Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION

Facility

$28.84

Service Code	HCPCS J0713
Hospital Charge Code	9476
Hospital Revenue Code	636
Min. Negotiated Rate	$18.17
Max. Negotiated Rate	$25.96
Rate for Payer: Aetna Commercial	$24.51
Rate for Payer: Aetna Commercial	$31.66
Rate for Payer: Aetna New Business (MI Preferred)	$18.75
Rate for Payer: Aetna New Business (MI Preferred)	$24.21
Rate for Payer: Cash Price	$29.80
Rate for Payer: Cash Price	$23.07
Rate for Payer: Cofinity Commercial	$32.04
Rate for Payer: Cofinity Commercial	$24.80
Rate for Payer: Cofinity Commercial	$26.08
Rate for Payer: Cofinity Commercial	$20.19
Rate for Payer: Healthscope Commercial	$33.52
Rate for Payer: Healthscope Commercial	$25.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.66
Rate for Payer: PHP Commercial	$24.51
Rate for Payer: PHP Commercial	$31.66
Rate for Payer: Priority Health Cigna Priority Health	$26.08
Rate for Payer: Priority Health Cigna Priority Health	$20.19
Rate for Payer: Priority Health SBD	$18.17
Rate for Payer: Priority Health SBD	$23.47

CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION

Facility

$1,176.68

Service Code	HCPCS J0714
Hospital Charge Code	161545
Hospital Revenue Code	636
Min. Negotiated Rate	$741.31
Max. Negotiated Rate	$1,059.01
Rate for Payer: Aetna Commercial	$1,000.18
Rate for Payer: Aetna New Business (MI Preferred)	$764.84
Rate for Payer: Cash Price	$941.34
Rate for Payer: Cofinity Commercial	$1,011.94
Rate for Payer: Cofinity Commercial	$823.68
Rate for Payer: Healthscope Commercial	$1,059.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,000.18
Rate for Payer: PHP Commercial	$1,000.18
Rate for Payer: Priority Health Cigna Priority Health	$823.68
Rate for Payer: Priority Health SBD	$741.31

CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION

Facility

$411.89

Service Code	HCPCS J0695
Hospital Charge Code	173413
Hospital Revenue Code	636
Min. Negotiated Rate	$259.49
Max. Negotiated Rate	$370.70
Rate for Payer: Aetna Commercial	$350.11
Rate for Payer: Aetna New Business (MI Preferred)	$267.73
Rate for Payer: Cash Price	$329.51
Rate for Payer: Cofinity Commercial	$288.32
Rate for Payer: Cofinity Commercial	$354.23
Rate for Payer: Healthscope Commercial	$370.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$350.11
Rate for Payer: PHP Commercial	$350.11
Rate for Payer: Priority Health Cigna Priority Health	$288.32
Rate for Payer: Priority Health SBD	$259.49

CEFTRIAXONE 100 GRAM SOLUTION FOR INJECTION

Facility

$2,175.00

Service Code	HCPCS J0696
Hospital Charge Code	78580
Hospital Revenue Code	636
Min. Negotiated Rate	$1,370.25
Max. Negotiated Rate	$1,957.50
Rate for Payer: Aetna Commercial	$1,848.75
Rate for Payer: Aetna New Business (MI Preferred)	$1,413.75
Rate for Payer: Cash Price	$1,740.00
Rate for Payer: Cofinity Commercial	$1,522.50
Rate for Payer: Cofinity Commercial	$1,870.50
Rate for Payer: Healthscope Commercial	$1,957.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,848.75
Rate for Payer: PHP Commercial	$1,848.75
Rate for Payer: Priority Health Cigna Priority Health	$1,522.50
Rate for Payer: Priority Health SBD	$1,370.25

CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION

Facility

$40.72

Service Code	HCPCS J0696
Hospital Charge Code	9491
Hospital Revenue Code	636
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$36.65
Rate for Payer: Aetna Commercial	$34.61
Rate for Payer: Aetna Commercial	$57.69
Rate for Payer: Aetna Commercial	$44.15
Rate for Payer: Aetna New Business (MI Preferred)	$26.47
Rate for Payer: Aetna New Business (MI Preferred)	$33.76
Rate for Payer: Aetna New Business (MI Preferred)	$44.12
Rate for Payer: Cash Price	$41.55
Rate for Payer: Cash Price	$32.58
Rate for Payer: Cash Price	$54.30
Rate for Payer: Cofinity Commercial	$58.37
Rate for Payer: Cofinity Commercial	$36.36
Rate for Payer: Cofinity Commercial	$35.02
Rate for Payer: Cofinity Commercial	$44.67
Rate for Payer: Cofinity Commercial	$47.51
Rate for Payer: Cofinity Commercial	$28.50
Rate for Payer: Healthscope Commercial	$36.65
Rate for Payer: Healthscope Commercial	$46.75
Rate for Payer: Healthscope Commercial	$61.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$44.15
Rate for Payer: PHP Commercial	$57.69
Rate for Payer: PHP Commercial	$34.61
Rate for Payer: PHP Commercial	$44.15
Rate for Payer: Priority Health Cigna Priority Health	$36.36
Rate for Payer: Priority Health Cigna Priority Health	$28.50
Rate for Payer: Priority Health Cigna Priority Health	$47.51
Rate for Payer: Priority Health SBD	$25.65
Rate for Payer: Priority Health SBD	$32.72
Rate for Payer: Priority Health SBD	$42.76

CEFTRIAXONE 1 GM IV SYRINGE

Facility

$17.98

Service Code	HCPCS J0696
Hospital Charge Code	500542
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$16.18
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna New Business (MI Preferred)	$11.69
Rate for Payer: BCBS Complete	$7.19
Rate for Payer: BCBS Trust/PPO	$1.45
Rate for Payer: Cash Price	$14.38
Rate for Payer: Cash Price	$14.38
Rate for Payer: Cofinity Commercial	$12.59
Rate for Payer: Cofinity Commercial	$15.46
Rate for Payer: Healthscope Commercial	$16.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.28
Rate for Payer: PHP Commercial	$15.28
Rate for Payer: Priority Health Cigna Priority Health	$12.59
Rate for Payer: Priority Health SBD	$11.33

CEFTRIAXONE 1 GM IV SYRINGE

Facility

$17.98

Service Code	HCPCS J0696
Hospital Charge Code	500542
Hospital Revenue Code	636
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$16.18
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna New Business (MI Preferred)	$11.69
Rate for Payer: Cash Price	$14.38
Rate for Payer: Cofinity Commercial	$12.59
Rate for Payer: Cofinity Commercial	$15.46
Rate for Payer: Healthscope Commercial	$16.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.28
Rate for Payer: PHP Commercial	$15.28
Rate for Payer: Priority Health Cigna Priority Health	$12.59
Rate for Payer: Priority Health SBD	$11.33

CEFTRIAXONE 1 GRAM CUSTOM IM SOLUTION

Facility

$17.80

Service Code	HCPCS J0696
Hospital Charge Code	150848
Hospital Revenue Code	636
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$16.02
Rate for Payer: Aetna Commercial	$15.13
Rate for Payer: Aetna New Business (MI Preferred)	$11.57
Rate for Payer: Cash Price	$14.24
Rate for Payer: Cofinity Commercial	$12.46
Rate for Payer: Cofinity Commercial	$15.31
Rate for Payer: Healthscope Commercial	$16.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.13
Rate for Payer: PHP Commercial	$15.13
Rate for Payer: Priority Health Cigna Priority Health	$12.46
Rate for Payer: Priority Health SBD	$11.21

CEFTRIAXONE 1 GRAM CUSTOM SOLUTION FOR DESENSITIZATION

Facility

$17.98

Service Code	HCPCS J0696
Hospital Charge Code	180569
Hospital Revenue Code	636
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$16.18
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna New Business (MI Preferred)	$11.69
Rate for Payer: Cash Price	$14.38
Rate for Payer: Cofinity Commercial	$12.59
Rate for Payer: Cofinity Commercial	$15.46
Rate for Payer: Healthscope Commercial	$16.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.28
Rate for Payer: PHP Commercial	$15.28
Rate for Payer: Priority Health Cigna Priority Health	$12.59
Rate for Payer: Priority Health SBD	$11.33

CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION

Facility

$18.88

Service Code	HCPCS J0696
Hospital Charge Code	9487
Hospital Revenue Code	636
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$16.99
Rate for Payer: Aetna Commercial	$16.05
Rate for Payer: Aetna Commercial	$11.28
Rate for Payer: Aetna Commercial	$19.72
Rate for Payer: Aetna New Business (MI Preferred)	$8.63
Rate for Payer: Aetna New Business (MI Preferred)	$12.27
Rate for Payer: Aetna New Business (MI Preferred)	$15.08
Rate for Payer: Cash Price	$18.56
Rate for Payer: Cash Price	$10.62
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$19.95
Rate for Payer: Cofinity Commercial	$16.24
Rate for Payer: Cofinity Commercial	$9.29
Rate for Payer: Cofinity Commercial	$16.24
Rate for Payer: Cofinity Commercial	$11.41
Rate for Payer: Cofinity Commercial	$13.22
Rate for Payer: Healthscope Commercial	$20.88
Rate for Payer: Healthscope Commercial	$11.94
Rate for Payer: Healthscope Commercial	$16.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.72
Rate for Payer: PHP Commercial	$19.72
Rate for Payer: PHP Commercial	$11.28
Rate for Payer: PHP Commercial	$16.05
Rate for Payer: Priority Health Cigna Priority Health	$13.22
Rate for Payer: Priority Health Cigna Priority Health	$9.29
Rate for Payer: Priority Health Cigna Priority Health	$16.24
Rate for Payer: Priority Health SBD	$8.36
Rate for Payer: Priority Health SBD	$14.62
Rate for Payer: Priority Health SBD	$11.89

CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION

Facility

$13.27

Service Code	HCPCS J0696
Hospital Charge Code	9487
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$11.94
Rate for Payer: Aetna Commercial	$11.28
Rate for Payer: Aetna New Business (MI Preferred)	$8.63
Rate for Payer: BCBS Complete	$5.31
Rate for Payer: BCBS Trust/PPO	$1.45
Rate for Payer: Cash Price	$10.62
Rate for Payer: Cash Price	$10.62
Rate for Payer: Cofinity Commercial	$11.41
Rate for Payer: Cofinity Commercial	$9.29
Rate for Payer: Healthscope Commercial	$11.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.28
Rate for Payer: PHP Commercial	$11.28
Rate for Payer: Priority Health Cigna Priority Health	$9.29
Rate for Payer: Priority Health SBD	$8.36

CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION

Facility

$16.65

Service Code	HCPCS J0696
Hospital Charge Code	9488
Hospital Revenue Code	636
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$14.98
Rate for Payer: Aetna Commercial	$14.15
Rate for Payer: Aetna Commercial	$14.00
Rate for Payer: Aetna Commercial	$21.25
Rate for Payer: Aetna Commercial	$18.92
Rate for Payer: Aetna New Business (MI Preferred)	$14.47
Rate for Payer: Aetna New Business (MI Preferred)	$16.25
Rate for Payer: Aetna New Business (MI Preferred)	$10.71
Rate for Payer: Aetna New Business (MI Preferred)	$10.82
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$17.81
Rate for Payer: Cash Price	$13.32
Rate for Payer: Cash Price	$13.18
Rate for Payer: Cofinity Commercial	$11.53
Rate for Payer: Cofinity Commercial	$19.14
Rate for Payer: Cofinity Commercial	$21.50
Rate for Payer: Cofinity Commercial	$11.66
Rate for Payer: Cofinity Commercial	$14.32
Rate for Payer: Cofinity Commercial	$17.50
Rate for Payer: Cofinity Commercial	$15.58
Rate for Payer: Cofinity Commercial	$14.16
Rate for Payer: Healthscope Commercial	$14.82
Rate for Payer: Healthscope Commercial	$22.50
Rate for Payer: Healthscope Commercial	$20.03
Rate for Payer: Healthscope Commercial	$14.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.25
Rate for Payer: PHP Commercial	$21.25
Rate for Payer: PHP Commercial	$14.15
Rate for Payer: PHP Commercial	$18.92
Rate for Payer: PHP Commercial	$14.00
Rate for Payer: Priority Health Cigna Priority Health	$11.53
Rate for Payer: Priority Health Cigna Priority Health	$17.50
Rate for Payer: Priority Health Cigna Priority Health	$11.66
Rate for Payer: Priority Health Cigna Priority Health	$15.58
Rate for Payer: Priority Health SBD	$15.75
Rate for Payer: Priority Health SBD	$14.02
Rate for Payer: Priority Health SBD	$10.49
Rate for Payer: Priority Health SBD	$10.38

