Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$16.39
Max. Negotiated Rate	$37.53
Rate for Payer: Aetna Commercial	$35.45
Rate for Payer: Aetna Medicare	$20.85
Rate for Payer: Aetna New Business (MI Preferred)	$27.11
Rate for Payer: BCBS Complete	$16.68
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: MI Amish Medical Board Commercial	$33.36
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
Rate for Payer: UHC All Payor (Choice/PPO)	$27.11
Rate for Payer: UHC Core	$21.73
Rate for Payer: UHC Exchange	$16.39

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$151.53

Service Code	NDC 51672409103
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$59.55
Max. Negotiated Rate	$136.38
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Aetna Medicare	$75.77
Rate for Payer: Aetna New Business (MI Preferred)	$98.49
Rate for Payer: BCBS Complete	$60.61
Rate for Payer: Cash Price	$121.22
Rate for Payer: Cofinity Advantage	$106.07
Rate for Payer: Cofinity Commercial	$130.32
Rate for Payer: Encore Health Key Benefits Commercial	$121.22
Rate for Payer: Healthscope Commercial	$136.38
Rate for Payer: MI Amish Medical Board Commercial	$121.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$128.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$113.65
Rate for Payer: PHP Commercial	$128.80
Rate for Payer: Priority Health SBD	$95.46
Rate for Payer: UHC All Payor (Choice/PPO)	$98.49
Rate for Payer: UHC Core	$78.95
Rate for Payer: UHC Exchange	$59.55

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	$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

$53.36

Service Code	NDC 68094076362
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

$116.38

Service Code	NDC 65162069179
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$45.74
Max. Negotiated Rate	$104.74
Rate for Payer: Aetna Commercial	$98.92
Rate for Payer: Aetna Medicare	$58.19
Rate for Payer: Aetna New Business (MI Preferred)	$75.65
Rate for Payer: BCBS Complete	$46.55
Rate for Payer: Cash Price	$93.10
Rate for Payer: Cofinity Advantage	$81.47
Rate for Payer: Cofinity Commercial	$100.09
Rate for Payer: Encore Health Key Benefits Commercial	$93.10
Rate for Payer: Healthscope Commercial	$104.74
Rate for Payer: MI Amish Medical Board Commercial	$93.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.28
Rate for Payer: PHP Commercial	$98.92
Rate for Payer: Priority Health SBD	$73.32
Rate for Payer: UHC All Payor (Choice/PPO)	$75.65
Rate for Payer: UHC Core	$60.63
Rate for Payer: UHC Exchange	$45.74

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$14.30

Service Code	NDC 09900000346
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$12.87
Rate for Payer: Aetna Commercial	$12.15
Rate for Payer: Aetna Medicare	$7.15
Rate for Payer: Aetna New Business (MI Preferred)	$9.29
Rate for Payer: BCBS Complete	$5.72
Rate for Payer: Cash Price	$11.44
Rate for Payer: Cofinity Advantage	$10.01
Rate for Payer: Cofinity Commercial	$12.30
Rate for Payer: Encore Health Key Benefits Commercial	$11.44
Rate for Payer: Healthscope Commercial	$12.87
Rate for Payer: MI Amish Medical Board Commercial	$11.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$10.72
Rate for Payer: PHP Commercial	$12.15
Rate for Payer: Priority Health SBD	$9.01
Rate for Payer: UHC All Payor (Choice/PPO)	$9.29
Rate for Payer: UHC Core	$7.45
Rate for Payer: UHC Exchange	$5.62

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$14.30

Service Code	NDC 09900000346
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$12.87
Rate for Payer: Aetna Commercial	$12.15
Rate for Payer: Aetna New Business (MI Preferred)	$9.29
Rate for Payer: Cash Price	$11.44
Rate for Payer: Cofinity Advantage	$10.01
Rate for Payer: Cofinity Commercial	$12.30
Rate for Payer: Encore Health Key Benefits Commercial	$11.44
Rate for Payer: Healthscope Commercial	$12.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$10.72
Rate for Payer: PHP Commercial	$12.15
Rate for Payer: Priority Health SBD	$9.01

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	$30.12
Max. Negotiated Rate	$43.03
Rate for Payer: Aetna Commercial	$40.64
Rate for Payer: Aetna New Business (MI Preferred)	$31.08
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: 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

