Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LUBIPROSTONE 8 MCG CAPSULE

Facility

$1,276.95

Service Code	NDC 64764008060
Hospital Charge Code	91534
Hospital Revenue Code	637
Min. Negotiated Rate	$804.48
Max. Negotiated Rate	$1,149.26
Rate for Payer: Aetna Commercial	$1,085.41
Rate for Payer: Aetna New Business (MI Preferred)	$830.02
Rate for Payer: Cash Price	$1,021.56
Rate for Payer: Cofinity Commercial	$1,098.18
Rate for Payer: Cofinity Commercial	$893.87
Rate for Payer: Cofinity Medicare Advantage	$893.87
Rate for Payer: Encore Health Key Benefits Commercial	$1,021.56
Rate for Payer: Healthscope Commercial	$1,149.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,085.41
Rate for Payer: PHP Commercial	$1,085.41
Rate for Payer: Priority Health Cigna Priority Health	$830.02
Rate for Payer: Priority Health SBD	$804.48

LUBIPROSTONE 8 MCG CAPSULE

Facility

$1,806.49

Service Code	NDC 69339016217
Hospital Charge Code	91534
Hospital Revenue Code	637
Min. Negotiated Rate	$722.60
Max. Negotiated Rate	$1,625.84
Rate for Payer: Aetna Commercial	$1,535.52
Rate for Payer: Aetna Medicare	$903.25
Rate for Payer: Aetna New Business (MI Preferred)	$1,174.22
Rate for Payer: BCBS Complete	$722.60
Rate for Payer: Cash Price	$1,445.19
Rate for Payer: Cofinity Commercial	$1,264.54
Rate for Payer: Cofinity Commercial	$1,553.58
Rate for Payer: Cofinity Medicare Advantage	$1,264.54
Rate for Payer: Encore Health Key Benefits Commercial	$1,445.19
Rate for Payer: Healthscope Commercial	$1,625.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,535.52
Rate for Payer: PHP Commercial	$1,535.52
Rate for Payer: Priority Health Cigna Priority Health	$1,174.22
Rate for Payer: Priority Health SBD	$1,138.09

LUBIPROSTONE 8 MCG CAPSULE

Facility

$45.17

Service Code	NDC 69339016298
Hospital Charge Code	91534
Hospital Revenue Code	637
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$40.65
Rate for Payer: Aetna Commercial	$38.39
Rate for Payer: Aetna New Business (MI Preferred)	$29.36
Rate for Payer: Cash Price	$36.14
Rate for Payer: Cofinity Commercial	$31.62
Rate for Payer: Cofinity Commercial	$38.85
Rate for Payer: Cofinity Medicare Advantage	$31.62
Rate for Payer: Encore Health Key Benefits Commercial	$36.14
Rate for Payer: Healthscope Commercial	$40.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.39
Rate for Payer: PHP Commercial	$38.39
Rate for Payer: Priority Health Cigna Priority Health	$29.36
Rate for Payer: Priority Health SBD	$28.46

LUBIPROSTONE 8 MCG CAPSULE

Facility

$1,806.49

Service Code	NDC 69339016217
Hospital Charge Code	91534
Hospital Revenue Code	637
Min. Negotiated Rate	$1,138.09
Max. Negotiated Rate	$1,625.84
Rate for Payer: Aetna Commercial	$1,535.52
Rate for Payer: Aetna New Business (MI Preferred)	$1,174.22
Rate for Payer: Cash Price	$1,445.19
Rate for Payer: Cofinity Commercial	$1,264.54
Rate for Payer: Cofinity Commercial	$1,553.58
Rate for Payer: Cofinity Medicare Advantage	$1,264.54
Rate for Payer: Encore Health Key Benefits Commercial	$1,445.19
Rate for Payer: Healthscope Commercial	$1,625.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,535.52
Rate for Payer: PHP Commercial	$1,535.52
Rate for Payer: Priority Health Cigna Priority Health	$1,174.22
Rate for Payer: Priority Health SBD	$1,138.09

