Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LINACLOTIDE 145 MCG CAPSULE

Facility

$226.27

Service Code	NDC 00456120104
Hospital Charge Code	163662
Hospital Revenue Code	637
Min. Negotiated Rate	$142.55
Max. Negotiated Rate	$203.64
Rate for Payer: Aetna Commercial	$192.33
Rate for Payer: Aetna New Business (MI Preferred)	$147.08
Rate for Payer: Cash Price	$181.02
Rate for Payer: Cofinity Advantage	$158.39
Rate for Payer: Cofinity Commercial	$194.59
Rate for Payer: Encore Health Key Benefits Commercial	$181.02
Rate for Payer: Healthscope Commercial	$203.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$169.70
Rate for Payer: PHP Commercial	$192.33
Rate for Payer: Priority Health SBD	$142.55

LINAGLIPTIN 5 MG TABLET

Facility

$5,420.50

Service Code	NDC 00597014061
Hospital Charge Code	152649
Hospital Revenue Code	637
Min. Negotiated Rate	$2,130.26
Max. Negotiated Rate	$4,878.45
Rate for Payer: Aetna Commercial	$4,607.43
Rate for Payer: Aetna Medicare	$2,710.25
Rate for Payer: Aetna New Business (MI Preferred)	$3,523.32
Rate for Payer: BCBS Complete	$2,168.20
Rate for Payer: Cash Price	$4,336.40
Rate for Payer: Cofinity Advantage	$3,794.35
Rate for Payer: Cofinity Commercial	$4,661.63
Rate for Payer: Encore Health Key Benefits Commercial	$4,336.40
Rate for Payer: Healthscope Commercial	$4,878.45
Rate for Payer: MI Amish Medical Board Commercial	$4,336.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,607.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,065.38
Rate for Payer: PHP Commercial	$4,607.43
Rate for Payer: Priority Health SBD	$3,414.91
Rate for Payer: UHC All Payor (Choice/PPO)	$3,523.32
Rate for Payer: UHC Core	$2,824.08
Rate for Payer: UHC Exchange	$2,130.26

LINAGLIPTIN 5 MG TABLET

Facility

$5,420.50

Service Code	NDC 00597014061
Hospital Charge Code	152649
Hospital Revenue Code	637
Min. Negotiated Rate	$3,414.91
Max. Negotiated Rate	$4,878.45
Rate for Payer: Aetna Commercial	$4,607.43
Rate for Payer: Aetna New Business (MI Preferred)	$3,523.32
Rate for Payer: Cash Price	$4,336.40
Rate for Payer: Cofinity Advantage	$3,794.35
Rate for Payer: Cofinity Commercial	$4,661.63
Rate for Payer: Encore Health Key Benefits Commercial	$4,336.40
Rate for Payer: Healthscope Commercial	$4,878.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,607.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,065.38
Rate for Payer: PHP Commercial	$4,607.43
Rate for Payer: Priority Health SBD	$3,414.91

LINEZOLID 600 MG TABLET

Facility

$12.05

Service Code	NDC 67877041933
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$10.85
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna Medicare	$6.03
Rate for Payer: Aetna New Business (MI Preferred)	$7.83
Rate for Payer: BCBS Complete	$4.82
Rate for Payer: Cash Price	$9.64
Rate for Payer: Cofinity Advantage	$8.44
Rate for Payer: Cofinity Commercial	$10.36
Rate for Payer: Encore Health Key Benefits Commercial	$9.64
Rate for Payer: Healthscope Commercial	$10.85
Rate for Payer: MI Amish Medical Board Commercial	$9.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.04
Rate for Payer: PHP Commercial	$10.24
Rate for Payer: Priority Health SBD	$7.59
Rate for Payer: UHC All Payor (Choice/PPO)	$7.83
Rate for Payer: UHC Core	$6.28
Rate for Payer: UHC Exchange	$4.74

