Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 24689078101
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Advantage	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: MI Amish Medical Board Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.31
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health SBD	$66.62
Rate for Payer: UHC All Payor (Choice/PPO)	$68.74
Rate for Payer: UHC Core	$55.10
Rate for Payer: UHC Exchange	$41.56

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 68382018001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Advantage	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: MI Amish Medical Board Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.31
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health SBD	$66.62
Rate for Payer: UHC All Payor (Choice/PPO)	$68.74
Rate for Payer: UHC Core	$55.10
Rate for Payer: UHC Exchange	$41.56

BUSPIRONE 5 MG TABLET

Facility

$329.00

Service Code	NDC 16729020016
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$207.27
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Advantage	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.75
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health SBD	$207.27

BUSPIRONE 5 MG TABLET

Facility

$329.00

Service Code	NDC 16729020016
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$129.30
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna Medicare	$164.50
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: BCBS Complete	$131.60
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Advantage	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: MI Amish Medical Board Commercial	$263.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.75
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health SBD	$207.27
Rate for Payer: UHC All Payor (Choice/PPO)	$213.85
Rate for Payer: UHC Core	$171.41
Rate for Payer: UHC Exchange	$129.30

BUSPIRONE 5 MG TABLET

Facility

$49.35

Service Code	NDC 72888006201
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$44.41
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 Advantage	$34.55
Rate for Payer: Cofinity Commercial	$42.44
Rate for Payer: Encore Health Key Benefits Commercial	$39.48
Rate for Payer: Healthscope Commercial	$44.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.01
Rate for Payer: PHP Commercial	$41.95
Rate for Payer: Priority Health SBD	$31.09

BUSPIRONE 5 MG TABLET

Facility

$249.10

Service Code	NDC 51079098520
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$156.93
Max. Negotiated Rate	$224.19
Rate for Payer: Aetna Commercial	$211.74
Rate for Payer: Aetna New Business (MI Preferred)	$161.91
Rate for Payer: Cash Price	$199.28
Rate for Payer: Cofinity Advantage	$174.37
Rate for Payer: Cofinity Commercial	$214.23
Rate for Payer: Encore Health Key Benefits Commercial	$199.28
Rate for Payer: Healthscope Commercial	$224.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$186.82
Rate for Payer: PHP Commercial	$211.74
Rate for Payer: Priority Health SBD	$156.93

BUSPIRONE 5 MG TABLET

Facility

$65.80

Service Code	NDC 16729020001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$25.86
Max. Negotiated Rate	$59.22
Rate for Payer: Aetna Commercial	$55.93
Rate for Payer: Aetna Medicare	$32.90
Rate for Payer: Aetna New Business (MI Preferred)	$42.77
Rate for Payer: BCBS Complete	$26.32
Rate for Payer: Cash Price	$52.64
Rate for Payer: Cofinity Advantage	$46.06
Rate for Payer: Cofinity Commercial	$56.59
Rate for Payer: Encore Health Key Benefits Commercial	$52.64
Rate for Payer: Healthscope Commercial	$59.22
Rate for Payer: MI Amish Medical Board Commercial	$52.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.35
Rate for Payer: PHP Commercial	$55.93
Rate for Payer: Priority Health SBD	$41.45
Rate for Payer: UHC All Payor (Choice/PPO)	$42.77
Rate for Payer: UHC Core	$34.28
Rate for Payer: UHC Exchange	$25.86

BUSPIRONE 5 MG TABLET

Facility

$249.10

Service Code	NDC 51079098520
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$224.19
Rate for Payer: Aetna Commercial	$211.74
Rate for Payer: Aetna Medicare	$124.55
Rate for Payer: Aetna New Business (MI Preferred)	$161.91
Rate for Payer: BCBS Complete	$99.64
Rate for Payer: Cash Price	$199.28
Rate for Payer: Cofinity Advantage	$174.37
Rate for Payer: Cofinity Commercial	$214.23
Rate for Payer: Encore Health Key Benefits Commercial	$199.28
Rate for Payer: Healthscope Commercial	$224.19
Rate for Payer: MI Amish Medical Board Commercial	$199.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$186.82
Rate for Payer: PHP Commercial	$211.74
Rate for Payer: Priority Health SBD	$156.93
Rate for Payer: UHC All Payor (Choice/PPO)	$161.91
Rate for Payer: UHC Core	$129.78
Rate for Payer: UHC Exchange	$97.90

BUSPIRONE 5 MG TABLET

Facility

$65.80

Service Code	NDC 16729020001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$41.45
Max. Negotiated Rate	$59.22
Rate for Payer: Aetna Commercial	$55.93
Rate for Payer: Aetna New Business (MI Preferred)	$42.77
Rate for Payer: Cash Price	$52.64
Rate for Payer: Cofinity Advantage	$46.06
Rate for Payer: Cofinity Commercial	$56.59
Rate for Payer: Encore Health Key Benefits Commercial	$52.64
Rate for Payer: Healthscope Commercial	$59.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.35
Rate for Payer: PHP Commercial	$55.93
Rate for Payer: Priority Health SBD	$41.45

