Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CELECOXIB 100 MG CAPSULE

Facility

$4.66

Service Code	NDC 60687043611
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Advantage	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.50
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health SBD	$2.94

CELECOXIB 100 MG CAPSULE

Facility

$8.08

Service Code	NDC 51079019901
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna New Business (MI Preferred)	$5.25
Rate for Payer: Cash Price	$6.46
Rate for Payer: Cofinity Advantage	$5.66
Rate for Payer: Cofinity Commercial	$6.95
Rate for Payer: Encore Health Key Benefits Commercial	$6.46
Rate for Payer: Healthscope Commercial	$7.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.06
Rate for Payer: PHP Commercial	$6.87
Rate for Payer: Priority Health SBD	$5.09

CELECOXIB 100 MG CAPSULE

Facility

$266.40

Service Code	NDC 59762151601
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$104.70
Max. Negotiated Rate	$239.76
Rate for Payer: Aetna Commercial	$226.44
Rate for Payer: Aetna Medicare	$133.20
Rate for Payer: Aetna New Business (MI Preferred)	$173.16
Rate for Payer: BCBS Complete	$106.56
Rate for Payer: Cash Price	$213.12
Rate for Payer: Cofinity Advantage	$186.48
Rate for Payer: Cofinity Commercial	$229.10
Rate for Payer: Encore Health Key Benefits Commercial	$213.12
Rate for Payer: Healthscope Commercial	$239.76
Rate for Payer: MI Amish Medical Board Commercial	$213.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$226.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.80
Rate for Payer: PHP Commercial	$226.44
Rate for Payer: Priority Health SBD	$167.83
Rate for Payer: UHC All Payor (Choice/PPO)	$173.16
Rate for Payer: UHC Core	$138.79
Rate for Payer: UHC Exchange	$104.70

CELECOXIB 100 MG CAPSULE

Facility

$465.60

Service Code	NDC 60687043601
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$182.98
Max. Negotiated Rate	$419.04
Rate for Payer: Aetna Commercial	$395.76
Rate for Payer: Aetna Medicare	$232.80
Rate for Payer: Aetna New Business (MI Preferred)	$302.64
Rate for Payer: BCBS Complete	$186.24
Rate for Payer: Cash Price	$372.48
Rate for Payer: Cofinity Advantage	$325.92
Rate for Payer: Cofinity Commercial	$400.42
Rate for Payer: Encore Health Key Benefits Commercial	$372.48
Rate for Payer: Healthscope Commercial	$419.04
Rate for Payer: MI Amish Medical Board Commercial	$372.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$395.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$349.20
Rate for Payer: PHP Commercial	$395.76
Rate for Payer: Priority Health SBD	$293.33
Rate for Payer: UHC All Payor (Choice/PPO)	$302.64
Rate for Payer: UHC Core	$242.58
Rate for Payer: UHC Exchange	$182.98

CELECOXIB 100 MG CAPSULE

Facility

$807.71

Service Code	NDC 51079019920
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$317.43
Max. Negotiated Rate	$726.94
Rate for Payer: Aetna Commercial	$686.55
Rate for Payer: Aetna Medicare	$403.86
Rate for Payer: Aetna New Business (MI Preferred)	$525.01
Rate for Payer: BCBS Complete	$323.08
Rate for Payer: Cash Price	$646.17
Rate for Payer: Cofinity Advantage	$565.40
Rate for Payer: Cofinity Commercial	$694.63
Rate for Payer: Encore Health Key Benefits Commercial	$646.17
Rate for Payer: Healthscope Commercial	$726.94
Rate for Payer: MI Amish Medical Board Commercial	$646.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$686.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$605.78
Rate for Payer: PHP Commercial	$686.55
Rate for Payer: Priority Health SBD	$508.86
Rate for Payer: UHC All Payor (Choice/PPO)	$525.01
Rate for Payer: UHC Core	$420.82
Rate for Payer: UHC Exchange	$317.43

