Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CARIPRAZINE 3 MG CAPSULE

Facility

$4,738.15

Service Code	NDC 61874-130-30
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$2,985.03
Max. Negotiated Rate	$4,264.34
Rate for Payer: Aetna Commercial	$4,027.43
Rate for Payer: Aetna New Business (MI Preferred)	$3,079.80
Rate for Payer: Cash Price	$3,790.52
Rate for Payer: Cofinity Commercial	$3,316.70
Rate for Payer: Cofinity Commercial	$4,074.81
Rate for Payer: Healthscope Commercial	$4,264.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,027.43
Rate for Payer: PHP Commercial	$4,027.43
Rate for Payer: Priority Health Cigna Priority Health	$3,316.70
Rate for Payer: Priority Health SBD	$2,985.03

CARIPRAZINE 3 MG CAPSULE

Facility

$3,158.84

Service Code	NDC 61874-130-20
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$1,990.07
Max. Negotiated Rate	$2,842.96
Rate for Payer: Aetna Commercial	$2,685.01
Rate for Payer: Aetna New Business (MI Preferred)	$2,053.25
Rate for Payer: Cash Price	$2,527.07
Rate for Payer: Cofinity Commercial	$2,211.19
Rate for Payer: Cofinity Commercial	$2,716.60
Rate for Payer: Healthscope Commercial	$2,842.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,685.01
Rate for Payer: PHP Commercial	$2,685.01
Rate for Payer: Priority Health Cigna Priority Health	$2,211.19
Rate for Payer: Priority Health SBD	$1,990.07

CARIPRAZINE 3 MG CAPSULE

Facility

$1,579.42

Service Code	NDC 61874-130-11
Hospital Charge Code	177103
Hospital Revenue Code	637
Min. Negotiated Rate	$995.03
Max. Negotiated Rate	$1,421.48
Rate for Payer: Aetna Commercial	$1,342.51
Rate for Payer: Aetna New Business (MI Preferred)	$1,026.62
Rate for Payer: Cash Price	$1,263.54
Rate for Payer: Cofinity Commercial	$1,105.59
Rate for Payer: Cofinity Commercial	$1,358.30
Rate for Payer: Healthscope Commercial	$1,421.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,342.51
Rate for Payer: PHP Commercial	$1,342.51
Rate for Payer: Priority Health Cigna Priority Health	$1,105.59
Rate for Payer: Priority Health SBD	$995.03

CARIPRAZINE 4.5 MG CAPSULE

Facility

$4,738.15

Service Code	NDC 61874-145-30
Hospital Charge Code	177104
Hospital Revenue Code	637
Min. Negotiated Rate	$2,985.03
Max. Negotiated Rate	$4,264.34
Rate for Payer: Aetna Commercial	$4,027.43
Rate for Payer: Aetna New Business (MI Preferred)	$3,079.80
Rate for Payer: Cash Price	$3,790.52
Rate for Payer: Cofinity Commercial	$3,316.70
Rate for Payer: Cofinity Commercial	$4,074.81
Rate for Payer: Healthscope Commercial	$4,264.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,027.43
Rate for Payer: PHP Commercial	$4,027.43
Rate for Payer: Priority Health Cigna Priority Health	$3,316.70
Rate for Payer: Priority Health SBD	$2,985.03

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$37,530.13

Service Code	MS-DRG 035
Min. Negotiated Rate	$16,200.58
Max. Negotiated Rate	$37,530.13
Rate for Payer: Aetna Medicare	$17,735.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,316.55
Rate for Payer: Amish Plain Church Group Commercial	$21,316.55
Rate for Payer: BCBS MAPPO	$17,053.24
Rate for Payer: BCBS Trust/PPO	$37,530.13
Rate for Payer: BCN Medicare Advantage	$17,053.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,053.24
Rate for Payer: Mclaren Medicare	$17,053.24
Rate for Payer: Meridian Wellcare - Medicare Advantage	$17,905.90
Rate for Payer: MI Amish Medical Board Commercial	$19,611.23
Rate for Payer: PACE Medicare	$16,200.58
Rate for Payer: PACE SWMI	$17,053.24
Rate for Payer: PHP Medicare Advantage	$17,053.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$32,997.64
Rate for Payer: Priority Health Medicare	$17,053.24
Rate for Payer: Priority Health Narrow Network	$26,398.11
Rate for Payer: Railroad Medicare Medicare	$17,053.24
Rate for Payer: UHC All Payor (Choice/PPO)	$35,076.57
Rate for Payer: UHC Core	$21,523.32
Rate for Payer: UHC Dual Complete DSNP	$17,053.24
Rate for Payer: UHC Exchange	$23,052.49
Rate for Payer: UHC Medicare Advantage	$17,564.84
Rate for Payer: VA VA	$17,053.24

