Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GLIPIZIDE 10 MG TABLET

Facility

$461.70

Service Code	NDC 51079081120
Hospital Charge Code	10116
Hospital Revenue Code	637
Min. Negotiated Rate	$184.68
Max. Negotiated Rate	$415.53
Rate for Payer: Aetna Commercial	$392.44
Rate for Payer: Aetna Medicare	$230.85
Rate for Payer: Aetna New Business (MI Preferred)	$300.11
Rate for Payer: BCBS Complete	$184.68
Rate for Payer: Cash Price	$369.36
Rate for Payer: Cofinity Commercial	$323.19
Rate for Payer: Cofinity Commercial	$397.06
Rate for Payer: Cofinity Medicare Advantage	$323.19
Rate for Payer: Encore Health Key Benefits Commercial	$369.36
Rate for Payer: Healthscope Commercial	$415.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$392.44
Rate for Payer: PHP Commercial	$392.44
Rate for Payer: Priority Health Cigna Priority Health	$300.11
Rate for Payer: Priority Health SBD	$290.87

GLIPIZIDE 10 MG TABLET

Facility

$136.30

Service Code	NDC 00591046101
Hospital Charge Code	10116
Hospital Revenue Code	637
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna New Business (MI Preferred)	$88.59
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Cofinity Commercial	$95.41
Rate for Payer: Cofinity Medicare Advantage	$95.41
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health Cigna Priority Health	$88.59
Rate for Payer: Priority Health SBD	$85.87

GLIPIZIDE 10 MG TABLET

Facility

$461.70

Service Code	NDC 51079081120
Hospital Charge Code	10116
Hospital Revenue Code	637
Min. Negotiated Rate	$290.87
Max. Negotiated Rate	$415.53
Rate for Payer: Aetna Commercial	$392.44
Rate for Payer: Aetna New Business (MI Preferred)	$300.11
Rate for Payer: Cash Price	$369.36
Rate for Payer: Cofinity Commercial	$323.19
Rate for Payer: Cofinity Commercial	$397.06
Rate for Payer: Cofinity Medicare Advantage	$323.19
Rate for Payer: Encore Health Key Benefits Commercial	$369.36
Rate for Payer: Healthscope Commercial	$415.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$392.44
Rate for Payer: PHP Commercial	$392.44
Rate for Payer: Priority Health Cigna Priority Health	$300.11
Rate for Payer: Priority Health SBD	$290.87

GLIPIZIDE 10 MG TABLET

Facility

$2.42

Service Code	NDC 50268036211
Hospital Charge Code	10116
Hospital Revenue Code	637
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.06
Rate for Payer: PHP Commercial	$2.06
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

GLIPIZIDE 10 MG TABLET

Facility

$2.42

Service Code	NDC 50268036211
Hospital Charge Code	10116
Hospital Revenue Code	637
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare	$1.21
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: BCBS Complete	$0.97
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.06
Rate for Payer: PHP Commercial	$2.06
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

GLIPIZIDE 5 MG TABLET

Facility

$206.15

Service Code	NDC 51079081020
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$82.46
Max. Negotiated Rate	$185.53
Rate for Payer: Aetna Commercial	$175.23
Rate for Payer: Aetna Medicare	$103.08
Rate for Payer: Aetna New Business (MI Preferred)	$134.00
Rate for Payer: BCBS Complete	$82.46
Rate for Payer: Cash Price	$164.92
Rate for Payer: Cofinity Commercial	$144.31
Rate for Payer: Cofinity Commercial	$177.29
Rate for Payer: Cofinity Medicare Advantage	$144.31
Rate for Payer: Encore Health Key Benefits Commercial	$164.92
Rate for Payer: Healthscope Commercial	$185.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.23
Rate for Payer: PHP Commercial	$175.23
Rate for Payer: Priority Health Cigna Priority Health	$134.00
Rate for Payer: Priority Health SBD	$129.87

