Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

KATE FARMS INTERMITTENT FEED LIQUID 1.4 0.06 GRAM-1.4 KCAL/ML ORAL LIQUID

Facility

$62.90

Service Code	NDC 09900001990
Hospital Charge Code	301453
Hospital Revenue Code	637
Min. Negotiated Rate	$39.63
Max. Negotiated Rate	$56.61
Rate for Payer: Aetna Commercial	$53.47
Rate for Payer: Aetna New Business (MI Preferred)	$40.88
Rate for Payer: Cash Price	$50.32
Rate for Payer: Cofinity Advantage	$44.03
Rate for Payer: Cofinity Commercial	$54.09
Rate for Payer: Encore Health Key Benefits Commercial	$50.32
Rate for Payer: Healthscope Commercial	$56.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.17
Rate for Payer: PHP Commercial	$53.47
Rate for Payer: Priority Health SBD	$39.63

KETAMINE 100 MG/ML INJECTION IM (CODE)

Facility

$38.63

Service Code	NDC 00409205105
Hospital Charge Code	163728
Hospital Revenue Code	250
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$34.77
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare	$19.32
Rate for Payer: Aetna New Business (MI Preferred)	$25.11
Rate for Payer: BCBS Complete	$15.45
Rate for Payer: Cash Price	$30.90
Rate for Payer: Cofinity Advantage	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Encore Health Key Benefits Commercial	$30.90
Rate for Payer: Healthscope Commercial	$34.77
Rate for Payer: MI Amish Medical Board Commercial	$30.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.97
Rate for Payer: PHP Commercial	$32.84
Rate for Payer: Priority Health SBD	$24.34
Rate for Payer: UHC All Payor (Choice/PPO)	$25.11
Rate for Payer: UHC Core	$20.13
Rate for Payer: UHC Exchange	$15.18

KETAMINE 100 MG/ML INJECTION IM (CODE)

Facility

$38.65

Service Code	NDC 00409004010
Hospital Charge Code	163728
Hospital Revenue Code	250
Min. Negotiated Rate	$24.35
Max. Negotiated Rate	$34.78
Rate for Payer: Aetna Commercial	$32.85
Rate for Payer: Aetna New Business (MI Preferred)	$25.12
Rate for Payer: Cash Price	$30.92
Rate for Payer: Cofinity Advantage	$27.05
Rate for Payer: Cofinity Commercial	$33.24
Rate for Payer: Encore Health Key Benefits Commercial	$30.92
Rate for Payer: Healthscope Commercial	$34.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.99
Rate for Payer: PHP Commercial	$32.85
Rate for Payer: Priority Health SBD	$24.35

KETAMINE 100 MG/ML INJECTION IM (CODE)

Facility

$38.65

Service Code	NDC 00409004010
Hospital Charge Code	163728
Hospital Revenue Code	250
Min. Negotiated Rate	$15.19
Max. Negotiated Rate	$34.78
Rate for Payer: Aetna Commercial	$32.85
Rate for Payer: Aetna Medicare	$19.32
Rate for Payer: Aetna New Business (MI Preferred)	$25.12
Rate for Payer: BCBS Complete	$15.46
Rate for Payer: Cash Price	$30.92
Rate for Payer: Cofinity Advantage	$27.05
Rate for Payer: Cofinity Commercial	$33.24
Rate for Payer: Encore Health Key Benefits Commercial	$30.92
Rate for Payer: Healthscope Commercial	$34.78
Rate for Payer: MI Amish Medical Board Commercial	$30.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.99
Rate for Payer: PHP Commercial	$32.85
Rate for Payer: Priority Health SBD	$24.35
Rate for Payer: UHC All Payor (Choice/PPO)	$25.12
Rate for Payer: UHC Core	$20.14
Rate for Payer: UHC Exchange	$15.19

KETAMINE 100 MG/ML INJECTION IM (CODE)

Facility

$38.63

Service Code	NDC 00409205105
Hospital Charge Code	163728
Hospital Revenue Code	250
Min. Negotiated Rate	$24.34
Max. Negotiated Rate	$34.77
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna New Business (MI Preferred)	$25.11
Rate for Payer: Cash Price	$30.90
Rate for Payer: Cofinity Advantage	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Encore Health Key Benefits Commercial	$30.90
Rate for Payer: Healthscope Commercial	$34.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.97
Rate for Payer: PHP Commercial	$32.84
Rate for Payer: Priority Health SBD	$24.34

