Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$238.26

Service Code	NDC 64380076111
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$150.10
Max. Negotiated Rate	$214.43
Rate for Payer: Aetna Commercial	$202.52
Rate for Payer: Aetna New Business (MI Preferred)	$154.87
Rate for Payer: Cash Price	$190.61
Rate for Payer: Cofinity Advantage	$166.78
Rate for Payer: Cofinity Commercial	$204.90
Rate for Payer: Encore Health Key Benefits Commercial	$190.61
Rate for Payer: Healthscope Commercial	$214.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$178.69
Rate for Payer: PHP Commercial	$202.52
Rate for Payer: Priority Health SBD	$150.10

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$495.43

Service Code	NDC 00904749506
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$312.12
Max. Negotiated Rate	$445.89
Rate for Payer: Aetna Commercial	$421.12
Rate for Payer: Aetna New Business (MI Preferred)	$322.03
Rate for Payer: Cash Price	$396.34
Rate for Payer: Cofinity Advantage	$346.80
Rate for Payer: Cofinity Commercial	$426.07
Rate for Payer: Encore Health Key Benefits Commercial	$396.34
Rate for Payer: Healthscope Commercial	$445.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$421.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$371.57
Rate for Payer: PHP Commercial	$421.12
Rate for Payer: Priority Health SBD	$312.12

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$238.26

Service Code	NDC 64380076111
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$214.43
Rate for Payer: Aetna Commercial	$202.52
Rate for Payer: Aetna Medicare	$119.13
Rate for Payer: Aetna New Business (MI Preferred)	$154.87
Rate for Payer: BCBS Complete	$95.30
Rate for Payer: Cash Price	$190.61
Rate for Payer: Cofinity Advantage	$166.78
Rate for Payer: Cofinity Commercial	$204.90
Rate for Payer: Encore Health Key Benefits Commercial	$190.61
Rate for Payer: Healthscope Commercial	$214.43
Rate for Payer: MI Amish Medical Board Commercial	$190.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$178.69
Rate for Payer: PHP Commercial	$202.52
Rate for Payer: Priority Health SBD	$150.10
Rate for Payer: UHC All Payor (Choice/PPO)	$154.87
Rate for Payer: UHC Core	$124.13
Rate for Payer: UHC Exchange	$93.64

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$434.88

Service Code	NDC 60505317007
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$273.97
Max. Negotiated Rate	$391.39
Rate for Payer: Aetna Commercial	$369.65
Rate for Payer: Aetna New Business (MI Preferred)	$282.67
Rate for Payer: Cash Price	$347.90
Rate for Payer: Cofinity Advantage	$304.42
Rate for Payer: Cofinity Commercial	$374.00
Rate for Payer: Encore Health Key Benefits Commercial	$347.90
Rate for Payer: Healthscope Commercial	$391.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$326.16
Rate for Payer: PHP Commercial	$369.65
Rate for Payer: Priority Health SBD	$273.97

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$547.08

Service Code	NDC 42806055212
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$215.00
Max. Negotiated Rate	$492.37
Rate for Payer: Aetna Commercial	$465.02
Rate for Payer: Aetna Medicare	$273.54
Rate for Payer: Aetna New Business (MI Preferred)	$355.60
Rate for Payer: BCBS Complete	$218.83
Rate for Payer: Cash Price	$437.66
Rate for Payer: Cofinity Advantage	$382.96
Rate for Payer: Cofinity Commercial	$470.49
Rate for Payer: Encore Health Key Benefits Commercial	$437.66
Rate for Payer: Healthscope Commercial	$492.37
Rate for Payer: MI Amish Medical Board Commercial	$437.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$465.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$410.31
Rate for Payer: PHP Commercial	$465.02
Rate for Payer: Priority Health SBD	$344.66
Rate for Payer: UHC All Payor (Choice/PPO)	$355.60
Rate for Payer: UHC Core	$285.03
Rate for Payer: UHC Exchange	$215.00

