Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MELOXICAM 7.5 MG TABLET

Facility

$123.38

Service Code	NDC 50268052515
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$111.04
Rate for Payer: Aetna Commercial	$104.87
Rate for Payer: Aetna Medicare	$61.69
Rate for Payer: Aetna New Business (MI Preferred)	$80.20
Rate for Payer: BCBS Complete	$49.35
Rate for Payer: Cash Price	$98.70
Rate for Payer: Cofinity Commercial	$106.11
Rate for Payer: Cofinity Commercial	$86.37
Rate for Payer: Cofinity Medicare Advantage	$86.37
Rate for Payer: Encore Health Key Benefits Commercial	$98.70
Rate for Payer: Healthscope Commercial	$111.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$104.87
Rate for Payer: PHP Commercial	$104.87
Rate for Payer: Priority Health Cigna Priority Health	$80.20
Rate for Payer: Priority Health SBD	$77.73

MELOXICAM 7.5 MG TABLET

Facility

$49.35

Service Code	NDC 69097015807
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$31.09
Max. Negotiated Rate	$44.41
Rate for Payer: Aetna Commercial	$41.95
Rate for Payer: Aetna New Business (MI Preferred)	$32.08
Rate for Payer: Cash Price	$39.48
Rate for Payer: Cofinity Commercial	$34.55
Rate for Payer: Cofinity Commercial	$42.44
Rate for Payer: Cofinity Medicare Advantage	$34.55
Rate for Payer: Encore Health Key Benefits Commercial	$39.48
Rate for Payer: Healthscope Commercial	$44.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.95
Rate for Payer: PHP Commercial	$41.95
Rate for Payer: Priority Health Cigna Priority Health	$32.08
Rate for Payer: Priority Health SBD	$31.09

MELOXICAM 7.5 MG TABLET

Facility

$2.47

Service Code	NDC 50268052511
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare	$1.24
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: BCBS Complete	$0.99
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Commercial	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Cofinity Medicare Advantage	$1.73
Rate for Payer: Encore Health Key Benefits Commercial	$1.98
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health Cigna Priority Health	$1.61
Rate for Payer: Priority Health SBD	$1.56

MELOXICAM 7.5 MG TABLET

Facility

$49.35

Service Code	NDC 69097015807
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$19.74
Max. Negotiated Rate	$44.41
Rate for Payer: Aetna Commercial	$41.95
Rate for Payer: Aetna Medicare	$24.68
Rate for Payer: Aetna New Business (MI Preferred)	$32.08
Rate for Payer: BCBS Complete	$19.74
Rate for Payer: Cash Price	$39.48
Rate for Payer: Cofinity Commercial	$34.55
Rate for Payer: Cofinity Commercial	$42.44
Rate for Payer: Cofinity Medicare Advantage	$34.55
Rate for Payer: Encore Health Key Benefits Commercial	$39.48
Rate for Payer: Healthscope Commercial	$44.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.95
Rate for Payer: PHP Commercial	$41.95
Rate for Payer: Priority Health Cigna Priority Health	$32.08
Rate for Payer: Priority Health SBD	$31.09

MELOXICAM 7.5 MG TABLET

Facility

$123.38

Service Code	NDC 50268052515
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$77.73
Max. Negotiated Rate	$111.04
Rate for Payer: Aetna Commercial	$104.87
Rate for Payer: Aetna New Business (MI Preferred)	$80.20
Rate for Payer: Cash Price	$98.70
Rate for Payer: Cofinity Commercial	$106.11
Rate for Payer: Cofinity Commercial	$86.37
Rate for Payer: Cofinity Medicare Advantage	$86.37
Rate for Payer: Encore Health Key Benefits Commercial	$98.70
Rate for Payer: Healthscope Commercial	$111.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$104.87
Rate for Payer: PHP Commercial	$104.87
Rate for Payer: Priority Health Cigna Priority Health	$80.20
Rate for Payer: Priority Health SBD	$77.73

