Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LACOSAMIDE 100 MG TABLET

Facility

$4,286.60

Service Code	NDC 00131247860
Hospital Charge Code	96969
Hospital Revenue Code	637
Min. Negotiated Rate	$2,700.56
Max. Negotiated Rate	$3,857.94
Rate for Payer: Aetna Commercial	$3,643.61
Rate for Payer: Aetna New Business (MI Preferred)	$2,786.29
Rate for Payer: Cash Price	$3,429.28
Rate for Payer: Cofinity Commercial	$3,000.62
Rate for Payer: Cofinity Commercial	$3,686.48
Rate for Payer: Cofinity Medicare Advantage	$3,000.62
Rate for Payer: Encore Health Key Benefits Commercial	$3,429.28
Rate for Payer: Healthscope Commercial	$3,857.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,643.61
Rate for Payer: PHP Commercial	$3,643.61
Rate for Payer: Priority Health Cigna Priority Health	$2,786.29
Rate for Payer: Priority Health SBD	$2,700.56

LACOSAMIDE 100 MG TABLET

Facility

$458.88

Service Code	NDC 60687068757
Hospital Charge Code	96969
Hospital Revenue Code	637
Min. Negotiated Rate	$183.55
Max. Negotiated Rate	$412.99
Rate for Payer: Aetna Commercial	$390.05
Rate for Payer: Aetna Medicare	$229.44
Rate for Payer: Aetna New Business (MI Preferred)	$298.27
Rate for Payer: BCBS Complete	$183.55
Rate for Payer: Cash Price	$367.10
Rate for Payer: Cofinity Commercial	$321.22
Rate for Payer: Cofinity Commercial	$394.64
Rate for Payer: Cofinity Medicare Advantage	$321.22
Rate for Payer: Encore Health Key Benefits Commercial	$367.10
Rate for Payer: Healthscope Commercial	$412.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.05
Rate for Payer: PHP Commercial	$390.05
Rate for Payer: Priority Health Cigna Priority Health	$298.27
Rate for Payer: Priority Health SBD	$289.09

LACOSAMIDE 100 MG TABLET

Facility

$458.88

Service Code	NDC 60687068757
Hospital Charge Code	96969
Hospital Revenue Code	637
Min. Negotiated Rate	$289.09
Max. Negotiated Rate	$412.99
Rate for Payer: Aetna Commercial	$390.05
Rate for Payer: Aetna New Business (MI Preferred)	$298.27
Rate for Payer: Cash Price	$367.10
Rate for Payer: Cofinity Commercial	$321.22
Rate for Payer: Cofinity Commercial	$394.64
Rate for Payer: Cofinity Medicare Advantage	$321.22
Rate for Payer: Encore Health Key Benefits Commercial	$367.10
Rate for Payer: Healthscope Commercial	$412.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$390.05
Rate for Payer: PHP Commercial	$390.05
Rate for Payer: Priority Health Cigna Priority Health	$298.27
Rate for Payer: Priority Health SBD	$289.09

LACOSAMIDE 100 MG TABLET

Facility

$7.65

Service Code	NDC 60687068711
Hospital Charge Code	96969
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna Medicare	$3.83
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: BCBS Complete	$3.06
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

LACOSAMIDE 100 MG TABLET

Facility

$7.65

Service Code	NDC 60687068711
Hospital Charge Code	96969
Hospital Revenue Code	637
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

LACOSAMIDE 100 MG TABLET

Facility

$4,286.60

Service Code	NDC 00131247860
Hospital Charge Code	96969
Hospital Revenue Code	637
Min. Negotiated Rate	$1,714.64
Max. Negotiated Rate	$3,857.94
Rate for Payer: Aetna Commercial	$3,643.61
Rate for Payer: Aetna Medicare	$2,143.30
Rate for Payer: Aetna New Business (MI Preferred)	$2,786.29
Rate for Payer: BCBS Complete	$1,714.64
Rate for Payer: Cash Price	$3,429.28
Rate for Payer: Cofinity Commercial	$3,000.62
Rate for Payer: Cofinity Commercial	$3,686.48
Rate for Payer: Cofinity Medicare Advantage	$3,000.62
Rate for Payer: Encore Health Key Benefits Commercial	$3,429.28
Rate for Payer: Healthscope Commercial	$3,857.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,643.61
Rate for Payer: PHP Commercial	$3,643.61
Rate for Payer: Priority Health Cigna Priority Health	$2,786.29
Rate for Payer: Priority Health SBD	$2,700.56