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$59,511.96

Service Code	MS-DRG 034
Min. Negotiated Rate	$27,160.31
Max. Negotiated Rate	$59,511.96
Rate for Payer: Aetna Medicare	$29,733.39
Rate for Payer: Allen County Amish Medical Aid Commercial	$35,737.25
Rate for Payer: Amish Plain Church Group Commercial	$35,737.25
Rate for Payer: BCBS MAPPO	$28,589.80
Rate for Payer: BCBS Trust/PPO	$58,628.33
Rate for Payer: BCN Medicare Advantage	$28,589.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$28,589.80
Rate for Payer: Mclaren Medicare	$28,589.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$30,019.29
Rate for Payer: MI Amish Medical Board Commercial	$32,878.27
Rate for Payer: PACE Medicare	$27,160.31
Rate for Payer: PACE SWMI	$28,589.80
Rate for Payer: PHP Medicare Advantage	$28,589.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55,984.78
Rate for Payer: Priority Health Medicare	$28,589.80
Rate for Payer: Priority Health Narrow Network	$44,787.82
Rate for Payer: Railroad Medicare Medicare	$28,589.80
Rate for Payer: UHC All Payor (Choice/PPO)	$59,511.96
Rate for Payer: UHC Core	$36,517.10
Rate for Payer: UHC Dual Complete DSNP	$28,589.80
Rate for Payer: UHC Exchange	$39,111.54
Rate for Payer: UHC Medicare Advantage	$29,447.49
Rate for Payer: VA VA	$28,589.80

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$27,716.65

Service Code	MS-DRG 036
Min. Negotiated Rate	$12,839.27
Max. Negotiated Rate	$27,716.65
Rate for Payer: Aetna Medicare	$14,055.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,893.78
Rate for Payer: Amish Plain Church Group Commercial	$16,893.78
Rate for Payer: BCBS MAPPO	$13,515.02
Rate for Payer: BCBS Trust/PPO	$27,716.65
Rate for Payer: BCN Medicare Advantage	$13,515.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,515.02
Rate for Payer: Mclaren Medicare	$13,515.02
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14,190.77
Rate for Payer: MI Amish Medical Board Commercial	$15,542.27
Rate for Payer: PACE Medicare	$12,839.27
Rate for Payer: PACE SWMI	$13,515.02
Rate for Payer: PHP Medicare Advantage	$13,515.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25,947.53
Rate for Payer: Priority Health Medicare	$13,515.02
Rate for Payer: Priority Health Narrow Network	$20,758.02
Rate for Payer: Railroad Medicare Medicare	$13,515.02
Rate for Payer: UHC All Payor (Choice/PPO)	$27,582.28
Rate for Payer: UHC Core	$16,924.75
Rate for Payer: UHC Dual Complete DSNP	$13,515.02
Rate for Payer: UHC Exchange	$18,127.21
Rate for Payer: UHC Medicare Advantage	$13,920.47
Rate for Payer: VA VA	$13,515.02

CARVEDILOL 12.5 MG TABLET

Facility

$180.95

Service Code	NDC 0904-6302-61
Hospital Charge Code	15749
Hospital Revenue Code	637
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$162.86
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Cofinity Commercial	$126.66
Rate for Payer: Healthscope Commercial	$162.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$126.66
Rate for Payer: Priority Health SBD	$114.00

CARVEDILOL 12.5 MG TABLET

Facility

$204.45

Service Code	NDC 51079-931-20
Hospital Charge Code	15749
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	$175.83
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$143.12
Rate for Payer: Priority Health SBD	$128.80

CARVEDILOL 25 MG TABLET

Facility

$180.95

Service Code	NDC 0904-6303-61
Hospital Charge Code	15748
Hospital Revenue Code	637
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$162.86
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$126.66
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Healthscope Commercial	$162.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$126.66
Rate for Payer: Priority Health SBD	$114.00

