Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$7.74
Max. Negotiated Rate	$212.54
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: BCBS Trust/PPO	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: Cash Price	$188.92
Rate for Payer: Cash Price	$188.92
Rate for Payer: Cofinity Commercial	$165.30
Rate for Payer: Cofinity Commercial	$203.09
Rate for Payer: Cofinity Medicare Advantage	$165.30
Rate for Payer: Encore Health Key Benefits Commercial	$188.92
Rate for Payer: Healthscope Commercial	$212.54
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	$148.77
Max. Negotiated Rate	$212.54
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	$165.30
Rate for Payer: Cofinity Commercial	$203.09
Rate for Payer: Cofinity Medicare Advantage	$165.30
Rate for Payer: Encore Health Key Benefits Commercial	$188.92
Rate for Payer: Healthscope Commercial	$212.54
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	$7.74
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: BCBS Trust/PPO	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: Cash Price	$375.23
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

$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

$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

$208.05

Service Code	NDC 60687022401
Hospital Charge Code	3378
Hospital Revenue Code	637
Min. Negotiated Rate	$83.22
Max. Negotiated Rate	$187.24
Rate for Payer: Aetna Commercial	$176.84
Rate for Payer: Aetna Medicare	$104.02
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	$145.64
Rate for Payer: Cofinity Commercial	$178.92
Rate for Payer: Cofinity Medicare Advantage	$145.64
Rate for Payer: Encore Health Key Benefits Commercial	$166.44
Rate for Payer: Healthscope Commercial	$187.24
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	$131.07
Max. Negotiated Rate	$187.24
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	$145.64
Rate for Payer: Cofinity Commercial	$178.92
Rate for Payer: Cofinity Medicare Advantage	$145.64
Rate for Payer: Encore Health Key Benefits Commercial	$166.44
Rate for Payer: Healthscope Commercial	$187.24
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	$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 0.1 % 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 0.3 % 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

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 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 Commercial	$56.29
Rate for Payer: Cofinity Commercial	$69.15
Rate for Payer: Cofinity Medicare Advantage	$56.29
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: PHP Commercial	$68.35
Rate for Payer: Priority Health Cigna Priority Health	$52.27
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	$7.74
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	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: Cash Price	$64.33
Rate for Payer: Cash Price	$64.33
Rate for Payer: Cofinity Commercial	$56.29
Rate for Payer: Cofinity Commercial	$69.15
Rate for Payer: Cofinity Medicare Advantage	$56.29
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: PHP Commercial	$68.35
Rate for Payer: Priority Health Cigna Priority Health	$52.27
Rate for Payer: Priority Health SBD	$50.66

GENTAMICIN 40 MG/ML FOR INHALATION

Facility

$34.65

Service Code	HCPCS J1580
Hospital Charge Code	180596
Hospital Revenue Code	636
Min. Negotiated Rate	$21.83
Max. Negotiated Rate	$31.18
Rate for Payer: Aetna Commercial	$29.45
Rate for Payer: Aetna Commercial	$38.97
Rate for Payer: Aetna New Business (MI Preferred)	$22.52
Rate for Payer: Aetna New Business (MI Preferred)	$29.80
Rate for Payer: Cash Price	$27.72
Rate for Payer: Cash Price	$36.68
Rate for Payer: Cofinity Commercial	$24.26
Rate for Payer: Cofinity Commercial	$32.10
Rate for Payer: Cofinity Commercial	$39.43
Rate for Payer: Cofinity Commercial	$29.80
Rate for Payer: Cofinity Medicare Advantage	$32.10
Rate for Payer: Cofinity Medicare Advantage	$24.26
Rate for Payer: Encore Health Key Benefits Commercial	$27.72
Rate for Payer: Encore Health Key Benefits Commercial	$36.68
Rate for Payer: Healthscope Commercial	$31.18
Rate for Payer: Healthscope Commercial	$41.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.97
Rate for Payer: PHP Commercial	$29.45
Rate for Payer: PHP Commercial	$38.97
Rate for Payer: Priority Health Cigna Priority Health	$29.80
Rate for Payer: Priority Health Cigna Priority Health	$22.52
Rate for Payer: Priority Health SBD	$28.89
Rate for Payer: Priority Health SBD	$21.83