LACOSAMIDE 10 MG/ML ORAL SOLUTION

Facility

$1,611.72

Service Code	NDC 00131541072
Hospital Charge Code	105482
Hospital Revenue Code	637
Min. Negotiated Rate	$644.69
Max. Negotiated Rate	$1,450.55
Rate for Payer: Aetna Commercial	$1,369.96
Rate for Payer: Aetna Medicare	$805.86
Rate for Payer: Aetna New Business (MI Preferred)	$1,047.62
Rate for Payer: BCBS Complete	$644.69
Rate for Payer: Cash Price	$1,289.38
Rate for Payer: Cofinity Commercial	$1,128.20
Rate for Payer: Cofinity Commercial	$1,386.08
Rate for Payer: Cofinity Medicare Advantage	$1,128.20
Rate for Payer: Encore Health Key Benefits Commercial	$1,289.38
Rate for Payer: Healthscope Commercial	$1,450.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,369.96
Rate for Payer: PHP Commercial	$1,369.96
Rate for Payer: Priority Health Cigna Priority Health	$1,047.62
Rate for Payer: Priority Health SBD	$1,015.38

LACOSAMIDE 10 MG/ML ORAL SOLUTION

Facility

$1,611.72

Service Code	NDC 00131541072
Hospital Charge Code	105482
Hospital Revenue Code	637
Min. Negotiated Rate	$1,015.38
Max. Negotiated Rate	$1,450.55
Rate for Payer: Aetna Commercial	$1,369.96
Rate for Payer: Aetna New Business (MI Preferred)	$1,047.62
Rate for Payer: Cash Price	$1,289.38
Rate for Payer: Cofinity Commercial	$1,128.20
Rate for Payer: Cofinity Commercial	$1,386.08
Rate for Payer: Cofinity Medicare Advantage	$1,128.20
Rate for Payer: Encore Health Key Benefits Commercial	$1,289.38
Rate for Payer: Healthscope Commercial	$1,450.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,369.96
Rate for Payer: PHP Commercial	$1,369.96
Rate for Payer: Priority Health Cigna Priority Health	$1,047.62
Rate for Payer: Priority Health SBD	$1,015.38

LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION

Facility

$62.75

Service Code	HCPCS C9254
Hospital Charge Code	96972
Hospital Revenue Code	636
Min. Negotiated Rate	$39.53
Max. Negotiated Rate	$56.48
Rate for Payer: Aetna Commercial	$53.34
Rate for Payer: Aetna Commercial	$278.04
Rate for Payer: Aetna New Business (MI Preferred)	$212.62
Rate for Payer: Aetna New Business (MI Preferred)	$40.79
Rate for Payer: Cash Price	$261.68
Rate for Payer: Cash Price	$50.20
Rate for Payer: Cofinity Commercial	$53.97
Rate for Payer: Cofinity Commercial	$43.92
Rate for Payer: Cofinity Commercial	$228.97
Rate for Payer: Cofinity Commercial	$281.31
Rate for Payer: Cofinity Medicare Advantage	$228.97
Rate for Payer: Cofinity Medicare Advantage	$43.92
Rate for Payer: Encore Health Key Benefits Commercial	$261.68
Rate for Payer: Encore Health Key Benefits Commercial	$50.20
Rate for Payer: Healthscope Commercial	$56.48
Rate for Payer: Healthscope Commercial	$294.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$278.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.34
Rate for Payer: PHP Commercial	$53.34
Rate for Payer: PHP Commercial	$278.04
Rate for Payer: Priority Health Cigna Priority Health	$212.62
Rate for Payer: Priority Health Cigna Priority Health	$40.79
Rate for Payer: Priority Health SBD	$206.07
Rate for Payer: Priority Health SBD	$39.53

LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION

Facility

$327.10

Service Code	HCPCS C9254
Hospital Charge Code	96972
Hospital Revenue Code	636
Min. Negotiated Rate	$130.84
Max. Negotiated Rate	$294.39
Rate for Payer: Aetna Commercial	$278.04
Rate for Payer: Aetna Commercial	$53.34
Rate for Payer: Aetna Medicare	$163.55
Rate for Payer: Aetna Medicare	$31.38
Rate for Payer: Aetna New Business (MI Preferred)	$212.62
Rate for Payer: Aetna New Business (MI Preferred)	$40.79
Rate for Payer: BCBS Complete	$25.10
Rate for Payer: BCBS Complete	$130.84
Rate for Payer: Cash Price	$261.68
Rate for Payer: Cash Price	$50.20
Rate for Payer: Cofinity Commercial	$43.92
Rate for Payer: Cofinity Commercial	$228.97
Rate for Payer: Cofinity Commercial	$281.31
Rate for Payer: Cofinity Commercial	$53.97
Rate for Payer: Cofinity Medicare Advantage	$43.92
Rate for Payer: Cofinity Medicare Advantage	$228.97
Rate for Payer: Encore Health Key Benefits Commercial	$50.20
Rate for Payer: Encore Health Key Benefits Commercial	$261.68
Rate for Payer: Healthscope Commercial	$56.48
Rate for Payer: Healthscope Commercial	$294.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$278.04
Rate for Payer: PHP Commercial	$53.34
Rate for Payer: PHP Commercial	$278.04
Rate for Payer: Priority Health Cigna Priority Health	$212.62
Rate for Payer: Priority Health Cigna Priority Health	$40.79
Rate for Payer: Priority Health SBD	$206.07
Rate for Payer: Priority Health SBD	$39.53