LINEZOLID 600 MG TABLET

Facility

$174.15

Service Code	NDC 67877041920
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$109.71
Max. Negotiated Rate	$156.74
Rate for Payer: Aetna Commercial	$148.03
Rate for Payer: Aetna New Business (MI Preferred)	$113.20
Rate for Payer: Cash Price	$139.32
Rate for Payer: Cofinity Advantage	$121.91
Rate for Payer: Cofinity Commercial	$149.77
Rate for Payer: Encore Health Key Benefits Commercial	$139.32
Rate for Payer: Healthscope Commercial	$156.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$148.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$130.61
Rate for Payer: PHP Commercial	$148.03
Rate for Payer: Priority Health SBD	$109.71

LINEZOLID 600 MG TABLET

Facility

$339.55

Service Code	NDC 00904655304
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$133.44
Max. Negotiated Rate	$305.60
Rate for Payer: Aetna Commercial	$288.62
Rate for Payer: Aetna Medicare	$169.78
Rate for Payer: Aetna New Business (MI Preferred)	$220.71
Rate for Payer: BCBS Complete	$135.82
Rate for Payer: Cash Price	$271.64
Rate for Payer: Cofinity Advantage	$237.69
Rate for Payer: Cofinity Commercial	$292.01
Rate for Payer: Encore Health Key Benefits Commercial	$271.64
Rate for Payer: Healthscope Commercial	$305.60
Rate for Payer: MI Amish Medical Board Commercial	$271.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$254.66
Rate for Payer: PHP Commercial	$288.62
Rate for Payer: Priority Health SBD	$213.92
Rate for Payer: UHC All Payor (Choice/PPO)	$220.71
Rate for Payer: UHC Core	$176.91
Rate for Payer: UHC Exchange	$133.44

LINEZOLID 600 MG TABLET

Facility

$118.03

Service Code	NDC 72606000111
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$74.36
Max. Negotiated Rate	$106.23
Rate for Payer: Aetna Commercial	$100.33
Rate for Payer: Aetna New Business (MI Preferred)	$76.72
Rate for Payer: Cash Price	$94.42
Rate for Payer: Cofinity Advantage	$82.62
Rate for Payer: Cofinity Commercial	$101.51
Rate for Payer: Encore Health Key Benefits Commercial	$94.42
Rate for Payer: Healthscope Commercial	$106.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.52
Rate for Payer: PHP Commercial	$100.33
Rate for Payer: Priority Health SBD	$74.36

LINEZOLID 600 MG TABLET

Facility

$118.03

Service Code	NDC 72606000111
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$106.23
Rate for Payer: Aetna Commercial	$100.33
Rate for Payer: Aetna Medicare	$59.02
Rate for Payer: Aetna New Business (MI Preferred)	$76.72
Rate for Payer: BCBS Complete	$47.21
Rate for Payer: Cash Price	$94.42
Rate for Payer: Cofinity Advantage	$82.62
Rate for Payer: Cofinity Commercial	$101.51
Rate for Payer: Encore Health Key Benefits Commercial	$94.42
Rate for Payer: Healthscope Commercial	$106.23
Rate for Payer: MI Amish Medical Board Commercial	$94.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$88.52
Rate for Payer: PHP Commercial	$100.33
Rate for Payer: Priority Health SBD	$74.36
Rate for Payer: UHC All Payor (Choice/PPO)	$76.72
Rate for Payer: UHC Core	$61.49
Rate for Payer: UHC Exchange	$46.39

LINEZOLID 600 MG TABLET

Facility

$361.31

Service Code	NDC 67877041984
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$227.63
Max. Negotiated Rate	$325.18
Rate for Payer: Aetna Commercial	$307.11
Rate for Payer: Aetna New Business (MI Preferred)	$234.85
Rate for Payer: Cash Price	$289.05
Rate for Payer: Cofinity Advantage	$252.92
Rate for Payer: Cofinity Commercial	$310.73
Rate for Payer: Encore Health Key Benefits Commercial	$289.05
Rate for Payer: Healthscope Commercial	$325.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$270.98
Rate for Payer: PHP Commercial	$307.11
Rate for Payer: Priority Health SBD	$227.63

