Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION

Facility

$32.26

Service Code	NDC 00409471201
Hospital Charge Code	27396
Hospital Revenue Code	250
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$29.03
Rate for Payer: Aetna Commercial	$27.42
Rate for Payer: Aetna New Business (MI Preferred)	$20.97
Rate for Payer: Cash Price	$25.81
Rate for Payer: Cofinity Commercial	$22.58
Rate for Payer: Cofinity Commercial	$27.74
Rate for Payer: Cofinity Medicare Advantage	$22.58
Rate for Payer: Encore Health Key Benefits Commercial	$25.81
Rate for Payer: Healthscope Commercial	$29.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.42
Rate for Payer: PHP Commercial	$27.42
Rate for Payer: Priority Health Cigna Priority Health	$20.97
Rate for Payer: Priority Health SBD	$20.32

LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION

Facility

$56.96

Service Code	HCPCS J2003
Hospital Charge Code	105635
Hospital Revenue Code	636
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$51.26
Rate for Payer: Aetna Commercial	$48.42
Rate for Payer: Aetna New Business (MI Preferred)	$37.02
Rate for Payer: Cash Price	$45.57
Rate for Payer: Cofinity Commercial	$39.87
Rate for Payer: Cofinity Commercial	$48.99
Rate for Payer: Cofinity Medicare Advantage	$39.87
Rate for Payer: Encore Health Key Benefits Commercial	$45.57
Rate for Payer: Healthscope Commercial	$51.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.42
Rate for Payer: PHP Commercial	$48.42
Rate for Payer: Priority Health Cigna Priority Health	$37.02
Rate for Payer: Priority Health SBD	$35.88

LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION

Facility

$56.96

Service Code	HCPCS J2003
Hospital Charge Code	105635
Hospital Revenue Code	636
Min. Negotiated Rate	$22.78
Max. Negotiated Rate	$51.26
Rate for Payer: Aetna Commercial	$48.42
Rate for Payer: Aetna Medicare	$28.48
Rate for Payer: Aetna New Business (MI Preferred)	$37.02
Rate for Payer: BCBS Complete	$22.78
Rate for Payer: Cash Price	$45.57
Rate for Payer: Cofinity Commercial	$39.87
Rate for Payer: Cofinity Commercial	$48.99
Rate for Payer: Cofinity Medicare Advantage	$39.87
Rate for Payer: Encore Health Key Benefits Commercial	$45.57
Rate for Payer: Healthscope Commercial	$51.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.42
Rate for Payer: PHP Commercial	$48.42
Rate for Payer: Priority Health Cigna Priority Health	$37.02
Rate for Payer: Priority Health SBD	$35.88

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$23.07

Service Code	NDC 00591207072
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$20.76
Rate for Payer: Aetna Commercial	$19.61
Rate for Payer: Aetna Medicare	$11.54
Rate for Payer: Aetna New Business (MI Preferred)	$15.00
Rate for Payer: BCBS Complete	$9.23
Rate for Payer: Cash Price	$18.46
Rate for Payer: Cofinity Commercial	$16.15
Rate for Payer: Cofinity Commercial	$19.84
Rate for Payer: Cofinity Medicare Advantage	$16.15
Rate for Payer: Encore Health Key Benefits Commercial	$18.46
Rate for Payer: Healthscope Commercial	$20.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.61
Rate for Payer: PHP Commercial	$19.61
Rate for Payer: Priority Health Cigna Priority Health	$15.00
Rate for Payer: Priority Health SBD	$14.53

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$26.88

Service Code	NDC 00168035755
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$16.93
Max. Negotiated Rate	$24.19
Rate for Payer: Aetna Commercial	$22.85
Rate for Payer: Aetna New Business (MI Preferred)	$17.47
Rate for Payer: Cash Price	$21.50
Rate for Payer: Cofinity Commercial	$18.82
Rate for Payer: Cofinity Commercial	$23.12
Rate for Payer: Cofinity Medicare Advantage	$18.82
Rate for Payer: Encore Health Key Benefits Commercial	$21.50
Rate for Payer: Healthscope Commercial	$24.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.85
Rate for Payer: PHP Commercial	$22.85
Rate for Payer: Priority Health Cigna Priority Health	$17.47
Rate for Payer: Priority Health SBD	$16.93