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 64380074106
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Advantage	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: MI Amish Medical Board Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.31
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health SBD	$66.62
Rate for Payer: UHC All Payor (Choice/PPO)	$68.74
Rate for Payer: UHC Core	$55.10
Rate for Payer: UHC Exchange	$41.56

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 68382018001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Advantage	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.31
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 64380074106
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Advantage	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.31
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$94.00

Service Code	NDC 23155002301
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$36.94
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna Commercial	$79.90
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: Aetna New Business (MI Preferred)	$61.10
Rate for Payer: BCBS Complete	$37.60
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Advantage	$65.80
Rate for Payer: Cofinity Commercial	$80.84
Rate for Payer: Encore Health Key Benefits Commercial	$75.20
Rate for Payer: Healthscope Commercial	$84.60
Rate for Payer: MI Amish Medical Board Commercial	$75.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.50
Rate for Payer: PHP Commercial	$79.90
Rate for Payer: Priority Health SBD	$59.22
Rate for Payer: UHC All Payor (Choice/PPO)	$61.10
Rate for Payer: UHC Core	$48.97
Rate for Payer: UHC Exchange	$36.94

BUSPIRONE 5 MG TABLET

Facility

$2.50

Service Code	NDC 51079098501
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$2.12
Rate for Payer: Aetna Medicare	$1.25
Rate for Payer: Aetna New Business (MI Preferred)	$1.62
Rate for Payer: BCBS Complete	$1.00
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cofinity Advantage	$1.75
Rate for Payer: Cofinity Commercial	$2.15
Rate for Payer: Encore Health Key Benefits Commercial	$2.00
Rate for Payer: Healthscope Commercial	$2.25
Rate for Payer: MI Amish Medical Board Commercial	$2.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.88
Rate for Payer: PHP Commercial	$2.12
Rate for Payer: Priority Health SBD	$1.57
Rate for Payer: UHC All Payor (Choice/PPO)	$1.62
Rate for Payer: UHC Core	$1.30
Rate for Payer: UHC Exchange	$0.98

BUSPIRONE 5 MG TABLET

Facility

$225.60

Service Code	NDC 00904712261
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$142.13
Max. Negotiated Rate	$203.04
Rate for Payer: Aetna Commercial	$191.76
Rate for Payer: Aetna New Business (MI Preferred)	$146.64
Rate for Payer: Cash Price	$180.48
Rate for Payer: Cofinity Advantage	$157.92
Rate for Payer: Cofinity Commercial	$194.02
Rate for Payer: Encore Health Key Benefits Commercial	$180.48
Rate for Payer: Healthscope Commercial	$203.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$169.20
Rate for Payer: PHP Commercial	$191.76
Rate for Payer: Priority Health SBD	$142.13

BUSPIRONE 5 MG TABLET

Facility

$94.00

Service Code	NDC 23155002301
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna Commercial	$79.90
Rate for Payer: Aetna New Business (MI Preferred)	$61.10
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Advantage	$65.80
Rate for Payer: Cofinity Commercial	$80.84
Rate for Payer: Encore Health Key Benefits Commercial	$75.20
Rate for Payer: Healthscope Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.50
Rate for Payer: PHP Commercial	$79.90
Rate for Payer: Priority Health SBD	$59.22

BUSPIRONE 5 MG TABLET

Facility

$49.35

Service Code	NDC 72888006201
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$19.39
Max. Negotiated Rate	$44.41
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 Advantage	$34.55
Rate for Payer: Cofinity Commercial	$42.44
Rate for Payer: Encore Health Key Benefits Commercial	$39.48
Rate for Payer: Healthscope Commercial	$44.41
Rate for Payer: MI Amish Medical Board Commercial	$39.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.01
Rate for Payer: PHP Commercial	$41.95
Rate for Payer: Priority Health SBD	$31.09
Rate for Payer: UHC All Payor (Choice/PPO)	$32.08
Rate for Payer: UHC Core	$25.71
Rate for Payer: UHC Exchange	$19.39

BUSPIRONE 5 MG TABLET

Facility

$2.50

Service Code	NDC 51079098501
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$2.12
Rate for Payer: Aetna New Business (MI Preferred)	$1.62
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cofinity Advantage	$1.75
Rate for Payer: Cofinity Commercial	$2.15
Rate for Payer: Encore Health Key Benefits Commercial	$2.00
Rate for Payer: Healthscope Commercial	$2.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.88
Rate for Payer: PHP Commercial	$2.12
Rate for Payer: Priority Health SBD	$1.57

BUSPIRONE 5 MG TABLET

Facility

$552.25

Service Code	NDC 00093005305
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$347.92
Max. Negotiated Rate	$497.02
Rate for Payer: Aetna Commercial	$469.41
Rate for Payer: Aetna New Business (MI Preferred)	$358.96
Rate for Payer: Cash Price	$441.80
Rate for Payer: Cofinity Advantage	$386.57
Rate for Payer: Cofinity Commercial	$474.94
Rate for Payer: Encore Health Key Benefits Commercial	$441.80
Rate for Payer: Healthscope Commercial	$497.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$469.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$414.19
Rate for Payer: PHP Commercial	$469.41
Rate for Payer: Priority Health SBD	$347.92

