Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NEOMYCIN 500 MG TABLET

Facility

$6.06

Service Code	NDC 39822031007
Hospital Charge Code	5472
Hospital Revenue Code	637
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$5.15
Rate for Payer: Aetna New Business (MI Preferred)	$3.94
Rate for Payer: Cash Price	$4.85
Rate for Payer: Cofinity Commercial	$4.24
Rate for Payer: Cofinity Commercial	$5.21
Rate for Payer: Cofinity Medicare Advantage	$4.24
Rate for Payer: Encore Health Key Benefits Commercial	$4.85
Rate for Payer: Healthscope Commercial	$5.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.15
Rate for Payer: PHP Commercial	$5.15
Rate for Payer: Priority Health Cigna Priority Health	$3.94
Rate for Payer: Priority Health SBD	$3.82

NEOMYCIN 500 MG TABLET

Facility

$454.56

Service Code	NDC 50383056510
Hospital Charge Code	5472
Hospital Revenue Code	637
Min. Negotiated Rate	$181.82
Max. Negotiated Rate	$409.10
Rate for Payer: Aetna Commercial	$386.38
Rate for Payer: Aetna Medicare	$227.28
Rate for Payer: Aetna New Business (MI Preferred)	$295.46
Rate for Payer: BCBS Complete	$181.82
Rate for Payer: Cash Price	$363.65
Rate for Payer: Cofinity Commercial	$318.19
Rate for Payer: Cofinity Commercial	$390.92
Rate for Payer: Cofinity Medicare Advantage	$318.19
Rate for Payer: Encore Health Key Benefits Commercial	$363.65
Rate for Payer: Healthscope Commercial	$409.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$386.38
Rate for Payer: PHP Commercial	$386.38
Rate for Payer: Priority Health Cigna Priority Health	$295.46
Rate for Payer: Priority Health SBD	$286.37

NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT

Facility

$85.64

Service Code	NDC 24208078555
Hospital Charge Code	849
Hospital Revenue Code	637
Min. Negotiated Rate	$53.95
Max. Negotiated Rate	$77.08
Rate for Payer: Aetna Commercial	$72.79
Rate for Payer: Aetna New Business (MI Preferred)	$55.67
Rate for Payer: Cash Price	$68.51
Rate for Payer: Cofinity Commercial	$59.95
Rate for Payer: Cofinity Commercial	$73.65
Rate for Payer: Cofinity Medicare Advantage	$59.95
Rate for Payer: Encore Health Key Benefits Commercial	$68.51
Rate for Payer: Healthscope Commercial	$77.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.79
Rate for Payer: PHP Commercial	$72.79
Rate for Payer: Priority Health Cigna Priority Health	$55.67
Rate for Payer: Priority Health SBD	$53.95

NEOMYCIN-BACITRACIN-POLY-HC 3.5 MG-400-10,000 UNIT/G-1 % EYE OINTMENT

Facility

$85.64

Service Code	NDC 24208078555
Hospital Charge Code	849
Hospital Revenue Code	637
Min. Negotiated Rate	$34.26
Max. Negotiated Rate	$77.08
Rate for Payer: Aetna Commercial	$72.79
Rate for Payer: Aetna Medicare	$42.82
Rate for Payer: Aetna New Business (MI Preferred)	$55.67
Rate for Payer: BCBS Complete	$34.26
Rate for Payer: Cash Price	$68.51
Rate for Payer: Cofinity Commercial	$59.95
Rate for Payer: Cofinity Commercial	$73.65
Rate for Payer: Cofinity Medicare Advantage	$59.95
Rate for Payer: Encore Health Key Benefits Commercial	$68.51
Rate for Payer: Healthscope Commercial	$77.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.79
Rate for Payer: PHP Commercial	$72.79
Rate for Payer: Priority Health Cigna Priority Health	$55.67
Rate for Payer: Priority Health SBD	$53.95

NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT

Facility

$56.22

Service Code	NDC 24208078055
Hospital Charge Code	38701
Hospital Revenue Code	637
Min. Negotiated Rate	$35.42
Max. Negotiated Rate	$50.60
Rate for Payer: Aetna Commercial	$47.79
Rate for Payer: Aetna New Business (MI Preferred)	$36.54
Rate for Payer: Cash Price	$44.98
Rate for Payer: Cofinity Commercial	$39.35
Rate for Payer: Cofinity Commercial	$48.35
Rate for Payer: Cofinity Medicare Advantage	$39.35
Rate for Payer: Encore Health Key Benefits Commercial	$44.98
Rate for Payer: Healthscope Commercial	$50.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.79
Rate for Payer: PHP Commercial	$47.79
Rate for Payer: Priority Health Cigna Priority Health	$36.54
Rate for Payer: Priority Health SBD	$35.42

NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT

Facility

$56.22

Service Code	NDC 24208078055
Hospital Charge Code	38701
Hospital Revenue Code	637
Min. Negotiated Rate	$22.49
Max. Negotiated Rate	$50.60
Rate for Payer: Aetna Commercial	$47.79
Rate for Payer: Aetna Medicare	$28.11
Rate for Payer: Aetna New Business (MI Preferred)	$36.54
Rate for Payer: BCBS Complete	$22.49
Rate for Payer: Cash Price	$44.98
Rate for Payer: Cofinity Commercial	$39.35
Rate for Payer: Cofinity Commercial	$48.35
Rate for Payer: Cofinity Medicare Advantage	$39.35
Rate for Payer: Encore Health Key Benefits Commercial	$44.98
Rate for Payer: Healthscope Commercial	$50.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.79
Rate for Payer: PHP Commercial	$47.79
Rate for Payer: Priority Health Cigna Priority Health	$36.54
Rate for Payer: Priority Health SBD	$35.42

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT

Facility

$7.98

Service Code	NDC 61269017934
Hospital Charge Code	854
Hospital Revenue Code	637
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$7.18
Rate for Payer: Aetna Commercial	$6.78
Rate for Payer: Aetna Medicare	$3.99
Rate for Payer: Aetna New Business (MI Preferred)	$5.19
Rate for Payer: BCBS Complete	$3.19
Rate for Payer: Cash Price	$6.38
Rate for Payer: Cofinity Commercial	$5.59
Rate for Payer: Cofinity Commercial	$6.86
Rate for Payer: Cofinity Medicare Advantage	$5.59
Rate for Payer: Encore Health Key Benefits Commercial	$6.38
Rate for Payer: Healthscope Commercial	$7.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.78
Rate for Payer: PHP Commercial	$6.78
Rate for Payer: Priority Health Cigna Priority Health	$5.19
Rate for Payer: Priority Health SBD	$5.03

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT

Facility

$9.58

Service Code	NDC 45802014301
Hospital Charge Code	854
Hospital Revenue Code	637
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$8.62
Rate for Payer: Aetna Commercial	$8.14
Rate for Payer: Aetna New Business (MI Preferred)	$6.23
Rate for Payer: Cash Price	$7.66
Rate for Payer: Cofinity Commercial	$6.71
Rate for Payer: Cofinity Commercial	$8.24
Rate for Payer: Cofinity Medicare Advantage	$6.71
Rate for Payer: Encore Health Key Benefits Commercial	$7.66
Rate for Payer: Healthscope Commercial	$8.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.14
Rate for Payer: PHP Commercial	$8.14
Rate for Payer: Priority Health Cigna Priority Health	$6.23
Rate for Payer: Priority Health SBD	$6.04

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT

Facility

$21.22

Service Code	NDC 00810073088
Hospital Charge Code	854
Hospital Revenue Code	637
Min. Negotiated Rate	$13.37
Max. Negotiated Rate	$19.10
Rate for Payer: Aetna Commercial	$18.04
Rate for Payer: Aetna New Business (MI Preferred)	$13.79
Rate for Payer: Cash Price	$16.98
Rate for Payer: Cofinity Commercial	$14.85
Rate for Payer: Cofinity Commercial	$18.25
Rate for Payer: Cofinity Medicare Advantage	$14.85
Rate for Payer: Encore Health Key Benefits Commercial	$16.98
Rate for Payer: Healthscope Commercial	$19.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.04
Rate for Payer: PHP Commercial	$18.04
Rate for Payer: Priority Health Cigna Priority Health	$13.79
Rate for Payer: Priority Health SBD	$13.37

