Payer: Cash Price	$53.14
Rate for Payer: Cofinity Advantage	$46.50
Rate for Payer: Cofinity Commercial	$57.13
Rate for Payer: Encore Health Key Benefits Commercial	$53.14
Rate for Payer: Healthscope Commercial	$59.79
Rate for Payer: MI Amish Medical Board Commercial	$53.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.82
Rate for Payer: PHP Commercial	$56.47
Rate for Payer: Priority Health SBD	$41.85
Rate for Payer: UHC All Payor (Choice/PPO)	$43.18
Rate for Payer: UHC Core	$34.61
Rate for Payer: UHC Exchange	$26.11

GENTAMICIN 80 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK

Facility

$66.43

Service Code	NDC 00338050941
Hospital Charge Code	15911
Hospital Revenue Code	250
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$59.79
Rate for Payer: Aetna Commercial	$56.47
Rate for Payer: Aetna New Business (MI Preferred)	$43.18
Rate for Payer: Cash Price	$53.14
Rate for Payer: Cofinity Advantage	$46.50
Rate for Payer: Cofinity Commercial	$57.13
Rate for Payer: Encore Health Key Benefits Commercial	$53.14
Rate for Payer: Healthscope Commercial	$59.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.82
Rate for Payer: PHP Commercial	$56.47
Rate for Payer: Priority Health SBD	$41.85

GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION

Facility

$27.93

Service Code	HCPCS J1580
Hospital Charge Code	117665
Hospital Revenue Code	636
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.14
Rate for Payer: Aetna Commercial	$23.74
Rate for Payer: Aetna New Business (MI Preferred)	$18.15
Rate for Payer: Cash Price	$22.34
Rate for Payer: Cofinity Advantage	$19.55
Rate for Payer: Cofinity Commercial	$24.02
Rate for Payer: Encore Health Key Benefits Commercial	$22.34
Rate for Payer: Healthscope Commercial	$25.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.95
Rate for Payer: PHP Commercial	$23.74
Rate for Payer: Priority Health SBD	$17.60

GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION

Facility

$27.93

Service Code	HCPCS J1580
Hospital Charge Code	117665
Hospital Revenue Code	636
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$25.14
Rate for Payer: Aetna Commercial	$23.74
Rate for Payer: Aetna Medicare	$13.96
Rate for Payer: Aetna New Business (MI Preferred)	$18.15
Rate for Payer: BCBS Complete	$11.17
Rate for Payer: BCBS Trust/PPO	$5.42
Rate for Payer: BCN Commercial	$5.42
Rate for Payer: Cash Price	$22.34
Rate for Payer: Cash Price	$22.34
Rate for Payer: Cofinity Advantage	$19.55
Rate for Payer: Cofinity Commercial	$24.02
Rate for Payer: Encore Health Key Benefits Commercial	$22.34
Rate for Payer: Healthscope Commercial	$25.14
Rate for Payer: MI Amish Medical Board Commercial	$22.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.95
Rate for Payer: PHP Commercial	$23.74
Rate for Payer: Priority Health SBD	$17.60
Rate for Payer: UHC All Payor (Choice/PPO)	$3.58
Rate for Payer: UHC Core	$3.58
Rate for Payer: UHC Exchange	$3.58

GLASSIA (ALPHA-1-PROTEINASE INHIBITOR) 1 GRAM/50 ML(2 %) IV SOLN

Facility

$1.57

Service Code	HCPCS J0257
Hospital Charge Code	106274
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$17.79
Rate for Payer: Aetna Commercial	$1.33
Rate for Payer: Aetna Medicare	$5.89
Rate for Payer: Aetna New Business (MI Preferred)	$1.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$7.08
Rate for Payer: Amish Plain Church Group Commercial	$7.08
Rate for Payer: BCBS Complete	$3.11
Rate for Payer: BCBS MAPPO	$5.66
Rate for Payer: BCBS Trust/PPO	$14.28
Rate for Payer: BCN Commercial	$14.28
Rate for Payer: BCN Medicare Advantage	$5.66
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cofinity Advantage	$1.10
Rate for Payer: Cofinity Commercial	$1.35
Rate for Payer: Encore Health Key Benefits Commercial	$1.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.66
Rate for Payer: Healthscope Commercial	$1.41
Rate for Payer: Mclaren Medicaid	$2.96
Rate for Payer: Mclaren Medicare	$5.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.94
Rate for Payer: Meridian Medicaid	$5.94
Rate for Payer: MI Amish Medical Board Commercial	$6.51
Rate for Payer: Molina Medicare/Medicaid	$6.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.33
Rate for Payer: Nomi Health Commercial	$16.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.18
Rate for Payer: PACE Medicare	$5.38
Rate for Payer: PACE SWMI	$5.66
Rate for Payer: PHP Commercial	$1.33
Rate for Payer: PHP Medicare Advantage	$5.66
Rate for Payer: Priority Health Choice Medicaid	$2.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$17.79
Rate for Payer: Priority Health Medicare	$5.66
Rate for Payer: Priority Health SBD	$0.99
Rate for Payer: Priority Health Tiered Network	$14.23
Rate for Payer: Railroad Medicare Medicare	$5.66
Rate for Payer: UHC All Payor (Choice/PPO)	$9.39
Rate for Payer: UHC Core	$9.39
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5.66
Rate for Payer: UHC Exchange	$9.39
Rate for Payer: UHC Medicaid	$2.96
Rate for Payer: UHCCP Medicaid	$2.96
Rate for Payer: VA VA	$5.66

GLASSIA (ALPHA-1-PROTEINASE INHIBITOR) 1 GRAM/50 ML(2 %) IV SOLN

Facility

$1.57

Service Code	HCPCS J0257
Hospital Charge Code	106274
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.41
Rate for Payer: Aetna Commercial	$1.33
Rate for Payer: Aetna New Business (MI Preferred)	$1.02
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cofinity Advantage	$1.10
Rate for Payer: Cofinity Commercial	$1.35
Rate for Payer: Encore Health Key Benefits Commercial	$1.26
Rate for Payer: Healthscope Commercial	$1.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.18
Rate for Payer: PHP Commercial	$1.33
Rate for Payer: Priority Health SBD	$0.99

GLIMEPIRIDE 1 MG TABLET

Facility

$204.73

Service Code	NDC 50268035815
Hospital Charge Code	16355
Hospital Revenue Code	637
Min. Negotiated Rate	$128.98
Max. Negotiated Rate	$184.26
Rate for Payer: Aetna Commercial	$174.02
Rate for Payer: Aetna New Business (MI Preferred)	$133.07
Rate for Payer: Cash Price	$163.78
Rate for Payer: Cofinity Advantage	$143.31
Rate for Payer: Cofinity Commercial	$176.07
Rate for Payer: Encore Health Key Benefits Commercial	$163.78
Rate for Payer: Healthscope Commercial	$184.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.55
Rate for Payer: PHP Commercial	$174.02
Rate for Payer: Priority Health SBD	$128.98

Know your out-of-pocket cost for care.

All Charges