LACOSAMIDE 200 MG TABLET

Facility

$4,127.87

Service Code	NDC 00131248035
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$1,651.15
Max. Negotiated Rate	$3,715.08
Rate for Payer: Aetna Commercial	$3,508.69
Rate for Payer: Aetna Medicare	$2,063.93
Rate for Payer: Aetna New Business (MI Preferred)	$2,683.12
Rate for Payer: BCBS Complete	$1,651.15
Rate for Payer: Cash Price	$3,302.30
Rate for Payer: Cofinity Commercial	$2,889.51
Rate for Payer: Cofinity Commercial	$3,549.97
Rate for Payer: Cofinity Medicare Advantage	$2,889.51
Rate for Payer: Encore Health Key Benefits Commercial	$3,302.30
Rate for Payer: Healthscope Commercial	$3,715.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,508.69
Rate for Payer: PHP Commercial	$3,508.69
Rate for Payer: Priority Health Cigna Priority Health	$2,683.12
Rate for Payer: Priority Health SBD	$2,600.56

LACOSAMIDE 200 MG TABLET

Facility

$4,541.24

Service Code	NDC 00131248060
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$2,860.98
Max. Negotiated Rate	$4,087.12
Rate for Payer: Aetna Commercial	$3,860.05
Rate for Payer: Aetna New Business (MI Preferred)	$2,951.81
Rate for Payer: Cash Price	$3,632.99
Rate for Payer: Cofinity Commercial	$3,178.87
Rate for Payer: Cofinity Commercial	$3,905.47
Rate for Payer: Cofinity Medicare Advantage	$3,178.87
Rate for Payer: Encore Health Key Benefits Commercial	$3,632.99
Rate for Payer: Healthscope Commercial	$4,087.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,860.05
Rate for Payer: PHP Commercial	$3,860.05
Rate for Payer: Priority Health Cigna Priority Health	$2,951.81
Rate for Payer: Priority Health SBD	$2,860.98

LACOSAMIDE 200 MG TABLET

Facility

$4,127.87

Service Code	NDC 00131248035
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$2,600.56
Max. Negotiated Rate	$3,715.08
Rate for Payer: Aetna Commercial	$3,508.69
Rate for Payer: Aetna New Business (MI Preferred)	$2,683.12
Rate for Payer: Cash Price	$3,302.30
Rate for Payer: Cofinity Commercial	$2,889.51
Rate for Payer: Cofinity Commercial	$3,549.97
Rate for Payer: Cofinity Medicare Advantage	$2,889.51
Rate for Payer: Encore Health Key Benefits Commercial	$3,302.30
Rate for Payer: Healthscope Commercial	$3,715.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,508.69
Rate for Payer: PHP Commercial	$3,508.69
Rate for Payer: Priority Health Cigna Priority Health	$2,683.12
Rate for Payer: Priority Health SBD	$2,600.56

LACOSAMIDE 200 MG TABLET

Facility

$4,541.24

Service Code	NDC 00131248060
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$1,816.50
Max. Negotiated Rate	$4,087.12
Rate for Payer: Aetna Commercial	$3,860.05
Rate for Payer: Aetna Medicare	$2,270.62
Rate for Payer: Aetna New Business (MI Preferred)	$2,951.81
Rate for Payer: BCBS Complete	$1,816.50
Rate for Payer: Cash Price	$3,632.99
Rate for Payer: Cofinity Commercial	$3,178.87
Rate for Payer: Cofinity Commercial	$3,905.47
Rate for Payer: Cofinity Medicare Advantage	$3,178.87
Rate for Payer: Encore Health Key Benefits Commercial	$3,632.99
Rate for Payer: Healthscope Commercial	$4,087.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,860.05
Rate for Payer: PHP Commercial	$3,860.05
Rate for Payer: Priority Health Cigna Priority Health	$2,951.81
Rate for Payer: Priority Health SBD	$2,860.98