CELECOXIB 100 MG CAPSULE

Facility

$3,464.31

Service Code	NDC 00025152031
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$1,361.47
Max. Negotiated Rate	$3,117.88
Rate for Payer: Aetna Commercial	$2,944.66
Rate for Payer: Aetna Medicare	$1,732.15
Rate for Payer: Aetna New Business (MI Preferred)	$2,251.80
Rate for Payer: BCBS Complete	$1,385.72
Rate for Payer: Cash Price	$2,771.45
Rate for Payer: Cofinity Advantage	$2,425.02
Rate for Payer: Cofinity Commercial	$2,979.31
Rate for Payer: Encore Health Key Benefits Commercial	$2,771.45
Rate for Payer: Healthscope Commercial	$3,117.88
Rate for Payer: MI Amish Medical Board Commercial	$2,771.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,944.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,598.23
Rate for Payer: PHP Commercial	$2,944.66
Rate for Payer: Priority Health SBD	$2,182.52
Rate for Payer: UHC All Payor (Choice/PPO)	$2,251.80
Rate for Payer: UHC Core	$1,804.91
Rate for Payer: UHC Exchange	$1,361.47

CELECOXIB 100 MG CAPSULE

Facility

$365.28

Service Code	NDC 00904650261
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$230.13
Max. Negotiated Rate	$328.75
Rate for Payer: Aetna Commercial	$310.49
Rate for Payer: Aetna New Business (MI Preferred)	$237.43
Rate for Payer: Cash Price	$292.22
Rate for Payer: Cofinity Advantage	$255.70
Rate for Payer: Cofinity Commercial	$314.14
Rate for Payer: Encore Health Key Benefits Commercial	$292.22
Rate for Payer: Healthscope Commercial	$328.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.96
Rate for Payer: PHP Commercial	$310.49
Rate for Payer: Priority Health SBD	$230.13

CELECOXIB 100 MG CAPSULE

Facility

$4.66

Service Code	NDC 60687043611
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Advantage	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: MI Amish Medical Board Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.50
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health SBD	$2.94
Rate for Payer: UHC All Payor (Choice/PPO)	$3.03
Rate for Payer: UHC Core	$2.43
Rate for Payer: UHC Exchange	$1.83

CELECOXIB 100 MG CAPSULE

Facility

$465.60

Service Code	NDC 60687043601
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$293.33
Max. Negotiated Rate	$419.04
Rate for Payer: Aetna Commercial	$395.76
Rate for Payer: Aetna New Business (MI Preferred)	$302.64
Rate for Payer: Cash Price	$372.48
Rate for Payer: Cofinity Advantage	$325.92
Rate for Payer: Cofinity Commercial	$400.42
Rate for Payer: Encore Health Key Benefits Commercial	$372.48
Rate for Payer: Healthscope Commercial	$419.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$395.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$349.20
Rate for Payer: PHP Commercial	$395.76
Rate for Payer: Priority Health SBD	$293.33

CELECOXIB 100 MG CAPSULE

Facility

$807.71

Service Code	NDC 51079019920
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$508.86
Max. Negotiated Rate	$726.94
Rate for Payer: Aetna Commercial	$686.55
Rate for Payer: Aetna New Business (MI Preferred)	$525.01
Rate for Payer: Cash Price	$646.17
Rate for Payer: Cofinity Advantage	$565.40
Rate for Payer: Cofinity Commercial	$694.63
Rate for Payer: Encore Health Key Benefits Commercial	$646.17
Rate for Payer: Healthscope Commercial	$726.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$686.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$605.78
Rate for Payer: PHP Commercial	$686.55
Rate for Payer: Priority Health SBD	$508.86

