Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LARYNGOSCOPY, FLEXIBLE; WITH THERAPEUTIC INJECTION(S) (EG, CHEMODENERVATION AGENT OR CORTICOSTEROID, INJECTED PERCUTANEOUS, TRANSORAL, OR VIA ENDOSCOPE CHANNEL), UNILATERAL

Facility

$4,734.21

Service Code	CPT 31573
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

LATANOPROST 0.005 % EYE DROPS

Facility

$50.75

Service Code	NDC 17478062512
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$20.30
Max. Negotiated Rate	$45.67
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna Medicare	$25.38
Rate for Payer: Aetna New Business (MI Preferred)	$32.99
Rate for Payer: BCBS Complete	$20.30
Rate for Payer: Cash Price	$40.60
Rate for Payer: Cofinity Commercial	$35.52
Rate for Payer: Cofinity Commercial	$43.65
Rate for Payer: Cofinity Medicare Advantage	$35.52
Rate for Payer: Encore Health Key Benefits Commercial	$40.60
Rate for Payer: Healthscope Commercial	$45.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.14
Rate for Payer: PHP Commercial	$43.14
Rate for Payer: Priority Health Cigna Priority Health	$32.99
Rate for Payer: Priority Health SBD	$31.97

LATANOPROST 0.005 % EYE DROPS

Facility

$46.39

Service Code	NDC 61314054703
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$41.75
Rate for Payer: Aetna Commercial	$39.43
Rate for Payer: Aetna Medicare	$23.20
Rate for Payer: Aetna New Business (MI Preferred)	$30.15
Rate for Payer: BCBS Complete	$18.56
Rate for Payer: Cash Price	$37.11
Rate for Payer: Cofinity Commercial	$32.47
Rate for Payer: Cofinity Commercial	$39.90
Rate for Payer: Cofinity Medicare Advantage	$32.47
Rate for Payer: Encore Health Key Benefits Commercial	$37.11
Rate for Payer: Healthscope Commercial	$41.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.43
Rate for Payer: PHP Commercial	$39.43
Rate for Payer: Priority Health Cigna Priority Health	$30.15
Rate for Payer: Priority Health SBD	$29.23

LATANOPROST 0.005 % EYE DROPS

Facility

$59.85

Service Code	NDC 24208046325
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$23.94
Max. Negotiated Rate	$53.87
Rate for Payer: Aetna Commercial	$50.87
Rate for Payer: Aetna Medicare	$29.93
Rate for Payer: Aetna New Business (MI Preferred)	$38.90
Rate for Payer: BCBS Complete	$23.94
Rate for Payer: Cash Price	$47.88
Rate for Payer: Cofinity Commercial	$41.90
Rate for Payer: Cofinity Commercial	$51.47
Rate for Payer: Cofinity Medicare Advantage	$41.90
Rate for Payer: Encore Health Key Benefits Commercial	$47.88
Rate for Payer: Healthscope Commercial	$53.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.87
Rate for Payer: PHP Commercial	$50.87
Rate for Payer: Priority Health Cigna Priority Health	$38.90
Rate for Payer: Priority Health SBD	$37.71

LATANOPROST 0.005 % EYE DROPS

Facility

$26.46

Service Code	NDC 61314054701
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$23.81
Rate for Payer: Aetna Commercial	$22.49
Rate for Payer: Aetna Medicare	$13.23
Rate for Payer: Aetna New Business (MI Preferred)	$17.20
Rate for Payer: BCBS Complete	$10.58
Rate for Payer: Cash Price	$21.17
Rate for Payer: Cofinity Commercial	$18.52
Rate for Payer: Cofinity Commercial	$22.76
Rate for Payer: Cofinity Medicare Advantage	$18.52
Rate for Payer: Encore Health Key Benefits Commercial	$21.17
Rate for Payer: Healthscope Commercial	$23.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.49
Rate for Payer: PHP Commercial	$22.49
Rate for Payer: Priority Health Cigna Priority Health	$17.20
Rate for Payer: Priority Health SBD	$16.67