GLIPIZIDE 5 MG TABLET

Facility

$2.07

Service Code	NDC 51079081001
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.86
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna Medicare	$1.03
Rate for Payer: Aetna New Business (MI Preferred)	$1.35
Rate for Payer: BCBS Complete	$0.83
Rate for Payer: Cash Price	$1.66
Rate for Payer: Cofinity Commercial	$1.45
Rate for Payer: Cofinity Commercial	$1.78
Rate for Payer: Cofinity Medicare Advantage	$1.45
Rate for Payer: Encore Health Key Benefits Commercial	$1.66
Rate for Payer: Healthscope Commercial	$1.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.76
Rate for Payer: PHP Commercial	$1.76
Rate for Payer: Priority Health Cigna Priority Health	$1.35
Rate for Payer: Priority Health SBD	$1.30

GLIPIZIDE 5 MG TABLET

Facility

$2.07

Service Code	NDC 51079081001
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.86
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna New Business (MI Preferred)	$1.35
Rate for Payer: Cash Price	$1.66
Rate for Payer: Cofinity Commercial	$1.45
Rate for Payer: Cofinity Commercial	$1.78
Rate for Payer: Cofinity Medicare Advantage	$1.45
Rate for Payer: Encore Health Key Benefits Commercial	$1.66
Rate for Payer: Healthscope Commercial	$1.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.76
Rate for Payer: PHP Commercial	$1.76
Rate for Payer: Priority Health Cigna Priority Health	$1.35
Rate for Payer: Priority Health SBD	$1.30

GLIPIZIDE 5 MG TABLET

Facility

$2.51

Service Code	NDC 50268036111
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$2.26
Rate for Payer: Aetna Commercial	$2.13
Rate for Payer: Aetna New Business (MI Preferred)	$1.63
Rate for Payer: Cash Price	$2.01
Rate for Payer: Cofinity Commercial	$1.76
Rate for Payer: Cofinity Commercial	$2.16
Rate for Payer: Cofinity Medicare Advantage	$1.76
Rate for Payer: Encore Health Key Benefits Commercial	$2.01
Rate for Payer: Healthscope Commercial	$2.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.13
Rate for Payer: PHP Commercial	$2.13
Rate for Payer: Priority Health Cigna Priority Health	$1.63
Rate for Payer: Priority Health SBD	$1.58

GLIPIZIDE 5 MG TABLET

Facility

$125.40

Service Code	NDC 50268036115
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$112.86
Rate for Payer: Aetna Commercial	$106.59
Rate for Payer: Aetna New Business (MI Preferred)	$81.51
Rate for Payer: Cash Price	$100.32
Rate for Payer: Cofinity Commercial	$107.84
Rate for Payer: Cofinity Commercial	$87.78
Rate for Payer: Cofinity Medicare Advantage	$87.78
Rate for Payer: Encore Health Key Benefits Commercial	$100.32
Rate for Payer: Healthscope Commercial	$112.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$106.59
Rate for Payer: PHP Commercial	$106.59
Rate for Payer: Priority Health Cigna Priority Health	$81.51
Rate for Payer: Priority Health SBD	$79.00

GLIPIZIDE 5 MG TABLET

Facility

$2.51

Service Code	NDC 50268036111
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.26
Rate for Payer: Aetna Commercial	$2.13
Rate for Payer: Aetna Medicare	$1.25
Rate for Payer: Aetna New Business (MI Preferred)	$1.63
Rate for Payer: BCBS Complete	$1.00
Rate for Payer: Cash Price	$2.01
Rate for Payer: Cofinity Commercial	$1.76
Rate for Payer: Cofinity Commercial	$2.16
Rate for Payer: Cofinity Medicare Advantage	$1.76
Rate for Payer: Encore Health Key Benefits Commercial	$2.01
Rate for Payer: Healthscope Commercial	$2.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.13
Rate for Payer: PHP Commercial	$2.13
Rate for Payer: Priority Health Cigna Priority Health	$1.63
Rate for Payer: Priority Health SBD	$1.58

GLIPIZIDE 5 MG TABLET

Facility

$232.75

Service Code	NDC 00904663761
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$146.63
Max. Negotiated Rate	$209.47
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Commercial	$162.93
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Cofinity Medicare Advantage	$162.93
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health Cigna Priority Health	$151.29
Rate for Payer: Priority Health SBD	$146.63

