Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$7.86

Service Code	NDC 68094-599-62
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$6.68
Rate for Payer: Aetna New Business (MI Preferred)	$5.11
Rate for Payer: Cash Price	$6.29
Rate for Payer: Cofinity Commercial	$5.50
Rate for Payer: Cofinity Commercial	$6.76
Rate for Payer: Healthscope Commercial	$7.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.68
Rate for Payer: PHP Commercial	$6.68
Rate for Payer: Priority Health Cigna Priority Health	$5.50
Rate for Payer: Priority Health SBD	$4.95

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$6.84

Service Code	NDC 0121-0868-05
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$6.16
Rate for Payer: Aetna Commercial	$5.81
Rate for Payer: Aetna New Business (MI Preferred)	$4.45
Rate for Payer: Cash Price	$5.47
Rate for Payer: Cofinity Commercial	$4.79
Rate for Payer: Cofinity Commercial	$5.88
Rate for Payer: Healthscope Commercial	$6.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.81
Rate for Payer: PHP Commercial	$5.81
Rate for Payer: Priority Health Cigna Priority Health	$4.79
Rate for Payer: Priority Health SBD	$4.31

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.49

Service Code	NDC 66689-037-01
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna Commercial	$4.67
Rate for Payer: Aetna New Business (MI Preferred)	$3.57
Rate for Payer: Cash Price	$4.39
Rate for Payer: Cofinity Commercial	$3.84
Rate for Payer: Cofinity Commercial	$4.72
Rate for Payer: Healthscope Commercial	$4.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.67
Rate for Payer: PHP Commercial	$4.67
Rate for Payer: Priority Health Cigna Priority Health	$3.84
Rate for Payer: Priority Health SBD	$3.46

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$41.37

Service Code	NDC 60432-537-60
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$26.06
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna Commercial	$35.16
Rate for Payer: Aetna New Business (MI Preferred)	$26.89
Rate for Payer: Cash Price	$33.10
Rate for Payer: Cofinity Commercial	$28.96
Rate for Payer: Cofinity Commercial	$35.58
Rate for Payer: Healthscope Commercial	$37.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$35.16
Rate for Payer: PHP Commercial	$35.16
Rate for Payer: Priority Health Cigna Priority Health	$28.96
Rate for Payer: Priority Health SBD	$26.06

NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM

Facility

$68.20

Service Code	NDC 51672-1263-1
Hospital Charge Code	5754
Hospital Revenue Code	637
Min. Negotiated Rate	$42.97
Max. Negotiated Rate	$61.38
Rate for Payer: Aetna Commercial	$57.97
Rate for Payer: Aetna New Business (MI Preferred)	$44.33
Rate for Payer: Cash Price	$54.56
Rate for Payer: Cofinity Commercial	$47.74
Rate for Payer: Cofinity Commercial	$58.65
Rate for Payer: Healthscope Commercial	$61.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.97
Rate for Payer: PHP Commercial	$57.97
Rate for Payer: Priority Health Cigna Priority Health	$47.74
Rate for Payer: Priority Health SBD	$42.97

NYSTATIN-TRIAMCINOLONE 100,000 UNIT/G-0.1 % TOPICAL CREAM

Facility

$18.03

Service Code	NDC 68462-314-17
Hospital Charge Code	5754
Hospital Revenue Code	637
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$16.23
Rate for Payer: Aetna Commercial	$15.33
Rate for Payer: Aetna New Business (MI Preferred)	$11.72
Rate for Payer: Cash Price	$14.42
Rate for Payer: Cofinity Commercial	$12.62
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Healthscope Commercial	$16.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.33
Rate for Payer: PHP Commercial	$15.33
Rate for Payer: Priority Health Cigna Priority Health	$12.62
Rate for Payer: Priority Health SBD	$11.36

OB/GYN SPEC KZOO ONLY - NITROUS OXIDE ADMIN

Professional

Both

$60.00

Service Code	HCPCS 00563
Hospital Revenue Code	990
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$42.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$42.00

OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION

Facility

$33,305.39

Service Code	HCPCS J9301
Hospital Charge Code	168805
Hospital Revenue Code	636
Min. Negotiated Rate	$20,982.40
Max. Negotiated Rate	$29,974.85
Rate for Payer: Aetna Commercial	$28,309.58
Rate for Payer: Aetna New Business (MI Preferred)	$21,648.50
Rate for Payer: Cash Price	$26,644.31
Rate for Payer: Cofinity Commercial	$23,313.77
Rate for Payer: Cofinity Commercial	$28,642.64
Rate for Payer: Healthscope Commercial	$29,974.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$28,309.58
Rate for Payer: PHP Commercial	$28,309.58
Rate for Payer: Priority Health Cigna Priority Health	$23,313.77
Rate for Payer: Priority Health SBD	$20,982.40

OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION

Facility

$33,305.39

Service Code	HCPCS J9301
Hospital Charge Code	168805
Hospital Revenue Code	636
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$29,974.85
Rate for Payer: Aetna Commercial	$28,309.58
Rate for Payer: Aetna Medicare	$73.16
Rate for Payer: Aetna New Business (MI Preferred)	$21,648.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$87.93
Rate for Payer: Amish Plain Church Group Commercial	$87.93
Rate for Payer: BCBS Complete	$40.40
Rate for Payer: BCBS MAPPO	$70.34
Rate for Payer: BCBS Trust/PPO	$208.22
Rate for Payer: BCN Medicare Advantage	$70.34
Rate for Payer: Cash Price	$26,644.31
Rate for Payer: Cash Price	$26,644.31
Rate for Payer: Cofinity Commercial	$23,313.77
Rate for Payer: Cofinity Commercial	$28,642.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$70.34
Rate for Payer: Healthscope Commercial	$29,974.85
Rate for Payer: Mclaren Medicaid	$38.48
Rate for Payer: Mclaren Medicare	$70.34
Rate for Payer: Meridian Medicaid	$40.40
Rate for Payer: Meridian Wellcare - Medicare Advantage	$73.86
Rate for Payer: MI Amish Medical Board Commercial	$80.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$28,309.58
Rate for Payer: PACE Medicare	$66.82
Rate for Payer: PACE SWMI	$70.34
Rate for Payer: PHP Commercial	$28,309.58
Rate for Payer: PHP Medicare Advantage	$70.34
Rate for Payer: Priority Health Choice Medicaid	$38.48
Rate for Payer: Priority Health Cigna Priority Health	$23,313.77
Rate for Payer: Priority Health Medicare	$70.34
Rate for Payer: Priority Health SBD	$20,982.40
Rate for Payer: Railroad Medicare Medicare	$70.34
Rate for Payer: UHC Dual Complete DSNP	$70.34
Rate for Payer: UHC Medicare Advantage	$72.45
Rate for Payer: VA VA	$70.34

OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION

Facility

$51,257.39

Service Code	HCPCS J2350
Hospital Charge Code	182454
Hospital Revenue Code	636
Min. Negotiated Rate	$32,292.16
Max. Negotiated Rate	$46,131.65
Rate for Payer: Aetna Commercial	$43,568.78
Rate for Payer: Aetna New Business (MI Preferred)	$33,317.30
Rate for Payer: Cash Price	$41,005.91
Rate for Payer: Cofinity Commercial	$35,880.17
Rate for Payer: Cofinity Commercial	$44,081.36
Rate for Payer: Healthscope Commercial	$46,131.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43,568.78
Rate for Payer: PHP Commercial	$43,568.78
Rate for Payer: Priority Health Cigna Priority Health	$35,880.17
Rate for Payer: Priority Health SBD	$32,292.16

OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION

Facility

$17.21

Service Code	HCPCS J2354
Hospital Charge Code	91279
Hospital Revenue Code	636
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$15.49
Rate for Payer: Aetna Commercial	$14.63
Rate for Payer: Aetna New Business (MI Preferred)	$11.19
Rate for Payer: BCBS Complete	$6.88
Rate for Payer: BCBS Trust/PPO	$3.52
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cofinity Commercial	$14.80
Rate for Payer: Cofinity Commercial	$12.05
Rate for Payer: Healthscope Commercial	$15.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.63
Rate for Payer: PHP Commercial	$14.63
Rate for Payer: Priority Health Cigna Priority Health	$12.05
Rate for Payer: Priority Health SBD	$10.84

OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION

Facility

$17.21

Service Code	HCPCS J2354
Hospital Charge Code	91279
Hospital Revenue Code	636
Min. Negotiated Rate	$10.84
Max. Negotiated Rate	$15.49
Rate for Payer: Aetna Commercial	$14.63
Rate for Payer: Aetna New Business (MI Preferred)	$11.19
Rate for Payer: Cash Price	$13.77
Rate for Payer: Cofinity Commercial	$12.05
Rate for Payer: Cofinity Commercial	$14.80
Rate for Payer: Healthscope Commercial	$15.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.63
Rate for Payer: PHP Commercial	$14.63
Rate for Payer: Priority Health Cigna Priority Health	$12.05
Rate for Payer: Priority Health SBD	$10.84

OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION

Facility

$48.59

Service Code	HCPCS J2354
Hospital Charge Code	91281
Hospital Revenue Code	636
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$43.73
Rate for Payer: Aetna Commercial	$41.30
Rate for Payer: Aetna New Business (MI Preferred)	$31.58
Rate for Payer: BCBS Complete	$19.44
Rate for Payer: BCBS Trust/PPO	$3.52
Rate for Payer: Cash Price	$38.87
Rate for Payer: Cash Price	$38.87
Rate for Payer: Cofinity Commercial	$34.01
Rate for Payer: Cofinity Commercial	$41.79
Rate for Payer: Healthscope Commercial	$43.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.30
Rate for Payer: PHP Commercial	$41.30
Rate for Payer: Priority Health Cigna Priority Health	$34.01
Rate for Payer: Priority Health SBD	$30.61

OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION

Facility

$144.85

Service Code	HCPCS J2354
Hospital Charge Code	91281
Hospital Revenue Code	636
Min. Negotiated Rate	$91.26
Max. Negotiated Rate	$130.36
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Commercial	$41.30
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna New Business (MI Preferred)	$31.58
Rate for Payer: Aetna New Business (MI Preferred)	$94.15
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cash Price	$38.87
Rate for Payer: Cash Price	$115.88
Rate for Payer: Cofinity Commercial	$41.79
Rate for Payer: Cofinity Commercial	$124.57
Rate for Payer: Cofinity Commercial	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Cofinity Commercial	$101.40
Rate for Payer: Cofinity Commercial	$34.01
Rate for Payer: Healthscope Commercial	$43.73
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: Healthscope Commercial	$130.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$123.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.30
Rate for Payer: PHP Commercial	$41.30
Rate for Payer: PHP Commercial	$123.12
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health Cigna Priority Health	$32.77
Rate for Payer: Priority Health Cigna Priority Health	$101.40
Rate for Payer: Priority Health Cigna Priority Health	$34.01
Rate for Payer: Priority Health SBD	$91.26
Rate for Payer: Priority Health SBD	$30.61
Rate for Payer: Priority Health SBD	$29.50

OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE

Facility

$10,621.47

Service Code	HCPCS J2353
Hospital Charge Code	161512
Hospital Revenue Code	636
Min. Negotiated Rate	$6,691.53
Max. Negotiated Rate	$9,559.32
Rate for Payer: Aetna Commercial	$9,028.25
Rate for Payer: Aetna New Business (MI Preferred)	$6,903.96
Rate for Payer: Cash Price	$8,497.18
Rate for Payer: Cofinity Commercial	$9,134.46
Rate for Payer: Cofinity Commercial	$7,435.03
Rate for Payer: Healthscope Commercial	$9,559.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,028.25
Rate for Payer: PHP Commercial	$9,028.25
Rate for Payer: Priority Health Cigna Priority Health	$7,435.03
Rate for Payer: Priority Health SBD	$6,691.53

OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE

Facility

$10,621.47

Service Code	HCPCS J2353
Hospital Charge Code	161512
Hospital Revenue Code	636
Min. Negotiated Rate	$115.32
Max. Negotiated Rate	$9,559.32
Rate for Payer: Aetna Commercial	$9,028.25
Rate for Payer: Aetna Medicare	$219.26
Rate for Payer: Aetna New Business (MI Preferred)	$6,903.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$263.54
Rate for Payer: Amish Plain Church Group Commercial	$263.54
Rate for Payer: BCBS Complete	$121.10
Rate for Payer: BCBS MAPPO	$210.83
Rate for Payer: BCBS Trust/PPO	$624.14
Rate for Payer: BCN Medicare Advantage	$210.83
Rate for Payer: Cash Price	$8,497.18
Rate for Payer: Cash Price	$8,497.18
Rate for Payer: Cofinity Commercial	$7,435.03
Rate for Payer: Cofinity Commercial	$9,134.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$210.83
Rate for Payer: Healthscope Commercial	$9,559.32
Rate for Payer: Mclaren Medicaid	$115.32
Rate for Payer: Mclaren Medicare	$210.83
Rate for Payer: Meridian Medicaid	$121.10
Rate for Payer: Meridian Wellcare - Medicare Advantage	$221.37
Rate for Payer: MI Amish Medical Board Commercial	$242.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,028.25
Rate for Payer: PACE Medicare	$200.29
Rate for Payer: PACE SWMI	$210.83
Rate for Payer: PHP Commercial	$9,028.25
Rate for Payer: PHP Medicare Advantage	$210.83
Rate for Payer: Priority Health Choice Medicaid	$115.32
Rate for Payer: Priority Health Cigna Priority Health	$7,435.03
Rate for Payer: Priority Health Medicare	$210.83
Rate for Payer: Priority Health SBD	$6,691.53
Rate for Payer: Railroad Medicare Medicare	$210.83
Rate for Payer: UHC Dual Complete DSNP	$210.83
Rate for Payer: UHC Medicare Advantage	$217.15
Rate for Payer: VA VA	$210.83

OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE

Facility

$15,904.88

Service Code	HCPCS J2353
Hospital Charge Code	161514
Hospital Revenue Code	636
Min. Negotiated Rate	$10,020.07
Max. Negotiated Rate	$14,314.39
Rate for Payer: Aetna Commercial	$13,519.15
Rate for Payer: Aetna New Business (MI Preferred)	$10,338.17
Rate for Payer: Cash Price	$12,723.90
Rate for Payer: Cofinity Commercial	$11,133.42
Rate for Payer: Cofinity Commercial	$13,678.20
Rate for Payer: Healthscope Commercial	$14,314.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13,519.15
Rate for Payer: PHP Commercial	$13,519.15
Rate for Payer: Priority Health Cigna Priority Health	$11,133.42
Rate for Payer: Priority Health SBD	$10,020.07

OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE

Facility

$15,904.88

Service Code	HCPCS J2353
Hospital Charge Code	161514
Hospital Revenue Code	636
Min. Negotiated Rate	$115.32
Max. Negotiated Rate	$14,314.39
Rate for Payer: Aetna Commercial	$13,519.15
Rate for Payer: Aetna Medicare	$219.26
Rate for Payer: Aetna New Business (MI Preferred)	$10,338.17
Rate for Payer: Allen County Amish Medical Aid Commercial	$263.54
Rate for Payer: Amish Plain Church Group Commercial	$263.54
Rate for Payer: BCBS Complete	$121.10
Rate for Payer: BCBS MAPPO	$210.83
Rate for Payer: BCBS Trust/PPO	$624.14
Rate for Payer: BCN Medicare Advantage	$210.83
Rate for Payer: Cash Price	$12,723.90
Rate for Payer: Cash Price	$12,723.90
Rate for Payer: Cofinity Commercial	$13,678.20
Rate for Payer: Cofinity Commercial	$11,133.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$210.83
Rate for Payer: Healthscope Commercial	$14,314.39
Rate for Payer: Mclaren Medicaid	$115.32
Rate for Payer: Mclaren Medicare	$210.83
Rate for Payer: Meridian Medicaid	$121.10
Rate for Payer: Meridian Wellcare - Medicare Advantage	$221.37
Rate for Payer: MI Amish Medical Board Commercial	$242.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13,519.15
Rate for Payer: PACE Medicare	$200.29
Rate for Payer: PACE SWMI	$210.83
Rate for Payer: PHP Commercial	$13,519.15
Rate for Payer: PHP Medicare Advantage	$210.83
Rate for Payer: Priority Health Choice Medicaid	$115.32
Rate for Payer: Priority Health Cigna Priority Health	$11,133.42
Rate for Payer: Priority Health Medicare	$210.83
Rate for Payer: Priority Health SBD	$10,020.07
Rate for Payer: Railroad Medicare Medicare	$210.83
Rate for Payer: UHC Dual Complete DSNP	$210.83
Rate for Payer: UHC Medicare Advantage	$217.15
Rate for Payer: VA VA	$210.83