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$440.86

Service Code	NDC 00904670606
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$277.74
Max. Negotiated Rate	$396.77
Rate for Payer: Aetna Commercial	$374.73
Rate for Payer: Aetna New Business (MI Preferred)	$286.56
Rate for Payer: Cash Price	$352.69
Rate for Payer: Cofinity Advantage	$308.60
Rate for Payer: Cofinity Commercial	$379.14
Rate for Payer: Encore Health Key Benefits Commercial	$352.69
Rate for Payer: Healthscope Commercial	$396.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$374.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$330.64
Rate for Payer: PHP Commercial	$374.73
Rate for Payer: Priority Health SBD	$277.74

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION

Facility

$2,083.20

Service Code	HCPCS J0585
Hospital Charge Code	32700
Hospital Revenue Code	636
Min. Negotiated Rate	$1,312.42
Max. Negotiated Rate	$1,874.88
Rate for Payer: Aetna Commercial	$1,770.72
Rate for Payer: Aetna New Business (MI Preferred)	$1,354.08
Rate for Payer: Cash Price	$1,666.56
Rate for Payer: Cofinity Advantage	$1,458.24
Rate for Payer: Cofinity Commercial	$1,791.55
Rate for Payer: Encore Health Key Benefits Commercial	$1,666.56
Rate for Payer: Healthscope Commercial	$1,874.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,770.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,562.40
Rate for Payer: PHP Commercial	$1,770.72
Rate for Payer: Priority Health SBD	$1,312.42

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION

Facility

$2,083.20

Service Code	HCPCS J0585
Hospital Charge Code	32700
Hospital Revenue Code	636
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$1,874.88
Rate for Payer: Aetna Commercial	$1,770.72
Rate for Payer: Aetna Medicare	$6.77
Rate for Payer: Aetna New Business (MI Preferred)	$1,354.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$8.14
Rate for Payer: Amish Plain Church Group Commercial	$8.14
Rate for Payer: BCBS Complete	$3.58
Rate for Payer: BCBS MAPPO	$6.51
Rate for Payer: BCBS Trust/PPO	$16.33
Rate for Payer: BCN Commercial	$16.33
Rate for Payer: BCN Medicare Advantage	$6.51
Rate for Payer: Cash Price	$1,666.56
Rate for Payer: Cash Price	$1,666.56
Rate for Payer: Cofinity Advantage	$1,458.24
Rate for Payer: Cofinity Commercial	$1,791.55
Rate for Payer: Encore Health Key Benefits Commercial	$1,666.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.51
Rate for Payer: Healthscope Commercial	$1,874.88
Rate for Payer: Mclaren Medicaid	$3.40
Rate for Payer: Mclaren Medicare	$6.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6.84
Rate for Payer: Meridian Medicaid	$6.84
Rate for Payer: MI Amish Medical Board Commercial	$7.49
Rate for Payer: Molina Medicare/Medicaid	$7.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,770.72
Rate for Payer: Nomi Health Commercial	$19.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,562.40
Rate for Payer: PACE Medicare	$6.18
Rate for Payer: PACE SWMI	$6.51
Rate for Payer: PHP Commercial	$1,770.72
Rate for Payer: PHP Medicare Advantage	$6.51
Rate for Payer: Priority Health Choice Medicaid	$3.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$20.50
Rate for Payer: Priority Health Medicare	$6.51
Rate for Payer: Priority Health SBD	$1,312.42
Rate for Payer: Priority Health Tiered Network	$16.40
Rate for Payer: Railroad Medicare Medicare	$6.51
Rate for Payer: UHC All Payor (Choice/PPO)	$7.16
Rate for Payer: UHC Core	$7.16
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6.51
Rate for Payer: UHC Exchange	$7.16
Rate for Payer: UHC Medicaid	$3.40
Rate for Payer: UHCCP Medicaid	$3.40
Rate for Payer: VA VA	$6.51