CEFTRIAXONE 500 MG SOLUTION FOR INJECTION

Facility

$3.04

Service Code	HCPCS J0696
Hospital Charge Code	9490
Hospital Revenue Code	636
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna Commercial	$2.58
Rate for Payer: Aetna New Business (MI Preferred)	$1.98
Rate for Payer: Cash Price	$2.43
Rate for Payer: Cofinity Commercial	$2.13
Rate for Payer: Cofinity Commercial	$2.61
Rate for Payer: Healthscope Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.58
Rate for Payer: PHP Commercial	$2.58
Rate for Payer: Priority Health Cigna Priority Health	$2.13
Rate for Payer: Priority Health SBD	$1.92

CEFTRIAXONE IV 0.01 MG/ML SYRINGE FOR DESENSITIZATION

Facility

$0.25

Service Code	HCPCS J0696
Hospital Charge Code	180547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna Commercial	$0.21
Rate for Payer: Aetna New Business (MI Preferred)	$0.16
Rate for Payer: Cash Price	$0.20
Rate for Payer: Cofinity Commercial	$0.18
Rate for Payer: Cofinity Commercial	$0.22
Rate for Payer: Healthscope Commercial	$0.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.21
Rate for Payer: PHP Commercial	$0.21
Rate for Payer: Priority Health Cigna Priority Health	$0.18
Rate for Payer: Priority Health SBD	$0.16

CEFTRIAXONE IV 0.1 MG/ML SYRINGE FOR DESENSITIZATION

Facility

$3.25

Service Code	HCPCS J0696
Hospital Charge Code	180546
Hospital Revenue Code	636
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$2.76
Rate for Payer: Aetna New Business (MI Preferred)	$2.11
Rate for Payer: Cash Price	$2.60
Rate for Payer: Cofinity Commercial	$2.28
Rate for Payer: Cofinity Commercial	$2.80
Rate for Payer: Healthscope Commercial	$2.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.76
Rate for Payer: PHP Commercial	$2.76
Rate for Payer: Priority Health Cigna Priority Health	$2.28
Rate for Payer: Priority Health SBD	$2.05

CELECOXIB 100 MG CAPSULE

Facility

$807.71

Service Code	NDC 51079-199-20
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$508.86
Max. Negotiated Rate	$726.94
Rate for Payer: Aetna Commercial	$686.55
Rate for Payer: Aetna New Business (MI Preferred)	$525.01
Rate for Payer: Cash Price	$646.17
Rate for Payer: Cofinity Commercial	$565.40
Rate for Payer: Cofinity Commercial	$694.63
Rate for Payer: Healthscope Commercial	$726.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$686.55
Rate for Payer: PHP Commercial	$686.55
Rate for Payer: Priority Health Cigna Priority Health	$565.40
Rate for Payer: Priority Health SBD	$508.86

CELECOXIB 100 MG CAPSULE

Facility

$356.16

Service Code	NDC 0904-6502-61
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$224.38
Max. Negotiated Rate	$320.54
Rate for Payer: Aetna Commercial	$302.74
Rate for Payer: Aetna New Business (MI Preferred)	$231.50
Rate for Payer: Cash Price	$284.93
Rate for Payer: Cofinity Commercial	$249.31
Rate for Payer: Cofinity Commercial	$306.30
Rate for Payer: Healthscope Commercial	$320.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$302.74
Rate for Payer: PHP Commercial	$302.74
Rate for Payer: Priority Health Cigna Priority Health	$249.31
Rate for Payer: Priority Health SBD	$224.38

CELECOXIB 100 MG CAPSULE

Facility

$8.08

Service Code	NDC 51079-199-01
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna New Business (MI Preferred)	$5.25
Rate for Payer: Cash Price	$6.46
Rate for Payer: Cofinity Commercial	$5.66
Rate for Payer: Cofinity Commercial	$6.95
Rate for Payer: Healthscope Commercial	$7.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.87
Rate for Payer: PHP Commercial	$6.87
Rate for Payer: Priority Health Cigna Priority Health	$5.66
Rate for Payer: Priority Health SBD	$5.09

CELECOXIB 100 MG CAPSULE

Facility

$3,280.05

Service Code	NDC 0025-1520-31
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$2,066.43
Max. Negotiated Rate	$2,952.04
Rate for Payer: Aetna Commercial	$2,788.04
Rate for Payer: Aetna New Business (MI Preferred)	$2,132.03
Rate for Payer: Cash Price	$2,624.04
Rate for Payer: Cofinity Commercial	$2,296.04
Rate for Payer: Cofinity Commercial	$2,820.84
Rate for Payer: Healthscope Commercial	$2,952.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,788.04
Rate for Payer: PHP Commercial	$2,788.04
Rate for Payer: Priority Health Cigna Priority Health	$2,296.04
Rate for Payer: Priority Health SBD	$2,066.43