LINEZOLID 600 MG TABLET

Facility

$174.15

Service Code	NDC 67877041920
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$68.44
Max. Negotiated Rate	$156.74
Rate for Payer: Aetna Commercial	$148.03
Rate for Payer: Aetna Medicare	$87.08
Rate for Payer: Aetna New Business (MI Preferred)	$113.20
Rate for Payer: BCBS Complete	$69.66
Rate for Payer: Cash Price	$139.32
Rate for Payer: Cofinity Advantage	$121.91
Rate for Payer: Cofinity Commercial	$149.77
Rate for Payer: Encore Health Key Benefits Commercial	$139.32
Rate for Payer: Healthscope Commercial	$156.74
Rate for Payer: MI Amish Medical Board Commercial	$139.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$148.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$130.61
Rate for Payer: PHP Commercial	$148.03
Rate for Payer: Priority Health SBD	$109.71
Rate for Payer: UHC All Payor (Choice/PPO)	$113.20
Rate for Payer: UHC Core	$90.73
Rate for Payer: UHC Exchange	$68.44

LINEZOLID 600 MG TABLET

Facility

$12.05

Service Code	NDC 67877041933
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$10.85
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna New Business (MI Preferred)	$7.83
Rate for Payer: Cash Price	$9.64
Rate for Payer: Cofinity Advantage	$8.44
Rate for Payer: Cofinity Commercial	$10.36
Rate for Payer: Encore Health Key Benefits Commercial	$9.64
Rate for Payer: Healthscope Commercial	$10.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.04
Rate for Payer: PHP Commercial	$10.24
Rate for Payer: Priority Health SBD	$7.59

LINEZOLID 600 MG TABLET

Facility

$361.31

Service Code	NDC 67877041984
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$141.99
Max. Negotiated Rate	$325.18
Rate for Payer: Aetna Commercial	$307.11
Rate for Payer: Aetna Medicare	$180.66
Rate for Payer: Aetna New Business (MI Preferred)	$234.85
Rate for Payer: BCBS Complete	$144.52
Rate for Payer: Cash Price	$289.05
Rate for Payer: Cofinity Advantage	$252.92
Rate for Payer: Cofinity Commercial	$310.73
Rate for Payer: Encore Health Key Benefits Commercial	$289.05
Rate for Payer: Healthscope Commercial	$325.18
Rate for Payer: MI Amish Medical Board Commercial	$289.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$270.98
Rate for Payer: PHP Commercial	$307.11
Rate for Payer: Priority Health SBD	$227.63
Rate for Payer: UHC All Payor (Choice/PPO)	$234.85
Rate for Payer: UHC Core	$188.24
Rate for Payer: UHC Exchange	$141.99

LINEZOLID 600 MG TABLET

Facility

$339.55

Service Code	NDC 00904655304
Hospital Charge Code	28224
Hospital Revenue Code	637
Min. Negotiated Rate	$213.92
Max. Negotiated Rate	$305.60
Rate for Payer: Aetna Commercial	$288.62
Rate for Payer: Aetna New Business (MI Preferred)	$220.71
Rate for Payer: Cash Price	$271.64
Rate for Payer: Cofinity Advantage	$237.69
Rate for Payer: Cofinity Commercial	$292.01
Rate for Payer: Encore Health Key Benefits Commercial	$271.64
Rate for Payer: Healthscope Commercial	$305.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$254.66
Rate for Payer: PHP Commercial	$288.62
Rate for Payer: Priority Health SBD	$213.92