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$139.59

Service Code	NDC 68462015713
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$87.94
Max. Negotiated Rate	$125.63
Rate for Payer: Aetna Commercial	$118.65
Rate for Payer: Aetna New Business (MI Preferred)	$90.73
Rate for Payer: Cash Price	$111.67
Rate for Payer: Cofinity Advantage	$97.71
Rate for Payer: Cofinity Commercial	$120.05
Rate for Payer: Encore Health Key Benefits Commercial	$111.67
Rate for Payer: Healthscope Commercial	$125.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.69
Rate for Payer: PHP Commercial	$118.65
Rate for Payer: Priority Health SBD	$87.94

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$4.66

Service Code	NDC 68462015740
Hospital Charge Code	27697
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

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$81.94

Service Code	NDC 00378773293
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$69.65
Rate for Payer: Aetna Medicare	$40.97
Rate for Payer: Aetna New Business (MI Preferred)	$53.26
Rate for Payer: BCBS Complete	$32.78
Rate for Payer: Cash Price	$65.55
Rate for Payer: Cofinity Advantage	$57.36
Rate for Payer: Cofinity Commercial	$70.47
Rate for Payer: Encore Health Key Benefits Commercial	$65.55
Rate for Payer: Healthscope Commercial	$73.75
Rate for Payer: MI Amish Medical Board Commercial	$65.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.45
Rate for Payer: PHP Commercial	$69.65
Rate for Payer: Priority Health SBD	$51.62
Rate for Payer: UHC All Payor (Choice/PPO)	$53.26
Rate for Payer: UHC Core	$42.69
Rate for Payer: UHC Exchange	$32.20

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$64.98

Service Code	NDC 57237007730
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$40.94
Max. Negotiated Rate	$58.48
Rate for Payer: Aetna Commercial	$55.23
Rate for Payer: Aetna New Business (MI Preferred)	$42.24
Rate for Payer: Cash Price	$51.98
Rate for Payer: Cofinity Advantage	$45.49
Rate for Payer: Cofinity Commercial	$55.88
Rate for Payer: Encore Health Key Benefits Commercial	$51.98
Rate for Payer: Healthscope Commercial	$58.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.73
Rate for Payer: PHP Commercial	$55.23
Rate for Payer: Priority Health SBD	$40.94

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$139.59

Service Code	NDC 68462015713
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$54.86
Max. Negotiated Rate	$125.63
Rate for Payer: Aetna Commercial	$118.65
Rate for Payer: Aetna Medicare	$69.80
Rate for Payer: Aetna New Business (MI Preferred)	$90.73
Rate for Payer: BCBS Complete	$55.84
Rate for Payer: Cash Price	$111.67
Rate for Payer: Cofinity Advantage	$97.71
Rate for Payer: Cofinity Commercial	$120.05
Rate for Payer: Encore Health Key Benefits Commercial	$111.67
Rate for Payer: Healthscope Commercial	$125.63
Rate for Payer: MI Amish Medical Board Commercial	$111.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.69
Rate for Payer: PHP Commercial	$118.65
Rate for Payer: Priority Health SBD	$87.94
Rate for Payer: UHC All Payor (Choice/PPO)	$90.73
Rate for Payer: UHC Core	$72.73
Rate for Payer: UHC Exchange	$54.86

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$64.98

Service Code	NDC 57237007730
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$25.54
Max. Negotiated Rate	$58.48
Rate for Payer: Aetna Commercial	$55.23
Rate for Payer: Aetna Medicare	$32.49
Rate for Payer: Aetna New Business (MI Preferred)	$42.24
Rate for Payer: BCBS Complete	$25.99
Rate for Payer: Cash Price	$51.98
Rate for Payer: Cofinity Advantage	$45.49
Rate for Payer: Cofinity Commercial	$55.88
Rate for Payer: Encore Health Key Benefits Commercial	$51.98
Rate for Payer: Healthscope Commercial	$58.48
Rate for Payer: MI Amish Medical Board Commercial	$51.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.73
Rate for Payer: PHP Commercial	$55.23
Rate for Payer: Priority Health SBD	$40.94
Rate for Payer: UHC All Payor (Choice/PPO)	$42.24
Rate for Payer: UHC Core	$33.85
Rate for Payer: UHC Exchange	$25.54