LATANOPROST 0.005 % EYE DROPS

Facility

$26.46

Service Code	NDC 61314054701
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$23.81
Rate for Payer: Aetna Commercial	$22.49
Rate for Payer: Aetna New Business (MI Preferred)	$17.20
Rate for Payer: Cash Price	$21.17
Rate for Payer: Cofinity Commercial	$18.52
Rate for Payer: Cofinity Commercial	$22.76
Rate for Payer: Cofinity Medicare Advantage	$18.52
Rate for Payer: Encore Health Key Benefits Commercial	$21.17
Rate for Payer: Healthscope Commercial	$23.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.49
Rate for Payer: PHP Commercial	$22.49
Rate for Payer: Priority Health Cigna Priority Health	$17.20
Rate for Payer: Priority Health SBD	$16.67

LATANOPROST 0.005 % EYE DROPS

Facility

$59.85

Service Code	NDC 24208046325
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$37.71
Max. Negotiated Rate	$53.87
Rate for Payer: Aetna Commercial	$50.87
Rate for Payer: Aetna New Business (MI Preferred)	$38.90
Rate for Payer: Cash Price	$47.88
Rate for Payer: Cofinity Commercial	$41.90
Rate for Payer: Cofinity Commercial	$51.47
Rate for Payer: Cofinity Medicare Advantage	$41.90
Rate for Payer: Encore Health Key Benefits Commercial	$47.88
Rate for Payer: Healthscope Commercial	$53.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.87
Rate for Payer: PHP Commercial	$50.87
Rate for Payer: Priority Health Cigna Priority Health	$38.90
Rate for Payer: Priority Health SBD	$37.71

LATANOPROST 0.005 % EYE DROPS

Facility

$46.39

Service Code	NDC 61314054703
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$29.23
Max. Negotiated Rate	$41.75
Rate for Payer: Aetna Commercial	$39.43
Rate for Payer: Aetna New Business (MI Preferred)	$30.15
Rate for Payer: Cash Price	$37.11
Rate for Payer: Cofinity Commercial	$32.47
Rate for Payer: Cofinity Commercial	$39.90
Rate for Payer: Cofinity Medicare Advantage	$32.47
Rate for Payer: Encore Health Key Benefits Commercial	$37.11
Rate for Payer: Healthscope Commercial	$41.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.43
Rate for Payer: PHP Commercial	$39.43
Rate for Payer: Priority Health Cigna Priority Health	$30.15
Rate for Payer: Priority Health SBD	$29.23

LATANOPROST 0.005 % EYE DROPS

Facility

$861.95

Service Code	NDC 00013830304
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$543.03
Max. Negotiated Rate	$775.75
Rate for Payer: Aetna Commercial	$732.66
Rate for Payer: Aetna New Business (MI Preferred)	$560.27
Rate for Payer: Cash Price	$689.56
Rate for Payer: Cofinity Commercial	$603.37
Rate for Payer: Cofinity Commercial	$741.28
Rate for Payer: Cofinity Medicare Advantage	$603.37
Rate for Payer: Encore Health Key Benefits Commercial	$689.56
Rate for Payer: Healthscope Commercial	$775.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$732.66
Rate for Payer: PHP Commercial	$732.66
Rate for Payer: Priority Health Cigna Priority Health	$560.27
Rate for Payer: Priority Health SBD	$543.03