LACOSAMIDE 200 MG TABLET

Facility

$262.20

Service Code	NDC 62332017460
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$104.88
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna Medicare	$131.10
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: BCBS Complete	$104.88
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Commercial	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Cofinity Medicare Advantage	$183.54
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health Cigna Priority Health	$170.43
Rate for Payer: Priority Health SBD	$165.19

LACOSAMIDE 200 MG TABLET

Facility

$262.20

Service Code	NDC 62332017460
Hospital Charge Code	96971
Hospital Revenue Code	637
Min. Negotiated Rate	$165.19
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Commercial	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Cofinity Medicare Advantage	$183.54
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health Cigna Priority Health	$170.43
Rate for Payer: Priority Health SBD	$165.19

LACOSAMIDE 50 MG TABLET

Facility

$2,492.40

Service Code	NDC 00131247735
Hospital Charge Code	96968
Hospital Revenue Code	637
Min. Negotiated Rate	$996.96
Max. Negotiated Rate	$2,243.16
Rate for Payer: Aetna Commercial	$2,118.54
Rate for Payer: Aetna Medicare	$1,246.20
Rate for Payer: Aetna New Business (MI Preferred)	$1,620.06
Rate for Payer: BCBS Complete	$996.96
Rate for Payer: Cash Price	$1,993.92
Rate for Payer: Cofinity Commercial	$1,744.68
Rate for Payer: Cofinity Commercial	$2,143.46
Rate for Payer: Cofinity Medicare Advantage	$1,744.68
Rate for Payer: Encore Health Key Benefits Commercial	$1,993.92
Rate for Payer: Healthscope Commercial	$2,243.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,118.54
Rate for Payer: PHP Commercial	$2,118.54
Rate for Payer: Priority Health Cigna Priority Health	$1,620.06
Rate for Payer: Priority Health SBD	$1,570.21

LACOSAMIDE 50 MG TABLET

Facility

$2,741.93

Service Code	NDC 00131247760
Hospital Charge Code	96968
Hospital Revenue Code	637
Min. Negotiated Rate	$1,727.42
Max. Negotiated Rate	$2,467.74
Rate for Payer: Aetna Commercial	$2,330.64
Rate for Payer: Aetna New Business (MI Preferred)	$1,782.25
Rate for Payer: Cash Price	$2,193.54
Rate for Payer: Cofinity Commercial	$1,919.35
Rate for Payer: Cofinity Commercial	$2,358.06
Rate for Payer: Cofinity Medicare Advantage	$1,919.35
Rate for Payer: Encore Health Key Benefits Commercial	$2,193.54
Rate for Payer: Healthscope Commercial	$2,467.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,330.64
Rate for Payer: PHP Commercial	$2,330.64
Rate for Payer: Priority Health Cigna Priority Health	$1,782.25
Rate for Payer: Priority Health SBD	$1,727.42

LACOSAMIDE 50 MG TABLET

Facility

$2,741.93

Service Code	NDC 00131247760
Hospital Charge Code	96968
Hospital Revenue Code	637
Min. Negotiated Rate	$1,096.77
Max. Negotiated Rate	$2,467.74
Rate for Payer: Aetna Commercial	$2,330.64
Rate for Payer: Aetna Medicare	$1,370.96
Rate for Payer: Aetna New Business (MI Preferred)	$1,782.25
Rate for Payer: BCBS Complete	$1,096.77
Rate for Payer: Cash Price	$2,193.54
Rate for Payer: Cofinity Commercial	$1,919.35
Rate for Payer: Cofinity Commercial	$2,358.06
Rate for Payer: Cofinity Medicare Advantage	$1,919.35
Rate for Payer: Encore Health Key Benefits Commercial	$2,193.54
Rate for Payer: Healthscope Commercial	$2,467.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,330.64
Rate for Payer: PHP Commercial	$2,330.64
Rate for Payer: Priority Health Cigna Priority Health	$1,782.25
Rate for Payer: Priority Health SBD	$1,727.42

LACOSAMIDE 50 MG TABLET

Facility

$2,492.40

Service Code	NDC 00131247735
Hospital Charge Code	96968
Hospital Revenue Code	637
Min. Negotiated Rate	$1,570.21
Max. Negotiated Rate	$2,243.16
Rate for Payer: Aetna Commercial	$2,118.54
Rate for Payer: Aetna New Business (MI Preferred)	$1,620.06
Rate for Payer: Cash Price	$1,993.92
Rate for Payer: Cofinity Commercial	$1,744.68
Rate for Payer: Cofinity Commercial	$2,143.46
Rate for Payer: Cofinity Medicare Advantage	$1,744.68
Rate for Payer: Encore Health Key Benefits Commercial	$1,993.92
Rate for Payer: Healthscope Commercial	$2,243.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,118.54
Rate for Payer: PHP Commercial	$2,118.54
Rate for Payer: Priority Health Cigna Priority Health	$1,620.06
Rate for Payer: Priority Health SBD	$1,570.21