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$23.07

Service Code	NDC 00591207026
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$20.76
Rate for Payer: Aetna Commercial	$19.61
Rate for Payer: Aetna Medicare	$11.54
Rate for Payer: Aetna New Business (MI Preferred)	$15.00
Rate for Payer: BCBS Complete	$9.23
Rate for Payer: Cash Price	$18.46
Rate for Payer: Cofinity Commercial	$16.15
Rate for Payer: Cofinity Commercial	$19.84
Rate for Payer: Cofinity Medicare Advantage	$16.15
Rate for Payer: Encore Health Key Benefits Commercial	$18.46
Rate for Payer: Healthscope Commercial	$20.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.61
Rate for Payer: PHP Commercial	$19.61
Rate for Payer: Priority Health Cigna Priority Health	$15.00
Rate for Payer: Priority Health SBD	$14.53

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$26.88

Service Code	NDC 00168035705
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$24.19
Rate for Payer: Aetna Commercial	$22.85
Rate for Payer: Aetna Medicare	$13.44
Rate for Payer: Aetna New Business (MI Preferred)	$17.47
Rate for Payer: BCBS Complete	$10.75
Rate for Payer: Cash Price	$21.50
Rate for Payer: Cofinity Commercial	$18.82
Rate for Payer: Cofinity Commercial	$23.12
Rate for Payer: Cofinity Medicare Advantage	$18.82
Rate for Payer: Encore Health Key Benefits Commercial	$21.50
Rate for Payer: Healthscope Commercial	$24.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.85
Rate for Payer: PHP Commercial	$22.85
Rate for Payer: Priority Health Cigna Priority Health	$17.47
Rate for Payer: Priority Health SBD	$16.93

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$23.07

Service Code	NDC 00591207026
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$20.76
Rate for Payer: Aetna Commercial	$19.61
Rate for Payer: Aetna New Business (MI Preferred)	$15.00
Rate for Payer: Cash Price	$18.46
Rate for Payer: Cofinity Commercial	$16.15
Rate for Payer: Cofinity Commercial	$19.84
Rate for Payer: Cofinity Medicare Advantage	$16.15
Rate for Payer: Encore Health Key Benefits Commercial	$18.46
Rate for Payer: Healthscope Commercial	$20.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.61
Rate for Payer: PHP Commercial	$19.61
Rate for Payer: Priority Health Cigna Priority Health	$15.00
Rate for Payer: Priority Health SBD	$14.53

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$26.88

Service Code	NDC 00168035705
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$16.93
Max. Negotiated Rate	$24.19
Rate for Payer: Aetna Commercial	$22.85
Rate for Payer: Aetna New Business (MI Preferred)	$17.47
Rate for Payer: Cash Price	$21.50
Rate for Payer: Cofinity Commercial	$18.82
Rate for Payer: Cofinity Commercial	$23.12
Rate for Payer: Cofinity Medicare Advantage	$18.82
Rate for Payer: Encore Health Key Benefits Commercial	$21.50
Rate for Payer: Healthscope Commercial	$24.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.85
Rate for Payer: PHP Commercial	$22.85
Rate for Payer: Priority Health Cigna Priority Health	$17.47
Rate for Payer: Priority Health SBD	$16.93

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$26.88

Service Code	NDC 00168035755
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$24.19
Rate for Payer: Aetna Commercial	$22.85
Rate for Payer: Aetna Medicare	$13.44
Rate for Payer: Aetna New Business (MI Preferred)	$17.47
Rate for Payer: BCBS Complete	$10.75
Rate for Payer: Cash Price	$21.50
Rate for Payer: Cofinity Commercial	$18.82
Rate for Payer: Cofinity Commercial	$23.12
Rate for Payer: Cofinity Medicare Advantage	$18.82
Rate for Payer: Encore Health Key Benefits Commercial	$21.50
Rate for Payer: Healthscope Commercial	$24.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.85
Rate for Payer: PHP Commercial	$22.85
Rate for Payer: Priority Health Cigna Priority Health	$17.47
Rate for Payer: Priority Health SBD	$16.93

