Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$108.10

Service Code	NDC 510509460
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.88
Rate for Payer: Aetna New Business (MI Preferred)	$70.26
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$91.88
Rate for Payer: PHP Commercial	$91.88
Rate for Payer: Priority Health Cigna Priority Health	$75.67
Rate for Payer: Priority Health SBD	$68.10

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$159.80

Service Code	NDC 7985409098
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$100.67
Max. Negotiated Rate	$143.82
Rate for Payer: Aetna Commercial	$135.83
Rate for Payer: Aetna New Business (MI Preferred)	$103.87
Rate for Payer: Cash Price	$127.84
Rate for Payer: Cofinity Commercial	$111.86
Rate for Payer: Cofinity Commercial	$137.43
Rate for Payer: Healthscope Commercial	$143.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$135.83
Rate for Payer: PHP Commercial	$135.83
Rate for Payer: Priority Health Cigna Priority Health	$111.86
Rate for Payer: Priority Health SBD	$100.67

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$35.25

Service Code	NDC 536333401
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$22.21
Max. Negotiated Rate	$31.72
Rate for Payer: Aetna Commercial	$29.96
Rate for Payer: Aetna New Business (MI Preferred)	$22.91
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cofinity Commercial	$24.68
Rate for Payer: Cofinity Commercial	$30.32
Rate for Payer: Healthscope Commercial	$31.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.96
Rate for Payer: PHP Commercial	$29.96
Rate for Payer: Priority Health Cigna Priority Health	$24.68
Rate for Payer: Priority Health SBD	$22.21

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$84.60

Service Code	NDC 2055503300
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$76.14
Rate for Payer: Aetna Commercial	$71.91
Rate for Payer: Aetna New Business (MI Preferred)	$54.99
Rate for Payer: Cash Price	$67.68
Rate for Payer: Cofinity Commercial	$59.22
Rate for Payer: Cofinity Commercial	$72.76
Rate for Payer: Healthscope Commercial	$76.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.91
Rate for Payer: PHP Commercial	$71.91
Rate for Payer: Priority Health Cigna Priority Health	$59.22
Rate for Payer: Priority Health SBD	$53.30

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$30.55

Service Code	NDC 904582460
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$25.97
Rate for Payer: Aetna New Business (MI Preferred)	$19.86
Rate for Payer: Cash Price	$24.44
Rate for Payer: Cofinity Commercial	$21.38
Rate for Payer: Cofinity Commercial	$26.27
Rate for Payer: Healthscope Commercial	$27.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.97
Rate for Payer: PHP Commercial	$25.97
Rate for Payer: Priority Health Cigna Priority Health	$21.38
Rate for Payer: Priority Health SBD	$19.25

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$37.60

Service Code	NDC 8068116900
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$33.84
Rate for Payer: Aetna Commercial	$31.96
Rate for Payer: Aetna New Business (MI Preferred)	$24.44
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Cofinity Commercial	$32.34
Rate for Payer: Healthscope Commercial	$33.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.96
Rate for Payer: PHP Commercial	$31.96
Rate for Payer: Priority Health Cigna Priority Health	$26.32
Rate for Payer: Priority Health SBD	$23.69

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$34,157.22

Service Code	MS-DRG 415
Min. Negotiated Rate	$13,985.93
Max. Negotiated Rate	$34,157.22
Rate for Payer: Aetna Medicare	$15,310.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,402.54
Rate for Payer: Amish Plain Church Group Commercial	$18,402.54
Rate for Payer: BCBS MAPPO	$14,722.03
Rate for Payer: BCBS Trust/PPO	$34,157.22
Rate for Payer: BCN Medicare Advantage	$14,722.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,722.03
Rate for Payer: Mclaren Medicare	$14,722.03
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,458.13
Rate for Payer: MI Amish Medical Board Commercial	$16,930.33
Rate for Payer: PACE Medicare	$13,985.93
Rate for Payer: PACE SWMI	$14,722.03
Rate for Payer: PHP Medicare Advantage	$14,722.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28,352.57
Rate for Payer: Priority Health Medicare	$14,722.03
Rate for Payer: Priority Health Narrow Network	$22,682.06
Rate for Payer: Railroad Medicare Medicare	$14,722.03
Rate for Payer: UHC All Payor (Choice/PPO)	$30,138.85
Rate for Payer: UHC Core	$18,493.49
Rate for Payer: UHC Dual Complete DSNP	$14,722.03
Rate for Payer: UHC Exchange	$19,807.40
Rate for Payer: UHC Medicare Advantage	$15,163.69
Rate for Payer: VA VA	$14,722.03

