Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MELOXICAM 7.5 MG TABLET

Facility

$2.43

Service Code	NDC 50268-525-11
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna Commercial	$2.07
Rate for Payer: Aetna New Business (MI Preferred)	$1.58
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.70
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Healthscope Commercial	$2.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.07
Rate for Payer: PHP Commercial	$2.07
Rate for Payer: Priority Health Cigna Priority Health	$1.70
Rate for Payer: Priority Health SBD	$1.53

MELOXICAM 7.5 MG TABLET

Facility

$121.03

Service Code	NDC 50268-525-15
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$108.93
Rate for Payer: Aetna Commercial	$102.88
Rate for Payer: Aetna New Business (MI Preferred)	$78.67
Rate for Payer: Cash Price	$96.82
Rate for Payer: Cofinity Commercial	$104.09
Rate for Payer: Cofinity Commercial	$84.72
Rate for Payer: Healthscope Commercial	$108.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.88
Rate for Payer: PHP Commercial	$102.88
Rate for Payer: Priority Health Cigna Priority Health	$84.72
Rate for Payer: Priority Health SBD	$76.25

MELOXICAM 7.5 MG TABLET

Facility

$310.20

Service Code	NDC 63739-701-10
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$195.43
Max. Negotiated Rate	$279.18
Rate for Payer: Aetna Commercial	$263.67
Rate for Payer: Aetna New Business (MI Preferred)	$201.63
Rate for Payer: Cash Price	$248.16
Rate for Payer: Cofinity Commercial	$217.14
Rate for Payer: Cofinity Commercial	$266.77
Rate for Payer: Healthscope Commercial	$279.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$263.67
Rate for Payer: PHP Commercial	$263.67
Rate for Payer: Priority Health Cigna Priority Health	$217.14
Rate for Payer: Priority Health SBD	$195.43

MELOXICAM 7.5 MG TABLET

Facility

$256.15

Service Code	NDC 0440-6841-01
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$161.37
Max. Negotiated Rate	$230.54
Rate for Payer: Aetna Commercial	$217.73
Rate for Payer: Aetna New Business (MI Preferred)	$166.50
Rate for Payer: Cash Price	$204.92
Rate for Payer: Cofinity Commercial	$179.30
Rate for Payer: Cofinity Commercial	$220.29
Rate for Payer: Healthscope Commercial	$230.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$217.73
Rate for Payer: PHP Commercial	$217.73
Rate for Payer: Priority Health Cigna Priority Health	$179.30
Rate for Payer: Priority Health SBD	$161.37

MELOXICAM 7.5 MG TABLET

Facility

$39.95

Service Code	NDC 69097-158-07
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$35.96
Rate for Payer: Aetna Commercial	$33.96
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: Cash Price	$31.96
Rate for Payer: Cofinity Commercial	$27.96
Rate for Payer: Cofinity Commercial	$34.36
Rate for Payer: Healthscope Commercial	$35.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.96
Rate for Payer: PHP Commercial	$33.96
Rate for Payer: Priority Health Cigna Priority Health	$27.96
Rate for Payer: Priority Health SBD	$25.17

MEMANTINE 10 MG TABLET

Facility

$238.45

Service Code	NDC 0904-6506-61
Hospital Charge Code	36966
Hospital Revenue Code	637
Min. Negotiated Rate	$150.22
Max. Negotiated Rate	$214.60
Rate for Payer: Aetna Commercial	$202.68
Rate for Payer: Aetna New Business (MI Preferred)	$154.99
Rate for Payer: Cash Price	$190.76
Rate for Payer: Cofinity Commercial	$166.92
Rate for Payer: Cofinity Commercial	$205.07
Rate for Payer: Healthscope Commercial	$214.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$202.68
Rate for Payer: PHP Commercial	$202.68
Rate for Payer: Priority Health Cigna Priority Health	$166.92
Rate for Payer: Priority Health SBD	$150.22

