Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GABAPENTIN 600 MG TABLET

Facility

$342.95

Service Code	NDC 42292002420
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$216.06
Max. Negotiated Rate	$308.66
Rate for Payer: Aetna Commercial	$291.51
Rate for Payer: Aetna New Business (MI Preferred)	$222.92
Rate for Payer: Cash Price	$274.36
Rate for Payer: Cofinity Commercial	$240.06
Rate for Payer: Cofinity Commercial	$294.94
Rate for Payer: Cofinity Medicare Advantage	$240.06
Rate for Payer: Encore Health Key Benefits Commercial	$274.36
Rate for Payer: Healthscope Commercial	$308.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$291.51
Rate for Payer: PHP Commercial	$291.51
Rate for Payer: Priority Health Cigna Priority Health	$222.92
Rate for Payer: Priority Health SBD	$216.06

GABAPENTIN 600 MG TABLET

Facility

$2,209.00

Service Code	NDC 68462012605
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$1,391.67
Max. Negotiated Rate	$1,988.10
Rate for Payer: Aetna Commercial	$1,877.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,435.85
Rate for Payer: Cash Price	$1,767.20
Rate for Payer: Cofinity Commercial	$1,546.30
Rate for Payer: Cofinity Commercial	$1,899.74
Rate for Payer: Cofinity Medicare Advantage	$1,546.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,767.20
Rate for Payer: Healthscope Commercial	$1,988.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,877.65
Rate for Payer: PHP Commercial	$1,877.65
Rate for Payer: Priority Health Cigna Priority Health	$1,435.85
Rate for Payer: Priority Health SBD	$1,391.67

GABAPENTIN 600 MG TABLET

Facility

$159.84

Service Code	NDC 50268035115
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$100.70
Max. Negotiated Rate	$143.86
Rate for Payer: Aetna Commercial	$135.86
Rate for Payer: Aetna New Business (MI Preferred)	$103.90
Rate for Payer: Cash Price	$127.87
Rate for Payer: Cofinity Commercial	$111.89
Rate for Payer: Cofinity Commercial	$137.46
Rate for Payer: Cofinity Medicare Advantage	$111.89
Rate for Payer: Encore Health Key Benefits Commercial	$127.87
Rate for Payer: Healthscope Commercial	$143.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.86
Rate for Payer: PHP Commercial	$135.86
Rate for Payer: Priority Health Cigna Priority Health	$103.90
Rate for Payer: Priority Health SBD	$100.70

GABAPENTIN 600 MG TABLET

Facility

$3.20

Service Code	NDC 50268035111
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna Medicare	$1.60
Rate for Payer: Aetna New Business (MI Preferred)	$2.08
Rate for Payer: BCBS Complete	$1.28
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cofinity Commercial	$2.24
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Cofinity Medicare Advantage	$2.24
Rate for Payer: Encore Health Key Benefits Commercial	$2.56
Rate for Payer: Healthscope Commercial	$2.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.72
Rate for Payer: PHP Commercial	$2.72
Rate for Payer: Priority Health Cigna Priority Health	$2.08
Rate for Payer: Priority Health SBD	$2.02

GABAPENTIN 600 MG TABLET

Facility

$441.80

Service Code	NDC 68462012601
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$176.72
Max. Negotiated Rate	$397.62
Rate for Payer: Aetna Commercial	$375.53
Rate for Payer: Aetna Medicare	$220.90
Rate for Payer: Aetna New Business (MI Preferred)	$287.17
Rate for Payer: BCBS Complete	$176.72
Rate for Payer: Cash Price	$353.44
Rate for Payer: Cofinity Commercial	$309.26
Rate for Payer: Cofinity Commercial	$379.95
Rate for Payer: Cofinity Medicare Advantage	$309.26
Rate for Payer: Encore Health Key Benefits Commercial	$353.44
Rate for Payer: Healthscope Commercial	$397.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.53
Rate for Payer: PHP Commercial	$375.53
Rate for Payer: Priority Health Cigna Priority Health	$287.17
Rate for Payer: Priority Health SBD	$278.33

