Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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 Commercial	$27.05
Rate for Payer: Cofinity Commercial	$33.24
Rate for Payer: Cofinity Medicare Advantage	$27.05
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: PHP Commercial	$32.85
Rate for Payer: Priority Health Cigna Priority Health	$25.12
Rate for Payer: Priority Health SBD	$24.35

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	$15.45
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 Commercial	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Cofinity Medicare Advantage	$27.04
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: PHP Commercial	$32.84
Rate for Payer: Priority Health Cigna Priority Health	$25.11
Rate for Payer: Priority Health SBD	$24.34

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$62.03

Service Code	NDC 42023011510
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$24.81
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 Commercial	$43.42
Rate for Payer: Cofinity Commercial	$53.35
Rate for Payer: Cofinity Medicare Advantage	$43.42
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: PHP Commercial	$52.73
Rate for Payer: Priority Health Cigna Priority Health	$40.32
Rate for Payer: Priority Health SBD	$39.08

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$38.63

Service Code	NDC 00409205115
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$15.45
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 Commercial	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Cofinity Medicare Advantage	$27.04
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: PHP Commercial	$32.84
Rate for Payer: Priority Health Cigna Priority Health	$25.11
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 Commercial	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Cofinity Medicare Advantage	$27.04
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: PHP Commercial	$32.84
Rate for Payer: Priority Health Cigna Priority Health	$25.11
Rate for Payer: Priority Health SBD	$24.34

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 Commercial	$43.42
Rate for Payer: Cofinity Commercial	$53.35
Rate for Payer: Cofinity Medicare Advantage	$43.42
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: PHP Commercial	$52.73
Rate for Payer: Priority Health Cigna Priority Health	$40.32
Rate for Payer: Priority Health SBD	$39.08

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$38.63

Service Code	NDC 00409205105
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$15.45
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 Commercial	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Cofinity Medicare Advantage	$27.04
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: PHP Commercial	$32.84
Rate for Payer: Priority Health Cigna Priority Health	$25.11
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 Commercial	$27.04
Rate for Payer: Cofinity Commercial	$33.22
Rate for Payer: Cofinity Medicare Advantage	$27.04
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: PHP Commercial	$32.84
Rate for Payer: Priority Health Cigna Priority Health	$25.11
Rate for Payer: Priority Health SBD	$24.34

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$68.00

Service Code	NDC 67457018120
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna Medicare	$34.00
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: BCBS Complete	$27.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Cofinity Medicare Advantage	$47.60
Rate for Payer: Encore Health Key Benefits Commercial	$54.40
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$44.20
Rate for Payer: Priority Health SBD	$42.84

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$35.00

Service Code	NDC 69374098255
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$14.00
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 Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Cofinity Medicare Advantage	$24.50
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: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$22.75
Rate for Payer: Priority Health SBD	$22.05

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 Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Cofinity Medicare Advantage	$24.50
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: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$22.75
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	$14.00
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 Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Cofinity Medicare Advantage	$24.50
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: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$22.75
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 Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Cofinity Medicare Advantage	$24.50
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: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$22.75
Rate for Payer: Priority Health SBD	$22.05

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$68.00

Service Code	NDC 67457018120
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Cofinity Medicare Advantage	$47.60
Rate for Payer: Encore Health Key Benefits Commercial	$54.40
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$44.20
Rate for Payer: Priority Health SBD	$42.84

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 Commercial	$67.20
Rate for Payer: Cofinity Commercial	$82.56
Rate for Payer: Cofinity Medicare Advantage	$67.20
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: PHP Commercial	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$62.40
Rate for Payer: Priority Health SBD	$60.48

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$96.00

Service Code	NDC 09900000869
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$38.40
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 Commercial	$67.20
Rate for Payer: Cofinity Commercial	$82.56
Rate for Payer: Cofinity Medicare Advantage	$67.20
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: PHP Commercial	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$62.40
Rate for Payer: Priority Health SBD	$60.48

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.85

Service Code	NDC 67457000110
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$29.57
Rate for Payer: Aetna Commercial	$27.92
Rate for Payer: Aetna New Business (MI Preferred)	$21.35
Rate for Payer: Cash Price	$26.28
Rate for Payer: Cofinity Commercial	$23.00
Rate for Payer: Cofinity Commercial	$28.25
Rate for Payer: Cofinity Medicare Advantage	$23.00
Rate for Payer: Encore Health Key Benefits Commercial	$26.28
Rate for Payer: Healthscope Commercial	$29.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.92
Rate for Payer: PHP Commercial	$27.92
Rate for Payer: Priority Health Cigna Priority Health	$21.35
Rate for Payer: Priority Health SBD	$20.70