CELECOXIB 100 MG CAPSULE

Facility

$265.92

Service Code	NDC 59762-1516-1
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$167.53
Max. Negotiated Rate	$239.33
Rate for Payer: Aetna Commercial	$226.03
Rate for Payer: Aetna New Business (MI Preferred)	$172.85
Rate for Payer: Cash Price	$212.74
Rate for Payer: Cofinity Commercial	$186.14
Rate for Payer: Cofinity Commercial	$228.69
Rate for Payer: Healthscope Commercial	$239.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$226.03
Rate for Payer: PHP Commercial	$226.03
Rate for Payer: Priority Health Cigna Priority Health	$186.14
Rate for Payer: Priority Health SBD	$167.53

CELECOXIB 200 MG CAPSULE

Facility

$5.99

Service Code	NDC 60687-447-11
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna Commercial	$5.09
Rate for Payer: Aetna New Business (MI Preferred)	$3.89
Rate for Payer: Cash Price	$4.79
Rate for Payer: Cofinity Commercial	$4.19
Rate for Payer: Cofinity Commercial	$5.15
Rate for Payer: Healthscope Commercial	$5.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.09
Rate for Payer: PHP Commercial	$5.09
Rate for Payer: Priority Health Cigna Priority Health	$4.19
Rate for Payer: Priority Health SBD	$3.77

CELECOXIB 200 MG CAPSULE

Facility

$5,380.17

Service Code	NDC 0025-1525-34
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$3,389.51
Max. Negotiated Rate	$4,842.15
Rate for Payer: Aetna Commercial	$4,573.14
Rate for Payer: Aetna New Business (MI Preferred)	$3,497.11
Rate for Payer: Cash Price	$4,304.14
Rate for Payer: Cofinity Commercial	$3,766.12
Rate for Payer: Cofinity Commercial	$4,626.95
Rate for Payer: Healthscope Commercial	$4,842.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,573.14
Rate for Payer: PHP Commercial	$4,573.14
Rate for Payer: Priority Health Cigna Priority Health	$3,766.12
Rate for Payer: Priority Health SBD	$3,389.51

CELECOXIB 200 MG CAPSULE

Facility

$4.23

Service Code	NDC 50268-169-11
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.81
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna New Business (MI Preferred)	$2.75
Rate for Payer: Cash Price	$3.38
Rate for Payer: Cofinity Commercial	$2.96
Rate for Payer: Cofinity Commercial	$3.64
Rate for Payer: Healthscope Commercial	$3.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.60
Rate for Payer: PHP Commercial	$3.60
Rate for Payer: Priority Health Cigna Priority Health	$2.96
Rate for Payer: Priority Health SBD	$2.66

CELECOXIB 200 MG CAPSULE

Facility

$598.56

Service Code	NDC 60687-447-01
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$377.09
Max. Negotiated Rate	$538.70
Rate for Payer: Aetna Commercial	$508.78
Rate for Payer: Aetna New Business (MI Preferred)	$389.06
Rate for Payer: Cash Price	$478.85
Rate for Payer: Cofinity Commercial	$418.99
Rate for Payer: Cofinity Commercial	$514.76
Rate for Payer: Healthscope Commercial	$538.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$508.78
Rate for Payer: PHP Commercial	$508.78
Rate for Payer: Priority Health Cigna Priority Health	$418.99
Rate for Payer: Priority Health SBD	$377.09

CELECOXIB 200 MG CAPSULE

Facility

$501.12

Service Code	NDC 0904-6503-61
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$315.71
Max. Negotiated Rate	$451.01
Rate for Payer: Aetna Commercial	$425.95
Rate for Payer: Aetna New Business (MI Preferred)	$325.73
Rate for Payer: Cash Price	$400.90
Rate for Payer: Cofinity Commercial	$350.78
Rate for Payer: Cofinity Commercial	$430.96
Rate for Payer: Healthscope Commercial	$451.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.95
Rate for Payer: PHP Commercial	$425.95
Rate for Payer: Priority Health Cigna Priority Health	$350.78
Rate for Payer: Priority Health SBD	$315.71

Know your out-of-pocket cost for care.

All Charges