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$81.94

Service Code	NDC 65862039010
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$69.65
Rate for Payer: Aetna Medicare	$40.97
Rate for Payer: Aetna New Business (MI Preferred)	$53.26
Rate for Payer: BCBS Complete	$32.78
Rate for Payer: Cash Price	$65.55
Rate for Payer: Cofinity Advantage	$57.36
Rate for Payer: Cofinity Commercial	$70.47
Rate for Payer: Encore Health Key Benefits Commercial	$65.55
Rate for Payer: Healthscope Commercial	$73.75
Rate for Payer: MI Amish Medical Board Commercial	$65.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.45
Rate for Payer: PHP Commercial	$69.65
Rate for Payer: Priority Health SBD	$51.62
Rate for Payer: UHC All Payor (Choice/PPO)	$53.26
Rate for Payer: UHC Core	$42.69
Rate for Payer: UHC Exchange	$32.20

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$4.66

Service Code	NDC 68462015740
Hospital Charge Code	27697
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

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$81.94

Service Code	NDC 00378773293
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$69.65
Rate for Payer: Aetna New Business (MI Preferred)	$53.26
Rate for Payer: Cash Price	$65.55
Rate for Payer: Cofinity Advantage	$57.36
Rate for Payer: Cofinity Commercial	$70.47
Rate for Payer: Encore Health Key Benefits Commercial	$65.55
Rate for Payer: Healthscope Commercial	$73.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.45
Rate for Payer: PHP Commercial	$69.65
Rate for Payer: Priority Health SBD	$51.62

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$81.94

Service Code	NDC 65862039010
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$51.62
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$69.65
Rate for Payer: Aetna New Business (MI Preferred)	$53.26
Rate for Payer: Cash Price	$65.55
Rate for Payer: Cofinity Advantage	$57.36
Rate for Payer: Cofinity Commercial	$70.47
Rate for Payer: Encore Health Key Benefits Commercial	$65.55
Rate for Payer: Healthscope Commercial	$73.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.45
Rate for Payer: PHP Commercial	$69.65
Rate for Payer: Priority Health SBD	$51.62

ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION

Facility

$128.00

Service Code	HCPCS J2405
Hospital Charge Code	10777
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna Commercial	$108.80
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: Aetna New Business (MI Preferred)	$83.20
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$0.22
Rate for Payer: BCN Commercial	$0.22
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cofinity Advantage	$89.60
Rate for Payer: Cofinity Commercial	$110.08
Rate for Payer: Encore Health Key Benefits Commercial	$102.40
Rate for Payer: Healthscope Commercial	$115.20
Rate for Payer: MI Amish Medical Board Commercial	$102.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.00
Rate for Payer: PHP Commercial	$108.80
Rate for Payer: Priority Health SBD	$80.64
Rate for Payer: UHC All Payor (Choice/PPO)	$0.15
Rate for Payer: UHC Core	$0.15
Rate for Payer: UHC Exchange	$0.15

ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION

Facility

$128.00

Service Code	HCPCS J2405
Hospital Charge Code	10777
Hospital Revenue Code	636
Min. Negotiated Rate	$80.64
Max. Negotiated Rate	$115.20
Rate for Payer: Aetna Commercial	$108.80
Rate for Payer: Aetna New Business (MI Preferred)	$83.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cofinity Advantage	$89.60
Rate for Payer: Cofinity Commercial	$110.08
Rate for Payer: Encore Health Key Benefits Commercial	$102.40
Rate for Payer: Healthscope Commercial	$115.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$108.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.00
Rate for Payer: PHP Commercial	$108.80
Rate for Payer: Priority Health SBD	$80.64