LUBIPROSTONE 8 MCG CAPSULE

Facility

$1,276.95

Service Code	NDC 64764008060
Hospital Charge Code	91534
Hospital Revenue Code	637
Min. Negotiated Rate	$510.78
Max. Negotiated Rate	$1,149.26
Rate for Payer: Aetna Commercial	$1,085.41
Rate for Payer: Aetna Medicare	$638.48
Rate for Payer: Aetna New Business (MI Preferred)	$830.02
Rate for Payer: BCBS Complete	$510.78
Rate for Payer: Cash Price	$1,021.56
Rate for Payer: Cofinity Commercial	$1,098.18
Rate for Payer: Cofinity Commercial	$893.87
Rate for Payer: Cofinity Medicare Advantage	$893.87
Rate for Payer: Encore Health Key Benefits Commercial	$1,021.56
Rate for Payer: Healthscope Commercial	$1,149.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,085.41
Rate for Payer: PHP Commercial	$1,085.41
Rate for Payer: Priority Health Cigna Priority Health	$830.02
Rate for Payer: Priority Health SBD	$804.48

LUMATEPERONE 42 MG CAPSULE

Facility

$170.93

Service Code	NDC 72060014201
Hospital Charge Code	192596
Hospital Revenue Code	637
Min. Negotiated Rate	$68.37
Max. Negotiated Rate	$153.84
Rate for Payer: Aetna Commercial	$145.29
Rate for Payer: Aetna Medicare	$85.47
Rate for Payer: Aetna New Business (MI Preferred)	$111.10
Rate for Payer: BCBS Complete	$68.37
Rate for Payer: Cash Price	$136.74
Rate for Payer: Cofinity Commercial	$119.65
Rate for Payer: Cofinity Commercial	$147.00
Rate for Payer: Cofinity Medicare Advantage	$119.65
Rate for Payer: Encore Health Key Benefits Commercial	$136.74
Rate for Payer: Healthscope Commercial	$153.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$145.29
Rate for Payer: PHP Commercial	$145.29
Rate for Payer: Priority Health Cigna Priority Health	$111.10
Rate for Payer: Priority Health SBD	$107.69

LUMATEPERONE 42 MG CAPSULE

Facility

$170.93

Service Code	NDC 72060014201
Hospital Charge Code	192596
Hospital Revenue Code	637
Min. Negotiated Rate	$107.69
Max. Negotiated Rate	$153.84
Rate for Payer: Aetna Commercial	$145.29
Rate for Payer: Aetna New Business (MI Preferred)	$111.10
Rate for Payer: Cash Price	$136.74
Rate for Payer: Cofinity Commercial	$119.65
Rate for Payer: Cofinity Commercial	$147.00
Rate for Payer: Cofinity Medicare Advantage	$119.65
Rate for Payer: Encore Health Key Benefits Commercial	$136.74
Rate for Payer: Healthscope Commercial	$153.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$145.29
Rate for Payer: PHP Commercial	$145.29
Rate for Payer: Priority Health Cigna Priority Health	$111.10
Rate for Payer: Priority Health SBD	$107.69

LUMATEPERONE 42 MG CAPSULE

Facility

$5,127.76

Service Code	NDC 72060014230
Hospital Charge Code	192596
Hospital Revenue Code	637
Min. Negotiated Rate	$2,051.10
Max. Negotiated Rate	$4,614.98
Rate for Payer: Aetna Commercial	$4,358.60
Rate for Payer: Aetna Medicare	$2,563.88
Rate for Payer: Aetna New Business (MI Preferred)	$3,333.04
Rate for Payer: BCBS Complete	$2,051.10
Rate for Payer: Cash Price	$4,102.21
Rate for Payer: Cofinity Commercial	$3,589.43
Rate for Payer: Cofinity Commercial	$4,409.87
Rate for Payer: Cofinity Medicare Advantage	$3,589.43
Rate for Payer: Encore Health Key Benefits Commercial	$4,102.21
Rate for Payer: Healthscope Commercial	$4,614.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,358.60
Rate for Payer: PHP Commercial	$4,358.60
Rate for Payer: Priority Health Cigna Priority Health	$3,333.04
Rate for Payer: Priority Health SBD	$3,230.49

LUMATEPERONE 42 MG CAPSULE

Facility

$5,127.76

Service Code	NDC 72060014230
Hospital Charge Code	192596
Hospital Revenue Code	637
Min. Negotiated Rate	$3,230.49
Max. Negotiated Rate	$4,614.98
Rate for Payer: Aetna Commercial	$4,358.60
Rate for Payer: Aetna New Business (MI Preferred)	$3,333.04
Rate for Payer: Cash Price	$4,102.21
Rate for Payer: Cofinity Commercial	$3,589.43
Rate for Payer: Cofinity Commercial	$4,409.87
Rate for Payer: Cofinity Medicare Advantage	$3,589.43
Rate for Payer: Encore Health Key Benefits Commercial	$4,102.21
Rate for Payer: Healthscope Commercial	$4,614.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,358.60
Rate for Payer: PHP Commercial	$4,358.60
Rate for Payer: Priority Health Cigna Priority Health	$3,333.04
Rate for Payer: Priority Health SBD	$3,230.49