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$38.63

Service Code	NDC 00409205115
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$24.34
Max. Negotiated Rate	$34.77
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna New Business (MI Preferred)	$25.11
Rate for Payer: Cash Price	$30.90
Rate for Payer: Cofinity Advantage	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Encore Health Key Benefits Commercial	$30.90
Rate for Payer: Healthscope Commercial	$34.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.97
Rate for Payer: PHP Commercial	$32.84
Rate for Payer: Priority Health SBD	$24.34

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$38.63

Service Code	NDC 00409205105
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$24.34
Max. Negotiated Rate	$34.77
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna New Business (MI Preferred)	$25.11
Rate for Payer: Cash Price	$30.90
Rate for Payer: Cofinity Advantage	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Encore Health Key Benefits Commercial	$30.90
Rate for Payer: Healthscope Commercial	$34.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.97
Rate for Payer: PHP Commercial	$32.84
Rate for Payer: Priority Health SBD	$24.34

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$38.63

Service Code	NDC 00409205105
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$34.77
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare	$19.32
Rate for Payer: Aetna New Business (MI Preferred)	$25.11
Rate for Payer: BCBS Complete	$15.45
Rate for Payer: Cash Price	$30.90
Rate for Payer: Cofinity Advantage	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Encore Health Key Benefits Commercial	$30.90
Rate for Payer: Healthscope Commercial	$34.77
Rate for Payer: MI Amish Medical Board Commercial	$30.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.97
Rate for Payer: PHP Commercial	$32.84
Rate for Payer: Priority Health SBD	$24.34
Rate for Payer: UHC All Payor (Choice/PPO)	$25.11
Rate for Payer: UHC Core	$20.13
Rate for Payer: UHC Exchange	$15.18

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$38.63

Service Code	NDC 00409205115
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$34.77
Rate for Payer: Aetna Commercial	$32.84
Rate for Payer: Aetna Medicare	$19.32
Rate for Payer: Aetna New Business (MI Preferred)	$25.11
Rate for Payer: BCBS Complete	$15.45
Rate for Payer: Cash Price	$30.90
Rate for Payer: Cofinity Advantage	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Encore Health Key Benefits Commercial	$30.90
Rate for Payer: Healthscope Commercial	$34.77
Rate for Payer: MI Amish Medical Board Commercial	$30.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.97
Rate for Payer: PHP Commercial	$32.84
Rate for Payer: Priority Health SBD	$24.34
Rate for Payer: UHC All Payor (Choice/PPO)	$25.11
Rate for Payer: UHC Core	$20.13
Rate for Payer: UHC Exchange	$15.18

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$62.03

Service Code	NDC 42023011510
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$39.08
Max. Negotiated Rate	$55.83
Rate for Payer: Aetna Commercial	$52.73
Rate for Payer: Aetna New Business (MI Preferred)	$40.32
Rate for Payer: Cash Price	$49.62
Rate for Payer: Cofinity Advantage	$43.42
Rate for Payer: Cofinity Commercial	$53.35
Rate for Payer: Encore Health Key Benefits Commercial	$49.62
Rate for Payer: Healthscope Commercial	$55.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.52
Rate for Payer: PHP Commercial	$52.73
Rate for Payer: Priority Health SBD	$39.08

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$62.03

Service Code	NDC 42023011510
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$55.83
Rate for Payer: Aetna Commercial	$52.73
Rate for Payer: Aetna Medicare	$31.02
Rate for Payer: Aetna New Business (MI Preferred)	$40.32
Rate for Payer: BCBS Complete	$24.81
Rate for Payer: Cash Price	$49.62
Rate for Payer: Cofinity Advantage	$43.42
Rate for Payer: Cofinity Commercial	$53.35
Rate for Payer: Encore Health Key Benefits Commercial	$49.62
Rate for Payer: Healthscope Commercial	$55.83
Rate for Payer: MI Amish Medical Board Commercial	$49.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.52
Rate for Payer: PHP Commercial	$52.73
Rate for Payer: Priority Health SBD	$39.08
Rate for Payer: UHC All Payor (Choice/PPO)	$40.32
Rate for Payer: UHC Core	$32.32
Rate for Payer: UHC Exchange	$24.38

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$35.00

Service Code	NDC 69374098255
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Advantage	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Encore Health Key Benefits Commercial	$28.00
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health SBD	$22.05

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$35.00

Service Code	NDC 69374030805
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Advantage	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Encore Health Key Benefits Commercial	$28.00
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health SBD	$22.05

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$35.00

Service Code	NDC 69374030805
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Advantage	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Encore Health Key Benefits Commercial	$28.00
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: MI Amish Medical Board Commercial	$28.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health SBD	$22.05
Rate for Payer: UHC All Payor (Choice/PPO)	$22.75
Rate for Payer: UHC Core	$18.23
Rate for Payer: UHC Exchange	$13.76

