Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$209.48
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	$162.92
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Cofinity Medicare Advantage	$162.92
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.48
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

$232.75

Service Code	NDC 00904663761
Hospital Charge Code	10117
Hospital Revenue Code	637
Min. Negotiated Rate	$146.63
Max. Negotiated Rate	$209.48
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	$162.92
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Cofinity Medicare Advantage	$162.92
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.48
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

$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	$1.26
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

$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	$1.58
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 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

$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

$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

$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

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

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	$98.72
Max. Negotiated Rate	$919.59
Rate for Payer: Aetna Commercial	$868.50
Rate for Payer: Aetna Medicare	$191.55
Rate for Payer: Aetna New Business (MI Preferred)	$664.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$230.22
Rate for Payer: Amish Plain Church Group Commercial	$230.22
Rate for Payer: BCBS Complete	$103.66
Rate for Payer: BCBS MAPPO	$184.18
Rate for Payer: BCBS Trust/PPO	$543.22
Rate for Payer: BCN Commercial	$543.22
Rate for Payer: BCN Medicare Advantage	$184.18
Rate for Payer: Cash Price	$817.42
Rate for Payer: Cash Price	$817.42
Rate for Payer: Cofinity Commercial	$878.72
Rate for Payer: Cofinity Commercial	$715.24
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	$184.18
Rate for Payer: Healthscope Commercial	$919.59
Rate for Payer: Mclaren Medicaid	$98.72
Rate for Payer: Mclaren Medicare	$184.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$193.39
Rate for Payer: Meridian Medicaid	$103.66
Rate for Payer: MI Amish Medical Board Commercial	$211.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$868.50
Rate for Payer: Nomi Health Commercial	$552.54
Rate for Payer: PACE Medicare	$174.97
Rate for Payer: PACE SWMI	$184.18
Rate for Payer: PHP Commercial	$868.50
Rate for Payer: PHP Medicare Advantage	$184.18
Rate for Payer: Priority Health Choice Medicaid	$98.72
Rate for Payer: Priority Health Cigna Priority Health	$664.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$553.45
Rate for Payer: Priority Health Medicare	$184.18
Rate for Payer: Priority Health Narrow Network	$442.76
Rate for Payer: Priority Health SBD	$643.72
Rate for Payer: Railroad Medicare Medicare	$184.18
Rate for Payer: UHC All Payor (Choice/PPO)	$518.45
Rate for Payer: UHC Dual Complete DSNP	$184.18
Rate for Payer: UHC Medicare Advantage	$184.18
Rate for Payer: UHCCP Medicaid	$103.69
Rate for Payer: VA VA	$184.18

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	$59.98
Max. Negotiated Rate	$384.30
Rate for Payer: Aetna Commercial	$362.95
Rate for Payer: Aetna Commercial	$362.93
Rate for Payer: Aetna Medicare	$116.39
Rate for Payer: Aetna Medicare	$116.39
Rate for Payer: Aetna New Business (MI Preferred)	$277.55
Rate for Payer: Aetna New Business (MI Preferred)	$277.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$139.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$139.89
Rate for Payer: Amish Plain Church Group Commercial	$139.89
Rate for Payer: Amish Plain Church Group Commercial	$139.89
Rate for Payer: BCBS Complete	$62.98
Rate for Payer: BCBS Complete	$62.98
Rate for Payer: BCBS MAPPO	$111.91
Rate for Payer: BCBS MAPPO	$111.91
Rate for Payer: BCBS Trust/PPO	$307.69
Rate for Payer: BCBS Trust/PPO	$307.69
Rate for Payer: BCN Commercial	$307.69
Rate for Payer: BCN Commercial	$307.69
Rate for Payer: BCN Medicare Advantage	$111.91
Rate for Payer: BCN Medicare Advantage	$111.91
Rate for Payer: Cash Price	$341.58
Rate for Payer: Cash Price	$341.58
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cofinity Commercial	$298.90
Rate for Payer: Cofinity Commercial	$298.89
Rate for Payer: Cofinity Commercial	$367.22
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	$341.60
Rate for Payer: Encore Health Key Benefits Commercial	$341.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$111.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$111.91
Rate for Payer: Healthscope Commercial	$384.30
Rate for Payer: Healthscope Commercial	$384.28
Rate for Payer: Mclaren Medicaid	$59.98
Rate for Payer: Mclaren Medicaid	$59.98
Rate for Payer: Mclaren Medicare	$111.91
Rate for Payer: Mclaren Medicare	$111.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$117.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$117.51
Rate for Payer: Meridian Medicaid	$62.98
Rate for Payer: Meridian Medicaid	$62.98
Rate for Payer: MI Amish Medical Board Commercial	$128.70
Rate for Payer: MI Amish Medical Board Commercial	$128.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$362.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$362.95
Rate for Payer: Nomi Health Commercial	$335.73
Rate for Payer: Nomi Health Commercial	$335.73
Rate for Payer: PACE Medicare	$106.31
Rate for Payer: PACE Medicare	$106.31
Rate for Payer: PACE SWMI	$111.91
Rate for Payer: PACE SWMI	$111.91
Rate for Payer: PHP Commercial	$362.95
Rate for Payer: PHP Commercial	$362.93
Rate for Payer: PHP Medicare Advantage	$111.91
Rate for Payer: PHP Medicare Advantage	$111.91
Rate for Payer: Priority Health Choice Medicaid	$59.98
Rate for Payer: Priority Health Choice Medicaid	$59.98
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 HMO/PPO/Tiered Network	$313.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$313.50
Rate for Payer: Priority Health Medicare	$111.91
Rate for Payer: Priority Health Medicare	$111.91
Rate for Payer: Priority Health Narrow Network	$250.80
Rate for Payer: Priority Health Narrow Network	$250.80
Rate for Payer: Priority Health SBD	$269.01
Rate for Payer: Priority Health SBD	$269.00
Rate for Payer: Railroad Medicare Medicare	$111.91
Rate for Payer: Railroad Medicare Medicare	$111.91
Rate for Payer: UHC All Payor (Choice/PPO)	$315.02
Rate for Payer: UHC All Payor (Choice/PPO)	$315.02
Rate for Payer: UHC Dual Complete DSNP	$111.91
Rate for Payer: UHC Dual Complete DSNP	$111.91
Rate for Payer: UHC Medicare Advantage	$111.91
Rate for Payer: UHC Medicare Advantage	$111.91
Rate for Payer: UHCCP Medicaid	$63.01
Rate for Payer: UHCCP Medicaid	$63.01
Rate for Payer: VA VA	$111.91
Rate for Payer: VA VA	$111.91

