Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MIRTAZAPINE 30 MG TABLET

Facility

$354.85

Service Code	NDC 63739-099-10
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$223.56
Max. Negotiated Rate	$319.36
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$248.40
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Healthscope Commercial	$319.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$301.62
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health Cigna Priority Health	$248.40
Rate for Payer: Priority Health SBD	$223.56

MIRTAZAPINE 30 MG TABLET

Facility

$444.15

Service Code	NDC 68084-120-11
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$279.81
Max. Negotiated Rate	$399.74
Rate for Payer: Aetna Commercial	$377.53
Rate for Payer: Aetna New Business (MI Preferred)	$288.70
Rate for Payer: Cash Price	$355.32
Rate for Payer: Cofinity Commercial	$310.90
Rate for Payer: Cofinity Commercial	$381.97
Rate for Payer: Healthscope Commercial	$399.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$377.53
Rate for Payer: PHP Commercial	$377.53
Rate for Payer: Priority Health Cigna Priority Health	$310.90
Rate for Payer: Priority Health SBD	$279.81

MIRTAZAPINE 30 MG TABLET

Facility

$248.90

Service Code	NDC 0378-3530-01
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$156.81
Max. Negotiated Rate	$224.01
Rate for Payer: Aetna Commercial	$211.56
Rate for Payer: Aetna New Business (MI Preferred)	$161.78
Rate for Payer: Cash Price	$199.12
Rate for Payer: Cofinity Commercial	$174.23
Rate for Payer: Cofinity Commercial	$214.05
Rate for Payer: Healthscope Commercial	$224.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$211.56
Rate for Payer: PHP Commercial	$211.56
Rate for Payer: Priority Health Cigna Priority Health	$174.23
Rate for Payer: Priority Health SBD	$156.81

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$21,425.40

Service Code	MS-DRG 640
Min. Negotiated Rate	$9,466.30
Max. Negotiated Rate	$21,425.40
Rate for Payer: Aetna Medicare	$10,363.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,455.66
Rate for Payer: Amish Plain Church Group Commercial	$12,455.66
Rate for Payer: BCBS MAPPO	$9,964.53
Rate for Payer: BCBS Trust/PPO	$21,425.40
Rate for Payer: BCN Medicare Advantage	$9,964.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,964.53
Rate for Payer: Mclaren Medicare	$9,964.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,462.76
Rate for Payer: MI Amish Medical Board Commercial	$11,459.21
Rate for Payer: PACE Medicare	$9,466.30
Rate for Payer: PACE SWMI	$9,964.53
Rate for Payer: PHP Medicare Advantage	$9,964.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18,873.01
Rate for Payer: Priority Health Medicare	$9,964.53
Rate for Payer: Priority Health Narrow Network	$15,098.41
Rate for Payer: Railroad Medicare Medicare	$9,964.53
Rate for Payer: UHC All Payor (Choice/PPO)	$20,062.06
Rate for Payer: UHC Core	$12,310.27
Rate for Payer: UHC Dual Complete DSNP	$9,964.53
Rate for Payer: UHC Exchange	$13,184.88
Rate for Payer: UHC Medicare Advantage	$10,263.47
Rate for Payer: VA VA	$9,964.53

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$11,976.44

Service Code	MS-DRG 641
Min. Negotiated Rate	$5,814.20
Max. Negotiated Rate	$11,976.44
Rate for Payer: Aetna Medicare	$6,365.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,650.26
Rate for Payer: Amish Plain Church Group Commercial	$7,650.26
Rate for Payer: BCBS MAPPO	$6,120.21
Rate for Payer: BCBS Trust/PPO	$11,976.44
Rate for Payer: BCN Medicare Advantage	$6,120.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,120.21
Rate for Payer: Mclaren Medicare	$6,120.21
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,426.22
Rate for Payer: MI Amish Medical Board Commercial	$7,038.24
Rate for Payer: PACE Medicare	$5,814.20
Rate for Payer: PACE SWMI	$6,120.21
Rate for Payer: PHP Medicare Advantage	$6,120.21
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,213.03
Rate for Payer: Priority Health Medicare	$6,120.21
Rate for Payer: Priority Health Narrow Network	$8,970.42
Rate for Payer: Railroad Medicare Medicare	$6,120.21
Rate for Payer: UHC All Payor (Choice/PPO)	$11,919.48
Rate for Payer: UHC Core	$7,313.90
Rate for Payer: UHC Dual Complete DSNP	$6,120.21
Rate for Payer: UHC Exchange	$7,833.54
Rate for Payer: UHC Medicare Advantage	$6,303.82
Rate for Payer: VA VA	$6,120.21