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$96.00

Service Code	NDC 09900000869
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$60.48
Max. Negotiated Rate	$86.40
Rate for Payer: Aetna Commercial	$81.60
Rate for Payer: Aetna New Business (MI Preferred)	$62.40
Rate for Payer: Cash Price	$76.80
Rate for Payer: Cofinity Advantage	$67.20
Rate for Payer: Cofinity Commercial	$82.56
Rate for Payer: Encore Health Key Benefits Commercial	$76.80
Rate for Payer: Healthscope Commercial	$86.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.00
Rate for Payer: PHP Commercial	$81.60
Rate for Payer: Priority Health SBD	$60.48

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$35.00

Service Code	NDC 69374098255
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Advantage	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Encore Health Key Benefits Commercial	$28.00
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: MI Amish Medical Board Commercial	$28.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health SBD	$22.05
Rate for Payer: UHC All Payor (Choice/PPO)	$22.75
Rate for Payer: UHC Core	$18.23
Rate for Payer: UHC Exchange	$13.76

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$96.00

Service Code	NDC 09900000869
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$37.73
Max. Negotiated Rate	$86.40
Rate for Payer: Aetna Commercial	$81.60
Rate for Payer: Aetna Medicare	$48.00
Rate for Payer: Aetna New Business (MI Preferred)	$62.40
Rate for Payer: BCBS Complete	$38.40
Rate for Payer: Cash Price	$76.80
Rate for Payer: Cofinity Advantage	$67.20
Rate for Payer: Cofinity Commercial	$82.56
Rate for Payer: Encore Health Key Benefits Commercial	$76.80
Rate for Payer: Healthscope Commercial	$86.40
Rate for Payer: MI Amish Medical Board Commercial	$76.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.00
Rate for Payer: PHP Commercial	$81.60
Rate for Payer: Priority Health SBD	$60.48
Rate for Payer: UHC All Payor (Choice/PPO)	$62.40
Rate for Payer: UHC Core	$50.02
Rate for Payer: UHC Exchange	$37.73

KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE

Facility

$32.20

Service Code	NDC 70092111944
Hospital Charge Code	118700
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$28.98
Rate for Payer: Aetna Commercial	$27.37
Rate for Payer: Aetna Medicare	$16.10
Rate for Payer: Aetna New Business (MI Preferred)	$20.93
Rate for Payer: BCBS Complete	$12.88
Rate for Payer: Cash Price	$25.76
Rate for Payer: Cofinity Advantage	$22.54
Rate for Payer: Cofinity Commercial	$27.69
Rate for Payer: Encore Health Key Benefits Commercial	$25.76
Rate for Payer: Healthscope Commercial	$28.98
Rate for Payer: MI Amish Medical Board Commercial	$25.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.15
Rate for Payer: PHP Commercial	$27.37
Rate for Payer: Priority Health SBD	$20.29
Rate for Payer: UHC All Payor (Choice/PPO)	$20.93
Rate for Payer: UHC Core	$16.78
Rate for Payer: UHC Exchange	$12.65

KETAMINE 50 MG/5 ML (10 MG/ML) IV SYRINGE

Facility

$32.20

Service Code	NDC 70092111944
Hospital Charge Code	118700
Hospital Revenue Code	250
Min. Negotiated Rate	$20.29
Max. Negotiated Rate	$28.98
Rate for Payer: Aetna Commercial	$27.37
Rate for Payer: Aetna New Business (MI Preferred)	$20.93
Rate for Payer: Cash Price	$25.76
Rate for Payer: Cofinity Advantage	$22.54
Rate for Payer: Cofinity Commercial	$27.69
Rate for Payer: Encore Health Key Benefits Commercial	$25.76
Rate for Payer: Healthscope Commercial	$28.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.15
Rate for Payer: PHP Commercial	$27.37
Rate for Payer: Priority Health SBD	$20.29

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.65

Service Code	NDC 42023011410
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$29.39
Rate for Payer: Aetna Commercial	$27.75
Rate for Payer: Aetna Medicare	$16.32
Rate for Payer: Aetna New Business (MI Preferred)	$21.22
Rate for Payer: BCBS Complete	$13.06
Rate for Payer: Cash Price	$26.12
Rate for Payer: Cofinity Advantage	$22.86
Rate for Payer: Cofinity Commercial	$28.08
Rate for Payer: Encore Health Key Benefits Commercial	$26.12
Rate for Payer: Healthscope Commercial	$29.39
Rate for Payer: MI Amish Medical Board Commercial	$26.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.49
Rate for Payer: PHP Commercial	$27.75
Rate for Payer: Priority Health SBD	$20.57
Rate for Payer: UHC All Payor (Choice/PPO)	$21.22
Rate for Payer: UHC Core	$17.01
Rate for Payer: UHC Exchange	$12.83