LURASIDONE 20 MG TABLET

Facility

$316.91

Service Code	NDC 60687074721
Hospital Charge Code	158952
Hospital Revenue Code	637
Min. Negotiated Rate	$199.65
Max. Negotiated Rate	$285.22
Rate for Payer: Aetna Commercial	$269.37
Rate for Payer: Aetna New Business (MI Preferred)	$205.99
Rate for Payer: Cash Price	$253.53
Rate for Payer: Cofinity Commercial	$221.84
Rate for Payer: Cofinity Commercial	$272.54
Rate for Payer: Cofinity Medicare Advantage	$221.84
Rate for Payer: Encore Health Key Benefits Commercial	$253.53
Rate for Payer: Healthscope Commercial	$285.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.37
Rate for Payer: PHP Commercial	$269.37
Rate for Payer: Priority Health Cigna Priority Health	$205.99
Rate for Payer: Priority Health SBD	$199.65

LURASIDONE 20 MG TABLET

Facility

$92.88

Service Code	NDC 00904735504
Hospital Charge Code	158952
Hospital Revenue Code	637
Min. Negotiated Rate	$58.51
Max. Negotiated Rate	$83.59
Rate for Payer: Aetna Commercial	$78.95
Rate for Payer: Aetna New Business (MI Preferred)	$60.37
Rate for Payer: Cash Price	$74.30
Rate for Payer: Cofinity Commercial	$65.02
Rate for Payer: Cofinity Commercial	$79.88
Rate for Payer: Cofinity Medicare Advantage	$65.02
Rate for Payer: Encore Health Key Benefits Commercial	$74.30
Rate for Payer: Healthscope Commercial	$83.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.95
Rate for Payer: PHP Commercial	$78.95
Rate for Payer: Priority Health Cigna Priority Health	$60.37
Rate for Payer: Priority Health SBD	$58.51

LURASIDONE 20 MG TABLET

Facility

$316.91

Service Code	NDC 60687074721
Hospital Charge Code	158952
Hospital Revenue Code	637
Min. Negotiated Rate	$126.76
Max. Negotiated Rate	$285.22
Rate for Payer: Aetna Commercial	$269.37
Rate for Payer: Aetna Medicare	$158.46
Rate for Payer: Aetna New Business (MI Preferred)	$205.99
Rate for Payer: BCBS Complete	$126.76
Rate for Payer: Cash Price	$253.53
Rate for Payer: Cofinity Commercial	$221.84
Rate for Payer: Cofinity Commercial	$272.54
Rate for Payer: Cofinity Medicare Advantage	$221.84
Rate for Payer: Encore Health Key Benefits Commercial	$253.53
Rate for Payer: Healthscope Commercial	$285.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$269.37
Rate for Payer: PHP Commercial	$269.37
Rate for Payer: Priority Health Cigna Priority Health	$205.99
Rate for Payer: Priority Health SBD	$199.65

LURASIDONE 20 MG TABLET

Facility

$117.74

Service Code	NDC 67877063830
Hospital Charge Code	158952
Hospital Revenue Code	637
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$105.97
Rate for Payer: Aetna Commercial	$100.08
Rate for Payer: Aetna Medicare	$58.87
Rate for Payer: Aetna New Business (MI Preferred)	$76.53
Rate for Payer: BCBS Complete	$47.10
Rate for Payer: Cash Price	$94.19
Rate for Payer: Cofinity Commercial	$101.26
Rate for Payer: Cofinity Commercial	$82.42
Rate for Payer: Cofinity Medicare Advantage	$82.42
Rate for Payer: Encore Health Key Benefits Commercial	$94.19
Rate for Payer: Healthscope Commercial	$105.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.08
Rate for Payer: PHP Commercial	$100.08
Rate for Payer: Priority Health Cigna Priority Health	$76.53
Rate for Payer: Priority Health SBD	$74.18