CELECOXIB 100 MG CAPSULE

Facility

$266.40

Service Code	NDC 59762151601
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$167.83
Max. Negotiated Rate	$239.76
Rate for Payer: Aetna Commercial	$226.44
Rate for Payer: Aetna New Business (MI Preferred)	$173.16
Rate for Payer: Cash Price	$213.12
Rate for Payer: Cofinity Advantage	$186.48
Rate for Payer: Cofinity Commercial	$229.10
Rate for Payer: Encore Health Key Benefits Commercial	$213.12
Rate for Payer: Healthscope Commercial	$239.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$226.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.80
Rate for Payer: PHP Commercial	$226.44
Rate for Payer: Priority Health SBD	$167.83

CELECOXIB 100 MG CAPSULE

Facility

$8.08

Service Code	NDC 51079019901
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna Medicare	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$5.25
Rate for Payer: BCBS Complete	$3.23
Rate for Payer: Cash Price	$6.46
Rate for Payer: Cofinity Advantage	$5.66
Rate for Payer: Cofinity Commercial	$6.95
Rate for Payer: Encore Health Key Benefits Commercial	$6.46
Rate for Payer: Healthscope Commercial	$7.27
Rate for Payer: MI Amish Medical Board Commercial	$6.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.06
Rate for Payer: PHP Commercial	$6.87
Rate for Payer: Priority Health SBD	$5.09
Rate for Payer: UHC All Payor (Choice/PPO)	$5.25
Rate for Payer: UHC Core	$4.21
Rate for Payer: UHC Exchange	$3.18

CELECOXIB 100 MG CAPSULE

Facility

$3,464.31

Service Code	NDC 00025152031
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$2,182.52
Max. Negotiated Rate	$3,117.88
Rate for Payer: Aetna Commercial	$2,944.66
Rate for Payer: Aetna New Business (MI Preferred)	$2,251.80
Rate for Payer: Cash Price	$2,771.45
Rate for Payer: Cofinity Advantage	$2,425.02
Rate for Payer: Cofinity Commercial	$2,979.31
Rate for Payer: Encore Health Key Benefits Commercial	$2,771.45
Rate for Payer: Healthscope Commercial	$3,117.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,944.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,598.23
Rate for Payer: PHP Commercial	$2,944.66
Rate for Payer: Priority Health SBD	$2,182.52

CELECOXIB 100 MG CAPSULE

Facility

$365.28

Service Code	NDC 00904650261
Hospital Charge Code	24500
Hospital Revenue Code	637
Min. Negotiated Rate	$143.56
Max. Negotiated Rate	$328.75
Rate for Payer: Aetna Commercial	$310.49
Rate for Payer: Aetna Medicare	$182.64
Rate for Payer: Aetna New Business (MI Preferred)	$237.43
Rate for Payer: BCBS Complete	$146.11
Rate for Payer: Cash Price	$292.22
Rate for Payer: Cofinity Advantage	$255.70
Rate for Payer: Cofinity Commercial	$314.14
Rate for Payer: Encore Health Key Benefits Commercial	$292.22
Rate for Payer: Healthscope Commercial	$328.75
Rate for Payer: MI Amish Medical Board Commercial	$292.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.96
Rate for Payer: PHP Commercial	$310.49
Rate for Payer: Priority Health SBD	$230.13
Rate for Payer: UHC All Payor (Choice/PPO)	$237.43
Rate for Payer: UHC Core	$190.31
Rate for Payer: UHC Exchange	$143.56

CELECOXIB 200 MG CAPSULE

Facility

$7.63

Service Code	NDC 60687044711
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$6.87
Rate for Payer: Aetna Commercial	$6.49
Rate for Payer: Aetna New Business (MI Preferred)	$4.96
Rate for Payer: Cash Price	$6.10
Rate for Payer: Cofinity Advantage	$5.34
Rate for Payer: Cofinity Commercial	$6.56
Rate for Payer: Encore Health Key Benefits Commercial	$6.10
Rate for Payer: Healthscope Commercial	$6.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.72
Rate for Payer: PHP Commercial	$6.49
Rate for Payer: Priority Health SBD	$4.81