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK

Facility

$68.85

Service Code	HCPCS J2020
Hospital Charge Code	112020
Hospital Revenue Code	636
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$61.97
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Commercial	$118.32
Rate for Payer: Aetna Medicare	$69.60
Rate for Payer: Aetna Medicare	$34.42
Rate for Payer: Aetna New Business (MI Preferred)	$44.75
Rate for Payer: Aetna New Business (MI Preferred)	$90.48
Rate for Payer: BCBS Complete	$55.68
Rate for Payer: BCBS Complete	$27.54
Rate for Payer: BCBS Trust/PPO	$6.87
Rate for Payer: BCBS Trust/PPO	$6.87
Rate for Payer: BCN Commercial	$6.87
Rate for Payer: BCN Commercial	$6.87
Rate for Payer: Cash Price	$55.08
Rate for Payer: Cash Price	$111.36
Rate for Payer: Cash Price	$55.08
Rate for Payer: Cash Price	$111.36
Rate for Payer: Cofinity Advantage	$48.20
Rate for Payer: Cofinity Advantage	$97.44
Rate for Payer: Cofinity Commercial	$59.21
Rate for Payer: Cofinity Commercial	$119.71
Rate for Payer: Encore Health Key Benefits Commercial	$111.36
Rate for Payer: Encore Health Key Benefits Commercial	$55.08
Rate for Payer: Healthscope Commercial	$125.28
Rate for Payer: Healthscope Commercial	$61.97
Rate for Payer: MI Amish Medical Board Commercial	$111.36
Rate for Payer: MI Amish Medical Board Commercial	$55.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$51.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.40
Rate for Payer: PHP Commercial	$58.52
Rate for Payer: PHP Commercial	$118.32
Rate for Payer: Priority Health SBD	$43.38
Rate for Payer: Priority Health SBD	$87.70
Rate for Payer: UHC All Payor (Choice/PPO)	$4.52
Rate for Payer: UHC All Payor (Choice/PPO)	$4.52
Rate for Payer: UHC Core	$4.52
Rate for Payer: UHC Core	$4.52
Rate for Payer: UHC Exchange	$4.52
Rate for Payer: UHC Exchange	$4.52

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK

Facility

$68.85

Service Code	HCPCS J2020
Hospital Charge Code	112020
Hospital Revenue Code	636
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$61.97
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Commercial	$118.32
Rate for Payer: Aetna New Business (MI Preferred)	$44.75
Rate for Payer: Aetna New Business (MI Preferred)	$90.48
Rate for Payer: Cash Price	$111.36
Rate for Payer: Cash Price	$55.08
Rate for Payer: Cofinity Advantage	$48.20
Rate for Payer: Cofinity Advantage	$97.44
Rate for Payer: Cofinity Commercial	$119.71
Rate for Payer: Cofinity Commercial	$59.21
Rate for Payer: Encore Health Key Benefits Commercial	$55.08
Rate for Payer: Encore Health Key Benefits Commercial	$111.36
Rate for Payer: Healthscope Commercial	$61.97
Rate for Payer: Healthscope Commercial	$125.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$51.64
Rate for Payer: PHP Commercial	$118.32
Rate for Payer: PHP Commercial	$58.52
Rate for Payer: Priority Health SBD	$43.38
Rate for Payer: Priority Health SBD	$87.70

LIOTHYRONINE 25 MCG TABLET

Facility

$261.12

Service Code	NDC 60793011601
Hospital Charge Code	4504
Hospital Revenue Code	637
Min. Negotiated Rate	$164.51
Max. Negotiated Rate	$235.01
Rate for Payer: Aetna Commercial	$221.95
Rate for Payer: Aetna New Business (MI Preferred)	$169.73
Rate for Payer: Cash Price	$208.90
Rate for Payer: Cofinity Advantage	$182.78
Rate for Payer: Cofinity Commercial	$224.56
Rate for Payer: Encore Health Key Benefits Commercial	$208.90
Rate for Payer: Healthscope Commercial	$235.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.84
Rate for Payer: PHP Commercial	$221.95
Rate for Payer: Priority Health SBD	$164.51

