Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$35.07

Service Code	NDC 69315050460
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$22.09
Max. Negotiated Rate	$31.56
Rate for Payer: Aetna Commercial	$29.81
Rate for Payer: Aetna New Business (MI Preferred)	$22.80
Rate for Payer: Cash Price	$28.06
Rate for Payer: Cofinity Commercial	$24.55
Rate for Payer: Cofinity Commercial	$30.16
Rate for Payer: Cofinity Medicare Advantage	$24.55
Rate for Payer: Encore Health Key Benefits Commercial	$28.06
Rate for Payer: Healthscope Commercial	$31.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.81
Rate for Payer: PHP Commercial	$29.81
Rate for Payer: Priority Health Cigna Priority Health	$22.80
Rate for Payer: Priority Health SBD	$22.09

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$7.86

Service Code	NDC 68094059962
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$6.68
Rate for Payer: Aetna Medicare	$3.93
Rate for Payer: Aetna New Business (MI Preferred)	$5.11
Rate for Payer: BCBS Complete	$3.14
Rate for Payer: Cash Price	$6.29
Rate for Payer: Cofinity Commercial	$5.50
Rate for Payer: Cofinity Commercial	$6.76
Rate for Payer: Cofinity Medicare Advantage	$5.50
Rate for Payer: Encore Health Key Benefits Commercial	$6.29
Rate for Payer: Healthscope Commercial	$7.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.68
Rate for Payer: PHP Commercial	$6.68
Rate for Payer: Priority Health Cigna Priority Health	$5.11
Rate for Payer: Priority Health SBD	$4.95

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.46

Service Code	NDC 68094059961
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$4.91
Rate for Payer: Aetna Commercial	$4.64
Rate for Payer: Aetna Medicare	$2.73
Rate for Payer: Aetna New Business (MI Preferred)	$3.55
Rate for Payer: BCBS Complete	$2.18
Rate for Payer: Cash Price	$4.37
Rate for Payer: Cofinity Commercial	$3.82
Rate for Payer: Cofinity Commercial	$4.70
Rate for Payer: Cofinity Medicare Advantage	$3.82
Rate for Payer: Encore Health Key Benefits Commercial	$4.37
Rate for Payer: Healthscope Commercial	$4.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.64
Rate for Payer: PHP Commercial	$4.64
Rate for Payer: Priority Health Cigna Priority Health	$3.55
Rate for Payer: Priority Health SBD	$3.44

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.49

Service Code	NDC 66689003701
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna Commercial	$4.67
Rate for Payer: Aetna Medicare	$2.75
Rate for Payer: Aetna New Business (MI Preferred)	$3.57
Rate for Payer: BCBS Complete	$2.20
Rate for Payer: Cash Price	$4.39
Rate for Payer: Cofinity Commercial	$3.84
Rate for Payer: Cofinity Commercial	$4.72
Rate for Payer: Cofinity Medicare Advantage	$3.84
Rate for Payer: Encore Health Key Benefits Commercial	$4.39
Rate for Payer: Healthscope Commercial	$4.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.67
Rate for Payer: PHP Commercial	$4.67
Rate for Payer: Priority Health Cigna Priority Health	$3.57
Rate for Payer: Priority Health SBD	$3.46

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.49

Service Code	NDC 66689003701
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna Commercial	$4.67
Rate for Payer: Aetna New Business (MI Preferred)	$3.57
Rate for Payer: Cash Price	$4.39
Rate for Payer: Cofinity Commercial	$3.84
Rate for Payer: Cofinity Commercial	$4.72
Rate for Payer: Cofinity Medicare Advantage	$3.84
Rate for Payer: Encore Health Key Benefits Commercial	$4.39
Rate for Payer: Healthscope Commercial	$4.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.67
Rate for Payer: PHP Commercial	$4.67
Rate for Payer: Priority Health Cigna Priority Health	$3.57
Rate for Payer: Priority Health SBD	$3.46