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$23.07

Service Code	NDC 00591207072
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$20.76
Rate for Payer: Aetna Commercial	$19.61
Rate for Payer: Aetna New Business (MI Preferred)	$15.00
Rate for Payer: Cash Price	$18.46
Rate for Payer: Cofinity Commercial	$16.15
Rate for Payer: Cofinity Commercial	$19.84
Rate for Payer: Cofinity Medicare Advantage	$16.15
Rate for Payer: Encore Health Key Benefits Commercial	$18.46
Rate for Payer: Healthscope Commercial	$20.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.61
Rate for Payer: PHP Commercial	$19.61
Rate for Payer: Priority Health Cigna Priority Health	$15.00
Rate for Payer: Priority Health SBD	$14.53

LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT

Facility

$14.18

Service Code	NDC 00496088207
Hospital Charge Code	30183
Hospital Revenue Code	637
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$12.76
Rate for Payer: Aetna Commercial	$12.05
Rate for Payer: Aetna New Business (MI Preferred)	$9.22
Rate for Payer: Cash Price	$11.34
Rate for Payer: Cofinity Commercial	$12.19
Rate for Payer: Cofinity Commercial	$9.93
Rate for Payer: Cofinity Medicare Advantage	$9.93
Rate for Payer: Encore Health Key Benefits Commercial	$11.34
Rate for Payer: Healthscope Commercial	$12.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.05
Rate for Payer: PHP Commercial	$12.05
Rate for Payer: Priority Health Cigna Priority Health	$9.22
Rate for Payer: Priority Health SBD	$8.93

LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT

Facility

$14.18

Service Code	NDC 00496088207
Hospital Charge Code	30183
Hospital Revenue Code	637
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$12.76
Rate for Payer: Aetna Commercial	$12.05
Rate for Payer: Aetna Medicare	$7.09
Rate for Payer: Aetna New Business (MI Preferred)	$9.22
Rate for Payer: BCBS Complete	$5.67
Rate for Payer: Cash Price	$11.34
Rate for Payer: Cofinity Commercial	$12.19
Rate for Payer: Cofinity Commercial	$9.93
Rate for Payer: Cofinity Medicare Advantage	$9.93
Rate for Payer: Encore Health Key Benefits Commercial	$11.34
Rate for Payer: Healthscope Commercial	$12.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.05
Rate for Payer: PHP Commercial	$12.05
Rate for Payer: Priority Health Cigna Priority Health	$9.22
Rate for Payer: Priority Health SBD	$8.93

LIDOCAINE WITH EPINEPHRINE IN NS 50 ML

Facility

$3.75

Service Code	NDC 99000000202
Hospital Charge Code	158459
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna Medicare	$1.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Cofinity Medicare Advantage	$2.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

LIDOCAINE WITH EPINEPHRINE IN NS 50 ML

Facility

$3.75

Service Code	NDC 99000000202
Hospital Charge Code	158459
Hospital Revenue Code	250
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Cofinity Medicare Advantage	$2.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS

Facility

$8,640.87

Service Code	CPT 37700
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.35
Max. Negotiated Rate	$8,640.87
Rate for Payer: Aetna Medicare	$3,192.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,837.11
Rate for Payer: Amish Plain Church Group Commercial	$3,837.11
Rate for Payer: BCBS Complete	$1,727.62
Rate for Payer: BCBS MAPPO	$3,069.69
Rate for Payer: BCN Medicare Advantage	$3,069.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,069.69
Rate for Payer: Mclaren Medicaid	$1,645.35
Rate for Payer: Mclaren Medicare	$3,069.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,223.17
Rate for Payer: Meridian Medicaid	$1,727.62
Rate for Payer: MI Amish Medical Board Commercial	$3,530.14
Rate for Payer: PACE Medicare	$2,916.21
Rate for Payer: PACE SWMI	$3,069.69
Rate for Payer: PHP Medicare Advantage	$3,069.69
Rate for Payer: Priority Health Choice Medicaid	$1,645.35
Rate for Payer: Priority Health Medicare	$3,069.69
Rate for Payer: Railroad Medicare Medicare	$3,069.69
Rate for Payer: UHC All Payor (Choice/PPO)	$8,640.87
Rate for Payer: UHC Dual Complete DSNP	$3,069.69
Rate for Payer: UHC Medicare Advantage	$3,069.69
Rate for Payer: UHCCP Medicaid	$1,728.24
Rate for Payer: VA VA	$3,069.69

LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO KNEE OR BELOW

Facility

$8,640.87

Service Code	CPT 37722
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.35
Max. Negotiated Rate	$8,640.87
Rate for Payer: Aetna Medicare	$3,192.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,837.11
Rate for Payer: Amish Plain Church Group Commercial	$3,837.11
Rate for Payer: BCBS Complete	$1,727.62
Rate for Payer: BCBS MAPPO	$3,069.69
Rate for Payer: BCN Medicare Advantage	$3,069.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,069.69
Rate for Payer: Mclaren Medicaid	$1,645.35
Rate for Payer: Mclaren Medicare	$3,069.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,223.17
Rate for Payer: Meridian Medicaid	$1,727.62
Rate for Payer: MI Amish Medical Board Commercial	$3,530.14
Rate for Payer: PACE Medicare	$2,916.21
Rate for Payer: PACE SWMI	$3,069.69
Rate for Payer: PHP Medicare Advantage	$3,069.69
Rate for Payer: Priority Health Choice Medicaid	$1,645.35
Rate for Payer: Priority Health Medicare	$3,069.69
Rate for Payer: Railroad Medicare Medicare	$3,069.69
Rate for Payer: UHC All Payor (Choice/PPO)	$8,640.87
Rate for Payer: UHC Dual Complete DSNP	$3,069.69
Rate for Payer: UHC Medicare Advantage	$3,069.69
Rate for Payer: UHCCP Medicaid	$1,728.24
Rate for Payer: VA VA	$3,069.69

LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA

Facility

$8,640.87

Service Code	CPT 37607
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.35
Max. Negotiated Rate	$8,640.87
Rate for Payer: Aetna Medicare	$3,192.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,837.11
Rate for Payer: Amish Plain Church Group Commercial	$3,837.11
Rate for Payer: BCBS Complete	$1,727.62
Rate for Payer: BCBS MAPPO	$3,069.69
Rate for Payer: BCN Medicare Advantage	$3,069.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,069.69
Rate for Payer: Mclaren Medicaid	$1,645.35
Rate for Payer: Mclaren Medicare	$3,069.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,223.17
Rate for Payer: Meridian Medicaid	$1,727.62
Rate for Payer: MI Amish Medical Board Commercial	$3,530.14
Rate for Payer: PACE Medicare	$2,916.21
Rate for Payer: PACE SWMI	$3,069.69
Rate for Payer: PHP Medicare Advantage	$3,069.69
Rate for Payer: Priority Health Choice Medicaid	$1,645.35
Rate for Payer: Priority Health Medicare	$3,069.69
Rate for Payer: Railroad Medicare Medicare	$3,069.69
Rate for Payer: UHC All Payor (Choice/PPO)	$8,640.87
Rate for Payer: UHC Dual Complete DSNP	$3,069.69
Rate for Payer: UHC Medicare Advantage	$3,069.69
Rate for Payer: UHCCP Medicaid	$1,728.24
Rate for Payer: VA VA	$3,069.69

LIGATION OR BIOPSY, TEMPORAL ARTERY

Facility

$4,448.08

Service Code	CPT 37609
Hospital Revenue Code	360
Min. Negotiated Rate	$846.98
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$889.65
Rate for Payer: VA VA	$1,580.19

LINACLOTIDE 145 MCG CAPSULE

Facility

$1,953.38

Service Code	NDC 00456120130
Hospital Charge Code	163662
Hospital Revenue Code	637
Min. Negotiated Rate	$781.35
Max. Negotiated Rate	$1,758.04
Rate for Payer: Aetna Commercial	$1,660.37
Rate for Payer: Aetna Medicare	$976.69
Rate for Payer: Aetna New Business (MI Preferred)	$1,269.70
Rate for Payer: BCBS Complete	$781.35
Rate for Payer: Cash Price	$1,562.70
Rate for Payer: Cofinity Commercial	$1,367.37
Rate for Payer: Cofinity Commercial	$1,679.91
Rate for Payer: Cofinity Medicare Advantage	$1,367.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,562.70
Rate for Payer: Healthscope Commercial	$1,758.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,660.37
Rate for Payer: PHP Commercial	$1,660.37
Rate for Payer: Priority Health Cigna Priority Health	$1,269.70
Rate for Payer: Priority Health SBD	$1,230.63

