Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CALCIUM GLUCONATE (BULK) POWDER

Facility

$366.00

Service Code	NDC 3877918268
Hospital Charge Code	1316
Hospital Revenue Code	637
Min. Negotiated Rate	$230.58
Max. Negotiated Rate	$329.40
Rate for Payer: Aetna Commercial	$311.10
Rate for Payer: Aetna New Business (MI Preferred)	$237.90
Rate for Payer: Cash Price	$292.80
Rate for Payer: Cofinity Commercial	$256.20
Rate for Payer: Cofinity Commercial	$314.76
Rate for Payer: Healthscope Commercial	$329.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$311.10
Rate for Payer: PHP Commercial	$311.10
Rate for Payer: Priority Health Cigna Priority Health	$256.20
Rate for Payer: Priority Health SBD	$230.58

CAPSAICIN 0.025 % TOPICAL CREAM

Facility

$14.85

Service Code	NDC 0536-2525-25
Hospital Charge Code	1350
Hospital Revenue Code	637
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$13.36
Rate for Payer: Aetna Commercial	$12.62
Rate for Payer: Aetna New Business (MI Preferred)	$9.65
Rate for Payer: Cash Price	$11.88
Rate for Payer: Cofinity Commercial	$10.40
Rate for Payer: Cofinity Commercial	$12.77
Rate for Payer: Healthscope Commercial	$13.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.62
Rate for Payer: PHP Commercial	$12.62
Rate for Payer: Priority Health Cigna Priority Health	$10.40
Rate for Payer: Priority Health SBD	$9.36

CAPSAICIN 0.075 % TOPICAL CREAM

Facility

$18.47

Service Code	NDC 0536-1118-25
Hospital Charge Code	9399
Hospital Revenue Code	637
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$15.70
Rate for Payer: Aetna New Business (MI Preferred)	$12.01
Rate for Payer: Cash Price	$14.78
Rate for Payer: Cofinity Commercial	$12.93
Rate for Payer: Cofinity Commercial	$15.88
Rate for Payer: Healthscope Commercial	$16.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.70
Rate for Payer: PHP Commercial	$15.70
Rate for Payer: Priority Health Cigna Priority Health	$12.93
Rate for Payer: Priority Health SBD	$11.64

CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)

Facility

$7,957.04

Service Code	CPT 23455
Hospital Revenue Code	360
Min. Negotiated Rate	$975.78
Max. Negotiated Rate	$7,957.04
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$3,005.76
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$1,073.36
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$975.78
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)

Facility

$4,155.00

Service Code	CPT 28270
Hospital Revenue Code	360
Min. Negotiated Rate	$331.70
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,058.03
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$364.87
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$331.70
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE

Facility

$8,925.64

Service Code	CPT 27435
Hospital Revenue Code	360
Min. Negotiated Rate	$803.54
Max. Negotiated Rate	$8,925.64
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,366.62
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,925.64
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health Narrow Network	$7,140.51
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$883.89
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$803.54
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

CAPTOPRIL 12.5 MG TABLET

Facility

$579.84

Service Code	NDC 51079-863-20
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$365.30
Max. Negotiated Rate	$521.86
Rate for Payer: Aetna Commercial	$492.86
Rate for Payer: Aetna New Business (MI Preferred)	$376.90
Rate for Payer: Cash Price	$463.87
Rate for Payer: Cofinity Commercial	$405.89
Rate for Payer: Cofinity Commercial	$498.66
Rate for Payer: Healthscope Commercial	$521.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$492.86
Rate for Payer: PHP Commercial	$492.86
Rate for Payer: Priority Health Cigna Priority Health	$405.89
Rate for Payer: Priority Health SBD	$365.30

CAPTOPRIL 12.5 MG TABLET

Facility

$5.80

Service Code	NDC 51079-863-01
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$4.93
Rate for Payer: Aetna New Business (MI Preferred)	$3.77
Rate for Payer: Cash Price	$4.64
Rate for Payer: Cofinity Commercial	$4.06
Rate for Payer: Cofinity Commercial	$4.99
Rate for Payer: Healthscope Commercial	$5.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.93
Rate for Payer: PHP Commercial	$4.93
Rate for Payer: Priority Health Cigna Priority Health	$4.06
Rate for Payer: Priority Health SBD	$3.65

CAPTOPRIL 12.5 MG TABLET

Facility

$523.68

Service Code	NDC 0904-7105-61
Hospital Charge Code	9401
Hospital Revenue Code	637
Min. Negotiated Rate	$329.92
Max. Negotiated Rate	$471.31
Rate for Payer: Aetna Commercial	$445.13
Rate for Payer: Aetna New Business (MI Preferred)	$340.39
Rate for Payer: Cash Price	$418.94
Rate for Payer: Cofinity Commercial	$366.58
Rate for Payer: Cofinity Commercial	$450.36
Rate for Payer: Healthscope Commercial	$471.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$445.13
Rate for Payer: PHP Commercial	$445.13
Rate for Payer: Priority Health Cigna Priority Health	$366.58
Rate for Payer: Priority Health SBD	$329.92