CELECOXIB 200 MG CAPSULE

Facility

$506.40

Service Code	NDC 00904650361
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$319.03
Max. Negotiated Rate	$455.76
Rate for Payer: Aetna Commercial	$430.44
Rate for Payer: Aetna New Business (MI Preferred)	$329.16
Rate for Payer: Cash Price	$405.12
Rate for Payer: Cofinity Advantage	$354.48
Rate for Payer: Cofinity Commercial	$435.50
Rate for Payer: Encore Health Key Benefits Commercial	$405.12
Rate for Payer: Healthscope Commercial	$455.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$430.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$379.80
Rate for Payer: PHP Commercial	$430.44
Rate for Payer: Priority Health SBD	$319.03

CELECOXIB 200 MG CAPSULE

Facility

$5,682.09

Service Code	NDC 00025152534
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$2,233.06
Max. Negotiated Rate	$5,113.88
Rate for Payer: Aetna Commercial	$4,829.78
Rate for Payer: Aetna Medicare	$2,841.05
Rate for Payer: Aetna New Business (MI Preferred)	$3,693.36
Rate for Payer: BCBS Complete	$2,272.84
Rate for Payer: Cash Price	$4,545.67
Rate for Payer: Cofinity Advantage	$3,977.46
Rate for Payer: Cofinity Commercial	$4,886.60
Rate for Payer: Encore Health Key Benefits Commercial	$4,545.67
Rate for Payer: Healthscope Commercial	$5,113.88
Rate for Payer: MI Amish Medical Board Commercial	$4,545.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,829.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,261.57
Rate for Payer: PHP Commercial	$4,829.78
Rate for Payer: Priority Health SBD	$3,579.72
Rate for Payer: UHC All Payor (Choice/PPO)	$3,693.36
Rate for Payer: UHC Core	$2,960.37
Rate for Payer: UHC Exchange	$2,233.06

CELECOXIB 200 MG CAPSULE

Facility

$506.40

Service Code	NDC 00904650361
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$199.02
Max. Negotiated Rate	$455.76
Rate for Payer: Aetna Commercial	$430.44
Rate for Payer: Aetna Medicare	$253.20
Rate for Payer: Aetna New Business (MI Preferred)	$329.16
Rate for Payer: BCBS Complete	$202.56
Rate for Payer: Cash Price	$405.12
Rate for Payer: Cofinity Advantage	$354.48
Rate for Payer: Cofinity Commercial	$435.50
Rate for Payer: Encore Health Key Benefits Commercial	$405.12
Rate for Payer: Healthscope Commercial	$455.76
Rate for Payer: MI Amish Medical Board Commercial	$405.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$430.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$379.80
Rate for Payer: PHP Commercial	$430.44
Rate for Payer: Priority Health SBD	$319.03
Rate for Payer: UHC All Payor (Choice/PPO)	$329.16
Rate for Payer: UHC Core	$263.83
Rate for Payer: UHC Exchange	$199.02

CELECOXIB 200 MG CAPSULE

Facility

$5,682.09

Service Code	NDC 00025152534
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$3,579.72
Max. Negotiated Rate	$5,113.88
Rate for Payer: Aetna Commercial	$4,829.78
Rate for Payer: Aetna New Business (MI Preferred)	$3,693.36
Rate for Payer: Cash Price	$4,545.67
Rate for Payer: Cofinity Advantage	$3,977.46
Rate for Payer: Cofinity Commercial	$4,886.60
Rate for Payer: Encore Health Key Benefits Commercial	$4,545.67
Rate for Payer: Healthscope Commercial	$5,113.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,829.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,261.57
Rate for Payer: PHP Commercial	$4,829.78
Rate for Payer: Priority Health SBD	$3,579.72