MEMANTINE 5 MG TABLET

Facility

$224.20

Service Code	NDC 0591-3870-44
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$141.25
Max. Negotiated Rate	$201.78
Rate for Payer: Aetna Commercial	$190.57
Rate for Payer: Aetna New Business (MI Preferred)	$145.73
Rate for Payer: Cash Price	$179.36
Rate for Payer: Cofinity Commercial	$192.81
Rate for Payer: Cofinity Commercial	$156.94
Rate for Payer: Healthscope Commercial	$201.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$190.57
Rate for Payer: PHP Commercial	$190.57
Rate for Payer: Priority Health Cigna Priority Health	$156.94
Rate for Payer: Priority Health SBD	$141.25

MEMANTINE 5 MG TABLET

Facility

$130.63

Service Code	NDC 0904-6505-06
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$82.30
Max. Negotiated Rate	$117.57
Rate for Payer: Aetna Commercial	$111.04
Rate for Payer: Aetna New Business (MI Preferred)	$84.91
Rate for Payer: Cash Price	$104.50
Rate for Payer: Cofinity Commercial	$112.34
Rate for Payer: Cofinity Commercial	$91.44
Rate for Payer: Healthscope Commercial	$117.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.04
Rate for Payer: PHP Commercial	$111.04
Rate for Payer: Priority Health Cigna Priority Health	$91.44
Rate for Payer: Priority Health SBD	$82.30

MEMANTINE 5 MG TABLET

Facility

$25.51

Service Code	NDC 0456-3205-11
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$22.96
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Aetna New Business (MI Preferred)	$16.58
Rate for Payer: Cash Price	$20.41
Rate for Payer: Cofinity Commercial	$17.86
Rate for Payer: Cofinity Commercial	$21.94
Rate for Payer: Healthscope Commercial	$22.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.68
Rate for Payer: PHP Commercial	$21.68
Rate for Payer: Priority Health Cigna Priority Health	$17.86
Rate for Payer: Priority Health SBD	$16.07

MEMANTINE 5 MG TABLET

Facility

$220.40

Service Code	NDC 0904-6505-61
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$138.85
Max. Negotiated Rate	$198.36
Rate for Payer: Aetna Commercial	$187.34
Rate for Payer: Aetna New Business (MI Preferred)	$143.26
Rate for Payer: Cash Price	$176.32
Rate for Payer: Cofinity Commercial	$154.28
Rate for Payer: Cofinity Commercial	$189.54
Rate for Payer: Healthscope Commercial	$198.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.34
Rate for Payer: PHP Commercial	$187.34
Rate for Payer: Priority Health Cigna Priority Health	$154.28
Rate for Payer: Priority Health SBD	$138.85

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$15,183.83

Service Code	MS-DRG 760
Min. Negotiated Rate	$7,278.32
Max. Negotiated Rate	$15,183.83
Rate for Payer: Aetna Medicare	$7,967.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,576.74
Rate for Payer: Amish Plain Church Group Commercial	$9,576.74
Rate for Payer: BCBS MAPPO	$7,661.39
Rate for Payer: BCBS Trust/PPO	$14,951.88
Rate for Payer: BCN Medicare Advantage	$7,661.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,661.39
Rate for Payer: Mclaren Medicare	$7,661.39
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,044.46
Rate for Payer: MI Amish Medical Board Commercial	$8,810.60
Rate for Payer: PACE Medicare	$7,278.32
Rate for Payer: PACE SWMI	$7,661.39
Rate for Payer: PHP Medicare Advantage	$7,661.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14,283.91
Rate for Payer: Priority Health Medicare	$7,661.39
Rate for Payer: Priority Health Narrow Network	$11,427.13
Rate for Payer: Railroad Medicare Medicare	$7,661.39
Rate for Payer: UHC All Payor (Choice/PPO)	$15,183.83
Rate for Payer: UHC Core	$9,316.94
Rate for Payer: UHC Dual Complete DSNP	$7,661.39
Rate for Payer: UHC Exchange	$9,978.89
Rate for Payer: UHC Medicare Advantage	$7,891.23
Rate for Payer: VA VA	$7,661.39