GLIPIZIDE 5 MG TABLET

Facility

$125.40

Service Code	NDC 50268036115
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$50.16
Max. Negotiated Rate	$112.86
Rate for Payer: Aetna Commercial	$106.59
Rate for Payer: Aetna Medicare	$62.70
Rate for Payer: Aetna New Business (MI Preferred)	$81.51
Rate for Payer: BCBS Complete	$50.16
Rate for Payer: Cash Price	$100.32
Rate for Payer: Cofinity Commercial	$107.84
Rate for Payer: Cofinity Commercial	$87.78
Rate for Payer: Cofinity Medicare Advantage	$87.78
Rate for Payer: Encore Health Key Benefits Commercial	$100.32
Rate for Payer: Healthscope Commercial	$112.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$106.59
Rate for Payer: PHP Commercial	$106.59
Rate for Payer: Priority Health Cigna Priority Health	$81.51
Rate for Payer: Priority Health SBD	$79.00

GLIPIZIDE 5 MG TABLET

Facility

$232.75

Service Code	NDC 00904663761
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$209.47
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna Medicare	$116.38
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: BCBS Complete	$93.10
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Commercial	$162.93
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Cofinity Medicare Advantage	$162.93
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health Cigna Priority Health	$151.29
Rate for Payer: Priority Health SBD	$146.63

GLIPIZIDE 5 MG TABLET

Facility

$206.15

Service Code	NDC 51079081020
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$129.87
Max. Negotiated Rate	$185.53
Rate for Payer: Aetna Commercial	$175.23
Rate for Payer: Aetna New Business (MI Preferred)	$134.00
Rate for Payer: Cash Price	$164.92
Rate for Payer: Cofinity Commercial	$144.31
Rate for Payer: Cofinity Commercial	$177.29
Rate for Payer: Cofinity Medicare Advantage	$144.31
Rate for Payer: Encore Health Key Benefits Commercial	$164.92
Rate for Payer: Healthscope Commercial	$185.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.23
Rate for Payer: PHP Commercial	$175.23
Rate for Payer: Priority Health Cigna Priority Health	$134.00
Rate for Payer: Priority Health SBD	$129.87

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR

Facility

$141.56

Service Code	NDC 68084029521
Hospital Charge Code	37648
Hospital Revenue Code	637
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$127.40
Rate for Payer: Aetna Commercial	$120.33
Rate for Payer: Aetna New Business (MI Preferred)	$92.01
Rate for Payer: Cash Price	$113.25
Rate for Payer: Cofinity Commercial	$121.74
Rate for Payer: Cofinity Commercial	$99.09
Rate for Payer: Cofinity Medicare Advantage	$99.09
Rate for Payer: Encore Health Key Benefits Commercial	$113.25
Rate for Payer: Healthscope Commercial	$127.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$120.33
Rate for Payer: PHP Commercial	$120.33
Rate for Payer: Priority Health Cigna Priority Health	$92.01
Rate for Payer: Priority Health SBD	$89.18

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR

Facility

$141.56

Service Code	NDC 68084029521
Hospital Charge Code	37648
Hospital Revenue Code	637
Min. Negotiated Rate	$56.62
Max. Negotiated Rate	$127.40
Rate for Payer: Aetna Commercial	$120.33
Rate for Payer: Aetna Medicare	$70.78
Rate for Payer: Aetna New Business (MI Preferred)	$92.01
Rate for Payer: BCBS Complete	$56.62
Rate for Payer: Cash Price	$113.25
Rate for Payer: Cofinity Commercial	$121.74
Rate for Payer: Cofinity Commercial	$99.09
Rate for Payer: Cofinity Medicare Advantage	$99.09
Rate for Payer: Encore Health Key Benefits Commercial	$113.25
Rate for Payer: Healthscope Commercial	$127.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$120.33
Rate for Payer: PHP Commercial	$120.33
Rate for Payer: Priority Health Cigna Priority Health	$92.01
Rate for Payer: Priority Health SBD	$89.18