MISOPROSTOL 100 MCG TABLET

Facility

$355.40

Service Code	NDC 59762-5007-2
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$223.90
Max. Negotiated Rate	$319.86
Rate for Payer: Aetna Commercial	$302.09
Rate for Payer: Aetna New Business (MI Preferred)	$231.01
Rate for Payer: Cash Price	$284.32
Rate for Payer: Cofinity Commercial	$248.78
Rate for Payer: Cofinity Commercial	$305.64
Rate for Payer: Healthscope Commercial	$319.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$302.09
Rate for Payer: PHP Commercial	$302.09
Rate for Payer: Priority Health Cigna Priority Health	$248.78
Rate for Payer: Priority Health SBD	$223.90

MISOPROSTOL 100 MCG TABLET

Facility

$177.12

Service Code	NDC 43386-160-06
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$111.59
Max. Negotiated Rate	$159.41
Rate for Payer: Aetna Commercial	$150.55
Rate for Payer: Aetna New Business (MI Preferred)	$115.13
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cofinity Commercial	$123.98
Rate for Payer: Cofinity Commercial	$152.32
Rate for Payer: Healthscope Commercial	$159.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$150.55
Rate for Payer: PHP Commercial	$150.55
Rate for Payer: Priority Health Cigna Priority Health	$123.98
Rate for Payer: Priority Health SBD	$111.59

MISOPROSTOL 100 MCG TABLET

Facility

$7.00

Service Code	NDC 68084-040-11
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna Commercial	$5.95
Rate for Payer: Aetna New Business (MI Preferred)	$4.55
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cofinity Commercial	$4.90
Rate for Payer: Cofinity Commercial	$6.02
Rate for Payer: Healthscope Commercial	$6.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.95
Rate for Payer: PHP Commercial	$5.95
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: Priority Health SBD	$4.41

MISOPROSTOL 100 MCG TABLET

Facility

$177.41

Service Code	NDC 59762-5007-1
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$111.77
Max. Negotiated Rate	$159.67
Rate for Payer: Aetna Commercial	$150.80
Rate for Payer: Aetna New Business (MI Preferred)	$115.32
Rate for Payer: Cash Price	$141.93
Rate for Payer: Cofinity Commercial	$124.19
Rate for Payer: Cofinity Commercial	$152.57
Rate for Payer: Healthscope Commercial	$159.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$150.80
Rate for Payer: PHP Commercial	$150.80
Rate for Payer: Priority Health Cigna Priority Health	$124.19
Rate for Payer: Priority Health SBD	$111.77

MISOPROSTOL 100 MCG TABLET

Facility

$699.84

Service Code	NDC 68084-040-01
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$440.90
Max. Negotiated Rate	$629.86
Rate for Payer: Aetna Commercial	$594.86
Rate for Payer: Aetna New Business (MI Preferred)	$454.90
Rate for Payer: Cash Price	$559.87
Rate for Payer: Cofinity Commercial	$489.89
Rate for Payer: Cofinity Commercial	$601.86
Rate for Payer: Healthscope Commercial	$629.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$594.86
Rate for Payer: PHP Commercial	$594.86
Rate for Payer: Priority Health Cigna Priority Health	$489.89
Rate for Payer: Priority Health SBD	$440.90

MISOPROSTOL 200 MCG TABLET

Facility

$818.88

Service Code	NDC 60687-746-01
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$515.89
Max. Negotiated Rate	$736.99
Rate for Payer: Aetna Commercial	$696.05
Rate for Payer: Aetna New Business (MI Preferred)	$532.27
Rate for Payer: Cash Price	$655.10
Rate for Payer: Cofinity Commercial	$573.22
Rate for Payer: Cofinity Commercial	$704.24
Rate for Payer: Healthscope Commercial	$736.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$696.05
Rate for Payer: PHP Commercial	$696.05
Rate for Payer: Priority Health Cigna Priority Health	$573.22
Rate for Payer: Priority Health SBD	$515.89

MISOPROSTOL 200 MCG TABLET

Facility

$2,002.44

Service Code	NDC 0025-1461-31
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$1,261.54
Max. Negotiated Rate	$1,802.20
Rate for Payer: Aetna Commercial	$1,702.07
Rate for Payer: Aetna New Business (MI Preferred)	$1,301.59
Rate for Payer: Cash Price	$1,601.95
Rate for Payer: Cofinity Commercial	$1,401.71
Rate for Payer: Cofinity Commercial	$1,722.10
Rate for Payer: Healthscope Commercial	$1,802.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,702.07
Rate for Payer: PHP Commercial	$1,702.07
Rate for Payer: Priority Health Cigna Priority Health	$1,401.71
Rate for Payer: Priority Health SBD	$1,261.54