CELECOXIB 200 MG CAPSULE

Facility

$762.24

Service Code	NDC 60687044701
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$299.56
Max. Negotiated Rate	$686.02
Rate for Payer: Aetna Commercial	$647.90
Rate for Payer: Aetna Medicare	$381.12
Rate for Payer: Aetna New Business (MI Preferred)	$495.46
Rate for Payer: BCBS Complete	$304.90
Rate for Payer: Cash Price	$609.79
Rate for Payer: Cofinity Advantage	$533.57
Rate for Payer: Cofinity Commercial	$655.53
Rate for Payer: Encore Health Key Benefits Commercial	$609.79
Rate for Payer: Healthscope Commercial	$686.02
Rate for Payer: MI Amish Medical Board Commercial	$609.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$647.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$571.68
Rate for Payer: PHP Commercial	$647.90
Rate for Payer: Priority Health SBD	$480.21
Rate for Payer: UHC All Payor (Choice/PPO)	$495.46
Rate for Payer: UHC Core	$397.13
Rate for Payer: UHC Exchange	$299.56

CELECOXIB 200 MG CAPSULE

Facility

$762.24

Service Code	NDC 60687044701
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$480.21
Max. Negotiated Rate	$686.02
Rate for Payer: Aetna Commercial	$647.90
Rate for Payer: Aetna New Business (MI Preferred)	$495.46
Rate for Payer: Cash Price	$609.79
Rate for Payer: Cofinity Advantage	$533.57
Rate for Payer: Cofinity Commercial	$655.53
Rate for Payer: Encore Health Key Benefits Commercial	$609.79
Rate for Payer: Healthscope Commercial	$686.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$647.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$571.68
Rate for Payer: PHP Commercial	$647.90
Rate for Payer: Priority Health SBD	$480.21

CELECOXIB 200 MG CAPSULE

Facility

$387.75

Service Code	NDC 69097042107
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$244.28
Max. Negotiated Rate	$348.98
Rate for Payer: Aetna Commercial	$329.59
Rate for Payer: Aetna New Business (MI Preferred)	$252.04
Rate for Payer: Cash Price	$310.20
Rate for Payer: Cofinity Advantage	$271.43
Rate for Payer: Cofinity Commercial	$333.46
Rate for Payer: Encore Health Key Benefits Commercial	$310.20
Rate for Payer: Healthscope Commercial	$348.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$290.81
Rate for Payer: PHP Commercial	$329.59
Rate for Payer: Priority Health SBD	$244.28

CELECOXIB 200 MG CAPSULE

Facility

$136.30

Service Code	NDC 50228015801
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna New Business (MI Preferred)	$88.59
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Advantage	$95.41
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.22
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health SBD	$85.87

CELECOXIB 200 MG CAPSULE

Facility

$7.63

Service Code	NDC 60687044711
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$6.87
Rate for Payer: Aetna Commercial	$6.49
Rate for Payer: Aetna Medicare	$3.81
Rate for Payer: Aetna New Business (MI Preferred)	$4.96
Rate for Payer: BCBS Complete	$3.05
Rate for Payer: Cash Price	$6.10
Rate for Payer: Cofinity Advantage	$5.34
Rate for Payer: Cofinity Commercial	$6.56
Rate for Payer: Encore Health Key Benefits Commercial	$6.10
Rate for Payer: Healthscope Commercial	$6.87
Rate for Payer: MI Amish Medical Board Commercial	$6.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.72
Rate for Payer: PHP Commercial	$6.49
Rate for Payer: Priority Health SBD	$4.81
Rate for Payer: UHC All Payor (Choice/PPO)	$4.96
Rate for Payer: UHC Core	$3.98
Rate for Payer: UHC Exchange	$3.00

CELECOXIB 200 MG CAPSULE

Facility

$136.30

Service Code	NDC 50228015801
Hospital Charge Code	24501
Hospital Revenue Code	637
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna Medicare	$68.15
Rate for Payer: Aetna New Business (MI Preferred)	$88.59
Rate for Payer: BCBS Complete	$54.52
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Advantage	$95.41
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: MI Amish Medical Board Commercial	$109.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.22
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health SBD	$85.87
Rate for Payer: UHC All Payor (Choice/PPO)	$88.59
Rate for Payer: UHC Core	$71.01
Rate for Payer: UHC Exchange	$53.57

Know your out-of-pocket cost for care.

All Charges