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR

Facility

$76.67

Service Code	NDC 00591090030
Hospital Charge Code	37648
Hospital Revenue Code	637
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$65.17
Rate for Payer: Aetna New Business (MI Preferred)	$49.84
Rate for Payer: Cash Price	$61.34
Rate for Payer: Cofinity Commercial	$53.67
Rate for Payer: Cofinity Commercial	$65.94
Rate for Payer: Cofinity Medicare Advantage	$53.67
Rate for Payer: Encore Health Key Benefits Commercial	$61.34
Rate for Payer: Healthscope Commercial	$69.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.17
Rate for Payer: PHP Commercial	$65.17
Rate for Payer: Priority Health Cigna Priority Health	$49.84
Rate for Payer: Priority Health SBD	$48.30

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR

Facility

$76.67

Service Code	NDC 00591090030
Hospital Charge Code	37648
Hospital Revenue Code	637
Min. Negotiated Rate	$30.67
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$65.17
Rate for Payer: Aetna Medicare	$38.34
Rate for Payer: Aetna New Business (MI Preferred)	$49.84
Rate for Payer: BCBS Complete	$30.67
Rate for Payer: Cash Price	$61.34
Rate for Payer: Cofinity Commercial	$53.67
Rate for Payer: Cofinity Commercial	$65.94
Rate for Payer: Cofinity Medicare Advantage	$53.67
Rate for Payer: Encore Health Key Benefits Commercial	$61.34
Rate for Payer: Healthscope Commercial	$69.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.17
Rate for Payer: PHP Commercial	$65.17
Rate for Payer: Priority Health Cigna Priority Health	$49.84
Rate for Payer: Priority Health SBD	$48.30

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR

Facility

$4.72

Service Code	NDC 68084029511
Hospital Charge Code	37648
Hospital Revenue Code	637
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$4.25
Rate for Payer: Aetna Commercial	$4.01
Rate for Payer: Aetna New Business (MI Preferred)	$3.07
Rate for Payer: Cash Price	$3.78
Rate for Payer: Cofinity Commercial	$3.30
Rate for Payer: Cofinity Commercial	$4.06
Rate for Payer: Cofinity Medicare Advantage	$3.30
Rate for Payer: Encore Health Key Benefits Commercial	$3.78
Rate for Payer: Healthscope Commercial	$4.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.01
Rate for Payer: PHP Commercial	$4.01
Rate for Payer: Priority Health Cigna Priority Health	$3.07
Rate for Payer: Priority Health SBD	$2.97

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR

Facility

$4.72

Service Code	NDC 68084029511
Hospital Charge Code	37648
Hospital Revenue Code	637
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$4.25
Rate for Payer: Aetna Commercial	$4.01
Rate for Payer: Aetna Medicare	$2.36
Rate for Payer: Aetna New Business (MI Preferred)	$3.07
Rate for Payer: BCBS Complete	$1.89
Rate for Payer: Cash Price	$3.78
Rate for Payer: Cofinity Commercial	$3.30
Rate for Payer: Cofinity Commercial	$4.06
Rate for Payer: Cofinity Medicare Advantage	$3.30
Rate for Payer: Encore Health Key Benefits Commercial	$3.78
Rate for Payer: Healthscope Commercial	$4.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.01
Rate for Payer: PHP Commercial	$4.01
Rate for Payer: Priority Health Cigna Priority Health	$3.07
Rate for Payer: Priority Health SBD	$2.97