LATANOPROST 0.005 % EYE DROPS

Facility

$861.95

Service Code	NDC 00013830304
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$344.78
Max. Negotiated Rate	$775.75
Rate for Payer: Aetna Commercial	$732.66
Rate for Payer: Aetna Medicare	$430.98
Rate for Payer: Aetna New Business (MI Preferred)	$560.27
Rate for Payer: BCBS Complete	$344.78
Rate for Payer: Cash Price	$689.56
Rate for Payer: Cofinity Commercial	$603.37
Rate for Payer: Cofinity Commercial	$741.28
Rate for Payer: Cofinity Medicare Advantage	$603.37
Rate for Payer: Encore Health Key Benefits Commercial	$689.56
Rate for Payer: Healthscope Commercial	$775.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$732.66
Rate for Payer: PHP Commercial	$732.66
Rate for Payer: Priority Health Cigna Priority Health	$560.27
Rate for Payer: Priority Health SBD	$543.03

LATANOPROST 0.005 % EYE DROPS

Facility

$50.75

Service Code	NDC 17478062512
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$31.97
Max. Negotiated Rate	$45.67
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna New Business (MI Preferred)	$32.99
Rate for Payer: Cash Price	$40.60
Rate for Payer: Cofinity Commercial	$35.52
Rate for Payer: Cofinity Commercial	$43.65
Rate for Payer: Cofinity Medicare Advantage	$35.52
Rate for Payer: Encore Health Key Benefits Commercial	$40.60
Rate for Payer: Healthscope Commercial	$45.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.14
Rate for Payer: PHP Commercial	$43.14
Rate for Payer: Priority Health Cigna Priority Health	$32.99
Rate for Payer: Priority Health SBD	$31.97

LATERAL RETINACULAR RELEASE, OPEN

Facility

$8,907.47

Service Code	CPT 27425
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

LEFLUNOMIDE 10 MG TABLET

Facility

$98.21

Service Code	NDC 59651034830
Hospital Charge Code	23872
Hospital Revenue Code	637
Min. Negotiated Rate	$61.87
Max. Negotiated Rate	$88.39
Rate for Payer: Aetna Commercial	$83.48
Rate for Payer: Aetna New Business (MI Preferred)	$63.84
Rate for Payer: Cash Price	$78.57
Rate for Payer: Cofinity Commercial	$68.75
Rate for Payer: Cofinity Commercial	$84.46
Rate for Payer: Cofinity Medicare Advantage	$68.75
Rate for Payer: Encore Health Key Benefits Commercial	$78.57
Rate for Payer: Healthscope Commercial	$88.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.48
Rate for Payer: PHP Commercial	$83.48
Rate for Payer: Priority Health Cigna Priority Health	$63.84
Rate for Payer: Priority Health SBD	$61.87

LEFLUNOMIDE 10 MG TABLET

Facility

$98.21

Service Code	NDC 59651034830
Hospital Charge Code	23872
Hospital Revenue Code	637
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$88.39
Rate for Payer: Aetna Commercial	$83.48
Rate for Payer: Aetna Medicare	$49.10
Rate for Payer: Aetna New Business (MI Preferred)	$63.84
Rate for Payer: BCBS Complete	$39.28
Rate for Payer: Cash Price	$78.57
Rate for Payer: Cofinity Commercial	$68.75
Rate for Payer: Cofinity Commercial	$84.46
Rate for Payer: Cofinity Medicare Advantage	$68.75
Rate for Payer: Encore Health Key Benefits Commercial	$78.57
Rate for Payer: Healthscope Commercial	$88.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.48
Rate for Payer: PHP Commercial	$83.48
Rate for Payer: Priority Health Cigna Priority Health	$63.84
Rate for Payer: Priority Health SBD	$61.87

LEFLUNOMIDE 20 MG TABLET

Facility

$5,391.39

Service Code	NDC 00088216130
Hospital Charge Code	23873
Hospital Revenue Code	637
Min. Negotiated Rate	$2,156.56
Max. Negotiated Rate	$4,852.25
Rate for Payer: Aetna Commercial	$4,582.68
Rate for Payer: Aetna Medicare	$2,695.70
Rate for Payer: Aetna New Business (MI Preferred)	$3,504.40
Rate for Payer: BCBS Complete	$2,156.56
Rate for Payer: Cash Price	$4,313.11
Rate for Payer: Cofinity Commercial	$3,773.97
Rate for Payer: Cofinity Commercial	$4,636.60
Rate for Payer: Cofinity Medicare Advantage	$3,773.97
Rate for Payer: Encore Health Key Benefits Commercial	$4,313.11
Rate for Payer: Healthscope Commercial	$4,852.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,582.68
Rate for Payer: PHP Commercial	$4,582.68
Rate for Payer: Priority Health Cigna Priority Health	$3,504.40
Rate for Payer: Priority Health SBD	$3,396.58