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT

Facility

$21.22

Service Code	NDC 00810073088
Hospital Charge Code	854
Hospital Revenue Code	637
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$19.10
Rate for Payer: Aetna Commercial	$18.04
Rate for Payer: Aetna Medicare	$10.61
Rate for Payer: Aetna New Business (MI Preferred)	$13.79
Rate for Payer: BCBS Complete	$8.49
Rate for Payer: Cash Price	$16.98
Rate for Payer: Cofinity Commercial	$14.85
Rate for Payer: Cofinity Commercial	$18.25
Rate for Payer: Cofinity Medicare Advantage	$14.85
Rate for Payer: Encore Health Key Benefits Commercial	$16.98
Rate for Payer: Healthscope Commercial	$19.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.04
Rate for Payer: PHP Commercial	$18.04
Rate for Payer: Priority Health Cigna Priority Health	$13.79
Rate for Payer: Priority Health SBD	$13.37

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT

Facility

$9.58

Service Code	NDC 45802014301
Hospital Charge Code	854
Hospital Revenue Code	637
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$8.62
Rate for Payer: Aetna Commercial	$8.14
Rate for Payer: Aetna Medicare	$4.79
Rate for Payer: Aetna New Business (MI Preferred)	$6.23
Rate for Payer: BCBS Complete	$3.83
Rate for Payer: Cash Price	$7.66
Rate for Payer: Cofinity Commercial	$6.71
Rate for Payer: Cofinity Commercial	$8.24
Rate for Payer: Cofinity Medicare Advantage	$6.71
Rate for Payer: Encore Health Key Benefits Commercial	$7.66
Rate for Payer: Healthscope Commercial	$8.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.14
Rate for Payer: PHP Commercial	$8.14
Rate for Payer: Priority Health Cigna Priority Health	$6.23
Rate for Payer: Priority Health SBD	$6.04

NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT

Facility

$7.98

Service Code	NDC 61269017934
Hospital Charge Code	854
Hospital Revenue Code	637
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$7.18
Rate for Payer: Aetna Commercial	$6.78
Rate for Payer: Aetna New Business (MI Preferred)	$5.19
Rate for Payer: Cash Price	$6.38
Rate for Payer: Cofinity Commercial	$5.59
Rate for Payer: Cofinity Commercial	$6.86
Rate for Payer: Cofinity Medicare Advantage	$5.59
Rate for Payer: Encore Health Key Benefits Commercial	$6.38
Rate for Payer: Healthscope Commercial	$7.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.78
Rate for Payer: PHP Commercial	$6.78
Rate for Payer: Priority Health Cigna Priority Health	$5.19
Rate for Payer: Priority Health SBD	$5.03

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$504.22

Service Code	NDC 47682022335
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$201.69
Max. Negotiated Rate	$453.80
Rate for Payer: Aetna Commercial	$428.59
Rate for Payer: Aetna Medicare	$252.11
Rate for Payer: Aetna New Business (MI Preferred)	$327.74
Rate for Payer: BCBS Complete	$201.69
Rate for Payer: Cash Price	$403.38
Rate for Payer: Cofinity Commercial	$352.95
Rate for Payer: Cofinity Commercial	$433.63
Rate for Payer: Cofinity Medicare Advantage	$352.95
Rate for Payer: Encore Health Key Benefits Commercial	$403.38
Rate for Payer: Healthscope Commercial	$453.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$428.59
Rate for Payer: PHP Commercial	$428.59
Rate for Payer: Priority Health Cigna Priority Health	$327.74
Rate for Payer: Priority Health SBD	$317.66

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$504.22

Service Code	NDC 47682022335
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$317.66
Max. Negotiated Rate	$453.80
Rate for Payer: Aetna Commercial	$428.59
Rate for Payer: Aetna New Business (MI Preferred)	$327.74
Rate for Payer: Cash Price	$403.38
Rate for Payer: Cofinity Commercial	$352.95
Rate for Payer: Cofinity Commercial	$433.63
Rate for Payer: Cofinity Medicare Advantage	$352.95
Rate for Payer: Encore Health Key Benefits Commercial	$403.38
Rate for Payer: Healthscope Commercial	$453.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$428.59
Rate for Payer: PHP Commercial	$428.59
Rate for Payer: Priority Health Cigna Priority Health	$327.74
Rate for Payer: Priority Health SBD	$317.66