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$59,291.50

Service Code	MS-DRG 414
Min. Negotiated Rate	$24,586.47
Max. Negotiated Rate	$59,291.50
Rate for Payer: Aetna Medicare	$26,915.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$32,350.61
Rate for Payer: Amish Plain Church Group Commercial	$32,350.61
Rate for Payer: BCBS MAPPO	$25,880.49
Rate for Payer: BCBS Trust/PPO	$59,291.50
Rate for Payer: BCN Medicare Advantage	$25,880.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$25,880.49
Rate for Payer: Mclaren Medicare	$25,880.49
Rate for Payer: Meridian Wellcare - Medicare Advantage	$27,174.51
Rate for Payer: MI Amish Medical Board Commercial	$29,762.56
Rate for Payer: PACE Medicare	$24,586.47
Rate for Payer: PACE SWMI	$25,880.49
Rate for Payer: PHP Medicare Advantage	$25,880.49
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50,586.34
Rate for Payer: Priority Health Medicare	$25,880.49
Rate for Payer: Priority Health Narrow Network	$40,469.07
Rate for Payer: Railroad Medicare Medicare	$25,880.49
Rate for Payer: UHC All Payor (Choice/PPO)	$53,773.40
Rate for Payer: UHC Core	$32,995.87
Rate for Payer: UHC Dual Complete DSNP	$25,880.49
Rate for Payer: UHC Exchange	$35,340.13
Rate for Payer: UHC Medicare Advantage	$26,656.90
Rate for Payer: VA VA	$25,880.49

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$26,471.57

Service Code	MS-DRG 416
Min. Negotiated Rate	$9,630.50
Max. Negotiated Rate	$26,471.57
Rate for Payer: Aetna Medicare	$10,542.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,671.71
Rate for Payer: Amish Plain Church Group Commercial	$12,671.71
Rate for Payer: BCBS MAPPO	$10,137.37
Rate for Payer: BCBS Trust/PPO	$26,471.57
Rate for Payer: BCN Medicare Advantage	$10,137.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,137.37
Rate for Payer: Mclaren Medicare	$10,137.37
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,644.24
Rate for Payer: MI Amish Medical Board Commercial	$11,657.98
Rate for Payer: PACE Medicare	$9,630.50
Rate for Payer: PACE SWMI	$10,137.37
Rate for Payer: PHP Medicare Advantage	$10,137.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,217.41
Rate for Payer: Priority Health Medicare	$10,137.37
Rate for Payer: Priority Health Narrow Network	$15,373.93
Rate for Payer: Railroad Medicare Medicare	$10,137.37
Rate for Payer: UHC All Payor (Choice/PPO)	$20,428.16
Rate for Payer: UHC Core	$12,534.91
Rate for Payer: UHC Dual Complete DSNP	$10,137.37
Rate for Payer: UHC Exchange	$13,425.48
Rate for Payer: UHC Medicare Advantage	$10,441.49
Rate for Payer: VA VA	$10,137.37