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$13.59

Service Code	NDC 68094-007-59
Hospital Charge Code	119222
Hospital Revenue Code	637
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$12.23
Rate for Payer: Aetna Commercial	$11.55
Rate for Payer: Aetna New Business (MI Preferred)	$8.83
Rate for Payer: Cash Price	$10.87
Rate for Payer: Cofinity Commercial	$11.69
Rate for Payer: Cofinity Commercial	$9.51
Rate for Payer: Healthscope Commercial	$12.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.55
Rate for Payer: PHP Commercial	$11.55
Rate for Payer: Priority Health Cigna Priority Health	$9.51
Rate for Payer: Priority Health SBD	$8.56

CARBAMAZEPINE 100 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$13.59

Service Code	NDC 68094-007-62
Hospital Charge Code	119222
Hospital Revenue Code	637
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$12.23
Rate for Payer: Aetna Commercial	$11.55
Rate for Payer: Aetna New Business (MI Preferred)	$8.83
Rate for Payer: Cash Price	$10.87
Rate for Payer: Cofinity Commercial	$11.69
Rate for Payer: Cofinity Commercial	$9.51
Rate for Payer: Healthscope Commercial	$12.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.55
Rate for Payer: PHP Commercial	$11.55
Rate for Payer: Priority Health Cigna Priority Health	$9.51
Rate for Payer: Priority Health SBD	$8.56

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,662.98

Service Code	NDC 0078-0508-83
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$1,047.68
Max. Negotiated Rate	$1,496.68
Rate for Payer: Aetna Commercial	$1,413.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,080.94
Rate for Payer: Cash Price	$1,330.38
Rate for Payer: Cofinity Commercial	$1,164.09
Rate for Payer: Cofinity Commercial	$1,430.16
Rate for Payer: Healthscope Commercial	$1,496.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,413.53
Rate for Payer: PHP Commercial	$1,413.53
Rate for Payer: Priority Health Cigna Priority Health	$1,164.09
Rate for Payer: Priority Health SBD	$1,047.68

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$13.75

Service Code	NDC 9900-0009-35
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$11.69
Rate for Payer: Aetna New Business (MI Preferred)	$8.94
Rate for Payer: Cash Price	$11.00
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Cofinity Commercial	$9.62
Rate for Payer: Healthscope Commercial	$12.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.69
Rate for Payer: PHP Commercial	$11.69
Rate for Payer: Priority Health Cigna Priority Health	$9.62
Rate for Payer: Priority Health SBD	$8.66

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,300.73

Service Code	NDC 60432-129-16
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$819.46
Max. Negotiated Rate	$1,170.66
Rate for Payer: Aetna Commercial	$1,105.62
Rate for Payer: Aetna New Business (MI Preferred)	$845.47
Rate for Payer: Cash Price	$1,040.58
Rate for Payer: Cofinity Commercial	$1,118.63
Rate for Payer: Cofinity Commercial	$910.51
Rate for Payer: Healthscope Commercial	$1,170.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,105.62
Rate for Payer: PHP Commercial	$1,105.62
Rate for Payer: Priority Health Cigna Priority Health	$910.51
Rate for Payer: Priority Health SBD	$819.46

CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION

Facility

$1,089.23

Service Code	NDC 51672-4047-9
Hospital Charge Code	109663
Hospital Revenue Code	637
Min. Negotiated Rate	$686.21
Max. Negotiated Rate	$980.31
Rate for Payer: Aetna Commercial	$925.85
Rate for Payer: Aetna New Business (MI Preferred)	$708.00
Rate for Payer: Cash Price	$871.38
Rate for Payer: Cofinity Commercial	$762.46
Rate for Payer: Cofinity Commercial	$936.74
Rate for Payer: Healthscope Commercial	$980.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$925.85
Rate for Payer: PHP Commercial	$925.85
Rate for Payer: Priority Health Cigna Priority Health	$762.46
Rate for Payer: Priority Health SBD	$686.21

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$312.55

Service Code	NDC 0904-3854-61
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$196.91
Max. Negotiated Rate	$281.30
Rate for Payer: Aetna Commercial	$265.67
Rate for Payer: Aetna New Business (MI Preferred)	$203.16
Rate for Payer: Cash Price	$250.04
Rate for Payer: Cofinity Commercial	$218.78
Rate for Payer: Cofinity Commercial	$268.79
Rate for Payer: Healthscope Commercial	$281.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$265.67
Rate for Payer: PHP Commercial	$265.67
Rate for Payer: Priority Health Cigna Priority Health	$218.78
Rate for Payer: Priority Health SBD	$196.91

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$313.50

Service Code	NDC 51079-870-20
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$282.15
Rate for Payer: Aetna Commercial	$266.48
Rate for Payer: Aetna New Business (MI Preferred)	$203.78
Rate for Payer: Cash Price	$250.80
Rate for Payer: Cofinity Commercial	$219.45
Rate for Payer: Cofinity Commercial	$269.61
Rate for Payer: Healthscope Commercial	$282.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$266.48
Rate for Payer: PHP Commercial	$266.48
Rate for Payer: Priority Health Cigna Priority Health	$219.45
Rate for Payer: Priority Health SBD	$197.50

