Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GANCICLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION

Facility

$148.68

Service Code	NDC 25021018510
Hospital Charge Code	186410
Hospital Revenue Code	250
Min. Negotiated Rate	$93.67
Max. Negotiated Rate	$133.81
Rate for Payer: Aetna Commercial	$126.38
Rate for Payer: Aetna New Business (MI Preferred)	$96.64
Rate for Payer: Cash Price	$118.94
Rate for Payer: Cofinity Commercial	$104.08
Rate for Payer: Cofinity Commercial	$127.86
Rate for Payer: Cofinity Medicare Advantage	$104.08
Rate for Payer: Encore Health Key Benefits Commercial	$118.94
Rate for Payer: Healthscope Commercial	$133.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.38
Rate for Payer: PHP Commercial	$126.38
Rate for Payer: Priority Health Cigna Priority Health	$96.64
Rate for Payer: Priority Health SBD	$93.67

GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)

Facility

$8,907.47

Service Code	CPT 27687
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE

Facility

$659.90

Service Code	NDC 63713001974
Hospital Charge Code	28025
Hospital Revenue Code	250
Min. Negotiated Rate	$415.74
Max. Negotiated Rate	$593.91
Rate for Payer: Aetna Commercial	$560.91
Rate for Payer: Aetna New Business (MI Preferred)	$428.94
Rate for Payer: Cash Price	$527.92
Rate for Payer: Cofinity Commercial	$461.93
Rate for Payer: Cofinity Commercial	$567.51
Rate for Payer: Cofinity Medicare Advantage	$461.93
Rate for Payer: Encore Health Key Benefits Commercial	$527.92
Rate for Payer: Healthscope Commercial	$593.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$560.91
Rate for Payer: PHP Commercial	$560.91
Rate for Payer: Priority Health Cigna Priority Health	$428.94
Rate for Payer: Priority Health SBD	$415.74

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE

Facility

$898.28

Service Code	NDC 00009034201
Hospital Charge Code	28025
Hospital Revenue Code	250
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$808.45
Rate for Payer: Aetna Commercial	$763.54
Rate for Payer: Aetna New Business (MI Preferred)	$583.88
Rate for Payer: Cash Price	$718.62
Rate for Payer: Cofinity Commercial	$628.80
Rate for Payer: Cofinity Commercial	$772.52
Rate for Payer: Cofinity Medicare Advantage	$628.80
Rate for Payer: Encore Health Key Benefits Commercial	$718.62
Rate for Payer: Healthscope Commercial	$808.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$763.54
Rate for Payer: PHP Commercial	$763.54
Rate for Payer: Priority Health Cigna Priority Health	$583.88
Rate for Payer: Priority Health SBD	$565.92

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE

Facility

$659.90

Service Code	NDC 63713001974
Hospital Charge Code	28025
Hospital Revenue Code	250
Min. Negotiated Rate	$263.96
Max. Negotiated Rate	$593.91
Rate for Payer: Aetna Commercial	$560.91
Rate for Payer: Aetna Medicare	$329.95
Rate for Payer: Aetna New Business (MI Preferred)	$428.94
Rate for Payer: BCBS Complete	$263.96
Rate for Payer: Cash Price	$527.92
Rate for Payer: Cofinity Commercial	$461.93
Rate for Payer: Cofinity Commercial	$567.51
Rate for Payer: Cofinity Medicare Advantage	$461.93
Rate for Payer: Encore Health Key Benefits Commercial	$527.92
Rate for Payer: Healthscope Commercial	$593.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$560.91
Rate for Payer: PHP Commercial	$560.91
Rate for Payer: Priority Health Cigna Priority Health	$428.94
Rate for Payer: Priority Health SBD	$415.74

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 100 TOPICAL SPONGE

Facility

$898.28

Service Code	NDC 00009034201
Hospital Charge Code	28025
Hospital Revenue Code	250
Min. Negotiated Rate	$359.31
Max. Negotiated Rate	$808.45
Rate for Payer: Aetna Commercial	$763.54
Rate for Payer: Aetna Medicare	$449.14
Rate for Payer: Aetna New Business (MI Preferred)	$583.88
Rate for Payer: BCBS Complete	$359.31
Rate for Payer: Cash Price	$718.62
Rate for Payer: Cofinity Commercial	$628.80
Rate for Payer: Cofinity Commercial	$772.52
Rate for Payer: Cofinity Medicare Advantage	$628.80
Rate for Payer: Encore Health Key Benefits Commercial	$718.62
Rate for Payer: Healthscope Commercial	$808.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$763.54
Rate for Payer: PHP Commercial	$763.54
Rate for Payer: Priority Health Cigna Priority Health	$583.88
Rate for Payer: Priority Health SBD	$565.92