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$9,237.82

Service Code	MS-DRG 761
Min. Negotiated Rate	$4,611.41
Max. Negotiated Rate	$9,237.82
Rate for Payer: Aetna Medicare	$5,048.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,067.65
Rate for Payer: Amish Plain Church Group Commercial	$6,067.65
Rate for Payer: BCBS MAPPO	$4,854.12
Rate for Payer: BCBS Trust/PPO	$9,097.61
Rate for Payer: BCN Medicare Advantage	$4,854.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,854.12
Rate for Payer: Mclaren Medicare	$4,854.12
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,096.83
Rate for Payer: MI Amish Medical Board Commercial	$5,582.24
Rate for Payer: PACE Medicare	$4,611.41
Rate for Payer: PACE SWMI	$4,854.12
Rate for Payer: PHP Medicare Advantage	$4,854.12
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,690.31
Rate for Payer: Priority Health Medicare	$4,854.12
Rate for Payer: Priority Health Narrow Network	$6,952.25
Rate for Payer: Railroad Medicare Medicare	$4,854.12
Rate for Payer: UHC All Payor (Choice/PPO)	$9,237.82
Rate for Payer: UHC Core	$5,668.42
Rate for Payer: UHC Dual Complete DSNP	$4,854.12
Rate for Payer: UHC Exchange	$6,071.14
Rate for Payer: UHC Medicare Advantage	$4,999.74
Rate for Payer: VA VA	$4,854.12

MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION

Facility

$34.75

Service Code	HCPCS J2175
Hospital Charge Code	116144
Hospital Revenue Code	636
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$31.28
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: BCBS Complete	$13.90
Rate for Payer: BCBS Trust/PPO	$21.59
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cofinity Commercial	$29.88
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Healthscope Commercial	$31.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.54
Rate for Payer: PHP Commercial	$29.54
Rate for Payer: Priority Health Cigna Priority Health	$24.32
Rate for Payer: Priority Health SBD	$21.89

MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION

Facility

$34.75

Service Code	HCPCS J2175
Hospital Charge Code	116144
Hospital Revenue Code	636
Min. Negotiated Rate	$21.89
Max. Negotiated Rate	$31.28
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cofinity Commercial	$29.88
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Healthscope Commercial	$31.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.54
Rate for Payer: PHP Commercial	$29.54
Rate for Payer: Priority Health Cigna Priority Health	$24.32
Rate for Payer: Priority Health SBD	$21.89

MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$25.10

Service Code	HCPCS J0670
Hospital Charge Code	105637
Hospital Revenue Code	636
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$22.59
Rate for Payer: Aetna Commercial	$21.34
Rate for Payer: Aetna Commercial	$15.33
Rate for Payer: Aetna New Business (MI Preferred)	$11.72
Rate for Payer: Aetna New Business (MI Preferred)	$16.32
Rate for Payer: Cash Price	$14.42
Rate for Payer: Cash Price	$20.08
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Cofinity Commercial	$12.62
Rate for Payer: Cofinity Commercial	$17.57
Rate for Payer: Cofinity Commercial	$21.59
Rate for Payer: Healthscope Commercial	$16.23
Rate for Payer: Healthscope Commercial	$22.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.34
Rate for Payer: PHP Commercial	$15.33
Rate for Payer: PHP Commercial	$21.34
Rate for Payer: Priority Health Cigna Priority Health	$12.62
Rate for Payer: Priority Health Cigna Priority Health	$17.57
Rate for Payer: Priority Health SBD	$15.81
Rate for Payer: Priority Health SBD	$11.36

MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION

Facility

$7,673.02

Service Code	HCPCS J2182
Hospital Charge Code	176478
Hospital Revenue Code	636
Min. Negotiated Rate	$4,834.00
Max. Negotiated Rate	$6,905.72
Rate for Payer: Aetna Commercial	$6,522.07
Rate for Payer: Aetna New Business (MI Preferred)	$4,987.46
Rate for Payer: Cash Price	$6,138.42
Rate for Payer: Cofinity Commercial	$5,371.11
Rate for Payer: Cofinity Commercial	$6,598.80
Rate for Payer: Healthscope Commercial	$6,905.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,522.07
Rate for Payer: PHP Commercial	$6,522.07
Rate for Payer: Priority Health Cigna Priority Health	$5,371.11
Rate for Payer: Priority Health SBD	$4,834.00