CARBAMAZEPINE 100 MG CHEWABLE TABLET

Facility

$3.14

Service Code	NDC 51079-870-01
Hospital Charge Code	1355
Hospital Revenue Code	637
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$1.98

CARBAMAZEPINE 200 MG TABLET

Facility

$3.74

Service Code	NDC 51079-385-01
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.37
Rate for Payer: Aetna Commercial	$3.18
Rate for Payer: Aetna New Business (MI Preferred)	$2.43
Rate for Payer: Cash Price	$2.99
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Healthscope Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.18
Rate for Payer: PHP Commercial	$3.18
Rate for Payer: Priority Health Cigna Priority Health	$2.62
Rate for Payer: Priority Health SBD	$2.36

CARBAMAZEPINE 200 MG TABLET

Facility

$373.92

Service Code	NDC 51079-385-20
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$235.57
Max. Negotiated Rate	$336.53
Rate for Payer: Aetna Commercial	$317.83
Rate for Payer: Aetna New Business (MI Preferred)	$243.05
Rate for Payer: Cash Price	$299.14
Rate for Payer: Cofinity Commercial	$261.74
Rate for Payer: Cofinity Commercial	$321.57
Rate for Payer: Healthscope Commercial	$336.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$317.83
Rate for Payer: PHP Commercial	$317.83
Rate for Payer: Priority Health Cigna Priority Health	$261.74
Rate for Payer: Priority Health SBD	$235.57

CARBAMAZEPINE 200 MG TABLET

Facility

$1,006.03

Service Code	NDC 0078-0509-05
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$633.80
Max. Negotiated Rate	$905.43
Rate for Payer: Aetna Commercial	$855.13
Rate for Payer: Aetna New Business (MI Preferred)	$653.92
Rate for Payer: Cash Price	$804.82
Rate for Payer: Cofinity Commercial	$704.22
Rate for Payer: Cofinity Commercial	$865.19
Rate for Payer: Healthscope Commercial	$905.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$855.13
Rate for Payer: PHP Commercial	$855.13
Rate for Payer: Priority Health Cigna Priority Health	$704.22
Rate for Payer: Priority Health SBD	$633.80

CARBAMAZEPINE 200 MG TABLET

Facility

$361.00

Service Code	NDC 51672-4005-1
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$227.43
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna Commercial	$306.85
Rate for Payer: Aetna New Business (MI Preferred)	$234.65
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cofinity Commercial	$252.70
Rate for Payer: Cofinity Commercial	$310.46
Rate for Payer: Healthscope Commercial	$324.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$306.85
Rate for Payer: PHP Commercial	$306.85
Rate for Payer: Priority Health Cigna Priority Health	$252.70
Rate for Payer: Priority Health SBD	$227.43

CARBAMAZEPINE 200 MG TABLET

Facility

$244.32

Service Code	NDC 0904-6172-61
Hospital Charge Code	1357
Hospital Revenue Code	637
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$219.89
Rate for Payer: Aetna Commercial	$207.67
Rate for Payer: Aetna New Business (MI Preferred)	$158.81
Rate for Payer: Cash Price	$195.46
Rate for Payer: Cofinity Commercial	$171.02
Rate for Payer: Cofinity Commercial	$210.12
Rate for Payer: Healthscope Commercial	$219.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.67
Rate for Payer: PHP Commercial	$207.67
Rate for Payer: Priority Health Cigna Priority Health	$171.02
Rate for Payer: Priority Health SBD	$153.92

CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR

Facility

$895.68

Service Code	NDC 66993-407-32
Hospital Charge Code	37567
Hospital Revenue Code	637
Min. Negotiated Rate	$564.28
Max. Negotiated Rate	$806.11
Rate for Payer: Aetna Commercial	$761.33
Rate for Payer: Aetna New Business (MI Preferred)	$582.19
Rate for Payer: Cash Price	$716.54
Rate for Payer: Cofinity Commercial	$626.98
Rate for Payer: Cofinity Commercial	$770.28
Rate for Payer: Healthscope Commercial	$806.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$761.33
Rate for Payer: PHP Commercial	$761.33
Rate for Payer: Priority Health Cigna Priority Health	$626.98
Rate for Payer: Priority Health SBD	$564.28

CARBAMIDE PEROXIDE 6.5 % EAR DROPS

Facility

$22.75

Service Code	NDC 7811273623
Hospital Charge Code	1359
Hospital Revenue Code	637
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$20.48
Rate for Payer: Aetna Commercial	$19.34
Rate for Payer: Aetna New Business (MI Preferred)	$14.79
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cofinity Commercial	$15.92
Rate for Payer: Cofinity Commercial	$19.56
Rate for Payer: Healthscope Commercial	$20.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.34
Rate for Payer: PHP Commercial	$19.34
Rate for Payer: Priority Health Cigna Priority Health	$15.92
Rate for Payer: Priority Health SBD	$14.33

Know your out-of-pocket cost for care.

All Charges