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$220.88

Service Code	NDC 54838055550
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$139.15
Max. Negotiated Rate	$198.79
Rate for Payer: Aetna Commercial	$187.75
Rate for Payer: Aetna New Business (MI Preferred)	$143.57
Rate for Payer: Cash Price	$176.70
Rate for Payer: Cofinity Advantage	$154.62
Rate for Payer: Cofinity Commercial	$189.96
Rate for Payer: Encore Health Key Benefits Commercial	$176.70
Rate for Payer: Healthscope Commercial	$198.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.66
Rate for Payer: PHP Commercial	$187.75
Rate for Payer: Priority Health SBD	$139.15

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$47.81

Service Code	NDC 00904707393
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$43.03
Rate for Payer: Aetna Commercial	$40.64
Rate for Payer: Aetna New Business (MI Preferred)	$31.08
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: 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

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$220.88

Service Code	NDC 54838055550
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$86.81
Max. Negotiated Rate	$198.79
Rate for Payer: Aetna Commercial	$187.75
Rate for Payer: Aetna Medicare	$110.44
Rate for Payer: Aetna New Business (MI Preferred)	$143.57
Rate for Payer: BCBS Complete	$88.35
Rate for Payer: Cash Price	$176.70
Rate for Payer: Cofinity Advantage	$154.62
Rate for Payer: Cofinity Commercial	$189.96
Rate for Payer: Encore Health Key Benefits Commercial	$176.70
Rate for Payer: Healthscope Commercial	$198.79
Rate for Payer: MI Amish Medical Board Commercial	$176.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.66
Rate for Payer: PHP Commercial	$187.75
Rate for Payer: Priority Health SBD	$139.15
Rate for Payer: UHC All Payor (Choice/PPO)	$143.57
Rate for Payer: UHC Core	$115.08
Rate for Payer: UHC Exchange	$86.81

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$151.53

Service Code	NDC 51672409103
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$95.46
Max. Negotiated Rate	$136.38
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Aetna New Business (MI Preferred)	$98.49
Rate for Payer: Cash Price	$121.22
Rate for Payer: Cofinity Advantage	$106.07
Rate for Payer: Cofinity Commercial	$130.32
Rate for Payer: Encore Health Key Benefits Commercial	$121.22
Rate for Payer: Healthscope Commercial	$136.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$128.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$113.65
Rate for Payer: PHP Commercial	$128.80
Rate for Payer: Priority Health SBD	$95.46

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$116.38

Service Code	NDC 65162069179
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$104.74
Rate for Payer: Aetna Commercial	$98.92
Rate for Payer: Aetna New Business (MI Preferred)	$75.65
Rate for Payer: Cash Price	$93.10
Rate for Payer: Cofinity Advantage	$81.47
Rate for Payer: Cofinity Commercial	$100.09
Rate for Payer: Encore Health Key Benefits Commercial	$93.10
Rate for Payer: Healthscope Commercial	$104.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.28
Rate for Payer: PHP Commercial	$98.92
Rate for Payer: Priority Health SBD	$73.32

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	$16.39
Max. Negotiated Rate	$37.53
Rate for Payer: Aetna Commercial	$35.45
Rate for Payer: Aetna Medicare	$20.85
Rate for Payer: Aetna New Business (MI Preferred)	$27.11
Rate for Payer: BCBS Complete	$16.68
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: MI Amish Medical Board Commercial	$33.36
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
Rate for Payer: UHC All Payor (Choice/PPO)	$27.11
Rate for Payer: UHC Core	$21.73
Rate for Payer: UHC Exchange	$16.39

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$47.81

Service Code	NDC 00904707393
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 TABLET

Facility

$166.73

Service Code	NDC 50268062115
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$150.06
Rate for Payer: Aetna Commercial	$141.72
Rate for Payer: Aetna Medicare	$83.36
Rate for Payer: Aetna New Business (MI Preferred)	$108.37
Rate for Payer: BCBS Complete	$66.69
Rate for Payer: Cash Price	$133.38
Rate for Payer: Cofinity Advantage	$116.71
Rate for Payer: Cofinity Commercial	$143.39
Rate for Payer: Encore Health Key Benefits Commercial	$133.38
Rate for Payer: Healthscope Commercial	$150.06
Rate for Payer: MI Amish Medical Board Commercial	$133.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$125.05
Rate for Payer: PHP Commercial	$141.72
Rate for Payer: Priority Health SBD	$105.04
Rate for Payer: UHC All Payor (Choice/PPO)	$108.37
Rate for Payer: UHC Core	$86.87
Rate for Payer: UHC Exchange	$65.52