MEROPENEM 1 GRAM INTRAVENOUS SOLUTION

Facility

$24.97

Service Code	HCPCS J2185
Hospital Charge Code	17380
Hospital Revenue Code	636
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$22.47
Rate for Payer: Aetna Commercial	$21.22
Rate for Payer: Aetna Commercial	$20.37
Rate for Payer: Aetna New Business (MI Preferred)	$16.23
Rate for Payer: Aetna New Business (MI Preferred)	$15.58
Rate for Payer: Cash Price	$19.98
Rate for Payer: Cash Price	$19.18
Rate for Payer: Cofinity Commercial	$17.48
Rate for Payer: Cofinity Commercial	$16.78
Rate for Payer: Cofinity Commercial	$20.61
Rate for Payer: Cofinity Commercial	$21.47
Rate for Payer: Healthscope Commercial	$21.57
Rate for Payer: Healthscope Commercial	$22.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.37
Rate for Payer: PHP Commercial	$20.37
Rate for Payer: PHP Commercial	$21.22
Rate for Payer: Priority Health Cigna Priority Health	$16.78
Rate for Payer: Priority Health Cigna Priority Health	$17.48
Rate for Payer: Priority Health SBD	$15.10
Rate for Payer: Priority Health SBD	$15.73

MEROPENEM 500 MG INTRAVENOUS SOLUTION

Facility

$19.90

Service Code	HCPCS J2185
Hospital Charge Code	17379
Hospital Revenue Code	636
Min. Negotiated Rate	$12.54
Max. Negotiated Rate	$17.91
Rate for Payer: Aetna Commercial	$16.92
Rate for Payer: Aetna Commercial	$16.65
Rate for Payer: Aetna Commercial	$17.96
Rate for Payer: Aetna New Business (MI Preferred)	$13.73
Rate for Payer: Aetna New Business (MI Preferred)	$12.73
Rate for Payer: Aetna New Business (MI Preferred)	$12.94
Rate for Payer: Cash Price	$15.67
Rate for Payer: Cash Price	$16.90
Rate for Payer: Cash Price	$15.92
Rate for Payer: Cofinity Commercial	$14.79
Rate for Payer: Cofinity Commercial	$13.71
Rate for Payer: Cofinity Commercial	$17.11
Rate for Payer: Cofinity Commercial	$18.17
Rate for Payer: Cofinity Commercial	$16.85
Rate for Payer: Cofinity Commercial	$13.93
Rate for Payer: Healthscope Commercial	$17.63
Rate for Payer: Healthscope Commercial	$19.02
Rate for Payer: Healthscope Commercial	$17.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.92
Rate for Payer: PHP Commercial	$16.92
Rate for Payer: PHP Commercial	$16.65
Rate for Payer: PHP Commercial	$17.96
Rate for Payer: Priority Health Cigna Priority Health	$13.93
Rate for Payer: Priority Health Cigna Priority Health	$13.71
Rate for Payer: Priority Health Cigna Priority Health	$14.79
Rate for Payer: Priority Health SBD	$13.31
Rate for Payer: Priority Health SBD	$12.34
Rate for Payer: Priority Health SBD	$12.54

MEROPENEM IV 0.00001 MG/ML IVPB FOR DESENSITIZATION 50 ML

Facility

$1.25

Service Code	HCPCS J2185
Hospital Charge Code	180552
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna New Business (MI Preferred)	$0.81
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Commercial	$1.08
Rate for Payer: Healthscope Commercial	$1.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.06
Rate for Payer: PHP Commercial	$1.06
Rate for Payer: Priority Health Cigna Priority Health	$0.88
Rate for Payer: Priority Health SBD	$0.79