GABAPENTIN 600 MG TABLET

Facility

$159.84

Service Code	NDC 50268035115
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$63.94
Max. Negotiated Rate	$143.86
Rate for Payer: Aetna Commercial	$135.86
Rate for Payer: Aetna Medicare	$79.92
Rate for Payer: Aetna New Business (MI Preferred)	$103.90
Rate for Payer: BCBS Complete	$63.94
Rate for Payer: Cash Price	$127.87
Rate for Payer: Cofinity Commercial	$111.89
Rate for Payer: Cofinity Commercial	$137.46
Rate for Payer: Cofinity Medicare Advantage	$111.89
Rate for Payer: Encore Health Key Benefits Commercial	$127.87
Rate for Payer: Healthscope Commercial	$143.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.86
Rate for Payer: PHP Commercial	$135.86
Rate for Payer: Priority Health Cigna Priority Health	$103.90
Rate for Payer: Priority Health SBD	$100.70

GABAPENTIN 600 MG TABLET

Facility

$3.43

Service Code	NDC 42292002401
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$3.09
Rate for Payer: Aetna Commercial	$2.92
Rate for Payer: Aetna New Business (MI Preferred)	$2.23
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cofinity Commercial	$2.40
Rate for Payer: Cofinity Commercial	$2.95
Rate for Payer: Cofinity Medicare Advantage	$2.40
Rate for Payer: Encore Health Key Benefits Commercial	$2.74
Rate for Payer: Healthscope Commercial	$3.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.92
Rate for Payer: PHP Commercial	$2.92
Rate for Payer: Priority Health Cigna Priority Health	$2.23
Rate for Payer: Priority Health SBD	$2.16

GABAPENTIN 600 MG TABLET

Facility

$3.43

Service Code	NDC 42292002401
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$3.09
Rate for Payer: Aetna Commercial	$2.92
Rate for Payer: Aetna Medicare	$1.72
Rate for Payer: Aetna New Business (MI Preferred)	$2.23
Rate for Payer: BCBS Complete	$1.37
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cofinity Commercial	$2.40
Rate for Payer: Cofinity Commercial	$2.95
Rate for Payer: Cofinity Medicare Advantage	$2.40
Rate for Payer: Encore Health Key Benefits Commercial	$2.74
Rate for Payer: Healthscope Commercial	$3.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.92
Rate for Payer: PHP Commercial	$2.92
Rate for Payer: Priority Health Cigna Priority Health	$2.23
Rate for Payer: Priority Health SBD	$2.16

GABAPENTIN 600 MG TABLET

Facility

$228.00

Service Code	NDC 00904682361
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$91.20
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare	$114.00
Rate for Payer: Aetna New Business (MI Preferred)	$148.20
Rate for Payer: BCBS Complete	$91.20
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cofinity Commercial	$159.60
Rate for Payer: Cofinity Commercial	$196.08
Rate for Payer: Cofinity Medicare Advantage	$159.60
Rate for Payer: Encore Health Key Benefits Commercial	$182.40
Rate for Payer: Healthscope Commercial	$205.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.80
Rate for Payer: PHP Commercial	$193.80
Rate for Payer: Priority Health Cigna Priority Health	$148.20
Rate for Payer: Priority Health SBD	$143.64

GABAPENTIN 600 MG TABLET

Facility

$342.95

Service Code	NDC 42292002420
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$137.18
Max. Negotiated Rate	$308.66
Rate for Payer: Aetna Commercial	$291.51
Rate for Payer: Aetna Medicare	$171.48
Rate for Payer: Aetna New Business (MI Preferred)	$222.92
Rate for Payer: BCBS Complete	$137.18
Rate for Payer: Cash Price	$274.36
Rate for Payer: Cofinity Commercial	$240.06
Rate for Payer: Cofinity Commercial	$294.94
Rate for Payer: Cofinity Medicare Advantage	$240.06
Rate for Payer: Encore Health Key Benefits Commercial	$274.36
Rate for Payer: Healthscope Commercial	$308.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$291.51
Rate for Payer: PHP Commercial	$291.51
Rate for Payer: Priority Health Cigna Priority Health	$222.92
Rate for Payer: Priority Health SBD	$216.06