LURASIDONE 20 MG TABLET

Facility

$10.57

Service Code	NDC 60687074711
Hospital Charge Code	158952
Hospital Revenue Code	637
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$9.51
Rate for Payer: Aetna Commercial	$8.98
Rate for Payer: Aetna Medicare	$5.29
Rate for Payer: Aetna New Business (MI Preferred)	$6.87
Rate for Payer: BCBS Complete	$4.23
Rate for Payer: Cash Price	$8.46
Rate for Payer: Cofinity Commercial	$7.40
Rate for Payer: Cofinity Commercial	$9.09
Rate for Payer: Cofinity Medicare Advantage	$7.40
Rate for Payer: Encore Health Key Benefits Commercial	$8.46
Rate for Payer: Healthscope Commercial	$9.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.98
Rate for Payer: PHP Commercial	$8.98
Rate for Payer: Priority Health Cigna Priority Health	$6.87
Rate for Payer: Priority Health SBD	$6.66

LURASIDONE 20 MG TABLET

Facility

$92.88

Service Code	NDC 00904735504
Hospital Charge Code	158952
Hospital Revenue Code	637
Min. Negotiated Rate	$37.15
Max. Negotiated Rate	$83.59
Rate for Payer: Aetna Commercial	$78.95
Rate for Payer: Aetna Medicare	$46.44
Rate for Payer: Aetna New Business (MI Preferred)	$60.37
Rate for Payer: BCBS Complete	$37.15
Rate for Payer: Cash Price	$74.30
Rate for Payer: Cofinity Commercial	$65.02
Rate for Payer: Cofinity Commercial	$79.88
Rate for Payer: Cofinity Medicare Advantage	$65.02
Rate for Payer: Encore Health Key Benefits Commercial	$74.30
Rate for Payer: Healthscope Commercial	$83.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.95
Rate for Payer: PHP Commercial	$78.95
Rate for Payer: Priority Health Cigna Priority Health	$60.37
Rate for Payer: Priority Health SBD	$58.51

LURASIDONE 20 MG TABLET

Facility

$10.57

Service Code	NDC 60687074711
Hospital Charge Code	158952
Hospital Revenue Code	637
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$9.51
Rate for Payer: Aetna Commercial	$8.98
Rate for Payer: Aetna New Business (MI Preferred)	$6.87
Rate for Payer: Cash Price	$8.46
Rate for Payer: Cofinity Commercial	$7.40
Rate for Payer: Cofinity Commercial	$9.09
Rate for Payer: Cofinity Medicare Advantage	$7.40
Rate for Payer: Encore Health Key Benefits Commercial	$8.46
Rate for Payer: Healthscope Commercial	$9.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.98
Rate for Payer: PHP Commercial	$8.98
Rate for Payer: Priority Health Cigna Priority Health	$6.87
Rate for Payer: Priority Health SBD	$6.66

LURASIDONE 20 MG TABLET

Facility

$117.74

Service Code	NDC 67877063830
Hospital Charge Code	158952
Hospital Revenue Code	637
Min. Negotiated Rate	$74.18
Max. Negotiated Rate	$105.97
Rate for Payer: Aetna Commercial	$100.08
Rate for Payer: Aetna New Business (MI Preferred)	$76.53
Rate for Payer: Cash Price	$94.19
Rate for Payer: Cofinity Commercial	$101.26
Rate for Payer: Cofinity Commercial	$82.42
Rate for Payer: Cofinity Medicare Advantage	$82.42
Rate for Payer: Encore Health Key Benefits Commercial	$94.19
Rate for Payer: Healthscope Commercial	$105.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.08
Rate for Payer: PHP Commercial	$100.08
Rate for Payer: Priority Health Cigna Priority Health	$76.53
Rate for Payer: Priority Health SBD	$74.18

LURASIDONE 40 MG TABLET

Facility

$412.80

Service Code	NDC 00904735661
Hospital Charge Code	107668
Hospital Revenue Code	637
Min. Negotiated Rate	$260.06
Max. Negotiated Rate	$371.52
Rate for Payer: Aetna Commercial	$350.88
Rate for Payer: Aetna New Business (MI Preferred)	$268.32
Rate for Payer: Cash Price	$330.24
Rate for Payer: Cofinity Commercial	$288.96
Rate for Payer: Cofinity Commercial	$355.01
Rate for Payer: Cofinity Medicare Advantage	$288.96
Rate for Payer: Encore Health Key Benefits Commercial	$330.24
Rate for Payer: Healthscope Commercial	$371.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$350.88
Rate for Payer: PHP Commercial	$350.88
Rate for Payer: Priority Health Cigna Priority Health	$268.32
Rate for Payer: Priority Health SBD	$260.06