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$406.98

Service Code	NDC 62135081346
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$162.79
Max. Negotiated Rate	$366.28
Rate for Payer: Aetna Commercial	$345.93
Rate for Payer: Aetna Medicare	$203.49
Rate for Payer: Aetna New Business (MI Preferred)	$264.54
Rate for Payer: BCBS Complete	$162.79
Rate for Payer: Cash Price	$325.58
Rate for Payer: Cofinity Commercial	$284.89
Rate for Payer: Cofinity Commercial	$350.00
Rate for Payer: Cofinity Medicare Advantage	$284.89
Rate for Payer: Encore Health Key Benefits Commercial	$325.58
Rate for Payer: Healthscope Commercial	$366.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.93
Rate for Payer: PHP Commercial	$345.93
Rate for Payer: Priority Health Cigna Priority Health	$264.54
Rate for Payer: Priority Health SBD	$256.40

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$406.98

Service Code	NDC 62135081346
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$256.40
Max. Negotiated Rate	$366.28
Rate for Payer: Aetna Commercial	$345.93
Rate for Payer: Aetna New Business (MI Preferred)	$264.54
Rate for Payer: Cash Price	$325.58
Rate for Payer: Cofinity Commercial	$284.89
Rate for Payer: Cofinity Commercial	$350.00
Rate for Payer: Cofinity Medicare Advantage	$284.89
Rate for Payer: Encore Health Key Benefits Commercial	$325.58
Rate for Payer: Healthscope Commercial	$366.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.93
Rate for Payer: PHP Commercial	$345.93
Rate for Payer: Priority Health Cigna Priority Health	$264.54
Rate for Payer: Priority Health SBD	$256.40

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$7.65

Service Code	NDC 60687080040
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna Medicare	$3.83
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: BCBS Complete	$3.06
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$7.65

Service Code	NDC 60687080017
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$41.58

Service Code	NDC 60432053760
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$37.42
Rate for Payer: Aetna Commercial	$35.34
Rate for Payer: Aetna Medicare	$20.79
Rate for Payer: Aetna New Business (MI Preferred)	$27.03
Rate for Payer: BCBS Complete	$16.63
Rate for Payer: Cash Price	$33.26
Rate for Payer: Cofinity Commercial	$29.11
Rate for Payer: Cofinity Commercial	$35.76
Rate for Payer: Cofinity Medicare Advantage	$29.11
Rate for Payer: Encore Health Key Benefits Commercial	$33.26
Rate for Payer: Healthscope Commercial	$37.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.34
Rate for Payer: PHP Commercial	$35.34
Rate for Payer: Priority Health Cigna Priority Health	$27.03
Rate for Payer: Priority Health SBD	$26.20

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$41.58

Service Code	NDC 60432053760
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$26.20
Max. Negotiated Rate	$37.42
Rate for Payer: Aetna Commercial	$35.34
Rate for Payer: Aetna New Business (MI Preferred)	$27.03
Rate for Payer: Cash Price	$33.26
Rate for Payer: Cofinity Commercial	$29.11
Rate for Payer: Cofinity Commercial	$35.76
Rate for Payer: Cofinity Medicare Advantage	$29.11
Rate for Payer: Encore Health Key Benefits Commercial	$33.26
Rate for Payer: Healthscope Commercial	$37.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.34
Rate for Payer: PHP Commercial	$35.34
Rate for Payer: Priority Health Cigna Priority Health	$27.03
Rate for Payer: Priority Health SBD	$26.20

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$289.72

Service Code	NDC 60432053716
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$115.89
Max. Negotiated Rate	$260.75
Rate for Payer: Aetna Commercial	$246.26
Rate for Payer: Aetna Medicare	$144.86
Rate for Payer: Aetna New Business (MI Preferred)	$188.32
Rate for Payer: BCBS Complete	$115.89
Rate for Payer: Cash Price	$231.78
Rate for Payer: Cofinity Commercial	$202.80
Rate for Payer: Cofinity Commercial	$249.16
Rate for Payer: Cofinity Medicare Advantage	$202.80
Rate for Payer: Encore Health Key Benefits Commercial	$231.78
Rate for Payer: Healthscope Commercial	$260.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.26
Rate for Payer: PHP Commercial	$246.26
Rate for Payer: Priority Health Cigna Priority Health	$188.32
Rate for Payer: Priority Health SBD	$182.52