MELOXICAM 7.5 MG TABLET

Facility

$256.15

Service Code	NDC 00440684101
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$161.37
Max. Negotiated Rate	$230.53
Rate for Payer: Aetna Commercial	$217.73
Rate for Payer: Aetna New Business (MI Preferred)	$166.50
Rate for Payer: Cash Price	$204.92
Rate for Payer: Cofinity Commercial	$179.31
Rate for Payer: Cofinity Commercial	$220.29
Rate for Payer: Cofinity Medicare Advantage	$179.31
Rate for Payer: Encore Health Key Benefits Commercial	$204.92
Rate for Payer: Healthscope Commercial	$230.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$217.73
Rate for Payer: PHP Commercial	$217.73
Rate for Payer: Priority Health Cigna Priority Health	$166.50
Rate for Payer: Priority Health SBD	$161.37

MELOXICAM 7.5 MG TABLET

Facility

$256.15

Service Code	NDC 00440684101
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$102.46
Max. Negotiated Rate	$230.53
Rate for Payer: Aetna Commercial	$217.73
Rate for Payer: Aetna Medicare	$128.07
Rate for Payer: Aetna New Business (MI Preferred)	$166.50
Rate for Payer: BCBS Complete	$102.46
Rate for Payer: Cash Price	$204.92
Rate for Payer: Cofinity Commercial	$179.31
Rate for Payer: Cofinity Commercial	$220.29
Rate for Payer: Cofinity Medicare Advantage	$179.31
Rate for Payer: Encore Health Key Benefits Commercial	$204.92
Rate for Payer: Healthscope Commercial	$230.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$217.73
Rate for Payer: PHP Commercial	$217.73
Rate for Payer: Priority Health Cigna Priority Health	$166.50
Rate for Payer: Priority Health SBD	$161.37

MELOXICAM 7.5 MG TABLET

Facility

$2.47

Service Code	NDC 50268052511
Hospital Charge Code	20566
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Commercial	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Cofinity Medicare Advantage	$1.73
Rate for Payer: Encore Health Key Benefits Commercial	$1.98
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health Cigna Priority Health	$1.61
Rate for Payer: Priority Health SBD	$1.56

MEMANTINE 10 MG TABLET

Facility

$268.85

Service Code	NDC 00904650661
Hospital Charge Code	36966
Hospital Revenue Code	637
Min. Negotiated Rate	$107.54
Max. Negotiated Rate	$241.97
Rate for Payer: Aetna Commercial	$228.52
Rate for Payer: Aetna Medicare	$134.43
Rate for Payer: Aetna New Business (MI Preferred)	$174.75
Rate for Payer: BCBS Complete	$107.54
Rate for Payer: Cash Price	$215.08
Rate for Payer: Cofinity Commercial	$188.19
Rate for Payer: Cofinity Commercial	$231.21
Rate for Payer: Cofinity Medicare Advantage	$188.19
Rate for Payer: Encore Health Key Benefits Commercial	$215.08
Rate for Payer: Healthscope Commercial	$241.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$228.52
Rate for Payer: PHP Commercial	$228.52
Rate for Payer: Priority Health Cigna Priority Health	$174.75
Rate for Payer: Priority Health SBD	$169.38

MEMANTINE 10 MG TABLET

Facility

$268.85

Service Code	NDC 00904650661
Hospital Charge Code	36966
Hospital Revenue Code	637
Min. Negotiated Rate	$169.38
Max. Negotiated Rate	$241.97
Rate for Payer: Aetna Commercial	$228.52
Rate for Payer: Aetna New Business (MI Preferred)	$174.75
Rate for Payer: Cash Price	$215.08
Rate for Payer: Cofinity Commercial	$188.19
Rate for Payer: Cofinity Commercial	$231.21
Rate for Payer: Cofinity Medicare Advantage	$188.19
Rate for Payer: Encore Health Key Benefits Commercial	$215.08
Rate for Payer: Healthscope Commercial	$241.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$228.52
Rate for Payer: PHP Commercial	$228.52
Rate for Payer: Priority Health Cigna Priority Health	$174.75
Rate for Payer: Priority Health SBD	$169.38