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$2.94

Service Code	NDC 45802014370
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna Medicare	$1.47
Rate for Payer: Aetna New Business (MI Preferred)	$1.91
Rate for Payer: BCBS Complete	$1.18
Rate for Payer: Cash Price	$2.35
Rate for Payer: Cofinity Commercial	$2.06
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Medicare Advantage	$2.06
Rate for Payer: Encore Health Key Benefits Commercial	$2.35
Rate for Payer: Healthscope Commercial	$2.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.50
Rate for Payer: PHP Commercial	$2.50
Rate for Payer: Priority Health Cigna Priority Health	$1.91
Rate for Payer: Priority Health SBD	$1.85

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$2.94

Service Code	NDC 45802014300
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna New Business (MI Preferred)	$1.91
Rate for Payer: Cash Price	$2.35
Rate for Payer: Cofinity Commercial	$2.06
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Medicare Advantage	$2.06
Rate for Payer: Encore Health Key Benefits Commercial	$2.35
Rate for Payer: Healthscope Commercial	$2.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.50
Rate for Payer: PHP Commercial	$2.50
Rate for Payer: Priority Health Cigna Priority Health	$1.91
Rate for Payer: Priority Health SBD	$1.85

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$2.94

Service Code	NDC 45802014370
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna New Business (MI Preferred)	$1.91
Rate for Payer: Cash Price	$2.35
Rate for Payer: Cofinity Commercial	$2.06
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Medicare Advantage	$2.06
Rate for Payer: Encore Health Key Benefits Commercial	$2.35
Rate for Payer: Healthscope Commercial	$2.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.50
Rate for Payer: PHP Commercial	$2.50
Rate for Payer: Priority Health Cigna Priority Health	$1.91
Rate for Payer: Priority Health SBD	$1.85

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$2.94

Service Code	NDC 45802014300
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna Medicare	$1.47
Rate for Payer: Aetna New Business (MI Preferred)	$1.91
Rate for Payer: BCBS Complete	$1.18
Rate for Payer: Cash Price	$2.35
Rate for Payer: Cofinity Commercial	$2.06
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Medicare Advantage	$2.06
Rate for Payer: Encore Health Key Benefits Commercial	$2.35
Rate for Payer: Healthscope Commercial	$2.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.50
Rate for Payer: PHP Commercial	$2.50
Rate for Payer: Priority Health Cigna Priority Health	$1.91
Rate for Payer: Priority Health SBD	$1.85

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$372.24

Service Code	NDC 00904880567
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$148.90
Max. Negotiated Rate	$335.02
Rate for Payer: Aetna Commercial	$316.40
Rate for Payer: Aetna Medicare	$186.12
Rate for Payer: Aetna New Business (MI Preferred)	$241.96
Rate for Payer: BCBS Complete	$148.90
Rate for Payer: Cash Price	$297.79
Rate for Payer: Cofinity Commercial	$260.57
Rate for Payer: Cofinity Commercial	$320.13
Rate for Payer: Cofinity Medicare Advantage	$260.57
Rate for Payer: Encore Health Key Benefits Commercial	$297.79
Rate for Payer: Healthscope Commercial	$335.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.40
Rate for Payer: PHP Commercial	$316.40
Rate for Payer: Priority Health Cigna Priority Health	$241.96
Rate for Payer: Priority Health SBD	$234.51

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$372.24

Service Code	NDC 00904880567
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$234.51
Max. Negotiated Rate	$335.02
Rate for Payer: Aetna Commercial	$316.40
Rate for Payer: Aetna New Business (MI Preferred)	$241.96
Rate for Payer: Cash Price	$297.79
Rate for Payer: Cofinity Commercial	$260.57
Rate for Payer: Cofinity Commercial	$320.13
Rate for Payer: Cofinity Medicare Advantage	$260.57
Rate for Payer: Encore Health Key Benefits Commercial	$297.79
Rate for Payer: Healthscope Commercial	$335.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$316.40
Rate for Payer: PHP Commercial	$316.40
Rate for Payer: Priority Health Cigna Priority Health	$241.96
Rate for Payer: Priority Health SBD	$234.51