GABAPENTIN 600 MG TABLET

Facility

$2,209.00

Service Code	NDC 68462012605
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$883.60
Max. Negotiated Rate	$1,988.10
Rate for Payer: Aetna Commercial	$1,877.65
Rate for Payer: Aetna Medicare	$1,104.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,435.85
Rate for Payer: BCBS Complete	$883.60
Rate for Payer: Cash Price	$1,767.20
Rate for Payer: Cofinity Commercial	$1,546.30
Rate for Payer: Cofinity Commercial	$1,899.74
Rate for Payer: Cofinity Medicare Advantage	$1,546.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,767.20
Rate for Payer: Healthscope Commercial	$1,988.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,877.65
Rate for Payer: PHP Commercial	$1,877.65
Rate for Payer: Priority Health Cigna Priority Health	$1,435.85
Rate for Payer: Priority Health SBD	$1,391.67

GABAPENTIN 600 MG TABLET

Facility

$441.80

Service Code	NDC 68462012601
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$278.33
Max. Negotiated Rate	$397.62
Rate for Payer: Aetna Commercial	$375.53
Rate for Payer: Aetna New Business (MI Preferred)	$287.17
Rate for Payer: Cash Price	$353.44
Rate for Payer: Cofinity Commercial	$309.26
Rate for Payer: Cofinity Commercial	$379.95
Rate for Payer: Cofinity Medicare Advantage	$309.26
Rate for Payer: Encore Health Key Benefits Commercial	$353.44
Rate for Payer: Healthscope Commercial	$397.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.53
Rate for Payer: PHP Commercial	$375.53
Rate for Payer: Priority Health Cigna Priority Health	$287.17
Rate for Payer: Priority Health SBD	$278.33

GABAPENTIN 600 MG TABLET

Facility

$3.20

Service Code	NDC 50268035111
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna New Business (MI Preferred)	$2.08
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cofinity Commercial	$2.24
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Cofinity Medicare Advantage	$2.24
Rate for Payer: Encore Health Key Benefits Commercial	$2.56
Rate for Payer: Healthscope Commercial	$2.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.72
Rate for Payer: PHP Commercial	$2.72
Rate for Payer: Priority Health Cigna Priority Health	$2.08
Rate for Payer: Priority Health SBD	$2.02

GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION

Facility

$20.00

Service Code	HCPCS A9585
Hospital Charge Code	152500
Hospital Revenue Code	636
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna New Business (MI Preferred)	$13.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Cofinity Medicare Advantage	$14.00
Rate for Payer: Encore Health Key Benefits Commercial	$16.00
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00
Rate for Payer: Priority Health SBD	$12.60

GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION

Facility

$20.00

Service Code	HCPCS A9585
Hospital Charge Code	152500
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna Medicare	$10.00
Rate for Payer: Aetna New Business (MI Preferred)	$13.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$0.37
Rate for Payer: BCN Commercial	$0.37
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Cofinity Commercial	$17.20
Rate for Payer: Cofinity Medicare Advantage	$14.00
Rate for Payer: Encore Health Key Benefits Commercial	$16.00
Rate for Payer: Healthscope Commercial	$18.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.00
Rate for Payer: PHP Commercial	$17.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00
Rate for Payer: Priority Health SBD	$12.60

GADOBUTROL 7.5 MMOL/7.5 ML (1 MMOL/ML) INTRAVENOUS SOLUTION

Facility

$15.00

Service Code	HCPCS A9585
Hospital Charge Code	152499
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$12.75
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: Aetna New Business (MI Preferred)	$9.75
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCBS Trust/PPO	$0.37
Rate for Payer: BCN Commercial	$0.37
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cofinity Commercial	$10.50
Rate for Payer: Cofinity Commercial	$12.90
Rate for Payer: Cofinity Medicare Advantage	$10.50
Rate for Payer: Encore Health Key Benefits Commercial	$12.00
Rate for Payer: Healthscope Commercial	$13.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.75
Rate for Payer: PHP Commercial	$12.75
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: Priority Health SBD	$9.45

GADOBUTROL 7.5 MMOL/7.5 ML (1 MMOL/ML) INTRAVENOUS SOLUTION

Facility

$15.00

Service Code	HCPCS A9585
Hospital Charge Code	152499
Hospital Revenue Code	636
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$12.75
Rate for Payer: Aetna New Business (MI Preferred)	$9.75
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cofinity Commercial	$10.50
Rate for Payer: Cofinity Commercial	$12.90
Rate for Payer: Cofinity Medicare Advantage	$10.50
Rate for Payer: Encore Health Key Benefits Commercial	$12.00
Rate for Payer: Healthscope Commercial	$13.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.75
Rate for Payer: PHP Commercial	$12.75
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: Priority Health SBD	$9.45

GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML(469.01 MG/ML) INTRAVENOUS SOLN

Facility

$77.62

Service Code	HCPCS A9579
Hospital Charge Code	118272
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$69.86
Rate for Payer: Aetna Commercial	$65.98
Rate for Payer: Aetna Medicare	$38.81
Rate for Payer: Aetna New Business (MI Preferred)	$50.45
Rate for Payer: BCBS Complete	$31.05
Rate for Payer: BCBS Trust/PPO	$1.81
Rate for Payer: BCN Commercial	$1.81
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cofinity Commercial	$54.33
Rate for Payer: Cofinity Commercial	$66.75
Rate for Payer: Cofinity Medicare Advantage	$54.33
Rate for Payer: Encore Health Key Benefits Commercial	$62.10
Rate for Payer: Healthscope Commercial	$69.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.98
Rate for Payer: PHP Commercial	$65.98
Rate for Payer: Priority Health Cigna Priority Health	$50.45
Rate for Payer: Priority Health SBD	$48.90

GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML(469.01 MG/ML) INTRAVENOUS SOLN

Facility

$77.62

Service Code	HCPCS A9579
Hospital Charge Code	118272
Hospital Revenue Code	636
Min. Negotiated Rate	$48.90
Max. Negotiated Rate	$69.86
Rate for Payer: Aetna Commercial	$65.98
Rate for Payer: Aetna New Business (MI Preferred)	$50.45
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cofinity Commercial	$54.33
Rate for Payer: Cofinity Commercial	$66.75
Rate for Payer: Cofinity Medicare Advantage	$54.33
Rate for Payer: Encore Health Key Benefits Commercial	$62.10
Rate for Payer: Healthscope Commercial	$69.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.98
Rate for Payer: PHP Commercial	$65.98
Rate for Payer: Priority Health Cigna Priority Health	$50.45
Rate for Payer: Priority Health SBD	$48.90

GADOPENTETATE DIMEGLUMINE 2.5 MMOL/5 ML(469.01 MG/ML) INTRAVENOUS SOLN

Facility

$21.62

Service Code	HCPCS A9579
Hospital Charge Code	118269
Hospital Revenue Code	636
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$19.46
Rate for Payer: Aetna Commercial	$18.38
Rate for Payer: Aetna New Business (MI Preferred)	$14.05
Rate for Payer: Cash Price	$17.30
Rate for Payer: Cofinity Commercial	$15.13
Rate for Payer: Cofinity Commercial	$18.59
Rate for Payer: Cofinity Medicare Advantage	$15.13
Rate for Payer: Encore Health Key Benefits Commercial	$17.30
Rate for Payer: Healthscope Commercial	$19.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.38
Rate for Payer: PHP Commercial	$18.38
Rate for Payer: Priority Health Cigna Priority Health	$14.05
Rate for Payer: Priority Health SBD	$13.62

GADOPENTETATE DIMEGLUMINE 2.5 MMOL/5 ML(469.01 MG/ML) INTRAVENOUS SOLN

Facility

$21.62

Service Code	HCPCS A9579
Hospital Charge Code	118269
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$19.46
Rate for Payer: Aetna Commercial	$18.38
Rate for Payer: Aetna Medicare	$10.81
Rate for Payer: Aetna New Business (MI Preferred)	$14.05
Rate for Payer: BCBS Complete	$8.65
Rate for Payer: BCBS Trust/PPO	$1.81
Rate for Payer: BCN Commercial	$1.81
Rate for Payer: Cash Price	$17.30
Rate for Payer: Cash Price	$17.30
Rate for Payer: Cofinity Commercial	$15.13
Rate for Payer: Cofinity Commercial	$18.59
Rate for Payer: Cofinity Medicare Advantage	$15.13
Rate for Payer: Encore Health Key Benefits Commercial	$17.30
Rate for Payer: Healthscope Commercial	$19.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.38
Rate for Payer: PHP Commercial	$18.38
Rate for Payer: Priority Health Cigna Priority Health	$14.05
Rate for Payer: Priority Health SBD	$13.62

GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION

Facility

$631.68

Service Code	HCPCS A9581
Hospital Charge Code	93574
Hospital Revenue Code	636
Min. Negotiated Rate	$397.96
Max. Negotiated Rate	$568.51
Rate for Payer: Aetna Commercial	$536.93
Rate for Payer: Aetna New Business (MI Preferred)	$410.59
Rate for Payer: Cash Price	$505.34
Rate for Payer: Cofinity Commercial	$442.18
Rate for Payer: Cofinity Commercial	$543.24
Rate for Payer: Cofinity Medicare Advantage	$442.18
Rate for Payer: Encore Health Key Benefits Commercial	$505.34
Rate for Payer: Healthscope Commercial	$568.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$536.93
Rate for Payer: PHP Commercial	$536.93
Rate for Payer: Priority Health Cigna Priority Health	$410.59
Rate for Payer: Priority Health SBD	$397.96

GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION

Facility

$631.68

Service Code	HCPCS A9581
Hospital Charge Code	93574
Hospital Revenue Code	636
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$568.51
Rate for Payer: Aetna Commercial	$536.93
Rate for Payer: Aetna Medicare	$315.84
Rate for Payer: Aetna New Business (MI Preferred)	$410.59
Rate for Payer: BCBS Complete	$252.67
Rate for Payer: BCBS Trust/PPO	$17.70
Rate for Payer: BCN Commercial	$17.70
Rate for Payer: Cash Price	$505.34
Rate for Payer: Cash Price	$505.34
Rate for Payer: Cofinity Commercial	$442.18
Rate for Payer: Cofinity Commercial	$543.24
Rate for Payer: Cofinity Medicare Advantage	$442.18
Rate for Payer: Encore Health Key Benefits Commercial	$505.34
Rate for Payer: Healthscope Commercial	$568.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$536.93
Rate for Payer: PHP Commercial	$536.93
Rate for Payer: Priority Health Cigna Priority Health	$410.59
Rate for Payer: Priority Health SBD	$397.96

GALANTAMINE 4 MG TABLET

Facility

$238.83

Service Code	NDC 70436000406
Hospital Charge Code	29806
Hospital Revenue Code	637
Min. Negotiated Rate	$95.53
Max. Negotiated Rate	$214.95
Rate for Payer: Aetna Commercial	$203.01
Rate for Payer: Aetna Medicare	$119.42
Rate for Payer: Aetna New Business (MI Preferred)	$155.24
Rate for Payer: BCBS Complete	$95.53
Rate for Payer: Cash Price	$191.06
Rate for Payer: Cofinity Commercial	$167.18
Rate for Payer: Cofinity Commercial	$205.39
Rate for Payer: Cofinity Medicare Advantage	$167.18
Rate for Payer: Encore Health Key Benefits Commercial	$191.06
Rate for Payer: Healthscope Commercial	$214.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$203.01
Rate for Payer: PHP Commercial	$203.01
Rate for Payer: Priority Health Cigna Priority Health	$155.24
Rate for Payer: Priority Health SBD	$150.46

GALANTAMINE 4 MG TABLET

Facility

$361.31

Service Code	NDC 68084072921
Hospital Charge Code	29806
Hospital Revenue Code	637
Min. Negotiated Rate	$227.63
Max. Negotiated Rate	$325.18
Rate for Payer: Aetna Commercial	$307.11
Rate for Payer: Aetna New Business (MI Preferred)	$234.85
Rate for Payer: Cash Price	$289.05
Rate for Payer: Cofinity Commercial	$252.92
Rate for Payer: Cofinity Commercial	$310.73
Rate for Payer: Cofinity Medicare Advantage	$252.92
Rate for Payer: Encore Health Key Benefits Commercial	$289.05
Rate for Payer: Healthscope Commercial	$325.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.11
Rate for Payer: PHP Commercial	$307.11
Rate for Payer: Priority Health Cigna Priority Health	$234.85
Rate for Payer: Priority Health SBD	$227.63

Know your out-of-pocket cost for care.

All Charges