ONDANSETRON HCL 4 MG TABLET

Facility

$3.34

Service Code	NDC 50268062111
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$3.01
Rate for Payer: Aetna Commercial	$2.84
Rate for Payer: Aetna Medicare	$1.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.17
Rate for Payer: BCBS Complete	$1.34
Rate for Payer: Cash Price	$2.67
Rate for Payer: Cofinity Advantage	$2.34
Rate for Payer: Cofinity Commercial	$2.87
Rate for Payer: Encore Health Key Benefits Commercial	$2.67
Rate for Payer: Healthscope Commercial	$3.01
Rate for Payer: MI Amish Medical Board Commercial	$2.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.50
Rate for Payer: PHP Commercial	$2.84
Rate for Payer: Priority Health SBD	$2.10
Rate for Payer: UHC All Payor (Choice/PPO)	$2.17
Rate for Payer: UHC Core	$1.74
Rate for Payer: UHC Exchange	$1.31

ONDANSETRON HCL 4 MG TABLET

Facility

$119.99

Service Code	NDC 45963053830
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$107.99
Rate for Payer: Aetna Commercial	$101.99
Rate for Payer: Aetna Medicare	$59.99
Rate for Payer: Aetna New Business (MI Preferred)	$77.99
Rate for Payer: BCBS Complete	$48.00
Rate for Payer: Cash Price	$95.99
Rate for Payer: Cofinity Advantage	$83.99
Rate for Payer: Cofinity Commercial	$103.19
Rate for Payer: Encore Health Key Benefits Commercial	$95.99
Rate for Payer: Healthscope Commercial	$107.99
Rate for Payer: MI Amish Medical Board Commercial	$95.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$101.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$89.99
Rate for Payer: PHP Commercial	$101.99
Rate for Payer: Priority Health SBD	$75.59
Rate for Payer: UHC All Payor (Choice/PPO)	$77.99
Rate for Payer: UHC Core	$62.51
Rate for Payer: UHC Exchange	$47.16

ONDANSETRON HCL 4 MG TABLET

Facility

$281.20

Service Code	NDC 00904655161
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$110.51
Max. Negotiated Rate	$253.08
Rate for Payer: Aetna Commercial	$239.02
Rate for Payer: Aetna Medicare	$140.60
Rate for Payer: Aetna New Business (MI Preferred)	$182.78
Rate for Payer: BCBS Complete	$112.48
Rate for Payer: Cash Price	$224.96
Rate for Payer: Cofinity Advantage	$196.84
Rate for Payer: Cofinity Commercial	$241.83
Rate for Payer: Encore Health Key Benefits Commercial	$224.96
Rate for Payer: Healthscope Commercial	$253.08
Rate for Payer: MI Amish Medical Board Commercial	$224.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.90
Rate for Payer: PHP Commercial	$239.02
Rate for Payer: Priority Health SBD	$177.16
Rate for Payer: UHC All Payor (Choice/PPO)	$182.78
Rate for Payer: UHC Core	$146.51
Rate for Payer: UHC Exchange	$110.51

ONDANSETRON HCL 4 MG TABLET

Facility

$3.34

Service Code	NDC 50268062111
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$3.01
Rate for Payer: Aetna Commercial	$2.84
Rate for Payer: Aetna New Business (MI Preferred)	$2.17
Rate for Payer: Cash Price	$2.67
Rate for Payer: Cofinity Advantage	$2.34
Rate for Payer: Cofinity Commercial	$2.87
Rate for Payer: Encore Health Key Benefits Commercial	$2.67
Rate for Payer: Healthscope Commercial	$3.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.50
Rate for Payer: PHP Commercial	$2.84
Rate for Payer: Priority Health SBD	$2.10