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$3.51

Service Code	NDC 47682022399
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.16
Rate for Payer: Aetna Commercial	$2.98
Rate for Payer: Aetna Medicare	$1.75
Rate for Payer: Aetna New Business (MI Preferred)	$2.28
Rate for Payer: BCBS Complete	$1.40
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cofinity Commercial	$2.46
Rate for Payer: Cofinity Commercial	$3.02
Rate for Payer: Cofinity Medicare Advantage	$2.46
Rate for Payer: Encore Health Key Benefits Commercial	$2.81
Rate for Payer: Healthscope Commercial	$3.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.98
Rate for Payer: PHP Commercial	$2.98
Rate for Payer: Priority Health Cigna Priority Health	$2.28
Rate for Payer: Priority Health SBD	$2.21

NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT TOP OINT PKT

Facility

$3.51

Service Code	NDC 47682022399
Hospital Charge Code	116684
Hospital Revenue Code	637
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$3.16
Rate for Payer: Aetna Commercial	$2.98
Rate for Payer: Aetna New Business (MI Preferred)	$2.28
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cofinity Commercial	$2.46
Rate for Payer: Cofinity Commercial	$3.02
Rate for Payer: Cofinity Medicare Advantage	$2.46
Rate for Payer: Encore Health Key Benefits Commercial	$2.81
Rate for Payer: Healthscope Commercial	$3.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.98
Rate for Payer: PHP Commercial	$2.98
Rate for Payer: Priority Health Cigna Priority Health	$2.28
Rate for Payer: Priority Health SBD	$2.21

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS

Facility

$58.59

Service Code	NDC 61314063006
Hospital Charge Code	10708
Hospital Revenue Code	637
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$52.73
Rate for Payer: Aetna Commercial	$49.80
Rate for Payer: Aetna Medicare	$29.30
Rate for Payer: Aetna New Business (MI Preferred)	$38.08
Rate for Payer: BCBS Complete	$23.44
Rate for Payer: Cash Price	$46.87
Rate for Payer: Cofinity Commercial	$41.01
Rate for Payer: Cofinity Commercial	$50.39
Rate for Payer: Cofinity Medicare Advantage	$41.01
Rate for Payer: Encore Health Key Benefits Commercial	$46.87
Rate for Payer: Healthscope Commercial	$52.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.80
Rate for Payer: PHP Commercial	$49.80
Rate for Payer: Priority Health Cigna Priority Health	$38.08
Rate for Payer: Priority Health SBD	$36.91

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS

Facility

$45.71

Service Code	NDC 24208083060
Hospital Charge Code	10708
Hospital Revenue Code	637
Min. Negotiated Rate	$18.28
Max. Negotiated Rate	$41.14
Rate for Payer: Aetna Commercial	$38.85
Rate for Payer: Aetna Medicare	$22.86
Rate for Payer: Aetna New Business (MI Preferred)	$29.71
Rate for Payer: BCBS Complete	$18.28
Rate for Payer: Cash Price	$36.57
Rate for Payer: Cofinity Commercial	$32.00
Rate for Payer: Cofinity Commercial	$39.31
Rate for Payer: Cofinity Medicare Advantage	$32.00
Rate for Payer: Encore Health Key Benefits Commercial	$36.57
Rate for Payer: Healthscope Commercial	$41.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.85
Rate for Payer: PHP Commercial	$38.85
Rate for Payer: Priority Health Cigna Priority Health	$29.71
Rate for Payer: Priority Health SBD	$28.80

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS

Facility

$58.59

Service Code	NDC 61314063006
Hospital Charge Code	10708
Hospital Revenue Code	637
Min. Negotiated Rate	$36.91
Max. Negotiated Rate	$52.73
Rate for Payer: Aetna Commercial	$49.80
Rate for Payer: Aetna New Business (MI Preferred)	$38.08
Rate for Payer: Cash Price	$46.87
Rate for Payer: Cofinity Commercial	$41.01
Rate for Payer: Cofinity Commercial	$50.39
Rate for Payer: Cofinity Medicare Advantage	$41.01
Rate for Payer: Encore Health Key Benefits Commercial	$46.87
Rate for Payer: Healthscope Commercial	$52.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.80
Rate for Payer: PHP Commercial	$49.80
Rate for Payer: Priority Health Cigna Priority Health	$38.08
Rate for Payer: Priority Health SBD	$36.91

Know your out-of-pocket cost for care.

All Charges