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$53.36

Service Code	NDC 68094076362
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$20.97
Max. Negotiated Rate	$48.02
Rate for Payer: Aetna Commercial	$45.36
Rate for Payer: Aetna Medicare	$26.68
Rate for Payer: Aetna New Business (MI Preferred)	$34.68
Rate for Payer: BCBS Complete	$21.34
Rate for Payer: Cash Price	$42.69
Rate for Payer: Cofinity Advantage	$37.35
Rate for Payer: Cofinity Commercial	$45.89
Rate for Payer: Encore Health Key Benefits Commercial	$42.69
Rate for Payer: Healthscope Commercial	$48.02
Rate for Payer: MI Amish Medical Board Commercial	$42.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.02
Rate for Payer: PHP Commercial	$45.36
Rate for Payer: Priority Health SBD	$33.62
Rate for Payer: UHC All Payor (Choice/PPO)	$34.68
Rate for Payer: UHC Core	$27.80
Rate for Payer: UHC Exchange	$20.97

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$41.70

Service Code	NDC 60687025286
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$37.53
Rate for Payer: Aetna Commercial	$35.45
Rate for Payer: Aetna New Business (MI Preferred)	$27.11
Rate for Payer: Cash Price	$33.36
Rate for Payer: Cofinity Advantage	$29.19
Rate for Payer: Cofinity Commercial	$35.86
Rate for Payer: Encore Health Key Benefits Commercial	$33.36
Rate for Payer: Healthscope Commercial	$37.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.27
Rate for Payer: PHP Commercial	$35.45
Rate for Payer: Priority Health SBD	$26.27

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$53.36

Service Code	NDC 68094076359
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$48.02
Rate for Payer: Aetna Commercial	$45.36
Rate for Payer: Aetna New Business (MI Preferred)	$34.68
Rate for Payer: Cash Price	$42.69
Rate for Payer: Cofinity Advantage	$37.35
Rate for Payer: Cofinity Commercial	$45.89
Rate for Payer: Encore Health Key Benefits Commercial	$42.69
Rate for Payer: Healthscope Commercial	$48.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$40.02
Rate for Payer: PHP Commercial	$45.36
Rate for Payer: Priority Health SBD	$33.62

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$47.81

Service Code	NDC 00904707341
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$18.79
Max. Negotiated Rate	$43.03
Rate for Payer: Aetna Commercial	$40.64
Rate for Payer: Aetna Medicare	$23.91
Rate for Payer: Aetna New Business (MI Preferred)	$31.08
Rate for Payer: BCBS Complete	$19.12
Rate for Payer: Cash Price	$38.25
Rate for Payer: Cofinity Advantage	$33.47
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Encore Health Key Benefits Commercial	$38.25
Rate for Payer: Healthscope Commercial	$43.03
Rate for Payer: MI Amish Medical Board Commercial	$38.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.86
Rate for Payer: PHP Commercial	$40.64
Rate for Payer: Priority Health SBD	$30.12
Rate for Payer: UHC All Payor (Choice/PPO)	$31.08
Rate for Payer: UHC Core	$24.91
Rate for Payer: UHC Exchange	$18.79

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$41.70

Service Code	NDC 60687025240
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$37.53
Rate for Payer: Aetna Commercial	$35.45
Rate for Payer: Aetna New Business (MI Preferred)	$27.11
Rate for Payer: Cash Price	$33.36
Rate for Payer: Cofinity Advantage	$29.19
Rate for Payer: Cofinity Commercial	$35.86
Rate for Payer: Encore Health Key Benefits Commercial	$33.36
Rate for Payer: Healthscope Commercial	$37.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.27
Rate for Payer: PHP Commercial	$35.45
Rate for Payer: Priority Health SBD	$26.27

Know your out-of-pocket cost for care.

All Charges