LIOTHYRONINE 25 MCG TABLET

Facility

$620.64

Service Code	NDC 51862032101
Hospital Charge Code	4504
Hospital Revenue Code	637
Min. Negotiated Rate	$243.91
Max. Negotiated Rate	$558.58
Rate for Payer: Aetna Commercial	$527.54
Rate for Payer: Aetna Medicare	$310.32
Rate for Payer: Aetna New Business (MI Preferred)	$403.42
Rate for Payer: BCBS Complete	$248.26
Rate for Payer: Cash Price	$496.51
Rate for Payer: Cofinity Advantage	$434.45
Rate for Payer: Cofinity Commercial	$533.75
Rate for Payer: Encore Health Key Benefits Commercial	$496.51
Rate for Payer: Healthscope Commercial	$558.58
Rate for Payer: MI Amish Medical Board Commercial	$496.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$527.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$465.48
Rate for Payer: PHP Commercial	$527.54
Rate for Payer: Priority Health SBD	$391.00
Rate for Payer: UHC All Payor (Choice/PPO)	$403.42
Rate for Payer: UHC Core	$323.35
Rate for Payer: UHC Exchange	$243.91

LIOTHYRONINE 25 MCG TABLET

Facility

$620.64

Service Code	NDC 51862032101
Hospital Charge Code	4504
Hospital Revenue Code	637
Min. Negotiated Rate	$391.00
Max. Negotiated Rate	$558.58
Rate for Payer: Aetna Commercial	$527.54
Rate for Payer: Aetna New Business (MI Preferred)	$403.42
Rate for Payer: Cash Price	$496.51
Rate for Payer: Cofinity Advantage	$434.45
Rate for Payer: Cofinity Commercial	$533.75
Rate for Payer: Encore Health Key Benefits Commercial	$496.51
Rate for Payer: Healthscope Commercial	$558.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$527.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$465.48
Rate for Payer: PHP Commercial	$527.54
Rate for Payer: Priority Health SBD	$391.00

LIOTHYRONINE 25 MCG TABLET

Facility

$261.12

Service Code	NDC 60793011601
Hospital Charge Code	4504
Hospital Revenue Code	637
Min. Negotiated Rate	$102.62
Max. Negotiated Rate	$235.01
Rate for Payer: Aetna Commercial	$221.95
Rate for Payer: Aetna Medicare	$130.56
Rate for Payer: Aetna New Business (MI Preferred)	$169.73
Rate for Payer: BCBS Complete	$104.45
Rate for Payer: Cash Price	$208.90
Rate for Payer: Cofinity Advantage	$182.78
Rate for Payer: Cofinity Commercial	$224.56
Rate for Payer: Encore Health Key Benefits Commercial	$208.90
Rate for Payer: Healthscope Commercial	$235.01
Rate for Payer: MI Amish Medical Board Commercial	$208.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.84
Rate for Payer: PHP Commercial	$221.95
Rate for Payer: Priority Health SBD	$164.51
Rate for Payer: UHC All Payor (Choice/PPO)	$169.73
Rate for Payer: UHC Core	$136.04
Rate for Payer: UHC Exchange	$102.62

LIOTHYRONINE 5 MCG TABLET

Facility

$374.30

Service Code	NDC 60793011501
Hospital Charge Code	10443
Hospital Revenue Code	637
Min. Negotiated Rate	$147.10
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna Medicare	$187.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: BCBS Complete	$149.72
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Advantage	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: MI Amish Medical Board Commercial	$299.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.73
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health SBD	$235.81
Rate for Payer: UHC All Payor (Choice/PPO)	$243.29
Rate for Payer: UHC Core	$195.01
Rate for Payer: UHC Exchange	$147.10

LIOTHYRONINE 5 MCG TABLET

Facility

$374.30

Service Code	NDC 60793011501
Hospital Charge Code	10443
Hospital Revenue Code	637
Min. Negotiated Rate	$235.81
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Advantage	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.73
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health SBD	$235.81