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.85

Service Code	NDC 67457000100
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$29.57
Rate for Payer: Aetna Commercial	$27.92
Rate for Payer: Aetna Medicare	$16.43
Rate for Payer: Aetna New Business (MI Preferred)	$21.35
Rate for Payer: BCBS Complete	$13.14
Rate for Payer: Cash Price	$26.28
Rate for Payer: Cofinity Commercial	$23.00
Rate for Payer: Cofinity Commercial	$28.25
Rate for Payer: Cofinity Medicare Advantage	$23.00
Rate for Payer: Encore Health Key Benefits Commercial	$26.28
Rate for Payer: Healthscope Commercial	$29.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.92
Rate for Payer: PHP Commercial	$27.92
Rate for Payer: Priority Health Cigna Priority Health	$21.35
Rate for Payer: Priority Health SBD	$20.70

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.85

Service Code	NDC 67457000110
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$29.57
Rate for Payer: Aetna Commercial	$27.92
Rate for Payer: Aetna Medicare	$16.43
Rate for Payer: Aetna New Business (MI Preferred)	$21.35
Rate for Payer: BCBS Complete	$13.14
Rate for Payer: Cash Price	$26.28
Rate for Payer: Cofinity Commercial	$23.00
Rate for Payer: Cofinity Commercial	$28.25
Rate for Payer: Cofinity Medicare Advantage	$23.00
Rate for Payer: Encore Health Key Benefits Commercial	$26.28
Rate for Payer: Healthscope Commercial	$29.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.92
Rate for Payer: PHP Commercial	$27.92
Rate for Payer: Priority Health Cigna Priority Health	$21.35
Rate for Payer: Priority Health SBD	$20.70

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 Commercial	$22.86
Rate for Payer: Cofinity Commercial	$28.08
Rate for Payer: Cofinity Medicare Advantage	$22.86
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: PHP Commercial	$27.75
Rate for Payer: Priority Health Cigna Priority Health	$21.22
Rate for Payer: Priority Health SBD	$20.57

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.65

Service Code	NDC 42023011410
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$13.06
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 Commercial	$22.86
Rate for Payer: Cofinity Commercial	$28.08
Rate for Payer: Cofinity Medicare Advantage	$22.86
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: PHP Commercial	$27.75
Rate for Payer: Priority Health Cigna Priority Health	$21.22
Rate for Payer: Priority Health SBD	$20.57

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.85

Service Code	NDC 67457000100
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$29.57
Rate for Payer: Aetna Commercial	$27.92
Rate for Payer: Aetna New Business (MI Preferred)	$21.35
Rate for Payer: Cash Price	$26.28
Rate for Payer: Cofinity Commercial	$23.00
Rate for Payer: Cofinity Commercial	$28.25
Rate for Payer: Cofinity Medicare Advantage	$23.00
Rate for Payer: Encore Health Key Benefits Commercial	$26.28
Rate for Payer: Healthscope Commercial	$29.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.92
Rate for Payer: PHP Commercial	$27.92
Rate for Payer: Priority Health Cigna Priority Health	$21.35
Rate for Payer: Priority Health SBD	$20.70

KETOCONAZOLE 2 % SHAMPOO

Facility

$71.82

Service Code	NDC 45802046564
Hospital Charge Code	14132
Hospital Revenue Code	637
Min. Negotiated Rate	$28.73
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 Commercial	$50.27
Rate for Payer: Cofinity Commercial	$61.77
Rate for Payer: Cofinity Medicare Advantage	$50.27
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: PHP Commercial	$61.05
Rate for Payer: Priority Health Cigna Priority Health	$46.68
Rate for Payer: Priority Health SBD	$45.25

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 Commercial	$50.27
Rate for Payer: Cofinity Commercial	$61.77
Rate for Payer: Cofinity Medicare Advantage	$50.27
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: PHP Commercial	$61.05
Rate for Payer: Priority Health Cigna Priority Health	$46.68
Rate for Payer: Priority Health SBD	$45.25

KETOCONAZOLE 2 % TOPICAL CREAM

Facility

$123.80

Service Code	NDC 51672129802
Hospital Charge Code	10368
Hospital Revenue Code	637
Min. Negotiated Rate	$77.99
Max. Negotiated Rate	$111.42
Rate for Payer: Aetna Commercial	$105.23
Rate for Payer: Aetna New Business (MI Preferred)	$80.47
Rate for Payer: Cash Price	$99.04
Rate for Payer: Cofinity Commercial	$106.47
Rate for Payer: Cofinity Commercial	$86.66
Rate for Payer: Cofinity Medicare Advantage	$86.66
Rate for Payer: Encore Health Key Benefits Commercial	$99.04
Rate for Payer: Healthscope Commercial	$111.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.23
Rate for Payer: PHP Commercial	$105.23
Rate for Payer: Priority Health Cigna Priority Health	$80.47
Rate for Payer: Priority Health SBD	$77.99

Know your out-of-pocket cost for care.

All Charges