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE

Facility

$270.31

Service Code	NDC 63713001972
Hospital Charge Code	28018
Hospital Revenue Code	250
Min. Negotiated Rate	$170.30
Max. Negotiated Rate	$243.28
Rate for Payer: Aetna Commercial	$229.76
Rate for Payer: Aetna New Business (MI Preferred)	$175.70
Rate for Payer: Cash Price	$216.25
Rate for Payer: Cofinity Commercial	$189.22
Rate for Payer: Cofinity Commercial	$232.47
Rate for Payer: Cofinity Medicare Advantage	$189.22
Rate for Payer: Encore Health Key Benefits Commercial	$216.25
Rate for Payer: Healthscope Commercial	$243.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$229.76
Rate for Payer: PHP Commercial	$229.76
Rate for Payer: Priority Health Cigna Priority Health	$175.70
Rate for Payer: Priority Health SBD	$170.30

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE

Facility

$270.31

Service Code	NDC 63713001972
Hospital Charge Code	28018
Hospital Revenue Code	250
Min. Negotiated Rate	$108.12
Max. Negotiated Rate	$243.28
Rate for Payer: Aetna Commercial	$229.76
Rate for Payer: Aetna Medicare	$135.16
Rate for Payer: Aetna New Business (MI Preferred)	$175.70
Rate for Payer: BCBS Complete	$108.12
Rate for Payer: Cash Price	$216.25
Rate for Payer: Cofinity Commercial	$189.22
Rate for Payer: Cofinity Commercial	$232.47
Rate for Payer: Cofinity Medicare Advantage	$189.22
Rate for Payer: Encore Health Key Benefits Commercial	$216.25
Rate for Payer: Healthscope Commercial	$243.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$229.76
Rate for Payer: PHP Commercial	$229.76
Rate for Payer: Priority Health Cigna Priority Health	$175.70
Rate for Payer: Priority Health SBD	$170.30

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE

Facility

$370.88

Service Code	NDC 00009031508
Hospital Charge Code	28018
Hospital Revenue Code	250
Min. Negotiated Rate	$148.35
Max. Negotiated Rate	$333.79
Rate for Payer: Aetna Commercial	$315.25
Rate for Payer: Aetna Medicare	$185.44
Rate for Payer: Aetna New Business (MI Preferred)	$241.07
Rate for Payer: BCBS Complete	$148.35
Rate for Payer: Cash Price	$296.70
Rate for Payer: Cofinity Commercial	$259.62
Rate for Payer: Cofinity Commercial	$318.96
Rate for Payer: Cofinity Medicare Advantage	$259.62
Rate for Payer: Encore Health Key Benefits Commercial	$296.70
Rate for Payer: Healthscope Commercial	$333.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.25
Rate for Payer: PHP Commercial	$315.25
Rate for Payer: Priority Health Cigna Priority Health	$241.07
Rate for Payer: Priority Health SBD	$233.65

GELATIN SPONGE,ABSORBABLE-PORCINE SKIN 12 MM-7 MM TOPICAL SPONGE

Facility

$370.88

Service Code	NDC 00009031508
Hospital Charge Code	28018
Hospital Revenue Code	250
Min. Negotiated Rate	$233.65
Max. Negotiated Rate	$333.79
Rate for Payer: Aetna Commercial	$315.25
Rate for Payer: Aetna New Business (MI Preferred)	$241.07
Rate for Payer: Cash Price	$296.70
Rate for Payer: Cofinity Commercial	$259.62
Rate for Payer: Cofinity Commercial	$318.96
Rate for Payer: Cofinity Medicare Advantage	$259.62
Rate for Payer: Encore Health Key Benefits Commercial	$296.70
Rate for Payer: Healthscope Commercial	$333.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.25
Rate for Payer: PHP Commercial	$315.25
Rate for Payer: Priority Health Cigna Priority Health	$241.07
Rate for Payer: Priority Health SBD	$233.65

GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION

Facility

$236.15

Service Code	HCPCS J9201
Hospital Charge Code	155791
Hospital Revenue Code	636
Min. Negotiated Rate	$148.77
Max. Negotiated Rate	$212.53
Rate for Payer: Aetna Commercial	$200.73
Rate for Payer: Aetna New Business (MI Preferred)	$153.50
Rate for Payer: Cash Price	$188.92
Rate for Payer: Cofinity Commercial	$165.31
Rate for Payer: Cofinity Commercial	$203.09
Rate for Payer: Cofinity Medicare Advantage	$165.31
Rate for Payer: Encore Health Key Benefits Commercial	$188.92
Rate for Payer: Healthscope Commercial	$212.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.73
Rate for Payer: PHP Commercial	$200.73
Rate for Payer: Priority Health Cigna Priority Health	$153.50
Rate for Payer: Priority Health SBD	$148.77

GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION

Facility

$236.15

Service Code	HCPCS J9201
Hospital Charge Code	155791
Hospital Revenue Code	636
Min. Negotiated Rate	$94.46
Max. Negotiated Rate	$212.53
Rate for Payer: Aetna Commercial	$200.73
Rate for Payer: Aetna Medicare	$118.08
Rate for Payer: Aetna New Business (MI Preferred)	$153.50
Rate for Payer: BCBS Complete	$94.46
Rate for Payer: Cash Price	$188.92
Rate for Payer: Cofinity Commercial	$165.31
Rate for Payer: Cofinity Commercial	$203.09
Rate for Payer: Cofinity Medicare Advantage	$165.31
Rate for Payer: Encore Health Key Benefits Commercial	$188.92
Rate for Payer: Healthscope Commercial	$212.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.73
Rate for Payer: PHP Commercial	$200.73
Rate for Payer: Priority Health Cigna Priority Health	$153.50
Rate for Payer: Priority Health SBD	$148.77

GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) INTRAVENOUS SOLUTION

Facility

$469.04

Service Code	HCPCS J9201
Hospital Charge Code	155792
Hospital Revenue Code	636
Min. Negotiated Rate	$187.62
Max. Negotiated Rate	$422.14
Rate for Payer: Aetna Commercial	$398.68
Rate for Payer: Aetna Medicare	$234.52
Rate for Payer: Aetna New Business (MI Preferred)	$304.88
Rate for Payer: BCBS Complete	$187.62
Rate for Payer: Cash Price	$375.23
Rate for Payer: Cofinity Commercial	$328.33
Rate for Payer: Cofinity Commercial	$403.37
Rate for Payer: Cofinity Medicare Advantage	$328.33
Rate for Payer: Encore Health Key Benefits Commercial	$375.23
Rate for Payer: Healthscope Commercial	$422.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$398.68
Rate for Payer: PHP Commercial	$398.68
Rate for Payer: Priority Health Cigna Priority Health	$304.88
Rate for Payer: Priority Health SBD	$295.50

GEMFIBROZIL 600 MG TABLET

Facility

$2.09

Service Code	NDC 60687022411
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna New Business (MI Preferred)	$1.36
Rate for Payer: Cash Price	$1.67
Rate for Payer: Cofinity Commercial	$1.46
Rate for Payer: Cofinity Commercial	$1.80
Rate for Payer: Cofinity Medicare Advantage	$1.46
Rate for Payer: Encore Health Key Benefits Commercial	$1.67
Rate for Payer: Healthscope Commercial	$1.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.78
Rate for Payer: PHP Commercial	$1.78
Rate for Payer: Priority Health Cigna Priority Health	$1.36
Rate for Payer: Priority Health SBD	$1.32

GEMFIBROZIL 600 MG TABLET

Facility

$204.45

Service Code	NDC 69097082103
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$81.78
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna Medicare	$102.22
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: BCBS Complete	$81.78
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Cofinity Medicare Advantage	$143.12
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$132.89
Rate for Payer: Priority Health SBD	$128.80

GEMFIBROZIL 600 MG TABLET

Facility

$204.45

Service Code	NDC 69097082103
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Cofinity Medicare Advantage	$143.12
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$132.89
Rate for Payer: Priority Health SBD	$128.80

GEMFIBROZIL 600 MG TABLET

Facility

$208.05

Service Code	NDC 60687022401
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$131.07
Max. Negotiated Rate	$187.25
Rate for Payer: Aetna Commercial	$176.84
Rate for Payer: Aetna New Business (MI Preferred)	$135.23
Rate for Payer: Cash Price	$166.44
Rate for Payer: Cofinity Commercial	$145.63
Rate for Payer: Cofinity Commercial	$178.92
Rate for Payer: Cofinity Medicare Advantage	$145.63
Rate for Payer: Encore Health Key Benefits Commercial	$166.44
Rate for Payer: Healthscope Commercial	$187.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.84
Rate for Payer: PHP Commercial	$176.84
Rate for Payer: Priority Health Cigna Priority Health	$135.23
Rate for Payer: Priority Health SBD	$131.07