LIOTHYRONINE 5 MCG TABLET

Facility

$472.32

Service Code	NDC 51862032001
Hospital Charge Code	10443
Hospital Revenue Code	637
Min. Negotiated Rate	$297.56
Max. Negotiated Rate	$425.09
Rate for Payer: Aetna Commercial	$401.47
Rate for Payer: Aetna New Business (MI Preferred)	$307.01
Rate for Payer: Cash Price	$377.86
Rate for Payer: Cofinity Advantage	$330.62
Rate for Payer: Cofinity Commercial	$406.20
Rate for Payer: Encore Health Key Benefits Commercial	$377.86
Rate for Payer: Healthscope Commercial	$425.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$401.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$354.24
Rate for Payer: PHP Commercial	$401.47
Rate for Payer: Priority Health SBD	$297.56

LIOTHYRONINE 5 MCG TABLET

Facility

$472.32

Service Code	NDC 51862032001
Hospital Charge Code	10443
Hospital Revenue Code	637
Min. Negotiated Rate	$185.62
Max. Negotiated Rate	$425.09
Rate for Payer: Aetna Commercial	$401.47
Rate for Payer: Aetna Medicare	$236.16
Rate for Payer: Aetna New Business (MI Preferred)	$307.01
Rate for Payer: BCBS Complete	$188.93
Rate for Payer: Cash Price	$377.86
Rate for Payer: Cofinity Advantage	$330.62
Rate for Payer: Cofinity Commercial	$406.20
Rate for Payer: Encore Health Key Benefits Commercial	$377.86
Rate for Payer: Healthscope Commercial	$425.09
Rate for Payer: MI Amish Medical Board Commercial	$377.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$401.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$354.24
Rate for Payer: PHP Commercial	$401.47
Rate for Payer: Priority Health SBD	$297.56
Rate for Payer: UHC All Payor (Choice/PPO)	$307.01
Rate for Payer: UHC Core	$246.08
Rate for Payer: UHC Exchange	$185.62

LIPASE-PROTEASE-AMYLASE (PORK)36,000-114,000-180K UNIT CAPSULE,DEL REL

Facility

$4,558.77

Service Code	NDC 00032301613
Hospital Charge Code	166135
Hospital Revenue Code	637
Min. Negotiated Rate	$1,791.60
Max. Negotiated Rate	$4,102.89
Rate for Payer: Aetna Commercial	$3,874.95
Rate for Payer: Aetna Medicare	$2,279.39
Rate for Payer: Aetna New Business (MI Preferred)	$2,963.20
Rate for Payer: BCBS Complete	$1,823.51
Rate for Payer: Cash Price	$3,647.02
Rate for Payer: Cofinity Advantage	$3,191.14
Rate for Payer: Cofinity Commercial	$3,920.54
Rate for Payer: Encore Health Key Benefits Commercial	$3,647.02
Rate for Payer: Healthscope Commercial	$4,102.89
Rate for Payer: MI Amish Medical Board Commercial	$3,647.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,874.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,419.08
Rate for Payer: PHP Commercial	$3,874.95
Rate for Payer: Priority Health SBD	$2,872.03
Rate for Payer: UHC All Payor (Choice/PPO)	$2,963.20
Rate for Payer: UHC Core	$2,375.12
Rate for Payer: UHC Exchange	$1,791.60

LIPASE-PROTEASE-AMYLASE (PORK)36,000-114,000-180K UNIT CAPSULE,DEL REL

Facility

$4,558.77

Service Code	NDC 00032301613
Hospital Charge Code	166135
Hospital Revenue Code	637
Min. Negotiated Rate	$2,872.03
Max. Negotiated Rate	$4,102.89
Rate for Payer: Aetna Commercial	$3,874.95
Rate for Payer: Aetna New Business (MI Preferred)	$2,963.20
Rate for Payer: Cash Price	$3,647.02
Rate for Payer: Cofinity Advantage	$3,191.14
Rate for Payer: Cofinity Commercial	$3,920.54
Rate for Payer: Encore Health Key Benefits Commercial	$3,647.02
Rate for Payer: Healthscope Commercial	$4,102.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,874.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,419.08
Rate for Payer: PHP Commercial	$3,874.95
Rate for Payer: Priority Health SBD	$2,872.03

Know your out-of-pocket cost for care.

All Charges