GENTAMICIN 40 MG/ML FOR INHALATION

Facility

$34.65

Service Code	HCPCS J1580
Hospital Charge Code	180596
Hospital Revenue Code	636
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$31.18
Rate for Payer: Aetna Commercial	$29.45
Rate for Payer: Aetna Commercial	$38.97
Rate for Payer: Aetna Medicare	$22.92
Rate for Payer: Aetna Medicare	$17.32
Rate for Payer: Aetna New Business (MI Preferred)	$22.52
Rate for Payer: Aetna New Business (MI Preferred)	$29.80
Rate for Payer: BCBS Complete	$18.34
Rate for Payer: BCBS Complete	$13.86
Rate for Payer: BCBS Trust/PPO	$7.74
Rate for Payer: BCBS Trust/PPO	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: Cash Price	$36.68
Rate for Payer: Cash Price	$36.68
Rate for Payer: Cash Price	$27.72
Rate for Payer: Cash Price	$27.72
Rate for Payer: Cofinity Commercial	$24.26
Rate for Payer: Cofinity Commercial	$39.43
Rate for Payer: Cofinity Commercial	$32.10
Rate for Payer: Cofinity Commercial	$29.80
Rate for Payer: Cofinity Medicare Advantage	$32.10
Rate for Payer: Cofinity Medicare Advantage	$24.26
Rate for Payer: Encore Health Key Benefits Commercial	$27.72
Rate for Payer: Encore Health Key Benefits Commercial	$36.68
Rate for Payer: Healthscope Commercial	$31.18
Rate for Payer: Healthscope Commercial	$41.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.45
Rate for Payer: PHP Commercial	$38.97
Rate for Payer: PHP Commercial	$29.45
Rate for Payer: Priority Health Cigna Priority Health	$22.52
Rate for Payer: Priority Health Cigna Priority Health	$29.80
Rate for Payer: Priority Health SBD	$28.89
Rate for Payer: Priority Health SBD	$21.83

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 Commercial	$16.62
Rate for Payer: Aetna Commercial	$38.97
Rate for Payer: Aetna New Business (MI Preferred)	$218.66
Rate for Payer: Aetna New Business (MI Preferred)	$12.71
Rate for Payer: Aetna New Business (MI Preferred)	$29.80
Rate for Payer: Cash Price	$15.64
Rate for Payer: Cash Price	$36.68
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cofinity Commercial	$13.68
Rate for Payer: Cofinity Commercial	$16.81
Rate for Payer: Cofinity Commercial	$235.48
Rate for Payer: Cofinity Commercial	$289.30
Rate for Payer: Cofinity Commercial	$32.10
Rate for Payer: Cofinity Commercial	$39.43
Rate for Payer: Cofinity Medicare Advantage	$13.68
Rate for Payer: Cofinity Medicare Advantage	$32.10
Rate for Payer: Cofinity Medicare Advantage	$235.48
Rate for Payer: Encore Health Key Benefits Commercial	$15.64
Rate for Payer: Encore Health Key Benefits Commercial	$269.12
Rate for Payer: Encore Health Key Benefits Commercial	$36.68
Rate for Payer: Healthscope Commercial	$17.60
Rate for Payer: Healthscope Commercial	$302.76
Rate for Payer: Healthscope Commercial	$41.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.97
Rate for Payer: PHP Commercial	$285.94
Rate for Payer: PHP Commercial	$38.97
Rate for Payer: PHP Commercial	$16.62
Rate for Payer: Priority Health Cigna Priority Health	$29.80
Rate for Payer: Priority Health Cigna Priority Health	$218.66
Rate for Payer: Priority Health Cigna Priority Health	$12.71
Rate for Payer: Priority Health SBD	$28.89
Rate for Payer: Priority Health SBD	$211.93
Rate for Payer: Priority Health SBD	$12.32