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 Commercial	$158.39
Rate for Payer: Cofinity Commercial	$194.59
Rate for Payer: Cofinity Medicare Advantage	$158.39
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: PHP Commercial	$192.33
Rate for Payer: Priority Health Cigna Priority Health	$147.08
Rate for Payer: Priority Health SBD	$142.55

LINACLOTIDE 145 MCG CAPSULE

Facility

$226.27

Service Code	NDC 00456120104
Hospital Charge Code	163662
Hospital Revenue Code	637
Min. Negotiated Rate	$90.51
Max. Negotiated Rate	$203.64
Rate for Payer: Aetna Commercial	$192.33
Rate for Payer: Aetna Medicare	$113.14
Rate for Payer: Aetna New Business (MI Preferred)	$147.08
Rate for Payer: BCBS Complete	$90.51
Rate for Payer: Cash Price	$181.02
Rate for Payer: Cofinity Commercial	$158.39
Rate for Payer: Cofinity Commercial	$194.59
Rate for Payer: Cofinity Medicare Advantage	$158.39
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: PHP Commercial	$192.33
Rate for Payer: Priority Health Cigna Priority Health	$147.08
Rate for Payer: Priority Health SBD	$142.55

LINACLOTIDE 145 MCG CAPSULE

Facility

$1,953.38

Service Code	NDC 00456120130
Hospital Charge Code	163662
Hospital Revenue Code	637
Min. Negotiated Rate	$1,230.63
Max. Negotiated Rate	$1,758.04
Rate for Payer: Aetna Commercial	$1,660.37
Rate for Payer: Aetna New Business (MI Preferred)	$1,269.70
Rate for Payer: Cash Price	$1,562.70
Rate for Payer: Cofinity Commercial	$1,367.37
Rate for Payer: Cofinity Commercial	$1,679.91
Rate for Payer: Cofinity Medicare Advantage	$1,367.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,562.70
Rate for Payer: Healthscope Commercial	$1,758.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,660.37
Rate for Payer: PHP Commercial	$1,660.37
Rate for Payer: Priority Health Cigna Priority Health	$1,269.70
Rate for Payer: Priority Health SBD	$1,230.63

LINAGLIPTIN 5 MG TABLET

Facility

$4,697.89

Service Code	NDC 00597014061
Hospital Charge Code	152649
Hospital Revenue Code	637
Min. Negotiated Rate	$2,959.67
Max. Negotiated Rate	$4,228.10
Rate for Payer: Aetna Commercial	$3,993.21
Rate for Payer: Aetna New Business (MI Preferred)	$3,053.63
Rate for Payer: Cash Price	$3,758.31
Rate for Payer: Cofinity Commercial	$3,288.52
Rate for Payer: Cofinity Commercial	$4,040.19
Rate for Payer: Cofinity Medicare Advantage	$3,288.52
Rate for Payer: Encore Health Key Benefits Commercial	$3,758.31
Rate for Payer: Healthscope Commercial	$4,228.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,993.21
Rate for Payer: PHP Commercial	$3,993.21
Rate for Payer: Priority Health Cigna Priority Health	$3,053.63
Rate for Payer: Priority Health SBD	$2,959.67

LINAGLIPTIN 5 MG TABLET

Facility

$4,697.89

Service Code	NDC 00597014061
Hospital Charge Code	152649
Hospital Revenue Code	637
Min. Negotiated Rate	$1,879.16
Max. Negotiated Rate	$4,228.10
Rate for Payer: Aetna Commercial	$3,993.21
Rate for Payer: Aetna Medicare	$2,348.95
Rate for Payer: Aetna New Business (MI Preferred)	$3,053.63
Rate for Payer: BCBS Complete	$1,879.16
Rate for Payer: Cash Price	$3,758.31
Rate for Payer: Cofinity Commercial	$3,288.52
Rate for Payer: Cofinity Commercial	$4,040.19
Rate for Payer: Cofinity Medicare Advantage	$3,288.52
Rate for Payer: Encore Health Key Benefits Commercial	$3,758.31
Rate for Payer: Healthscope Commercial	$4,228.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,993.21
Rate for Payer: PHP Commercial	$3,993.21
Rate for Payer: Priority Health Cigna Priority Health	$3,053.63
Rate for Payer: Priority Health SBD	$2,959.67

Know your out-of-pocket cost for care.

All Charges