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.65

Service Code	NDC 42023011410
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$20.57
Max. Negotiated Rate	$29.39
Rate for Payer: Aetna Commercial	$27.75
Rate for Payer: Aetna New Business (MI Preferred)	$21.22
Rate for Payer: Cash Price	$26.12
Rate for Payer: Cofinity Advantage	$22.86
Rate for Payer: Cofinity Commercial	$28.08
Rate for Payer: Encore Health Key Benefits Commercial	$26.12
Rate for Payer: Healthscope Commercial	$29.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.49
Rate for Payer: PHP Commercial	$27.75
Rate for Payer: Priority Health SBD	$20.57

KETOCONAZOLE 2 % SHAMPOO

Facility

$71.82

Service Code	NDC 45802046564
Hospital Charge Code	14132
Hospital Revenue Code	637
Min. Negotiated Rate	$28.23
Max. Negotiated Rate	$64.64
Rate for Payer: Aetna Commercial	$61.05
Rate for Payer: Aetna Medicare	$35.91
Rate for Payer: Aetna New Business (MI Preferred)	$46.68
Rate for Payer: BCBS Complete	$28.73
Rate for Payer: Cash Price	$57.46
Rate for Payer: Cofinity Advantage	$50.27
Rate for Payer: Cofinity Commercial	$61.77
Rate for Payer: Encore Health Key Benefits Commercial	$57.46
Rate for Payer: Healthscope Commercial	$64.64
Rate for Payer: MI Amish Medical Board Commercial	$57.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.87
Rate for Payer: PHP Commercial	$61.05
Rate for Payer: Priority Health SBD	$45.25
Rate for Payer: UHC All Payor (Choice/PPO)	$46.68
Rate for Payer: UHC Core	$37.42
Rate for Payer: UHC Exchange	$28.23

KETOCONAZOLE 2 % SHAMPOO

Facility

$71.82

Service Code	NDC 45802046564
Hospital Charge Code	14132
Hospital Revenue Code	637
Min. Negotiated Rate	$45.25
Max. Negotiated Rate	$64.64
Rate for Payer: Aetna Commercial	$61.05
Rate for Payer: Aetna New Business (MI Preferred)	$46.68
Rate for Payer: Cash Price	$57.46
Rate for Payer: Cofinity Advantage	$50.27
Rate for Payer: Cofinity Commercial	$61.77
Rate for Payer: Encore Health Key Benefits Commercial	$57.46
Rate for Payer: Healthscope Commercial	$64.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.87
Rate for Payer: PHP Commercial	$61.05
Rate for Payer: Priority Health SBD	$45.25

KETOCONAZOLE 2 % TOPICAL CREAM

Facility

$20.59

Service Code	NDC 00168009915
Hospital Charge Code	10368
Hospital Revenue Code	637
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$18.53
Rate for Payer: Aetna Commercial	$17.50
Rate for Payer: Aetna New Business (MI Preferred)	$13.38
Rate for Payer: Cash Price	$16.47
Rate for Payer: Cofinity Advantage	$14.41
Rate for Payer: Cofinity Commercial	$17.71
Rate for Payer: Encore Health Key Benefits Commercial	$16.47
Rate for Payer: Healthscope Commercial	$18.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.44
Rate for Payer: PHP Commercial	$17.50
Rate for Payer: Priority Health SBD	$12.97

KETOCONAZOLE 2 % TOPICAL CREAM

Facility

$20.59

Service Code	NDC 00168009915
Hospital Charge Code	10368
Hospital Revenue Code	637
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$18.53
Rate for Payer: Aetna Commercial	$17.50
Rate for Payer: Aetna Medicare	$10.29
Rate for Payer: Aetna New Business (MI Preferred)	$13.38
Rate for Payer: BCBS Complete	$8.24
Rate for Payer: Cash Price	$16.47
Rate for Payer: Cofinity Advantage	$14.41
Rate for Payer: Cofinity Commercial	$17.71
Rate for Payer: Encore Health Key Benefits Commercial	$16.47
Rate for Payer: Healthscope Commercial	$18.53
Rate for Payer: MI Amish Medical Board Commercial	$16.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.44
Rate for Payer: PHP Commercial	$17.50
Rate for Payer: Priority Health SBD	$12.97
Rate for Payer: UHC All Payor (Choice/PPO)	$13.38
Rate for Payer: UHC Core	$10.73
Rate for Payer: UHC Exchange	$8.09

Know your out-of-pocket cost for care.

All Charges