MEMANTINE 5 MG TABLET

Facility

$132.05

Service Code	NDC 00904650506
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$52.82
Max. Negotiated Rate	$118.84
Rate for Payer: Aetna Commercial	$112.24
Rate for Payer: Aetna Medicare	$66.03
Rate for Payer: Aetna New Business (MI Preferred)	$85.83
Rate for Payer: BCBS Complete	$52.82
Rate for Payer: Cash Price	$105.64
Rate for Payer: Cofinity Commercial	$113.56
Rate for Payer: Cofinity Commercial	$92.44
Rate for Payer: Cofinity Medicare Advantage	$92.44
Rate for Payer: Encore Health Key Benefits Commercial	$105.64
Rate for Payer: Healthscope Commercial	$118.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.24
Rate for Payer: PHP Commercial	$112.24
Rate for Payer: Priority Health Cigna Priority Health	$85.83
Rate for Payer: Priority Health SBD	$83.19

MEMANTINE 5 MG TABLET

Facility

$243.20

Service Code	NDC 00904650561
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$153.22
Max. Negotiated Rate	$218.88
Rate for Payer: Aetna Commercial	$206.72
Rate for Payer: Aetna New Business (MI Preferred)	$158.08
Rate for Payer: Cash Price	$194.56
Rate for Payer: Cofinity Commercial	$170.24
Rate for Payer: Cofinity Commercial	$209.15
Rate for Payer: Cofinity Medicare Advantage	$170.24
Rate for Payer: Encore Health Key Benefits Commercial	$194.56
Rate for Payer: Healthscope Commercial	$218.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.72
Rate for Payer: PHP Commercial	$206.72
Rate for Payer: Priority Health Cigna Priority Health	$158.08
Rate for Payer: Priority Health SBD	$153.22

MEMANTINE 5 MG TABLET

Facility

$132.05

Service Code	NDC 00904650506
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$83.19
Max. Negotiated Rate	$118.84
Rate for Payer: Aetna Commercial	$112.24
Rate for Payer: Aetna New Business (MI Preferred)	$85.83
Rate for Payer: Cash Price	$105.64
Rate for Payer: Cofinity Commercial	$113.56
Rate for Payer: Cofinity Commercial	$92.44
Rate for Payer: Cofinity Medicare Advantage	$92.44
Rate for Payer: Encore Health Key Benefits Commercial	$105.64
Rate for Payer: Healthscope Commercial	$118.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.24
Rate for Payer: PHP Commercial	$112.24
Rate for Payer: Priority Health Cigna Priority Health	$85.83
Rate for Payer: Priority Health SBD	$83.19

MEMANTINE 5 MG TABLET

Facility

$267.90

Service Code	NDC 00591387044
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$107.16
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna Medicare	$133.95
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: BCBS Complete	$107.16
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Cofinity Medicare Advantage	$187.53
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$174.13
Rate for Payer: Priority Health SBD	$168.78

MEMANTINE 5 MG TABLET

Facility

$243.20

Service Code	NDC 00904650561
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$97.28
Max. Negotiated Rate	$218.88
Rate for Payer: Aetna Commercial	$206.72
Rate for Payer: Aetna Medicare	$121.60
Rate for Payer: Aetna New Business (MI Preferred)	$158.08
Rate for Payer: BCBS Complete	$97.28
Rate for Payer: Cash Price	$194.56
Rate for Payer: Cofinity Commercial	$170.24
Rate for Payer: Cofinity Commercial	$209.15
Rate for Payer: Cofinity Medicare Advantage	$170.24
Rate for Payer: Encore Health Key Benefits Commercial	$194.56
Rate for Payer: Healthscope Commercial	$218.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.72
Rate for Payer: PHP Commercial	$206.72
Rate for Payer: Priority Health Cigna Priority Health	$158.08
Rate for Payer: Priority Health SBD	$153.22

MEMANTINE 5 MG TABLET

Facility

$267.90

Service Code	NDC 00591387044
Hospital Charge Code	37170
Hospital Revenue Code	637
Min. Negotiated Rate	$168.78
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Cofinity Medicare Advantage	$187.53
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$174.13
Rate for Payer: Priority Health SBD	$168.78

MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE

Facility

$744.04

Service Code	HCPCS 90620
Hospital Charge Code	173649
Hospital Revenue Code	636
Min. Negotiated Rate	$297.62
Max. Negotiated Rate	$669.64
Rate for Payer: Aetna Commercial	$632.43
Rate for Payer: Aetna Medicare	$372.02
Rate for Payer: Aetna New Business (MI Preferred)	$483.63
Rate for Payer: BCBS Complete	$297.62
Rate for Payer: Cash Price	$595.23
Rate for Payer: Cofinity Commercial	$520.83
Rate for Payer: Cofinity Commercial	$639.87
Rate for Payer: Cofinity Medicare Advantage	$520.83
Rate for Payer: Encore Health Key Benefits Commercial	$595.23
Rate for Payer: Healthscope Commercial	$669.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$632.43
Rate for Payer: PHP Commercial	$632.43
Rate for Payer: Priority Health Cigna Priority Health	$483.63
Rate for Payer: Priority Health SBD	$468.75

MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE

Facility

$744.04

Service Code	HCPCS 90620
Hospital Charge Code	173649
Hospital Revenue Code	636
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$669.64
Rate for Payer: Aetna Commercial	$632.43
Rate for Payer: Aetna New Business (MI Preferred)	$483.63
Rate for Payer: Cash Price	$595.23
Rate for Payer: Cofinity Commercial	$520.83
Rate for Payer: Cofinity Commercial	$639.87
Rate for Payer: Cofinity Medicare Advantage	$520.83
Rate for Payer: Encore Health Key Benefits Commercial	$595.23
Rate for Payer: Healthscope Commercial	$669.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$632.43
Rate for Payer: PHP Commercial	$632.43
Rate for Payer: Priority Health Cigna Priority Health	$483.63
Rate for Payer: Priority Health SBD	$468.75

MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION

Facility

$389.44

Service Code	HCPCS 90619
Hospital Charge Code	194943
Hospital Revenue Code	636
Min. Negotiated Rate	$155.78
Max. Negotiated Rate	$350.50
Rate for Payer: Aetna Commercial	$331.02
Rate for Payer: Aetna Commercial	$323.31
Rate for Payer: Aetna Medicare	$190.18
Rate for Payer: Aetna Medicare	$194.72
Rate for Payer: Aetna New Business (MI Preferred)	$253.14
Rate for Payer: Aetna New Business (MI Preferred)	$247.23
Rate for Payer: BCBS Complete	$155.78
Rate for Payer: BCBS Complete	$152.14
Rate for Payer: Cash Price	$311.55
Rate for Payer: Cash Price	$304.29
Rate for Payer: Cofinity Commercial	$334.92
Rate for Payer: Cofinity Commercial	$266.25
Rate for Payer: Cofinity Commercial	$327.11
Rate for Payer: Cofinity Commercial	$272.61
Rate for Payer: Cofinity Medicare Advantage	$266.25
Rate for Payer: Cofinity Medicare Advantage	$272.61
Rate for Payer: Encore Health Key Benefits Commercial	$304.29
Rate for Payer: Encore Health Key Benefits Commercial	$311.55
Rate for Payer: Healthscope Commercial	$350.50
Rate for Payer: Healthscope Commercial	$342.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$323.31
Rate for Payer: PHP Commercial	$331.02
Rate for Payer: PHP Commercial	$323.31
Rate for Payer: Priority Health Cigna Priority Health	$247.23
Rate for Payer: Priority Health Cigna Priority Health	$253.14
Rate for Payer: Priority Health SBD	$239.63
Rate for Payer: Priority Health SBD	$245.35