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$31,202.06

Service Code	MS-DRG 412
Min. Negotiated Rate	$14,603.73
Max. Negotiated Rate	$31,202.06
Rate for Payer: Aetna Medicare	$15,987.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,215.44
Rate for Payer: Amish Plain Church Group Commercial	$19,215.44
Rate for Payer: BCBS MAPPO	$15,372.35
Rate for Payer: BCBS Trust/PPO	$29,411.88
Rate for Payer: BCN Medicare Advantage	$15,372.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,372.35
Rate for Payer: Mclaren Medicare	$15,372.35
Rate for Payer: Meridian Wellcare - Medicare Advantage	$16,140.97
Rate for Payer: MI Amish Medical Board Commercial	$17,678.20
Rate for Payer: PACE Medicare	$14,603.73
Rate for Payer: PACE SWMI	$15,372.35
Rate for Payer: PHP Medicare Advantage	$15,372.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29,352.76
Rate for Payer: Priority Health Medicare	$15,372.35
Rate for Payer: Priority Health Narrow Network	$23,482.21
Rate for Payer: Railroad Medicare Medicare	$15,372.35
Rate for Payer: UHC All Payor (Choice/PPO)	$31,202.06
Rate for Payer: UHC Core	$19,145.88
Rate for Payer: UHC Dual Complete DSNP	$15,372.35
Rate for Payer: UHC Exchange	$20,506.14
Rate for Payer: UHC Medicare Advantage	$15,833.52
Rate for Payer: VA VA	$15,372.35

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$44,148.57

Service Code	MS-DRG 411
Min. Negotiated Rate	$21,269.60
Max. Negotiated Rate	$44,148.57
Rate for Payer: Aetna Medicare	$23,284.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$27,986.31
Rate for Payer: Amish Plain Church Group Commercial	$27,986.31
Rate for Payer: BCBS MAPPO	$22,389.05
Rate for Payer: BCBS Trust/PPO	$44,148.57
Rate for Payer: BCN Medicare Advantage	$22,389.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$22,389.05
Rate for Payer: Mclaren Medicare	$22,389.05
Rate for Payer: Meridian Wellcare - Medicare Advantage	$23,508.50
Rate for Payer: MI Amish Medical Board Commercial	$25,747.41
Rate for Payer: PACE Medicare	$21,269.60
Rate for Payer: PACE SWMI	$22,389.05
Rate for Payer: PHP Medicare Advantage	$22,389.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41,334.94
Rate for Payer: Priority Health Medicare	$22,389.05
Rate for Payer: Priority Health Narrow Network	$33,067.95
Rate for Payer: Railroad Medicare Medicare	$22,389.05
Rate for Payer: UHC All Payor (Choice/PPO)	$43,939.15
Rate for Payer: UHC Core	$26,961.48
Rate for Payer: UHC Dual Complete DSNP	$22,389.05
Rate for Payer: UHC Exchange	$28,877.01
Rate for Payer: UHC Medicare Advantage	$23,060.72
Rate for Payer: VA VA	$22,389.05

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$26,627.48

Service Code	MS-DRG 413
Min. Negotiated Rate	$10,796.32
Max. Negotiated Rate	$26,627.48
Rate for Payer: Aetna Medicare	$11,819.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,205.69
Rate for Payer: Amish Plain Church Group Commercial	$14,205.69
Rate for Payer: BCBS MAPPO	$11,364.55
Rate for Payer: BCBS Trust/PPO	$26,627.48
Rate for Payer: BCN Medicare Advantage	$11,364.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,364.55
Rate for Payer: Mclaren Medicare	$11,364.55
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,932.78
Rate for Payer: MI Amish Medical Board Commercial	$13,069.23
Rate for Payer: PACE Medicare	$10,796.32
Rate for Payer: PACE SWMI	$11,364.55
Rate for Payer: PHP Medicare Advantage	$11,364.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21,662.64
Rate for Payer: Priority Health Medicare	$11,364.55
Rate for Payer: Priority Health Narrow Network	$17,330.11
Rate for Payer: Railroad Medicare Medicare	$11,364.55
Rate for Payer: UHC All Payor (Choice/PPO)	$23,027.44
Rate for Payer: UHC Core	$14,129.86
Rate for Payer: UHC Dual Complete DSNP	$11,364.55
Rate for Payer: UHC Exchange	$15,133.74
Rate for Payer: UHC Medicare Advantage	$11,705.49
Rate for Payer: VA VA	$11,364.55

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$3.78

Service Code	NDC 49884-465-64
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.40
Rate for Payer: Aetna Commercial	$3.21
Rate for Payer: Aetna New Business (MI Preferred)	$2.46
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cofinity Commercial	$2.65
Rate for Payer: Cofinity Commercial	$3.25
Rate for Payer: Healthscope Commercial	$3.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.21
Rate for Payer: PHP Commercial	$3.21
Rate for Payer: Priority Health Cigna Priority Health	$2.65
Rate for Payer: Priority Health SBD	$2.38