LACTASE 9,000 UNIT TABLET

Facility

$46.47

Service Code	NDC 00904590887
Hospital Charge Code	109044
Hospital Revenue Code	637
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$41.82
Rate for Payer: Aetna Commercial	$39.50
Rate for Payer: Aetna New Business (MI Preferred)	$30.21
Rate for Payer: Cash Price	$37.18
Rate for Payer: Cofinity Commercial	$32.53
Rate for Payer: Cofinity Commercial	$39.96
Rate for Payer: Cofinity Medicare Advantage	$32.53
Rate for Payer: Encore Health Key Benefits Commercial	$37.18
Rate for Payer: Healthscope Commercial	$41.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.50
Rate for Payer: PHP Commercial	$39.50
Rate for Payer: Priority Health Cigna Priority Health	$30.21
Rate for Payer: Priority Health SBD	$29.28

LACTASE 9,000 UNIT TABLET

Facility

$114.24

Service Code	NDC 00450091060
Hospital Charge Code	109044
Hospital Revenue Code	637
Min. Negotiated Rate	$71.97
Max. Negotiated Rate	$102.82
Rate for Payer: Aetna Commercial	$97.10
Rate for Payer: Aetna New Business (MI Preferred)	$74.26
Rate for Payer: Cash Price	$91.39
Rate for Payer: Cofinity Commercial	$79.97
Rate for Payer: Cofinity Commercial	$98.25
Rate for Payer: Cofinity Medicare Advantage	$79.97
Rate for Payer: Encore Health Key Benefits Commercial	$91.39
Rate for Payer: Healthscope Commercial	$102.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.10
Rate for Payer: PHP Commercial	$97.10
Rate for Payer: Priority Health Cigna Priority Health	$74.26
Rate for Payer: Priority Health SBD	$71.97

LACTASE 9,000 UNIT TABLET

Facility

$114.24

Service Code	NDC 00450091060
Hospital Charge Code	109044
Hospital Revenue Code	637
Min. Negotiated Rate	$45.70
Max. Negotiated Rate	$102.82
Rate for Payer: Aetna Commercial	$97.10
Rate for Payer: Aetna Medicare	$57.12
Rate for Payer: Aetna New Business (MI Preferred)	$74.26
Rate for Payer: BCBS Complete	$45.70
Rate for Payer: Cash Price	$91.39
Rate for Payer: Cofinity Commercial	$79.97
Rate for Payer: Cofinity Commercial	$98.25
Rate for Payer: Cofinity Medicare Advantage	$79.97
Rate for Payer: Encore Health Key Benefits Commercial	$91.39
Rate for Payer: Healthscope Commercial	$102.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.10
Rate for Payer: PHP Commercial	$97.10
Rate for Payer: Priority Health Cigna Priority Health	$74.26
Rate for Payer: Priority Health SBD	$71.97

LACTASE 9,000 UNIT TABLET

Facility

$46.47

Service Code	NDC 00904590887
Hospital Charge Code	109044
Hospital Revenue Code	637
Min. Negotiated Rate	$18.59
Max. Negotiated Rate	$41.82
Rate for Payer: Aetna Commercial	$39.50
Rate for Payer: Aetna Medicare	$23.23
Rate for Payer: Aetna New Business (MI Preferred)	$30.21
Rate for Payer: BCBS Complete	$18.59
Rate for Payer: Cash Price	$37.18
Rate for Payer: Cofinity Commercial	$32.53
Rate for Payer: Cofinity Commercial	$39.96
Rate for Payer: Cofinity Medicare Advantage	$32.53
Rate for Payer: Encore Health Key Benefits Commercial	$37.18
Rate for Payer: Healthscope Commercial	$41.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.50
Rate for Payer: PHP Commercial	$39.50
Rate for Payer: Priority Health Cigna Priority Health	$30.21
Rate for Payer: Priority Health SBD	$29.28

LACTATED RINGERS EYE BOLUS

Facility

$69.92

Service Code	HCPCS J7120
Hospital Charge Code	300324
Hospital Revenue Code	636
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Cofinity Medicare Advantage	$48.94
Rate for Payer: Encore Health Key Benefits Commercial	$55.94
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$45.45
Rate for Payer: Priority Health SBD	$44.05

Know your out-of-pocket cost for care.

All Charges