OFATUMUMAB 1,000 MG/50 ML INTRAVENOUS SOLUTION

Facility

$26,414.00

Service Code	HCPCS J9302
Hospital Charge Code	153045
Hospital Revenue Code	636
Min. Negotiated Rate	$34.98
Max. Negotiated Rate	$23,772.60
Rate for Payer: Aetna Commercial	$22,451.90
Rate for Payer: Aetna Medicare	$66.52
Rate for Payer: Aetna New Business (MI Preferred)	$17,169.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$79.95
Rate for Payer: Amish Plain Church Group Commercial	$79.95
Rate for Payer: BCBS Complete	$36.74
Rate for Payer: BCBS MAPPO	$63.96
Rate for Payer: BCBS Trust/PPO	$178.50
Rate for Payer: BCN Medicare Advantage	$63.96
Rate for Payer: Cash Price	$21,131.20
Rate for Payer: Cash Price	$21,131.20
Rate for Payer: Cofinity Commercial	$22,716.04
Rate for Payer: Cofinity Commercial	$18,489.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$63.96
Rate for Payer: Healthscope Commercial	$23,772.60
Rate for Payer: Mclaren Medicaid	$34.98
Rate for Payer: Mclaren Medicare	$63.96
Rate for Payer: Meridian Medicaid	$36.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$67.15
Rate for Payer: MI Amish Medical Board Commercial	$73.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22,451.90
Rate for Payer: PACE Medicare	$60.76
Rate for Payer: PACE SWMI	$63.96
Rate for Payer: PHP Commercial	$22,451.90
Rate for Payer: PHP Medicare Advantage	$63.96
Rate for Payer: Priority Health Choice Medicaid	$34.98
Rate for Payer: Priority Health Cigna Priority Health	$18,489.80
Rate for Payer: Priority Health Medicare	$63.96
Rate for Payer: Priority Health SBD	$16,640.82
Rate for Payer: Railroad Medicare Medicare	$63.96
Rate for Payer: UHC Dual Complete DSNP	$63.96
Rate for Payer: UHC Medicare Advantage	$65.88
Rate for Payer: VA VA	$63.96

OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION

Facility

$2,641.40

Service Code	HCPCS J9302
Hospital Charge Code	100265
Hospital Revenue Code	636
Min. Negotiated Rate	$34.98
Max. Negotiated Rate	$2,377.26
Rate for Payer: Aetna Commercial	$2,245.19
Rate for Payer: Aetna Medicare	$66.52
Rate for Payer: Aetna New Business (MI Preferred)	$1,716.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$79.95
Rate for Payer: Amish Plain Church Group Commercial	$79.95
Rate for Payer: BCBS Complete	$36.74
Rate for Payer: BCBS MAPPO	$63.96
Rate for Payer: BCBS Trust/PPO	$178.50
Rate for Payer: BCN Medicare Advantage	$63.96
Rate for Payer: Cash Price	$2,113.12
Rate for Payer: Cash Price	$2,113.12
Rate for Payer: Cofinity Commercial	$1,848.98
Rate for Payer: Cofinity Commercial	$2,271.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$63.96
Rate for Payer: Healthscope Commercial	$2,377.26
Rate for Payer: Mclaren Medicaid	$34.98
Rate for Payer: Mclaren Medicare	$63.96
Rate for Payer: Meridian Medicaid	$36.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$67.15
Rate for Payer: MI Amish Medical Board Commercial	$73.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,245.19
Rate for Payer: PACE Medicare	$60.76
Rate for Payer: PACE SWMI	$63.96
Rate for Payer: PHP Commercial	$2,245.19
Rate for Payer: PHP Medicare Advantage	$63.96
Rate for Payer: Priority Health Choice Medicaid	$34.98
Rate for Payer: Priority Health Cigna Priority Health	$1,848.98
Rate for Payer: Priority Health Medicare	$63.96
Rate for Payer: Priority Health SBD	$1,664.08
Rate for Payer: Railroad Medicare Medicare	$63.96
Rate for Payer: UHC Dual Complete DSNP	$63.96
Rate for Payer: UHC Medicare Advantage	$65.88
Rate for Payer: VA VA	$63.96

OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION

Facility

$2,641.40

Service Code	HCPCS J9302
Hospital Charge Code	100265
Hospital Revenue Code	636
Min. Negotiated Rate	$1,664.08
Max. Negotiated Rate	$2,377.26
Rate for Payer: Aetna Commercial	$2,245.19
Rate for Payer: Aetna New Business (MI Preferred)	$1,716.91
Rate for Payer: Cash Price	$2,113.12
Rate for Payer: Cofinity Commercial	$1,848.98
Rate for Payer: Cofinity Commercial	$2,271.60
Rate for Payer: Healthscope Commercial	$2,377.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,245.19
Rate for Payer: PHP Commercial	$2,245.19
Rate for Payer: Priority Health Cigna Priority Health	$1,848.98
Rate for Payer: Priority Health SBD	$1,664.08

OFLOXACIN 0.3 % EYE DROPS

Facility

$66.54

Service Code	NDC 24208-434-05
Hospital Charge Code	19746
Hospital Revenue Code	637
Min. Negotiated Rate	$41.92
Max. Negotiated Rate	$59.89
Rate for Payer: Aetna Commercial	$56.56
Rate for Payer: Aetna New Business (MI Preferred)	$43.25
Rate for Payer: Cash Price	$53.23
Rate for Payer: Cofinity Commercial	$46.58
Rate for Payer: Cofinity Commercial	$57.22
Rate for Payer: Healthscope Commercial	$59.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.56
Rate for Payer: PHP Commercial	$56.56
Rate for Payer: Priority Health Cigna Priority Health	$46.58
Rate for Payer: Priority Health SBD	$41.92

OFLOXACIN 0.3 % EYE DROPS

Facility

$403.83

Service Code	NDC 11980-779-05
Hospital Charge Code	19746
Hospital Revenue Code	637
Min. Negotiated Rate	$254.41
Max. Negotiated Rate	$363.45
Rate for Payer: Aetna Commercial	$343.26
Rate for Payer: Aetna New Business (MI Preferred)	$262.49
Rate for Payer: Cash Price	$323.06
Rate for Payer: Cofinity Commercial	$282.68
Rate for Payer: Cofinity Commercial	$347.29
Rate for Payer: Healthscope Commercial	$363.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$343.26
Rate for Payer: PHP Commercial	$343.26
Rate for Payer: Priority Health Cigna Priority Health	$282.68
Rate for Payer: Priority Health SBD	$254.41

OFLOXACIN 0.3 % EYE DROPS

Facility

$31.75

Service Code	NDC 17478-713-10
Hospital Charge Code	19746
Hospital Revenue Code	637
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$28.58
Rate for Payer: Aetna Commercial	$26.99
Rate for Payer: Aetna New Business (MI Preferred)	$20.64
Rate for Payer: Cash Price	$25.40
Rate for Payer: Cofinity Commercial	$22.22
Rate for Payer: Cofinity Commercial	$27.30
Rate for Payer: Healthscope Commercial	$28.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.99
Rate for Payer: PHP Commercial	$26.99
Rate for Payer: Priority Health Cigna Priority Health	$22.22
Rate for Payer: Priority Health SBD	$20.00

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$5.62

Service Code	NDC 49884-321-52
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna Commercial	$4.78
Rate for Payer: Aetna New Business (MI Preferred)	$3.65
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cofinity Commercial	$3.93
Rate for Payer: Cofinity Commercial	$4.83
Rate for Payer: Healthscope Commercial	$5.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.78
Rate for Payer: PHP Commercial	$4.78
Rate for Payer: Priority Health Cigna Priority Health	$3.93
Rate for Payer: Priority Health SBD	$3.54

Know your out-of-pocket cost for care.

All Charges