ONDANSETRON HCL 4 MG TABLET

Facility

$71.21

Service Code	NDC 65862018730
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$44.86
Max. Negotiated Rate	$64.09
Rate for Payer: Aetna Commercial	$60.53
Rate for Payer: Aetna New Business (MI Preferred)	$46.29
Rate for Payer: Cash Price	$56.97
Rate for Payer: Cofinity Advantage	$49.85
Rate for Payer: Cofinity Commercial	$61.24
Rate for Payer: Encore Health Key Benefits Commercial	$56.97
Rate for Payer: Healthscope Commercial	$64.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.41
Rate for Payer: PHP Commercial	$60.53
Rate for Payer: Priority Health SBD	$44.86

ONDANSETRON HCL 4 MG TABLET

Facility

$281.20

Service Code	NDC 904655161
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$110.51
Max. Negotiated Rate	$253.08
Rate for Payer: Aetna Commercial	$239.02
Rate for Payer: Aetna Medicare	$140.60
Rate for Payer: Aetna New Business (MI Preferred)	$182.78
Rate for Payer: BCBS Complete	$112.48
Rate for Payer: Cash Price	$224.96
Rate for Payer: Cofinity Advantage	$196.84
Rate for Payer: Cofinity Commercial	$241.83
Rate for Payer: Encore Health Key Benefits Commercial	$224.96
Rate for Payer: Healthscope Commercial	$253.08
Rate for Payer: MI Amish Medical Board Commercial	$224.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.90
Rate for Payer: PHP Commercial	$239.02
Rate for Payer: Priority Health SBD	$177.16
Rate for Payer: UHC All Payor (Choice/PPO)	$182.78
Rate for Payer: UHC Core	$146.51
Rate for Payer: UHC Exchange	$110.51

ONDANSETRON HCL 4 MG TABLET

Facility

$166.73

Service Code	NDC 50268062115
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$105.04
Max. Negotiated Rate	$150.06
Rate for Payer: Aetna Commercial	$141.72
Rate for Payer: Aetna New Business (MI Preferred)	$108.37
Rate for Payer: Cash Price	$133.38
Rate for Payer: Cofinity Advantage	$116.71
Rate for Payer: Cofinity Commercial	$143.39
Rate for Payer: Encore Health Key Benefits Commercial	$133.38
Rate for Payer: Healthscope Commercial	$150.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$125.05
Rate for Payer: PHP Commercial	$141.72
Rate for Payer: Priority Health SBD	$105.04

ONDANSETRON HCL 4 MG TABLET

Facility

$119.99

Service Code	NDC 45963053830
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$75.59
Max. Negotiated Rate	$107.99
Rate for Payer: Aetna Commercial	$101.99
Rate for Payer: Aetna New Business (MI Preferred)	$77.99
Rate for Payer: Cash Price	$95.99
Rate for Payer: Cofinity Advantage	$83.99
Rate for Payer: Cofinity Commercial	$103.19
Rate for Payer: Encore Health Key Benefits Commercial	$95.99
Rate for Payer: Healthscope Commercial	$107.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$101.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$89.99
Rate for Payer: PHP Commercial	$101.99
Rate for Payer: Priority Health SBD	$75.59

ONDANSETRON HCL 4 MG TABLET

Facility

$71.21

Service Code	NDC 65862018730
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$27.99
Max. Negotiated Rate	$64.09
Rate for Payer: Aetna Commercial	$60.53
Rate for Payer: Aetna Medicare	$35.60
Rate for Payer: Aetna New Business (MI Preferred)	$46.29
Rate for Payer: BCBS Complete	$28.48
Rate for Payer: Cash Price	$56.97
Rate for Payer: Cofinity Advantage	$49.85
Rate for Payer: Cofinity Commercial	$61.24
Rate for Payer: Encore Health Key Benefits Commercial	$56.97
Rate for Payer: Healthscope Commercial	$64.09
Rate for Payer: MI Amish Medical Board Commercial	$56.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.41
Rate for Payer: PHP Commercial	$60.53
Rate for Payer: Priority Health SBD	$44.86
Rate for Payer: UHC All Payor (Choice/PPO)	$46.29
Rate for Payer: UHC Core	$37.10
Rate for Payer: UHC Exchange	$27.99

Know your out-of-pocket cost for care.

All Charges