CARVEDILOL 3.125 MG TABLET

Facility

$185.65

Service Code	NDC 51079-771-20
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$116.96
Max. Negotiated Rate	$167.08
Rate for Payer: Aetna Commercial	$157.80
Rate for Payer: Aetna New Business (MI Preferred)	$120.67
Rate for Payer: Cash Price	$148.52
Rate for Payer: Cofinity Commercial	$129.96
Rate for Payer: Cofinity Commercial	$159.66
Rate for Payer: Healthscope Commercial	$167.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$157.80
Rate for Payer: PHP Commercial	$157.80
Rate for Payer: Priority Health Cigna Priority Health	$129.96
Rate for Payer: Priority Health SBD	$116.96

CARVEDILOL 3.125 MG TABLET

Facility

$129.25

Service Code	NDC 68462-162-01
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$81.43
Max. Negotiated Rate	$116.32
Rate for Payer: Aetna Commercial	$109.86
Rate for Payer: Aetna New Business (MI Preferred)	$84.01
Rate for Payer: Cash Price	$103.40
Rate for Payer: Cofinity Commercial	$111.16
Rate for Payer: Cofinity Commercial	$90.48
Rate for Payer: Healthscope Commercial	$116.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$109.86
Rate for Payer: PHP Commercial	$109.86
Rate for Payer: Priority Health Cigna Priority Health	$90.48
Rate for Payer: Priority Health SBD	$81.43

CARVEDILOL 3.125 MG TABLET

Facility

$180.95

Service Code	NDC 0904-6300-61
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$162.86
Rate for Payer: Aetna Commercial	$153.81
Rate for Payer: Aetna New Business (MI Preferred)	$117.62
Rate for Payer: Cash Price	$144.76
Rate for Payer: Cofinity Commercial	$126.66
Rate for Payer: Cofinity Commercial	$155.62
Rate for Payer: Healthscope Commercial	$162.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.81
Rate for Payer: PHP Commercial	$153.81
Rate for Payer: Priority Health Cigna Priority Health	$126.66
Rate for Payer: Priority Health SBD	$114.00

CARVEDILOL 3.125 MG TABLET

Facility

$220.90

Service Code	NDC 43547-254-10
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$139.17
Max. Negotiated Rate	$198.81
Rate for Payer: Aetna Commercial	$187.76
Rate for Payer: Aetna New Business (MI Preferred)	$143.58
Rate for Payer: Cash Price	$176.72
Rate for Payer: Cofinity Commercial	$154.63
Rate for Payer: Cofinity Commercial	$189.97
Rate for Payer: Healthscope Commercial	$198.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.76
Rate for Payer: PHP Commercial	$187.76
Rate for Payer: Priority Health Cigna Priority Health	$154.63
Rate for Payer: Priority Health SBD	$139.17

CARVEDILOL 3.125 MG TABLET

Facility

$1.86

Service Code	NDC 51079-771-01
Hospital Charge Code	18551
Hospital Revenue Code	637
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.67
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna New Business (MI Preferred)	$1.21
Rate for Payer: Cash Price	$1.49
Rate for Payer: Cofinity Commercial	$1.30
Rate for Payer: Cofinity Commercial	$1.60
Rate for Payer: Healthscope Commercial	$1.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.58
Rate for Payer: PHP Commercial	$1.58
Rate for Payer: Priority Health Cigna Priority Health	$1.30
Rate for Payer: Priority Health SBD	$1.17

CARVEDILOL 6.25 MG TABLET

Facility

$220.90

Service Code	NDC 43547-255-10
Hospital Charge Code	15747
Hospital Revenue Code	637
Min. Negotiated Rate	$139.17
Max. Negotiated Rate	$198.81
Rate for Payer: Aetna Commercial	$187.76
Rate for Payer: Aetna New Business (MI Preferred)	$143.58
Rate for Payer: Cash Price	$176.72
Rate for Payer: Cofinity Commercial	$154.63
Rate for Payer: Cofinity Commercial	$189.97
Rate for Payer: Healthscope Commercial	$198.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.76
Rate for Payer: PHP Commercial	$187.76
Rate for Payer: Priority Health Cigna Priority Health	$154.63
Rate for Payer: Priority Health SBD	$139.17