MISOPROSTOL 200 MCG TABLET

Facility

$431.04

Service Code	NDC 43386-161-01
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$271.56
Max. Negotiated Rate	$387.94
Rate for Payer: Aetna Commercial	$366.38
Rate for Payer: Aetna New Business (MI Preferred)	$280.18
Rate for Payer: Cash Price	$344.83
Rate for Payer: Cofinity Commercial	$301.73
Rate for Payer: Cofinity Commercial	$370.69
Rate for Payer: Healthscope Commercial	$387.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$366.38
Rate for Payer: PHP Commercial	$366.38
Rate for Payer: Priority Health Cigna Priority Health	$301.73
Rate for Payer: Priority Health SBD	$271.56

MISOPROSTOL 200 MCG TABLET

Facility

$327.84

Service Code	NDC 70954-444-20
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$206.54
Max. Negotiated Rate	$295.06
Rate for Payer: Aetna Commercial	$278.66
Rate for Payer: Aetna New Business (MI Preferred)	$213.10
Rate for Payer: Cash Price	$262.27
Rate for Payer: Cofinity Commercial	$229.49
Rate for Payer: Cofinity Commercial	$281.94
Rate for Payer: Healthscope Commercial	$295.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$278.66
Rate for Payer: PHP Commercial	$278.66
Rate for Payer: Priority Health Cigna Priority Health	$229.49
Rate for Payer: Priority Health SBD	$206.54

MISOPROSTOL 200 MCG TABLET

Facility

$8.19

Service Code	NDC 60687-746-11
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna Commercial	$6.96
Rate for Payer: Aetna New Business (MI Preferred)	$5.32
Rate for Payer: Cash Price	$6.55
Rate for Payer: Cofinity Commercial	$5.73
Rate for Payer: Cofinity Commercial	$7.04
Rate for Payer: Healthscope Commercial	$7.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.96
Rate for Payer: PHP Commercial	$6.96
Rate for Payer: Priority Health Cigna Priority Health	$5.73
Rate for Payer: Priority Health SBD	$5.16

MISOPROSTOL 200 MCG TABLET

Facility

$794.88

Service Code	NDC 68084-041-01
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$500.77
Max. Negotiated Rate	$715.39
Rate for Payer: Aetna Commercial	$675.65
Rate for Payer: Aetna New Business (MI Preferred)	$516.67
Rate for Payer: Cash Price	$635.90
Rate for Payer: Cofinity Commercial	$556.42
Rate for Payer: Cofinity Commercial	$683.60
Rate for Payer: Healthscope Commercial	$715.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$675.65
Rate for Payer: PHP Commercial	$675.65
Rate for Payer: Priority Health Cigna Priority Health	$556.42
Rate for Payer: Priority Health SBD	$500.77

MISOPROSTOL 200 MCG TABLET

Facility

$431.04

Service Code	NDC 59762-5008-2
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$271.56
Max. Negotiated Rate	$387.94
Rate for Payer: Aetna Commercial	$366.38
Rate for Payer: Aetna New Business (MI Preferred)	$280.18
Rate for Payer: Cash Price	$344.83
Rate for Payer: Cofinity Commercial	$301.73
Rate for Payer: Cofinity Commercial	$370.69
Rate for Payer: Healthscope Commercial	$387.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$366.38
Rate for Payer: PHP Commercial	$366.38
Rate for Payer: Priority Health Cigna Priority Health	$301.73
Rate for Payer: Priority Health SBD	$271.56

MISOPROSTOL 200 MCG TABLET

Facility

$7.95

Service Code	NDC 68084-041-11
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$7.16
Rate for Payer: Aetna Commercial	$6.76
Rate for Payer: Aetna New Business (MI Preferred)	$5.17
Rate for Payer: Cash Price	$6.36
Rate for Payer: Cofinity Commercial	$5.56
Rate for Payer: Cofinity Commercial	$6.84
Rate for Payer: Healthscope Commercial	$7.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.76
Rate for Payer: PHP Commercial	$6.76
Rate for Payer: Priority Health Cigna Priority Health	$5.56
Rate for Payer: Priority Health SBD	$5.01