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$226.37

Service Code	NDC 49884-465-65
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$142.61
Max. Negotiated Rate	$203.73
Rate for Payer: Aetna Commercial	$192.41
Rate for Payer: Aetna New Business (MI Preferred)	$147.14
Rate for Payer: Cash Price	$181.10
Rate for Payer: Cofinity Commercial	$158.46
Rate for Payer: Cofinity Commercial	$194.68
Rate for Payer: Healthscope Commercial	$203.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$192.41
Rate for Payer: PHP Commercial	$192.41
Rate for Payer: Priority Health Cigna Priority Health	$158.46
Rate for Payer: Priority Health SBD	$142.61

CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION

Facility

$246.50

Service Code	NDC 0409-4093-01
Hospital Charge Code	1685
Hospital Revenue Code	250
Min. Negotiated Rate	$155.30
Max. Negotiated Rate	$221.85
Rate for Payer: Aetna Commercial	$209.52
Rate for Payer: Aetna New Business (MI Preferred)	$160.22
Rate for Payer: Cash Price	$197.20
Rate for Payer: Cofinity Commercial	$211.99
Rate for Payer: Cofinity Commercial	$172.55
Rate for Payer: Healthscope Commercial	$221.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$209.52
Rate for Payer: PHP Commercial	$209.52
Rate for Payer: Priority Health Cigna Priority Health	$172.55
Rate for Payer: Priority Health SBD	$155.30

CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS

Facility

$5,532.19

Service Code	CPT 58350
Hospital Revenue Code	360
Min. Negotiated Rate	$94.30
Max. Negotiated Rate	$5,532.19
Rate for Payer: Aetna Medicare	$4,602.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,532.19
Rate for Payer: Amish Plain Church Group Commercial	$5,532.19
Rate for Payer: BCBS Complete	$2,542.15
Rate for Payer: BCBS MAPPO	$4,425.75
Rate for Payer: BCBS Trust/PPO	$1,439.35
Rate for Payer: BCN Medicare Advantage	$4,425.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,425.75
Rate for Payer: Mclaren Medicaid	$2,420.89
Rate for Payer: Mclaren Medicare	$4,425.75
Rate for Payer: Meridian Medicaid	$2,542.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,647.04
Rate for Payer: MI Amish Medical Board Commercial	$5,089.61
Rate for Payer: PACE Medicare	$4,204.46
Rate for Payer: PACE SWMI	$4,425.75
Rate for Payer: PHP Medicare Advantage	$4,425.75
Rate for Payer: Priority Health Choice Medicaid	$2,420.89
Rate for Payer: Priority Health Medicare	$4,425.75
Rate for Payer: Railroad Medicare Medicare	$4,425.75
Rate for Payer: UHC All Payor (Choice/PPO)	$103.73
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$4,425.75
Rate for Payer: UHC Exchange	$94.30
Rate for Payer: UHC Medicare Advantage	$4,558.52
Rate for Payer: VA VA	$4,425.75

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$14,547.84

Service Code	MS-DRG 191
Min. Negotiated Rate	$6,276.70
Max. Negotiated Rate	$14,547.84
Rate for Payer: Aetna Medicare	$6,871.33
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,258.81
Rate for Payer: Amish Plain Church Group Commercial	$8,258.81
Rate for Payer: BCBS MAPPO	$6,607.05
Rate for Payer: BCBS Trust/PPO	$14,547.84
Rate for Payer: BCN Medicare Advantage	$6,607.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,607.05
Rate for Payer: Mclaren Medicare	$6,607.05
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,937.40
Rate for Payer: MI Amish Medical Board Commercial	$7,598.11
Rate for Payer: PACE Medicare	$6,276.70
Rate for Payer: PACE SWMI	$6,607.05
Rate for Payer: PHP Medicare Advantage	$6,607.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12,183.08
Rate for Payer: Priority Health Medicare	$6,607.05
Rate for Payer: Priority Health Narrow Network	$9,746.46
Rate for Payer: Railroad Medicare Medicare	$6,607.05
Rate for Payer: UHC All Payor (Choice/PPO)	$12,950.65
Rate for Payer: UHC Core	$7,946.64
Rate for Payer: UHC Dual Complete DSNP	$6,607.05
Rate for Payer: UHC Exchange	$8,511.23
Rate for Payer: UHC Medicare Advantage	$6,805.26
Rate for Payer: VA VA	$6,607.05