GEMFIBROZIL 600 MG TABLET

Facility

$2.09

Service Code	NDC 60687022411
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare	$1.04
Rate for Payer: Aetna New Business (MI Preferred)	$1.36
Rate for Payer: BCBS Complete	$0.84
Rate for Payer: Cash Price	$1.67
Rate for Payer: Cofinity Commercial	$1.46
Rate for Payer: Cofinity Commercial	$1.80
Rate for Payer: Cofinity Medicare Advantage	$1.46
Rate for Payer: Encore Health Key Benefits Commercial	$1.67
Rate for Payer: Healthscope Commercial	$1.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.78
Rate for Payer: PHP Commercial	$1.78
Rate for Payer: Priority Health Cigna Priority Health	$1.36
Rate for Payer: Priority Health SBD	$1.32

GEMFIBROZIL 600 MG TABLET

Facility

$208.05

Service Code	NDC 60687022401
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$83.22
Max. Negotiated Rate	$187.25
Rate for Payer: Aetna Commercial	$176.84
Rate for Payer: Aetna Medicare	$104.03
Rate for Payer: Aetna New Business (MI Preferred)	$135.23
Rate for Payer: BCBS Complete	$83.22
Rate for Payer: Cash Price	$166.44
Rate for Payer: Cofinity Commercial	$145.63
Rate for Payer: Cofinity Commercial	$178.92
Rate for Payer: Cofinity Medicare Advantage	$145.63
Rate for Payer: Encore Health Key Benefits Commercial	$166.44
Rate for Payer: Healthscope Commercial	$187.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.84
Rate for Payer: PHP Commercial	$176.84
Rate for Payer: Priority Health Cigna Priority Health	$135.23
Rate for Payer: Priority Health SBD	$131.07

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 Commercial	$110.58
Rate for Payer: Cofinity Commercial	$90.01
Rate for Payer: Cofinity Medicare Advantage	$90.01
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: PHP Commercial	$109.29
Rate for Payer: Priority Health Cigna Priority Health	$83.58
Rate for Payer: Priority Health SBD	$81.01

GENTAMICIN 0.1 % TOPICAL CREAM

Facility

$128.58

Service Code	NDC 45802005635
Hospital Charge Code	3423
Hospital Revenue Code	637
Min. Negotiated Rate	$51.43
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 Commercial	$110.58
Rate for Payer: Cofinity Commercial	$90.01
Rate for Payer: Cofinity Medicare Advantage	$90.01
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: PHP Commercial	$109.29
Rate for Payer: Priority Health Cigna Priority Health	$83.58
Rate for Payer: Priority Health SBD	$81.01

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 Commercial	$81.37
Rate for Payer: Cofinity Commercial	$99.97
Rate for Payer: Cofinity Medicare Advantage	$81.37
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: PHP Commercial	$98.80
Rate for Payer: Priority Health Cigna Priority Health	$75.56
Rate for Payer: Priority Health SBD	$73.23

GENTAMICIN 0.3 % EYE DROPS

Facility

$19.22

Service Code	NDC 61314063305
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna New Business (MI Preferred)	$12.49
Rate for Payer: Cash Price	$15.38
Rate for Payer: Cofinity Commercial	$13.45
Rate for Payer: Cofinity Commercial	$16.53
Rate for Payer: Cofinity Medicare Advantage	$13.45
Rate for Payer: Encore Health Key Benefits Commercial	$15.38
Rate for Payer: Healthscope Commercial	$17.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.34
Rate for Payer: PHP Commercial	$16.34
Rate for Payer: Priority Health Cigna Priority Health	$12.49
Rate for Payer: Priority Health SBD	$12.11

GENTAMICIN 0.3 % EYE DROPS

Facility

$19.22

Service Code	NDC 61314063305
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare	$9.61
Rate for Payer: Aetna New Business (MI Preferred)	$12.49
Rate for Payer: BCBS Complete	$7.69
Rate for Payer: Cash Price	$15.38
Rate for Payer: Cofinity Commercial	$13.45
Rate for Payer: Cofinity Commercial	$16.53
Rate for Payer: Cofinity Medicare Advantage	$13.45
Rate for Payer: Encore Health Key Benefits Commercial	$15.38
Rate for Payer: Healthscope Commercial	$17.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.34
Rate for Payer: PHP Commercial	$16.34
Rate for Payer: Priority Health Cigna Priority Health	$12.49
Rate for Payer: Priority Health SBD	$12.11

GENTAMICIN 0.3 % EYE DROPS

Facility

$116.24

Service Code	NDC 24208058060
Hospital Charge Code	3428
Hospital Revenue Code	637
Min. Negotiated Rate	$46.50
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 Commercial	$81.37
Rate for Payer: Cofinity Commercial	$99.97
Rate for Payer: Cofinity Medicare Advantage	$81.37
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: PHP Commercial	$98.80
Rate for Payer: Priority Health Cigna Priority Health	$75.56
Rate for Payer: Priority Health SBD	$73.23

Know your out-of-pocket cost for care.

All Charges