MISOPROSTOL 25 MCG CUSTOM TAB

Facility

$1,442.63

Service Code	NDC 9900-0000-16
Hospital Charge Code	150707
Hospital Revenue Code	637
Min. Negotiated Rate	$908.86
Max. Negotiated Rate	$1,298.37
Rate for Payer: Aetna Commercial	$1,226.24
Rate for Payer: Aetna New Business (MI Preferred)	$937.71
Rate for Payer: Cash Price	$1,154.10
Rate for Payer: Cofinity Commercial	$1,009.84
Rate for Payer: Cofinity Commercial	$1,240.66
Rate for Payer: Healthscope Commercial	$1,298.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,226.24
Rate for Payer: PHP Commercial	$1,226.24
Rate for Payer: Priority Health Cigna Priority Health	$1,009.84
Rate for Payer: Priority Health SBD	$908.86

MITOMYCIN 20 MG INTRAVENOUS SOLUTION

Facility

$770.95

Service Code	HCPCS J9280
Hospital Charge Code	10630
Hospital Revenue Code	636
Min. Negotiated Rate	$485.70
Max. Negotiated Rate	$693.86
Rate for Payer: Aetna Commercial	$655.31
Rate for Payer: Aetna New Business (MI Preferred)	$501.12
Rate for Payer: Cash Price	$616.76
Rate for Payer: Cofinity Commercial	$539.66
Rate for Payer: Cofinity Commercial	$663.02
Rate for Payer: Healthscope Commercial	$693.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$655.31
Rate for Payer: PHP Commercial	$655.31
Rate for Payer: Priority Health Cigna Priority Health	$539.66
Rate for Payer: Priority Health SBD	$485.70

MITOMYCIN 20 MG INTRAVENOUS SOLUTION

Facility

$463.71

Service Code	HCPCS J9280
Hospital Charge Code	10630
Hospital Revenue Code	636
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$417.34
Rate for Payer: Aetna Commercial	$394.15
Rate for Payer: Aetna Commercial	$655.31
Rate for Payer: Aetna Medicare	$65.88
Rate for Payer: Aetna Medicare	$65.88
Rate for Payer: Aetna New Business (MI Preferred)	$501.12
Rate for Payer: Aetna New Business (MI Preferred)	$301.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$79.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$79.18
Rate for Payer: Amish Plain Church Group Commercial	$79.18
Rate for Payer: Amish Plain Church Group Commercial	$79.18
Rate for Payer: BCBS Complete	$36.39
Rate for Payer: BCBS Complete	$36.39
Rate for Payer: BCBS MAPPO	$63.35
Rate for Payer: BCBS MAPPO	$63.35
Rate for Payer: BCBS Trust/PPO	$187.53
Rate for Payer: BCBS Trust/PPO	$187.53
Rate for Payer: BCN Medicare Advantage	$63.35
Rate for Payer: BCN Medicare Advantage	$63.35
Rate for Payer: Cash Price	$616.76
Rate for Payer: Cash Price	$616.76
Rate for Payer: Cash Price	$370.97
Rate for Payer: Cash Price	$370.97
Rate for Payer: Cofinity Commercial	$324.60
Rate for Payer: Cofinity Commercial	$398.79
Rate for Payer: Cofinity Commercial	$539.66
Rate for Payer: Cofinity Commercial	$663.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$63.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$63.35
Rate for Payer: Healthscope Commercial	$693.86
Rate for Payer: Healthscope Commercial	$417.34
Rate for Payer: Mclaren Medicaid	$34.65
Rate for Payer: Mclaren Medicaid	$34.65
Rate for Payer: Mclaren Medicare	$63.35
Rate for Payer: Mclaren Medicare	$63.35
Rate for Payer: Meridian Medicaid	$36.39
Rate for Payer: Meridian Medicaid	$36.39
Rate for Payer: Meridian Wellcare - Medicare Advantage	$66.52
Rate for Payer: Meridian Wellcare - Medicare Advantage	$66.52
Rate for Payer: MI Amish Medical Board Commercial	$72.85
Rate for Payer: MI Amish Medical Board Commercial	$72.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$394.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$655.31
Rate for Payer: PACE Medicare	$60.18
Rate for Payer: PACE Medicare	$60.18
Rate for Payer: PACE SWMI	$63.35
Rate for Payer: PACE SWMI	$63.35
Rate for Payer: PHP Commercial	$655.31
Rate for Payer: PHP Commercial	$394.15
Rate for Payer: PHP Medicare Advantage	$63.35
Rate for Payer: PHP Medicare Advantage	$63.35
Rate for Payer: Priority Health Choice Medicaid	$34.65
Rate for Payer: Priority Health Choice Medicaid	$34.65
Rate for Payer: Priority Health Cigna Priority Health	$324.60
Rate for Payer: Priority Health Cigna Priority Health	$539.66
Rate for Payer: Priority Health Medicare	$63.35
Rate for Payer: Priority Health Medicare	$63.35
Rate for Payer: Priority Health SBD	$292.14
Rate for Payer: Priority Health SBD	$485.70
Rate for Payer: Railroad Medicare Medicare	$63.35
Rate for Payer: Railroad Medicare Medicare	$63.35
Rate for Payer: UHC Dual Complete DSNP	$63.35
Rate for Payer: UHC Dual Complete DSNP	$63.35
Rate for Payer: UHC Medicare Advantage	$65.25
Rate for Payer: UHC Medicare Advantage	$65.25
Rate for Payer: VA VA	$63.35
Rate for Payer: VA VA	$63.35