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$16,809.91

Service Code	MS-DRG 190
Min. Negotiated Rate	$8,007.65
Max. Negotiated Rate	$16,809.91
Rate for Payer: Aetna Medicare	$8,766.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,536.39
Rate for Payer: Amish Plain Church Group Commercial	$10,536.39
Rate for Payer: BCBS MAPPO	$8,429.11
Rate for Payer: BCBS Trust/PPO	$16,348.48
Rate for Payer: BCN Medicare Advantage	$8,429.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,429.11
Rate for Payer: Mclaren Medicare	$8,429.11
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,850.57
Rate for Payer: MI Amish Medical Board Commercial	$9,693.48
Rate for Payer: PACE Medicare	$8,007.65
Rate for Payer: PACE SWMI	$8,429.11
Rate for Payer: PHP Medicare Advantage	$8,429.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,813.61
Rate for Payer: Priority Health Medicare	$8,429.11
Rate for Payer: Priority Health Narrow Network	$12,650.89
Rate for Payer: Railroad Medicare Medicare	$8,429.11
Rate for Payer: UHC All Payor (Choice/PPO)	$16,809.91
Rate for Payer: UHC Core	$10,314.72
Rate for Payer: UHC Dual Complete DSNP	$8,429.11
Rate for Payer: UHC Exchange	$11,047.55
Rate for Payer: UHC Medicare Advantage	$8,681.98
Rate for Payer: VA VA	$8,429.11

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$10,674.27

Service Code	MS-DRG 192
Min. Negotiated Rate	$4,859.10
Max. Negotiated Rate	$10,674.27
Rate for Payer: Aetna Medicare	$5,319.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,393.55
Rate for Payer: Amish Plain Church Group Commercial	$6,393.55
Rate for Payer: BCBS MAPPO	$5,114.84
Rate for Payer: BCBS Trust/PPO	$10,674.27
Rate for Payer: BCN Medicare Advantage	$5,114.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,114.84
Rate for Payer: Mclaren Medicare	$5,114.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,370.58
Rate for Payer: MI Amish Medical Board Commercial	$5,882.07
Rate for Payer: PACE Medicare	$4,859.10
Rate for Payer: PACE SWMI	$5,114.84
Rate for Payer: PHP Medicare Advantage	$5,114.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,209.78
Rate for Payer: Priority Health Medicare	$5,114.84
Rate for Payer: Priority Health Narrow Network	$7,367.82
Rate for Payer: Railroad Medicare Medicare	$5,114.84
Rate for Payer: UHC All Payor (Choice/PPO)	$9,790.02
Rate for Payer: UHC Core	$6,007.25
Rate for Payer: UHC Dual Complete DSNP	$5,114.84
Rate for Payer: UHC Exchange	$6,434.05
Rate for Payer: UHC Medicare Advantage	$5,268.29
Rate for Payer: VA VA	$5,114.84

CILOSTAZOL 100 MG TABLET

Facility

$133.95

Service Code	NDC 60505-2522-1
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$84.39
Max. Negotiated Rate	$120.56
Rate for Payer: Aetna Commercial	$113.86
Rate for Payer: Aetna New Business (MI Preferred)	$87.07
Rate for Payer: Cash Price	$107.16
Rate for Payer: Cofinity Commercial	$115.20
Rate for Payer: Cofinity Commercial	$93.76
Rate for Payer: Healthscope Commercial	$120.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.86
Rate for Payer: PHP Commercial	$113.86
Rate for Payer: Priority Health Cigna Priority Health	$93.76
Rate for Payer: Priority Health SBD	$84.39