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

GLYCERIN (ADULT) RECTAL SUPPOSITORY

Facility

$89.30

Service Code	NDC 00132007950
Hospital Charge Code	15053
Hospital Revenue Code	637
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$80.37
Rate for Payer: Aetna Commercial	$75.90
Rate for Payer: Aetna New Business (MI Preferred)	$58.04
Rate for Payer: Cash Price	$71.44
Rate for Payer: Cofinity Commercial	$62.51
Rate for Payer: Cofinity Commercial	$76.80
Rate for Payer: Cofinity Medicare Advantage	$62.51
Rate for Payer: Encore Health Key Benefits Commercial	$71.44
Rate for Payer: Healthscope Commercial	$80.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.90
Rate for Payer: PHP Commercial	$75.90
Rate for Payer: Priority Health Cigna Priority Health	$58.04
Rate for Payer: Priority Health SBD	$56.26

GLYCERIN (ADULT) RECTAL SUPPOSITORY

Facility

$89.30

Service Code	NDC 00132007950
Hospital Charge Code	15053
Hospital Revenue Code	637
Min. Negotiated Rate	$35.72
Max. Negotiated Rate	$80.37
Rate for Payer: Aetna Commercial	$75.90
Rate for Payer: Aetna Medicare	$44.65
Rate for Payer: Aetna New Business (MI Preferred)	$58.04
Rate for Payer: BCBS Complete	$35.72
Rate for Payer: Cash Price	$71.44
Rate for Payer: Cofinity Commercial	$62.51
Rate for Payer: Cofinity Commercial	$76.80
Rate for Payer: Cofinity Medicare Advantage	$62.51
Rate for Payer: Encore Health Key Benefits Commercial	$71.44
Rate for Payer: Healthscope Commercial	$80.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.90
Rate for Payer: PHP Commercial	$75.90
Rate for Payer: Priority Health Cigna Priority Health	$58.04
Rate for Payer: Priority Health SBD	$56.26

GLYCERIN (ADULT) RECTAL SUPPOSITORY

Facility

$60.35

Service Code	NDC 00132007924
Hospital Charge Code	15053
Hospital Revenue Code	637
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$54.32
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

GLYCERIN (ADULT) RECTAL SUPPOSITORY

Facility

$60.35

Service Code	NDC 00132007924
Hospital Charge Code	15053
Hospital Revenue Code	637
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$54.32
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare	$30.18
Rate for Payer: Aetna New Business (MI Preferred)	$39.23
Rate for Payer: BCBS Complete	$24.14
Rate for Payer: Cash Price	$48.28
Rate for Payer: Cofinity Commercial	$42.24
Rate for Payer: Cofinity Commercial	$51.90
Rate for Payer: Cofinity Medicare Advantage	$42.24
Rate for Payer: Encore Health Key Benefits Commercial	$48.28
Rate for Payer: Healthscope Commercial	$54.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.30
Rate for Payer: PHP Commercial	$51.30
Rate for Payer: Priority Health Cigna Priority Health	$39.23
Rate for Payer: Priority Health SBD	$38.02

GLYCERIN (CHILD) RECTAL SUPPOSITORY

Facility

$37.51

Service Code	NDC 00132008112
Hospital Charge Code	3492
Hospital Revenue Code	637
Min. Negotiated Rate	$23.63
Max. Negotiated Rate	$33.76
Rate for Payer: Aetna Commercial	$31.88
Rate for Payer: Aetna New Business (MI Preferred)	$24.38
Rate for Payer: Cash Price	$30.01
Rate for Payer: Cofinity Commercial	$26.26
Rate for Payer: Cofinity Commercial	$32.26
Rate for Payer: Cofinity Medicare Advantage	$26.26
Rate for Payer: Encore Health Key Benefits Commercial	$30.01
Rate for Payer: Healthscope Commercial	$33.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.88
Rate for Payer: PHP Commercial	$31.88
Rate for Payer: Priority Health Cigna Priority Health	$24.38
Rate for Payer: Priority Health SBD	$23.63