GENTAMICIN 40 MG/ML INJECTION SOLUTION

Facility

$45.85

Service Code	HCPCS J1580
Hospital Charge Code	3426
Hospital Revenue Code	636
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$41.26
Rate for Payer: Aetna Commercial	$38.97
Rate for Payer: Aetna Commercial	$16.62
Rate for Payer: Aetna Commercial	$285.94
Rate for Payer: Aetna Medicare	$9.78
Rate for Payer: Aetna Medicare	$168.20
Rate for Payer: Aetna Medicare	$22.92
Rate for Payer: Aetna New Business (MI Preferred)	$218.66
Rate for Payer: Aetna New Business (MI Preferred)	$12.71
Rate for Payer: Aetna New Business (MI Preferred)	$29.80
Rate for Payer: BCBS Complete	$134.56
Rate for Payer: BCBS Complete	$7.82
Rate for Payer: BCBS Complete	$18.34
Rate for Payer: BCBS Trust/PPO	$7.74
Rate for Payer: BCBS Trust/PPO	$7.74
Rate for Payer: BCBS Trust/PPO	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cash Price	$15.64
Rate for Payer: Cash Price	$36.68
Rate for Payer: Cash Price	$269.12
Rate for Payer: Cash Price	$15.64
Rate for Payer: Cash Price	$36.68
Rate for Payer: Cofinity Commercial	$235.48
Rate for Payer: Cofinity Commercial	$13.68
Rate for Payer: Cofinity Commercial	$16.81
Rate for Payer: Cofinity Commercial	$289.30
Rate for Payer: Cofinity Commercial	$32.10
Rate for Payer: Cofinity Commercial	$39.43
Rate for Payer: Cofinity Medicare Advantage	$32.10
Rate for Payer: Cofinity Medicare Advantage	$235.48
Rate for Payer: Cofinity Medicare Advantage	$13.68
Rate for Payer: Encore Health Key Benefits Commercial	$15.64
Rate for Payer: Encore Health Key Benefits Commercial	$269.12
Rate for Payer: Encore Health Key Benefits Commercial	$36.68
Rate for Payer: Healthscope Commercial	$302.76
Rate for Payer: Healthscope Commercial	$17.60
Rate for Payer: Healthscope Commercial	$41.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.97
Rate for Payer: PHP Commercial	$285.94
Rate for Payer: PHP Commercial	$38.97
Rate for Payer: PHP Commercial	$16.62
Rate for Payer: Priority Health Cigna Priority Health	$218.66
Rate for Payer: Priority Health Cigna Priority Health	$29.80
Rate for Payer: Priority Health Cigna Priority Health	$12.71
Rate for Payer: Priority Health SBD	$12.32
Rate for Payer: Priority Health SBD	$28.89
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	$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 Commercial	$46.50
Rate for Payer: Cofinity Commercial	$57.13
Rate for Payer: Cofinity Medicare Advantage	$46.50
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: PHP Commercial	$56.47
Rate for Payer: Priority Health Cigna Priority Health	$43.18
Rate for Payer: Priority Health SBD	$41.85

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	$26.57
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 Commercial	$46.50
Rate for Payer: Cofinity Commercial	$57.13
Rate for Payer: Cofinity Medicare Advantage	$46.50
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: PHP Commercial	$56.47
Rate for Payer: Priority Health Cigna Priority Health	$43.18
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 Commercial	$19.55
Rate for Payer: Cofinity Commercial	$24.02
Rate for Payer: Cofinity Medicare Advantage	$19.55
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: PHP Commercial	$23.74
Rate for Payer: Priority Health Cigna Priority Health	$18.15
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	$7.74
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	$7.74
Rate for Payer: BCN Commercial	$7.74
Rate for Payer: Cash Price	$22.34
Rate for Payer: Cash Price	$22.34
Rate for Payer: Cofinity Commercial	$19.55
Rate for Payer: Cofinity Commercial	$24.02
Rate for Payer: Cofinity Medicare Advantage	$19.55
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: PHP Commercial	$23.74
Rate for Payer: Priority Health Cigna Priority Health	$18.15
Rate for Payer: Priority Health SBD	$17.60

Know your out-of-pocket cost for care.

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