CILOSTAZOL 100 MG TABLET

Facility

$161.57

Service Code	NDC 0185-0223-60
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$101.79
Max. Negotiated Rate	$145.41
Rate for Payer: Aetna Commercial	$137.33
Rate for Payer: Aetna New Business (MI Preferred)	$105.02
Rate for Payer: Cash Price	$129.26
Rate for Payer: Cofinity Commercial	$113.10
Rate for Payer: Cofinity Commercial	$138.95
Rate for Payer: Healthscope Commercial	$145.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$137.33
Rate for Payer: PHP Commercial	$137.33
Rate for Payer: Priority Health Cigna Priority Health	$113.10
Rate for Payer: Priority Health SBD	$101.79

CILOSTAZOL 100 MG TABLET

Facility

$3.25

Service Code	NDC 50268-177-11
Hospital Charge Code	24474
Hospital Revenue Code	637
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

CILOSTAZOL 100 MG TABLET

Facility

$162.24

Service Code	NDC 50268-177-15
Hospital Charge Code	24474
Hospital Revenue Code	637
Min. Negotiated Rate	$102.21
Max. Negotiated Rate	$146.02
Rate for Payer: Aetna Commercial	$137.90
Rate for Payer: Aetna New Business (MI Preferred)	$105.46
Rate for Payer: Cash Price	$129.79
Rate for Payer: Cofinity Commercial	$113.57
Rate for Payer: Cofinity Commercial	$139.53
Rate for Payer: Healthscope Commercial	$146.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$137.90
Rate for Payer: PHP Commercial	$137.90
Rate for Payer: Priority Health Cigna Priority Health	$113.57
Rate for Payer: Priority Health SBD	$102.21

CIMETIDINE 200 MG TABLET

Facility

$269.80

Service Code	NDC 0378-0053-01
Hospital Charge Code	9604
Hospital Revenue Code	637
Min. Negotiated Rate	$169.97
Max. Negotiated Rate	$242.82
Rate for Payer: Aetna Commercial	$229.33
Rate for Payer: Aetna New Business (MI Preferred)	$175.37
Rate for Payer: Cash Price	$215.84
Rate for Payer: Cofinity Commercial	$188.86
Rate for Payer: Cofinity Commercial	$232.03
Rate for Payer: Healthscope Commercial	$242.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.33
Rate for Payer: PHP Commercial	$229.33
Rate for Payer: Priority Health Cigna Priority Health	$188.86
Rate for Payer: Priority Health SBD	$169.97

CINACALCET 30 MG TABLET

Facility

$132.53

Service Code	HCPCS J8499
Hospital Charge Code	38100
Hospital Revenue Code	637
Min. Negotiated Rate	$83.49
Max. Negotiated Rate	$119.28
Rate for Payer: Aetna Commercial	$112.65
Rate for Payer: Aetna Commercial	$80.19
Rate for Payer: Aetna Commercial	$1,533.66
Rate for Payer: Aetna New Business (MI Preferred)	$1,172.80
Rate for Payer: Aetna New Business (MI Preferred)	$86.14
Rate for Payer: Aetna New Business (MI Preferred)	$61.32
Rate for Payer: Cash Price	$1,443.45
Rate for Payer: Cash Price	$75.47
Rate for Payer: Cash Price	$106.02
Rate for Payer: Cofinity Commercial	$81.13
Rate for Payer: Cofinity Commercial	$113.98
Rate for Payer: Cofinity Commercial	$92.77
Rate for Payer: Cofinity Commercial	$1,263.02
Rate for Payer: Cofinity Commercial	$1,551.71
Rate for Payer: Cofinity Commercial	$66.04
Rate for Payer: Healthscope Commercial	$1,623.88
Rate for Payer: Healthscope Commercial	$84.91
Rate for Payer: Healthscope Commercial	$119.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,533.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.19
Rate for Payer: PHP Commercial	$1,533.66
Rate for Payer: PHP Commercial	$112.65
Rate for Payer: PHP Commercial	$80.19
Rate for Payer: Priority Health Cigna Priority Health	$92.77
Rate for Payer: Priority Health Cigna Priority Health	$66.04
Rate for Payer: Priority Health Cigna Priority Health	$1,263.02
Rate for Payer: Priority Health SBD	$83.49
Rate for Payer: Priority Health SBD	$1,136.72
Rate for Payer: Priority Health SBD	$59.43

Know your out-of-pocket cost for care.

All Charges