LEFLUNOMIDE 20 MG TABLET

Facility

$5,391.39

Service Code	NDC 00088216130
Hospital Charge Code	23873
Hospital Revenue Code	637
Min. Negotiated Rate	$3,396.58
Max. Negotiated Rate	$4,852.25
Rate for Payer: Aetna Commercial	$4,582.68
Rate for Payer: Aetna New Business (MI Preferred)	$3,504.40
Rate for Payer: Cash Price	$4,313.11
Rate for Payer: Cofinity Commercial	$3,773.97
Rate for Payer: Cofinity Commercial	$4,636.60
Rate for Payer: Cofinity Medicare Advantage	$3,773.97
Rate for Payer: Encore Health Key Benefits Commercial	$4,313.11
Rate for Payer: Healthscope Commercial	$4,852.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,582.68
Rate for Payer: PHP Commercial	$4,582.68
Rate for Payer: Priority Health Cigna Priority Health	$3,504.40
Rate for Payer: Priority Health SBD	$3,396.58

LEFLUNOMIDE 20 MG TABLET

Facility

$527.25

Service Code	NDC 00955173730
Hospital Charge Code	23873
Hospital Revenue Code	637
Min. Negotiated Rate	$332.17
Max. Negotiated Rate	$474.52
Rate for Payer: Aetna Commercial	$448.16
Rate for Payer: Aetna New Business (MI Preferred)	$342.71
Rate for Payer: Cash Price	$421.80
Rate for Payer: Cofinity Commercial	$369.07
Rate for Payer: Cofinity Commercial	$453.44
Rate for Payer: Cofinity Medicare Advantage	$369.07
Rate for Payer: Encore Health Key Benefits Commercial	$421.80
Rate for Payer: Healthscope Commercial	$474.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$448.16
Rate for Payer: PHP Commercial	$448.16
Rate for Payer: Priority Health Cigna Priority Health	$342.71
Rate for Payer: Priority Health SBD	$332.17

LEFLUNOMIDE 20 MG TABLET

Facility

$527.25

Service Code	NDC 00955173730
Hospital Charge Code	23873
Hospital Revenue Code	637
Min. Negotiated Rate	$210.90
Max. Negotiated Rate	$474.52
Rate for Payer: Aetna Commercial	$448.16
Rate for Payer: Aetna Medicare	$263.62
Rate for Payer: Aetna New Business (MI Preferred)	$342.71
Rate for Payer: BCBS Complete	$210.90
Rate for Payer: Cash Price	$421.80
Rate for Payer: Cofinity Commercial	$369.07
Rate for Payer: Cofinity Commercial	$453.44
Rate for Payer: Cofinity Medicare Advantage	$369.07
Rate for Payer: Encore Health Key Benefits Commercial	$421.80
Rate for Payer: Healthscope Commercial	$474.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$448.16
Rate for Payer: PHP Commercial	$448.16
Rate for Payer: Priority Health Cigna Priority Health	$342.71
Rate for Payer: Priority Health SBD	$332.17

LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE)