GLYCERIN (CHILD) RECTAL SUPPOSITORY

Facility

$49.35

Service Code	NDC 70000042901
Hospital Charge Code	3492
Hospital Revenue Code	637
Min. Negotiated Rate	$19.74
Max. Negotiated Rate	$44.42
Rate for Payer: Aetna Commercial	$41.95
Rate for Payer: Aetna Medicare	$24.68
Rate for Payer: Aetna New Business (MI Preferred)	$32.08
Rate for Payer: BCBS Complete	$19.74
Rate for Payer: Cash Price	$39.48
Rate for Payer: Cofinity Commercial	$34.54
Rate for Payer: Cofinity Commercial	$42.44
Rate for Payer: Cofinity Medicare Advantage	$34.54
Rate for Payer: Encore Health Key Benefits Commercial	$39.48
Rate for Payer: Healthscope Commercial	$44.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.95
Rate for Payer: PHP Commercial	$41.95
Rate for Payer: Priority Health Cigna Priority Health	$32.08
Rate for Payer: Priority Health SBD	$31.09

GLYCERIN (CHILD) RECTAL SUPPOSITORY

Facility

$49.35

Service Code	NDC 70000042901
Hospital Charge Code	3492
Hospital Revenue Code	637
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$44.42
Rate for Payer: Aetna Commercial	$41.95
Rate for Payer: Aetna New Business (MI Preferred)	$32.08
Rate for Payer: Cash Price	$39.48
Rate for Payer: Cofinity Commercial	$34.54
Rate for Payer: Cofinity Commercial	$42.44
Rate for Payer: Cofinity Medicare Advantage	$34.54
Rate for Payer: Encore Health Key Benefits Commercial	$39.48
Rate for Payer: Healthscope Commercial	$44.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.95
Rate for Payer: PHP Commercial	$41.95
Rate for Payer: Priority Health Cigna Priority Health	$32.08
Rate for Payer: Priority Health SBD	$31.09

GLYCERIN (CHILD) RECTAL SUPPOSITORY

Facility

$37.51

Service Code	NDC 00132008112
Hospital Charge Code	3492
Hospital Revenue Code	637
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$33.76
Rate for Payer: Aetna Commercial	$31.88
Rate for Payer: Aetna Medicare	$18.76
Rate for Payer: Aetna New Business (MI Preferred)	$24.38
Rate for Payer: BCBS Complete	$15.00
Rate for Payer: Cash Price	$30.01
Rate for Payer: Cofinity Commercial	$26.26
Rate for Payer: Cofinity Commercial	$32.26
Rate for Payer: Cofinity Medicare Advantage	$26.26
Rate for Payer: Encore Health Key Benefits Commercial	$30.01
Rate for Payer: Healthscope Commercial	$33.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.88
Rate for Payer: PHP Commercial	$31.88
Rate for Payer: Priority Health Cigna Priority Health	$24.38
Rate for Payer: Priority Health SBD	$23.63

GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS

Facility

$11.70

Service Code	NDC 50289325001
Hospital Charge Code	116088
Hospital Revenue Code	637
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$10.53
Rate for Payer: Aetna Commercial	$9.94
Rate for Payer: Aetna Medicare	$5.85
Rate for Payer: Aetna New Business (MI Preferred)	$7.60
Rate for Payer: BCBS Complete	$4.68
Rate for Payer: Cash Price	$9.36
Rate for Payer: Cofinity Commercial	$10.06
Rate for Payer: Cofinity Commercial	$8.19
Rate for Payer: Cofinity Medicare Advantage	$8.19
Rate for Payer: Encore Health Key Benefits Commercial	$9.36
Rate for Payer: Healthscope Commercial	$10.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.94
Rate for Payer: PHP Commercial	$9.94
Rate for Payer: Priority Health Cigna Priority Health	$7.60
Rate for Payer: Priority Health SBD	$7.37

GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS

Facility

$11.70

Service Code	NDC 50289325001
Hospital Charge Code	116088
Hospital Revenue Code	637
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$10.53
Rate for Payer: Aetna Commercial	$9.94
Rate for Payer: Aetna New Business (MI Preferred)	$7.60
Rate for Payer: Cash Price	$9.36
Rate for Payer: Cofinity Commercial	$10.06
Rate for Payer: Cofinity Commercial	$8.19
Rate for Payer: Cofinity Medicare Advantage	$8.19
Rate for Payer: Encore Health Key Benefits Commercial	$9.36
Rate for Payer: Healthscope Commercial	$10.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.94
Rate for Payer: PHP Commercial	$9.94
Rate for Payer: Priority Health Cigna Priority Health	$7.60
Rate for Payer: Priority Health SBD	$7.37

Know your out-of-pocket cost for care.

All Charges