MENINGOCOCCAL VAC A,C,Y,W-135,CONJ TET (PF) 10 MCG/0.5 ML IM SOLUTION

Facility

$380.36

Service Code	HCPCS 90619
Hospital Charge Code	194943
Hospital Revenue Code	636
Min. Negotiated Rate	$239.63
Max. Negotiated Rate	$342.32
Rate for Payer: Aetna Commercial	$323.31
Rate for Payer: Aetna Commercial	$331.02
Rate for Payer: Aetna New Business (MI Preferred)	$247.23
Rate for Payer: Aetna New Business (MI Preferred)	$253.14
Rate for Payer: Cash Price	$304.29
Rate for Payer: Cash Price	$311.55
Rate for Payer: Cofinity Commercial	$266.25
Rate for Payer: Cofinity Commercial	$272.61
Rate for Payer: Cofinity Commercial	$334.92
Rate for Payer: Cofinity Commercial	$327.11
Rate for Payer: Cofinity Medicare Advantage	$272.61
Rate for Payer: Cofinity Medicare Advantage	$266.25
Rate for Payer: Encore Health Key Benefits Commercial	$304.29
Rate for Payer: Encore Health Key Benefits Commercial	$311.55
Rate for Payer: Healthscope Commercial	$342.32
Rate for Payer: Healthscope Commercial	$350.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$323.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$331.02
Rate for Payer: PHP Commercial	$323.31
Rate for Payer: PHP Commercial	$331.02
Rate for Payer: Priority Health Cigna Priority Health	$253.14
Rate for Payer: Priority Health Cigna Priority Health	$247.23
Rate for Payer: Priority Health SBD	$245.35
Rate for Payer: Priority Health SBD	$239.63

MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION

Facility

$34.75

Service Code	HCPCS J2175
Hospital Charge Code	116144
Hospital Revenue Code	636
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$31.27
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna Medicare	$17.38
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: BCBS Complete	$13.90
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Cofinity Commercial	$29.89
Rate for Payer: Cofinity Medicare Advantage	$24.32
Rate for Payer: Encore Health Key Benefits Commercial	$27.80
Rate for Payer: Healthscope Commercial	$31.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.54
Rate for Payer: PHP Commercial	$29.54
Rate for Payer: Priority Health Cigna Priority Health	$22.59
Rate for Payer: Priority Health SBD	$21.89

MEPERIDINE (PF) 25 MG/ML INJECTION SOLUTION

Facility

$34.75

Service Code	HCPCS J2175
Hospital Charge Code	116144
Hospital Revenue Code	636
Min. Negotiated Rate	$21.89
Max. Negotiated Rate	$31.27
Rate for Payer: Aetna Commercial	$29.54
Rate for Payer: Aetna New Business (MI Preferred)	$22.59
Rate for Payer: Cash Price	$27.80
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Cofinity Commercial	$29.89
Rate for Payer: Cofinity Medicare Advantage	$24.32
Rate for Payer: Encore Health Key Benefits Commercial	$27.80
Rate for Payer: Healthscope Commercial	$31.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.54
Rate for Payer: PHP Commercial	$29.54
Rate for Payer: Priority Health Cigna Priority Health	$22.59
Rate for Payer: Priority Health SBD	$21.89

MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$25.10

Service Code	HCPCS J0670
Hospital Charge Code	105637
Hospital Revenue Code	636
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$22.59
Rate for Payer: Aetna Commercial	$21.34
Rate for Payer: Aetna Commercial	$15.33
Rate for Payer: Aetna New Business (MI Preferred)	$11.72
Rate for Payer: Aetna New Business (MI Preferred)	$16.32
Rate for Payer: Cash Price	$14.42
Rate for Payer: Cash Price	$20.08
Rate for Payer: Cofinity Commercial	$21.59
Rate for Payer: Cofinity Commercial	$17.57
Rate for Payer: Cofinity Commercial	$12.62
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Cofinity Medicare Advantage	$12.62
Rate for Payer: Cofinity Medicare Advantage	$17.57
Rate for Payer: Encore Health Key Benefits Commercial	$14.42
Rate for Payer: Encore Health Key Benefits Commercial	$20.08
Rate for Payer: Healthscope Commercial	$22.59
Rate for Payer: Healthscope Commercial	$16.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.34
Rate for Payer: PHP Commercial	$21.34
Rate for Payer: PHP Commercial	$15.33
Rate for Payer: Priority Health Cigna Priority Health	$11.72
Rate for Payer: Priority Health Cigna Priority Health	$16.32
Rate for Payer: Priority Health SBD	$11.36
Rate for Payer: Priority Health SBD	$15.81

MEPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$25.10

Service Code	HCPCS J0670
Hospital Charge Code	105637
Hospital Revenue Code	636
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$22.59
Rate for Payer: Aetna Commercial	$21.34
Rate for Payer: Aetna Commercial	$15.33
Rate for Payer: Aetna Medicare	$9.02
Rate for Payer: Aetna Medicare	$12.55
Rate for Payer: Aetna New Business (MI Preferred)	$11.72
Rate for Payer: Aetna New Business (MI Preferred)	$16.32
Rate for Payer: BCBS Complete	$7.21
Rate for Payer: BCBS Complete	$10.04
Rate for Payer: Cash Price	$20.08
Rate for Payer: Cash Price	$14.42
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Cofinity Commercial	$21.59
Rate for Payer: Cofinity Commercial	$17.57
Rate for Payer: Cofinity Commercial	$12.62
Rate for Payer: Cofinity Medicare Advantage	$12.62
Rate for Payer: Cofinity Medicare Advantage	$17.57
Rate for Payer: Encore Health Key Benefits Commercial	$20.08
Rate for Payer: Encore Health Key Benefits Commercial	$14.42
Rate for Payer: Healthscope Commercial	$22.59
Rate for Payer: Healthscope Commercial	$16.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.33
Rate for Payer: PHP Commercial	$21.34
Rate for Payer: PHP Commercial	$15.33
Rate for Payer: Priority Health Cigna Priority Health	$11.72
Rate for Payer: Priority Health Cigna Priority Health	$16.32
Rate for Payer: Priority Health SBD	$15.81
Rate for Payer: Priority Health SBD	$11.36

MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION

Facility

$7,943.89

Service Code	HCPCS J2182
Hospital Charge Code	176478
Hospital Revenue Code	636
Min. Negotiated Rate	$16.76
Max. Negotiated Rate	$7,149.50
Rate for Payer: Aetna Commercial	$6,752.31
Rate for Payer: Aetna Medicare	$32.52
Rate for Payer: Aetna New Business (MI Preferred)	$5,163.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$39.09
Rate for Payer: Amish Plain Church Group Commercial	$39.09
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS MAPPO	$31.27
Rate for Payer: BCN Medicare Advantage	$31.27
Rate for Payer: Cash Price	$6,355.11
Rate for Payer: Cash Price	$6,355.11
Rate for Payer: Cofinity Commercial	$6,831.75
Rate for Payer: Cofinity Commercial	$5,560.72
Rate for Payer: Cofinity Medicare Advantage	$5,560.72
Rate for Payer: Encore Health Key Benefits Commercial	$6,355.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$31.27
Rate for Payer: Healthscope Commercial	$7,149.50
Rate for Payer: Mclaren Medicaid	$16.76
Rate for Payer: Mclaren Medicare	$31.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$32.83
Rate for Payer: Meridian Medicaid	$17.60
Rate for Payer: MI Amish Medical Board Commercial	$35.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,752.31
Rate for Payer: PACE Medicare	$29.71
Rate for Payer: PACE SWMI	$31.27
Rate for Payer: PHP Commercial	$6,752.31
Rate for Payer: PHP Medicare Advantage	$31.27
Rate for Payer: Priority Health Choice Medicaid	$16.76
Rate for Payer: Priority Health Cigna Priority Health	$5,163.53
Rate for Payer: Priority Health Medicare	$31.27
Rate for Payer: Priority Health SBD	$5,004.65
Rate for Payer: Railroad Medicare Medicare	$31.27
Rate for Payer: UHC All Payor (Choice/PPO)	$88.02
Rate for Payer: UHC Dual Complete DSNP	$31.27
Rate for Payer: UHC Medicare Advantage	$31.27
Rate for Payer: UHCCP Medicaid	$17.61
Rate for Payer: VA VA	$31.27

Know your out-of-pocket cost for care.

All Charges