CARVEDILOL 6.25 MG TABLET

Facility

$987.00

Service Code	NDC 43547-255-50
Hospital Charge Code	15747
Hospital Revenue Code	637
Min. Negotiated Rate	$621.81
Max. Negotiated Rate	$888.30
Rate for Payer: Aetna Commercial	$838.95
Rate for Payer: Aetna New Business (MI Preferred)	$641.55
Rate for Payer: Cash Price	$789.60
Rate for Payer: Cofinity Commercial	$848.82
Rate for Payer: Cofinity Commercial	$690.90
Rate for Payer: Healthscope Commercial	$888.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$838.95
Rate for Payer: PHP Commercial	$838.95
Rate for Payer: Priority Health Cigna Priority Health	$690.90
Rate for Payer: Priority Health SBD	$621.81

CARVEDILOL 6.25 MG TABLET

Facility

$185.65

Service Code	NDC 0904-6301-61
Hospital Charge Code	15747
Hospital Revenue Code	637
Min. Negotiated Rate	$116.96
Max. Negotiated Rate	$167.08
Rate for Payer: Aetna Commercial	$157.80
Rate for Payer: Aetna New Business (MI Preferred)	$120.67
Rate for Payer: Cash Price	$148.52
Rate for Payer: Cofinity Commercial	$129.96
Rate for Payer: Cofinity Commercial	$159.66
Rate for Payer: Healthscope Commercial	$167.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$157.80
Rate for Payer: PHP Commercial	$157.80
Rate for Payer: Priority Health Cigna Priority Health	$129.96
Rate for Payer: Priority Health SBD	$116.96

CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRAST MATERIAL FOR SALINE INFUSION SONOHYSTEROGRAPHY (SIS) OR HYSTEROSALPINGOGRAPHY

Facility

$878.00

Service Code	CPT 58340
Hospital Revenue Code	361
Min. Negotiated Rate	$56.65
Max. Negotiated Rate	$878.00
Rate for Payer: BCBS Trust/PPO	$288.45
Rate for Payer: UHC All Payor (Choice/PPO)	$62.32
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$56.65

CAUTERY OF CERVIX; ELECTRO OR THERMAL

Facility

$4,155.00

Service Code	CPT 57510
Hospital Revenue Code	360
Min. Negotiated Rate	$42.07
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Medicare	$2,893.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,477.26
Rate for Payer: Amish Plain Church Group Commercial	$3,477.26
Rate for Payer: BCBS Complete	$1,597.87
Rate for Payer: BCBS MAPPO	$2,781.81
Rate for Payer: BCBS Trust/PPO	$42.07
Rate for Payer: BCN Medicare Advantage	$2,781.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,781.81
Rate for Payer: Mclaren Medicaid	$1,521.65
Rate for Payer: Mclaren Medicare	$2,781.81
Rate for Payer: Meridian Medicaid	$1,597.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,920.90
Rate for Payer: MI Amish Medical Board Commercial	$3,199.08
Rate for Payer: PACE Medicare	$2,642.72
Rate for Payer: PACE SWMI	$2,781.81
Rate for Payer: PHP Medicare Advantage	$2,781.81
Rate for Payer: Priority Health Choice Medicaid	$1,521.65
Rate for Payer: Priority Health Medicare	$2,781.81
Rate for Payer: Railroad Medicare Medicare	$2,781.81
Rate for Payer: UHC All Payor (Choice/PPO)	$122.83
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,781.81
Rate for Payer: UHC Exchange	$111.66
Rate for Payer: UHC Medicare Advantage	$2,865.26
Rate for Payer: VA VA	$2,781.81

CEFAZOLIN 100 GRAM SOLUTION FOR INJECTION

Facility

$301.75

Service Code	HCPCS J0690
Hospital Charge Code	31086
Hospital Revenue Code	636
Min. Negotiated Rate	$190.10
Max. Negotiated Rate	$271.58
Rate for Payer: Aetna Commercial	$256.49
Rate for Payer: Aetna New Business (MI Preferred)	$196.14
Rate for Payer: Cash Price	$241.40
Rate for Payer: Cofinity Commercial	$211.22
Rate for Payer: Cofinity Commercial	$259.50
Rate for Payer: Healthscope Commercial	$271.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$256.49
Rate for Payer: PHP Commercial	$256.49
Rate for Payer: Priority Health Cigna Priority Health	$211.22
Rate for Payer: Priority Health SBD	$190.10

CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION

Facility

$49.67

Service Code	HCPCS J0690
Hospital Charge Code	1446
Hospital Revenue Code	636
Min. Negotiated Rate	$31.29
Max. Negotiated Rate	$44.70
Rate for Payer: Aetna Commercial	$42.22
Rate for Payer: Aetna Commercial	$24.71
Rate for Payer: Aetna New Business (MI Preferred)	$18.90
Rate for Payer: Aetna New Business (MI Preferred)	$32.29
Rate for Payer: Cash Price	$39.74
Rate for Payer: Cash Price	$23.26
Rate for Payer: Cofinity Commercial	$34.77
Rate for Payer: Cofinity Commercial	$20.35
Rate for Payer: Cofinity Commercial	$25.00
Rate for Payer: Cofinity Commercial	$42.72
Rate for Payer: Healthscope Commercial	$26.16
Rate for Payer: Healthscope Commercial	$44.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.22
Rate for Payer: PHP Commercial	$42.22
Rate for Payer: PHP Commercial	$24.71
Rate for Payer: Priority Health Cigna Priority Health	$20.35
Rate for Payer: Priority Health Cigna Priority Health	$34.77
Rate for Payer: Priority Health SBD	$18.31
Rate for Payer: Priority Health SBD	$31.29

CEFAZOLIN 1 GRAM INTRAVENOUS SOLUTION

Facility

$15.83

Service Code	HCPCS J0690
Hospital Charge Code	27297
Hospital Revenue Code	636
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna New Business (MI Preferred)	$10.29
Rate for Payer: Cash Price	$12.66
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$13.61
Rate for Payer: Healthscope Commercial	$14.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.46
Rate for Payer: PHP Commercial	$13.46
Rate for Payer: Priority Health Cigna Priority Health	$11.08
Rate for Payer: Priority Health SBD	$9.97

CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION

Facility

$13.95

Service Code	HCPCS J0690
Hospital Charge Code	1445
Hospital Revenue Code	636
Min. Negotiated Rate	$8.79
Max. Negotiated Rate	$12.56
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Commercial	$16.50
Rate for Payer: Aetna New Business (MI Preferred)	$9.07
Rate for Payer: Aetna New Business (MI Preferred)	$8.75
Rate for Payer: Aetna New Business (MI Preferred)	$12.62
Rate for Payer: Cash Price	$11.16
Rate for Payer: Cash Price	$10.77
Rate for Payer: Cash Price	$15.53
Rate for Payer: Cofinity Commercial	$9.42
Rate for Payer: Cofinity Commercial	$11.58
Rate for Payer: Cofinity Commercial	$12.00
Rate for Payer: Cofinity Commercial	$9.76
Rate for Payer: Cofinity Commercial	$16.69
Rate for Payer: Cofinity Commercial	$13.59
Rate for Payer: Healthscope Commercial	$12.11
Rate for Payer: Healthscope Commercial	$12.56
Rate for Payer: Healthscope Commercial	$17.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.86
Rate for Payer: PHP Commercial	$16.50
Rate for Payer: PHP Commercial	$11.44
Rate for Payer: PHP Commercial	$11.86
Rate for Payer: Priority Health Cigna Priority Health	$9.76
Rate for Payer: Priority Health Cigna Priority Health	$9.42
Rate for Payer: Priority Health Cigna Priority Health	$13.59
Rate for Payer: Priority Health SBD	$8.48
Rate for Payer: Priority Health SBD	$12.23
Rate for Payer: Priority Health SBD	$8.79

CEFAZOLIN 3 GM IVPB 50 ML (IV PREMIX)

Facility

$63.80

Service Code	HCPCS J0690
Hospital Charge Code	168912
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$57.42
Rate for Payer: Aetna Commercial	$54.23
Rate for Payer: Aetna New Business (MI Preferred)	$41.47
Rate for Payer: Cash Price	$51.04
Rate for Payer: Cofinity Commercial	$44.66
Rate for Payer: Cofinity Commercial	$54.87
Rate for Payer: Healthscope Commercial	$57.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.23
Rate for Payer: PHP Commercial	$54.23
Rate for Payer: Priority Health Cigna Priority Health	$44.66
Rate for Payer: Priority Health SBD	$40.19

Know your out-of-pocket cost for care.

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