LURASIDONE 40 MG TABLET

Facility

$4,735.26

Service Code	NDC 63402030430
Hospital Charge Code	107668
Hospital Revenue Code	637
Min. Negotiated Rate	$1,894.10
Max. Negotiated Rate	$4,261.73
Rate for Payer: Aetna Commercial	$4,024.97
Rate for Payer: Aetna Medicare	$2,367.63
Rate for Payer: Aetna New Business (MI Preferred)	$3,077.92
Rate for Payer: BCBS Complete	$1,894.10
Rate for Payer: Cash Price	$3,788.21
Rate for Payer: Cofinity Commercial	$3,314.68
Rate for Payer: Cofinity Commercial	$4,072.32
Rate for Payer: Cofinity Medicare Advantage	$3,314.68
Rate for Payer: Encore Health Key Benefits Commercial	$3,788.21
Rate for Payer: Healthscope Commercial	$4,261.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,024.97
Rate for Payer: PHP Commercial	$4,024.97
Rate for Payer: Priority Health Cigna Priority Health	$3,077.92
Rate for Payer: Priority Health SBD	$2,983.21

LURASIDONE 40 MG TABLET

Facility

$4,735.26

Service Code	NDC 63402030430
Hospital Charge Code	107668
Hospital Revenue Code	637
Min. Negotiated Rate	$2,983.21
Max. Negotiated Rate	$4,261.73
Rate for Payer: Aetna Commercial	$4,024.97
Rate for Payer: Aetna New Business (MI Preferred)	$3,077.92
Rate for Payer: Cash Price	$3,788.21
Rate for Payer: Cofinity Commercial	$3,314.68
Rate for Payer: Cofinity Commercial	$4,072.32
Rate for Payer: Cofinity Medicare Advantage	$3,314.68
Rate for Payer: Encore Health Key Benefits Commercial	$3,788.21
Rate for Payer: Healthscope Commercial	$4,261.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,024.97
Rate for Payer: PHP Commercial	$4,024.97
Rate for Payer: Priority Health Cigna Priority Health	$3,077.92
Rate for Payer: Priority Health SBD	$2,983.21

LURASIDONE 40 MG TABLET

Facility

$412.80

Service Code	NDC 00904735661
Hospital Charge Code	107668
Hospital Revenue Code	637
Min. Negotiated Rate	$165.12
Max. Negotiated Rate	$371.52
Rate for Payer: Aetna Commercial	$350.88
Rate for Payer: Aetna Medicare	$206.40
Rate for Payer: Aetna New Business (MI Preferred)	$268.32
Rate for Payer: BCBS Complete	$165.12
Rate for Payer: Cash Price	$330.24
Rate for Payer: Cofinity Commercial	$288.96
Rate for Payer: Cofinity Commercial	$355.01
Rate for Payer: Cofinity Medicare Advantage	$288.96
Rate for Payer: Encore Health Key Benefits Commercial	$330.24
Rate for Payer: Healthscope Commercial	$371.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$350.88
Rate for Payer: PHP Commercial	$350.88
Rate for Payer: Priority Health Cigna Priority Health	$268.32
Rate for Payer: Priority Health SBD	$260.06

LURASIDONE 80 MG TABLET

Facility

$4,735.26

Service Code	NDC 63402030830
Hospital Charge Code	107669
Hospital Revenue Code	637
Min. Negotiated Rate	$1,894.10
Max. Negotiated Rate	$4,261.73
Rate for Payer: Aetna Commercial	$4,024.97
Rate for Payer: Aetna Medicare	$2,367.63
Rate for Payer: Aetna New Business (MI Preferred)	$3,077.92
Rate for Payer: BCBS Complete	$1,894.10
Rate for Payer: Cash Price	$3,788.21
Rate for Payer: Cofinity Commercial	$3,314.68
Rate for Payer: Cofinity Commercial	$4,072.32
Rate for Payer: Cofinity Medicare Advantage	$3,314.68
Rate for Payer: Encore Health Key Benefits Commercial	$3,788.21
Rate for Payer: Healthscope Commercial	$4,261.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,024.97
Rate for Payer: PHP Commercial	$4,024.97
Rate for Payer: Priority Health Cigna Priority Health	$3,077.92
Rate for Payer: Priority Health SBD	$2,983.21