MITOMYCIN 20 MG SOLUTION FOR BLADDER IRRIGATION (CUSTOM)

Facility

$463.71

Service Code	HCPCS J9280
Hospital Charge Code	300956
Hospital Revenue Code	636
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$417.34
Rate for Payer: Aetna Commercial	$394.15
Rate for Payer: Aetna Medicare	$65.88
Rate for Payer: Aetna New Business (MI Preferred)	$301.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$79.18
Rate for Payer: Amish Plain Church Group Commercial	$79.18
Rate for Payer: BCBS Complete	$36.39
Rate for Payer: BCBS MAPPO	$63.35
Rate for Payer: BCBS Trust/PPO	$187.53
Rate for Payer: BCN Medicare Advantage	$63.35
Rate for Payer: Cash Price	$370.97
Rate for Payer: Cash Price	$370.97
Rate for Payer: Cofinity Commercial	$324.60
Rate for Payer: Cofinity Commercial	$398.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$63.35
Rate for Payer: Healthscope Commercial	$417.34
Rate for Payer: Mclaren Medicaid	$34.65
Rate for Payer: Mclaren Medicare	$63.35
Rate for Payer: Meridian Medicaid	$36.39
Rate for Payer: Meridian Wellcare - Medicare Advantage	$66.52
Rate for Payer: MI Amish Medical Board Commercial	$72.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$394.15
Rate for Payer: PACE Medicare	$60.18
Rate for Payer: PACE SWMI	$63.35
Rate for Payer: PHP Commercial	$394.15
Rate for Payer: PHP Medicare Advantage	$63.35
Rate for Payer: Priority Health Choice Medicaid	$34.65
Rate for Payer: Priority Health Cigna Priority Health	$324.60
Rate for Payer: Priority Health Medicare	$63.35
Rate for Payer: Priority Health SBD	$292.14
Rate for Payer: Railroad Medicare Medicare	$63.35
Rate for Payer: UHC Dual Complete DSNP	$63.35
Rate for Payer: UHC Medicare Advantage	$65.25
Rate for Payer: VA VA	$63.35

MODAFINIL 100 MG TABLET

Facility

$353.40

Service Code	NDC 65862-601-01
Hospital Charge Code	24702
Hospital Revenue Code	637
Min. Negotiated Rate	$222.64
Max. Negotiated Rate	$318.06
Rate for Payer: Aetna Commercial	$300.39
Rate for Payer: Aetna New Business (MI Preferred)	$229.71
Rate for Payer: Cash Price	$282.72
Rate for Payer: Cofinity Commercial	$247.38
Rate for Payer: Cofinity Commercial	$303.92
Rate for Payer: Healthscope Commercial	$318.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$300.39
Rate for Payer: PHP Commercial	$300.39
Rate for Payer: Priority Health Cigna Priority Health	$247.38
Rate for Payer: Priority Health SBD	$222.64

MODAFINIL 200 MG TABLET

Facility

$716.95

Service Code	NDC 55253-802-30
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$451.68
Max. Negotiated Rate	$645.26
Rate for Payer: Aetna Commercial	$609.41
Rate for Payer: Aetna New Business (MI Preferred)	$466.02
Rate for Payer: Cash Price	$573.56
Rate for Payer: Cofinity Commercial	$501.86
Rate for Payer: Cofinity Commercial	$616.58
Rate for Payer: Healthscope Commercial	$645.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$609.41
Rate for Payer: PHP Commercial	$609.41
Rate for Payer: Priority Health Cigna Priority Health	$501.86
Rate for Payer: Priority Health SBD	$451.68

MODAFINIL 200 MG TABLET

Facility

$272.60

Service Code	NDC 62332-386-90
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$171.74
Max. Negotiated Rate	$245.34
Rate for Payer: Aetna Commercial	$231.71
Rate for Payer: Aetna New Business (MI Preferred)	$177.19
Rate for Payer: Cash Price	$218.08
Rate for Payer: Cofinity Commercial	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.71
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health Cigna Priority Health	$190.82
Rate for Payer: Priority Health SBD	$171.74

Know your out-of-pocket cost for care.

All Charges