Facility

$8,907.47

Service Code	CPT 27685
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

LETROZOLE 2.5 MG TABLET

Facility

$185.73

Service Code	NDC 50268047615
Hospital Charge Code	21509
Hospital Revenue Code	637
Min. Negotiated Rate	$117.01
Max. Negotiated Rate	$167.16
Rate for Payer: Aetna Commercial	$157.87
Rate for Payer: Aetna New Business (MI Preferred)	$120.72
Rate for Payer: Cash Price	$148.58
Rate for Payer: Cofinity Commercial	$130.01
Rate for Payer: Cofinity Commercial	$159.73
Rate for Payer: Cofinity Medicare Advantage	$130.01
Rate for Payer: Encore Health Key Benefits Commercial	$148.58
Rate for Payer: Healthscope Commercial	$167.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$157.87
Rate for Payer: PHP Commercial	$157.87
Rate for Payer: Priority Health Cigna Priority Health	$120.72
Rate for Payer: Priority Health SBD	$117.01

LETROZOLE 2.5 MG TABLET

Facility

$3.72

Service Code	NDC 50268047611
Hospital Charge Code	21509
Hospital Revenue Code	637
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Commercial	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Cofinity Medicare Advantage	$2.60
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health Cigna Priority Health	$2.42
Rate for Payer: Priority Health SBD	$2.34

LETROZOLE 2.5 MG TABLET

Facility

$98.70

Service Code	NDC 16729003410
Hospital Charge Code	21509
Hospital Revenue Code	637
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna Medicare	$49.35
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: BCBS Complete	$39.48
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Commercial	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Cofinity Medicare Advantage	$69.09
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health Cigna Priority Health	$64.16
Rate for Payer: Priority Health SBD	$62.18

LETROZOLE 2.5 MG TABLET

Facility

$98.70

Service Code	NDC 16729003410
Hospital Charge Code	21509
Hospital Revenue Code	637
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.89
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Commercial	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Cofinity Medicare Advantage	$69.09
Rate for Payer: Encore Health Key Benefits Commercial	$78.96
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.89
Rate for Payer: PHP Commercial	$83.89
Rate for Payer: Priority Health Cigna Priority Health	$64.16
Rate for Payer: Priority Health SBD	$62.18

LETROZOLE 2.5 MG TABLET

Facility

$79.52

Service Code	NDC 00093762056
Hospital Charge Code	21509
Hospital Revenue Code	637
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$71.57
Rate for Payer: Aetna Commercial	$67.59
Rate for Payer: Aetna New Business (MI Preferred)	$51.69
Rate for Payer: Cash Price	$63.62
Rate for Payer: Cofinity Commercial	$55.66
Rate for Payer: Cofinity Commercial	$68.39
Rate for Payer: Cofinity Medicare Advantage	$55.66
Rate for Payer: Encore Health Key Benefits Commercial	$63.62
Rate for Payer: Healthscope Commercial	$71.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.59
Rate for Payer: PHP Commercial	$67.59
Rate for Payer: Priority Health Cigna Priority Health	$51.69
Rate for Payer: Priority Health SBD	$50.10

LETROZOLE 2.5 MG TABLET

Facility

$79.52

Service Code	NDC 00093762056
Hospital Charge Code	21509
Hospital Revenue Code	637
Min. Negotiated Rate	$31.81
Max. Negotiated Rate	$71.57
Rate for Payer: Aetna Commercial	$67.59
Rate for Payer: Aetna Medicare	$39.76
Rate for Payer: Aetna New Business (MI Preferred)	$51.69
Rate for Payer: BCBS Complete	$31.81
Rate for Payer: Cash Price	$63.62
Rate for Payer: Cofinity Commercial	$55.66
Rate for Payer: Cofinity Commercial	$68.39
Rate for Payer: Cofinity Medicare Advantage	$55.66
Rate for Payer: Encore Health Key Benefits Commercial	$63.62
Rate for Payer: Healthscope Commercial	$71.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$67.59
Rate for Payer: PHP Commercial	$67.59
Rate for Payer: Priority Health Cigna Priority Health	$51.69
Rate for Payer: Priority Health SBD	$50.10

Know your out-of-pocket cost for care.

All Charges