LURASIDONE 80 MG TABLET

Facility

$4,735.26

Service Code	NDC 63402030830
Hospital Charge Code	107669
Hospital Revenue Code	637
Min. Negotiated Rate	$2,983.21
Max. Negotiated Rate	$4,261.73
Rate for Payer: Aetna Commercial	$4,024.97
Rate for Payer: Aetna New Business (MI Preferred)	$3,077.92
Rate for Payer: Cash Price	$3,788.21
Rate for Payer: Cofinity Commercial	$3,314.68
Rate for Payer: Cofinity Commercial	$4,072.32
Rate for Payer: Cofinity Medicare Advantage	$3,314.68
Rate for Payer: Encore Health Key Benefits Commercial	$3,788.21
Rate for Payer: Healthscope Commercial	$4,261.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,024.97
Rate for Payer: PHP Commercial	$4,024.97
Rate for Payer: Priority Health Cigna Priority Health	$3,077.92
Rate for Payer: Priority Health SBD	$2,983.21

LURBINECTEDIN 4 MG INTRAVENOUS SOLUTION

Facility

$20,878.00

Service Code	HCPCS J9223
Hospital Charge Code	194141
Hospital Revenue Code	636
Min. Negotiated Rate	$111.02
Max. Negotiated Rate	$18,790.20
Rate for Payer: Aetna Commercial	$17,746.30
Rate for Payer: Aetna Medicare	$215.42
Rate for Payer: Aetna New Business (MI Preferred)	$13,570.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$258.91
Rate for Payer: Amish Plain Church Group Commercial	$258.91
Rate for Payer: BCBS Complete	$116.57
Rate for Payer: BCBS MAPPO	$207.13
Rate for Payer: BCN Medicare Advantage	$207.13
Rate for Payer: Cash Price	$16,702.40
Rate for Payer: Cash Price	$16,702.40
Rate for Payer: Cofinity Commercial	$14,614.60
Rate for Payer: Cofinity Commercial	$17,955.08
Rate for Payer: Cofinity Medicare Advantage	$14,614.60
Rate for Payer: Encore Health Key Benefits Commercial	$16,702.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$207.13
Rate for Payer: Healthscope Commercial	$18,790.20
Rate for Payer: Mclaren Medicaid	$111.02
Rate for Payer: Mclaren Medicare	$207.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$217.49
Rate for Payer: Meridian Medicaid	$116.57
Rate for Payer: MI Amish Medical Board Commercial	$238.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17,746.30
Rate for Payer: PACE Medicare	$196.77
Rate for Payer: PACE SWMI	$207.13
Rate for Payer: PHP Commercial	$17,746.30
Rate for Payer: PHP Medicare Advantage	$207.13
Rate for Payer: Priority Health Choice Medicaid	$111.02
Rate for Payer: Priority Health Cigna Priority Health	$13,570.70
Rate for Payer: Priority Health Medicare	$207.13
Rate for Payer: Priority Health SBD	$13,153.14
Rate for Payer: Railroad Medicare Medicare	$207.13
Rate for Payer: UHC All Payor (Choice/PPO)	$583.05
Rate for Payer: UHC Dual Complete DSNP	$207.13
Rate for Payer: UHC Medicare Advantage	$207.13
Rate for Payer: UHCCP Medicaid	$116.61
Rate for Payer: VA VA	$207.13

LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION

Facility

$10,484.48

Service Code	HCPCS J0896
Hospital Charge Code	192114
Hospital Revenue Code	636
Min. Negotiated Rate	$6,605.22
Max. Negotiated Rate	$9,436.03
Rate for Payer: Aetna Commercial	$8,911.81
Rate for Payer: Aetna New Business (MI Preferred)	$6,814.91
Rate for Payer: Cash Price	$8,387.58
Rate for Payer: Cofinity Commercial	$7,339.14
Rate for Payer: Cofinity Commercial	$9,016.65
Rate for Payer: Cofinity Medicare Advantage	$7,339.14
Rate for Payer: Encore Health Key Benefits Commercial	$8,387.58
Rate for Payer: Healthscope Commercial	$9,436.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8,911.81
Rate for Payer: PHP Commercial	$8,911.81
Rate for Payer: Priority Health Cigna Priority Health	$6,814.91
Rate for Payer: Priority Health SBD	$6,605.22

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