MEROPENEM IV 0.0001 MG/ML IVPB FOR DESENSITIZATION 50 ML

Facility

$1.25

Service Code	HCPCS J2185
Hospital Charge Code	180553
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna New Business (MI Preferred)	$0.81
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Commercial	$1.08
Rate for Payer: Healthscope Commercial	$1.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.06
Rate for Payer: PHP Commercial	$1.06
Rate for Payer: Priority Health Cigna Priority Health	$0.88
Rate for Payer: Priority Health SBD	$0.79

MEROPENEM IV 0.001 MG/ML IVPB FOR DESENSITIZATION 50 ML

Facility

$1.25

Service Code	HCPCS J2185
Hospital Charge Code	180554
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna New Business (MI Preferred)	$0.81
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Commercial	$1.08
Rate for Payer: Healthscope Commercial	$1.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.06
Rate for Payer: PHP Commercial	$1.06
Rate for Payer: Priority Health Cigna Priority Health	$0.88
Rate for Payer: Priority Health SBD	$0.79

MEROPENEM IV 0.01 MG/ML IVPB FOR DESENSITIZATION 50 ML

Facility

$1.25

Service Code	HCPCS J2185
Hospital Charge Code	180555
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna New Business (MI Preferred)	$0.81
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Commercial	$1.08
Rate for Payer: Healthscope Commercial	$1.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.06
Rate for Payer: PHP Commercial	$1.06
Rate for Payer: Priority Health Cigna Priority Health	$0.88
Rate for Payer: Priority Health SBD	$0.79

MESALAMINE 1,000 MG RECTAL SUPPOSITORY

Facility

$344.10

Service Code	NDC 64980-282-03
Hospital Charge Code	40369
Hospital Revenue Code	637
Min. Negotiated Rate	$216.78
Max. Negotiated Rate	$309.69
Rate for Payer: Aetna Commercial	$292.48
Rate for Payer: Aetna New Business (MI Preferred)	$223.66
Rate for Payer: Cash Price	$275.28
Rate for Payer: Cofinity Commercial	$240.87
Rate for Payer: Cofinity Commercial	$295.93
Rate for Payer: Healthscope Commercial	$309.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$292.48
Rate for Payer: PHP Commercial	$292.48
Rate for Payer: Priority Health Cigna Priority Health	$240.87
Rate for Payer: Priority Health SBD	$216.78

MESALAMINE 1,000 MG RECTAL SUPPOSITORY

Facility

$3,997.67

Service Code	NDC 58914-501-56
Hospital Charge Code	40369
Hospital Revenue Code	637
Min. Negotiated Rate	$2,518.53
Max. Negotiated Rate	$3,597.90
Rate for Payer: Aetna Commercial	$3,398.02
Rate for Payer: Aetna New Business (MI Preferred)	$2,598.49
Rate for Payer: Cash Price	$3,198.14
Rate for Payer: Cofinity Commercial	$2,798.37
Rate for Payer: Cofinity Commercial	$3,438.00
Rate for Payer: Healthscope Commercial	$3,597.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,398.02
Rate for Payer: PHP Commercial	$3,398.02
Rate for Payer: Priority Health Cigna Priority Health	$2,798.37
Rate for Payer: Priority Health SBD	$2,518.53

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE

Facility

$1,419.47

Service Code	NDC 68382-711-19
Hospital Charge Code	78310
Hospital Revenue Code	637
Min. Negotiated Rate	$894.27
Max. Negotiated Rate	$1,277.52
Rate for Payer: Aetna Commercial	$1,206.55
Rate for Payer: Aetna New Business (MI Preferred)	$922.66
Rate for Payer: Cash Price	$1,135.58
Rate for Payer: Cofinity Commercial	$993.63
Rate for Payer: Cofinity Commercial	$1,220.74
Rate for Payer: Healthscope Commercial	$1,277.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,206.55
Rate for Payer: PHP Commercial	$1,206.55
Rate for Payer: Priority Health Cigna Priority Health	$993.63
Rate for Payer: Priority Health SBD	$894.27

Know your out-of-pocket cost for care.

All Charges