GLUCAGON 1 MG SOLUTION FOR INJECTION

Facility

$1,021.77

Service Code	HCPCS J1610
Hospital Charge Code	109673
Hospital Revenue Code	636
Min. Negotiated Rate	$97.79
Max. Negotiated Rate	$919.59
Rate for Payer: Aetna Commercial	$868.50
Rate for Payer: Aetna Medicare	$189.75
Rate for Payer: Aetna New Business (MI Preferred)	$664.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$228.06
Rate for Payer: Amish Plain Church Group Commercial	$228.06
Rate for Payer: BCBS Complete	$102.68
Rate for Payer: BCBS MAPPO	$182.45
Rate for Payer: BCN Medicare Advantage	$182.45
Rate for Payer: Cash Price	$817.42
Rate for Payer: Cash Price	$817.42
Rate for Payer: Cofinity Commercial	$715.24
Rate for Payer: Cofinity Commercial	$878.72
Rate for Payer: Cofinity Medicare Advantage	$715.24
Rate for Payer: Encore Health Key Benefits Commercial	$817.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$182.45
Rate for Payer: Healthscope Commercial	$919.59
Rate for Payer: Mclaren Medicaid	$97.79
Rate for Payer: Mclaren Medicare	$182.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$191.57
Rate for Payer: Meridian Medicaid	$102.68
Rate for Payer: MI Amish Medical Board Commercial	$209.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$868.50
Rate for Payer: PACE Medicare	$173.33
Rate for Payer: PACE SWMI	$182.45
Rate for Payer: PHP Commercial	$868.50
Rate for Payer: PHP Medicare Advantage	$182.45
Rate for Payer: Priority Health Choice Medicaid	$97.79
Rate for Payer: Priority Health Cigna Priority Health	$664.15
Rate for Payer: Priority Health Medicare	$182.45
Rate for Payer: Priority Health SBD	$643.72
Rate for Payer: Railroad Medicare Medicare	$182.45
Rate for Payer: UHC All Payor (Choice/PPO)	$513.58
Rate for Payer: UHC Dual Complete DSNP	$182.45
Rate for Payer: UHC Medicare Advantage	$182.45
Rate for Payer: UHCCP Medicaid	$102.72
Rate for Payer: VA VA	$182.45

GLUCAGON 1 MG SOLUTION FOR INJECTION

Facility

$1,021.77

Service Code	HCPCS J1610
Hospital Charge Code	109673
Hospital Revenue Code	636
Min. Negotiated Rate	$643.72
Max. Negotiated Rate	$919.59
Rate for Payer: Aetna Commercial	$868.50
Rate for Payer: Aetna New Business (MI Preferred)	$664.15
Rate for Payer: Cash Price	$817.42
Rate for Payer: Cofinity Commercial	$715.24
Rate for Payer: Cofinity Commercial	$878.72
Rate for Payer: Cofinity Medicare Advantage	$715.24
Rate for Payer: Encore Health Key Benefits Commercial	$817.42
Rate for Payer: Healthscope Commercial	$919.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$868.50
Rate for Payer: PHP Commercial	$868.50
Rate for Payer: Priority Health Cigna Priority Health	$664.15
Rate for Payer: Priority Health SBD	$643.72

GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION

Facility

$427.00

Service Code	HCPCS J1611
Hospital Charge Code	168350
Hospital Revenue Code	636
Min. Negotiated Rate	$269.01
Max. Negotiated Rate	$384.30
Rate for Payer: Aetna Commercial	$362.95
Rate for Payer: Aetna Commercial	$362.93
Rate for Payer: Aetna New Business (MI Preferred)	$277.54
Rate for Payer: Aetna New Business (MI Preferred)	$277.55
Rate for Payer: Cash Price	$341.58
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cofinity Commercial	$367.22
Rate for Payer: Cofinity Commercial	$298.90
Rate for Payer: Cofinity Commercial	$298.89
Rate for Payer: Cofinity Commercial	$367.20
Rate for Payer: Cofinity Medicare Advantage	$298.89
Rate for Payer: Cofinity Medicare Advantage	$298.90
Rate for Payer: Encore Health Key Benefits Commercial	$341.58
Rate for Payer: Encore Health Key Benefits Commercial	$341.60
Rate for Payer: Healthscope Commercial	$384.30
Rate for Payer: Healthscope Commercial	$384.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$362.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$362.95
Rate for Payer: PHP Commercial	$362.95
Rate for Payer: PHP Commercial	$362.93
Rate for Payer: Priority Health Cigna Priority Health	$277.54
Rate for Payer: Priority Health Cigna Priority Health	$277.55
Rate for Payer: Priority Health SBD	$269.00
Rate for Payer: Priority Health SBD	$269.01

GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION

Facility

$426.98

Service Code	HCPCS J1611
Hospital Charge Code	168350
Hospital Revenue Code	636
Min. Negotiated Rate	$79.86
Max. Negotiated Rate	$419.39
Rate for Payer: Aetna Commercial	$362.93
Rate for Payer: Aetna Commercial	$362.95
Rate for Payer: Aetna Medicare	$154.95
Rate for Payer: Aetna Medicare	$154.95
Rate for Payer: Aetna New Business (MI Preferred)	$277.54
Rate for Payer: Aetna New Business (MI Preferred)	$277.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$186.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$186.24
Rate for Payer: Amish Plain Church Group Commercial	$186.24
Rate for Payer: Amish Plain Church Group Commercial	$186.24
Rate for Payer: BCBS Complete	$83.85
Rate for Payer: BCBS Complete	$83.85
Rate for Payer: BCBS MAPPO	$148.99
Rate for Payer: BCBS MAPPO	$148.99
Rate for Payer: BCN Medicare Advantage	$148.99
Rate for Payer: BCN Medicare Advantage	$148.99
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cash Price	$341.58
Rate for Payer: Cash Price	$341.58
Rate for Payer: Cofinity Commercial	$298.90
Rate for Payer: Cofinity Commercial	$367.22
Rate for Payer: Cofinity Commercial	$367.20
Rate for Payer: Cofinity Commercial	$298.89
Rate for Payer: Cofinity Medicare Advantage	$298.89
Rate for Payer: Cofinity Medicare Advantage	$298.90
Rate for Payer: Encore Health Key Benefits Commercial	$341.60
Rate for Payer: Encore Health Key Benefits Commercial	$341.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$148.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$148.99
Rate for Payer: Healthscope Commercial	$384.28
Rate for Payer: Healthscope Commercial	$384.30
Rate for Payer: Mclaren Medicaid	$79.86
Rate for Payer: Mclaren Medicaid	$79.86
Rate for Payer: Mclaren Medicare	$148.99
Rate for Payer: Mclaren Medicare	$148.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$156.44
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$156.44
Rate for Payer: Meridian Medicaid	$83.85
Rate for Payer: Meridian Medicaid	$83.85
Rate for Payer: MI Amish Medical Board Commercial	$171.34
Rate for Payer: MI Amish Medical Board Commercial	$171.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$362.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$362.95
Rate for Payer: PACE Medicare	$141.54
Rate for Payer: PACE Medicare	$141.54
Rate for Payer: PACE SWMI	$148.99
Rate for Payer: PACE SWMI	$148.99
Rate for Payer: PHP Commercial	$362.95
Rate for Payer: PHP Commercial	$362.93
Rate for Payer: PHP Medicare Advantage	$148.99
Rate for Payer: PHP Medicare Advantage	$148.99
Rate for Payer: Priority Health Choice Medicaid	$79.86
Rate for Payer: Priority Health Choice Medicaid	$79.86
Rate for Payer: Priority Health Cigna Priority Health	$277.55
Rate for Payer: Priority Health Cigna Priority Health	$277.54
Rate for Payer: Priority Health Medicare	$148.99
Rate for Payer: Priority Health Medicare	$148.99
Rate for Payer: Priority Health SBD	$269.01
Rate for Payer: Priority Health SBD	$269.00
Rate for Payer: Railroad Medicare Medicare	$148.99
Rate for Payer: Railroad Medicare Medicare	$148.99
Rate for Payer: UHC All Payor (Choice/PPO)	$419.39
Rate for Payer: UHC All Payor (Choice/PPO)	$419.39
Rate for Payer: UHC Dual Complete DSNP	$148.99
Rate for Payer: UHC Dual Complete DSNP	$148.99
Rate for Payer: UHC Medicare Advantage	$148.99
Rate for Payer: UHC Medicare Advantage	$148.99
Rate for Payer: UHCCP Medicaid	$83.88
Rate for Payer: UHCCP Medicaid	$83.88
Rate for Payer: VA VA	$148.99
Rate for Payer: VA VA	$148.99

Know your out-of-pocket cost for care.

All Charges