BUSPIRONE 5 MG TABLET

Facility

$225.60

Service Code	NDC 00904712261
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$88.66
Max. Negotiated Rate	$203.04
Rate for Payer: Aetna Commercial	$191.76
Rate for Payer: Aetna Medicare	$112.80
Rate for Payer: Aetna New Business (MI Preferred)	$146.64
Rate for Payer: BCBS Complete	$90.24
Rate for Payer: Cash Price	$180.48
Rate for Payer: Cofinity Advantage	$157.92
Rate for Payer: Cofinity Commercial	$194.02
Rate for Payer: Encore Health Key Benefits Commercial	$180.48
Rate for Payer: Healthscope Commercial	$203.04
Rate for Payer: MI Amish Medical Board Commercial	$180.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$169.20
Rate for Payer: PHP Commercial	$191.76
Rate for Payer: Priority Health SBD	$142.13
Rate for Payer: UHC All Payor (Choice/PPO)	$146.64
Rate for Payer: UHC Core	$117.54
Rate for Payer: UHC Exchange	$88.66

BUSPIRONE 5 MG TABLET

Facility

$552.25

Service Code	NDC 00093005305
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$217.03
Max. Negotiated Rate	$497.02
Rate for Payer: Aetna Commercial	$469.41
Rate for Payer: Aetna Medicare	$276.12
Rate for Payer: Aetna New Business (MI Preferred)	$358.96
Rate for Payer: BCBS Complete	$220.90
Rate for Payer: Cash Price	$441.80
Rate for Payer: Cofinity Advantage	$386.57
Rate for Payer: Cofinity Commercial	$474.94
Rate for Payer: Encore Health Key Benefits Commercial	$441.80
Rate for Payer: Healthscope Commercial	$497.02
Rate for Payer: MI Amish Medical Board Commercial	$441.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$469.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$414.19
Rate for Payer: PHP Commercial	$469.41
Rate for Payer: Priority Health SBD	$347.92
Rate for Payer: UHC All Payor (Choice/PPO)	$358.96
Rate for Payer: UHC Core	$287.72
Rate for Payer: UHC Exchange	$217.03

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 24689078101
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Advantage	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.31
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health SBD	$66.62

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$373.45

Service Code	NDC 00904693806
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$235.27
Max. Negotiated Rate	$336.11
Rate for Payer: Aetna Commercial	$317.43
Rate for Payer: Aetna New Business (MI Preferred)	$242.74
Rate for Payer: Cash Price	$298.76
Rate for Payer: Cofinity Advantage	$261.42
Rate for Payer: Cofinity Commercial	$321.17
Rate for Payer: Encore Health Key Benefits Commercial	$298.76
Rate for Payer: Healthscope Commercial	$336.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.09
Rate for Payer: PHP Commercial	$317.43
Rate for Payer: Priority Health SBD	$235.27

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$735.70

Service Code	NDC 00603254421
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$289.13
Max. Negotiated Rate	$662.13
Rate for Payer: Aetna Commercial	$625.35
Rate for Payer: Aetna Medicare	$367.85
Rate for Payer: Aetna New Business (MI Preferred)	$478.20
Rate for Payer: BCBS Complete	$294.28
Rate for Payer: Cash Price	$588.56
Rate for Payer: Cofinity Advantage	$514.99
Rate for Payer: Cofinity Commercial	$632.70
Rate for Payer: Encore Health Key Benefits Commercial	$588.56
Rate for Payer: Healthscope Commercial	$662.13
Rate for Payer: MI Amish Medical Board Commercial	$588.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$625.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$551.77
Rate for Payer: PHP Commercial	$625.35
Rate for Payer: Priority Health SBD	$463.49
Rate for Payer: UHC All Payor (Choice/PPO)	$478.20
Rate for Payer: UHC Core	$383.30
Rate for Payer: UHC Exchange	$289.13

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$8.17

Service Code	NDC 60687067211
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$7.35
Rate for Payer: Aetna Commercial	$6.94
Rate for Payer: Aetna Medicare	$4.08
Rate for Payer: Aetna New Business (MI Preferred)	$5.31
Rate for Payer: BCBS Complete	$3.27
Rate for Payer: Cash Price	$6.54
Rate for Payer: Cofinity Advantage	$5.72
Rate for Payer: Cofinity Commercial	$7.03
Rate for Payer: Encore Health Key Benefits Commercial	$6.54
Rate for Payer: Healthscope Commercial	$7.35
Rate for Payer: MI Amish Medical Board Commercial	$6.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.13
Rate for Payer: PHP Commercial	$6.94
Rate for Payer: Priority Health SBD	$5.15
Rate for Payer: UHC All Payor (Choice/PPO)	$5.31
Rate for Payer: UHC Core	$4.26
Rate for Payer: UHC Exchange	$3.21

Know your out-of-pocket cost for care.

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