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$289.72

Service Code	NDC 60432053716
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$182.52
Max. Negotiated Rate	$260.75
Rate for Payer: Aetna Commercial	$246.26
Rate for Payer: Aetna New Business (MI Preferred)	$188.32
Rate for Payer: Cash Price	$231.78
Rate for Payer: Cofinity Commercial	$202.80
Rate for Payer: Cofinity Commercial	$249.16
Rate for Payer: Cofinity Medicare Advantage	$202.80
Rate for Payer: Encore Health Key Benefits Commercial	$231.78
Rate for Payer: Healthscope Commercial	$260.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$246.26
Rate for Payer: PHP Commercial	$246.26
Rate for Payer: Priority Health Cigna Priority Health	$188.32
Rate for Payer: Priority Health SBD	$182.52

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$3.72

Service Code	NDC 09900001998
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna Medicare	$1.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: BCBS Complete	$1.49
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Commercial	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Cofinity Medicare Advantage	$2.60
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health Cigna Priority Health	$2.42
Rate for Payer: Priority Health SBD	$2.34

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$3.72

Service Code	NDC 09900001998
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Commercial	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Cofinity Medicare Advantage	$2.60
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health Cigna Priority Health	$2.42
Rate for Payer: Priority Health SBD	$2.34

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.10

Service Code	NDC 00121478505
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$4.59
Rate for Payer: Aetna Commercial	$4.33
Rate for Payer: Aetna Medicare	$2.55
Rate for Payer: Aetna New Business (MI Preferred)	$3.31
Rate for Payer: BCBS Complete	$2.04
Rate for Payer: Cash Price	$4.08
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Cofinity Commercial	$4.39
Rate for Payer: Cofinity Medicare Advantage	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$4.08
Rate for Payer: Healthscope Commercial	$4.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.33
Rate for Payer: PHP Commercial	$4.33
Rate for Payer: Priority Health Cigna Priority Health	$3.31
Rate for Payer: Priority Health SBD	$3.21

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.10

Service Code	NDC 00121478505
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$4.59
Rate for Payer: Aetna Commercial	$4.33
Rate for Payer: Aetna New Business (MI Preferred)	$3.31
Rate for Payer: Cash Price	$4.08
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Cofinity Commercial	$4.39
Rate for Payer: Cofinity Medicare Advantage	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$4.08
Rate for Payer: Healthscope Commercial	$4.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.33
Rate for Payer: PHP Commercial	$4.33
Rate for Payer: Priority Health Cigna Priority Health	$3.31
Rate for Payer: Priority Health SBD	$3.21

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$4.68

Service Code	NDC 00121086840
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna New Business (MI Preferred)	$3.04
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cofinity Commercial	$3.28
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Cofinity Medicare Advantage	$3.28
Rate for Payer: Encore Health Key Benefits Commercial	$3.74
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.98
Rate for Payer: PHP Commercial	$3.98
Rate for Payer: Priority Health Cigna Priority Health	$3.04
Rate for Payer: Priority Health SBD	$2.95

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$120.86

Service Code	NDC 69315050447
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$48.34
Max. Negotiated Rate	$108.77
Rate for Payer: Aetna Commercial	$102.73
Rate for Payer: Aetna Medicare	$60.43
Rate for Payer: Aetna New Business (MI Preferred)	$78.56
Rate for Payer: BCBS Complete	$48.34
Rate for Payer: Cash Price	$96.69
Rate for Payer: Cofinity Commercial	$103.94
Rate for Payer: Cofinity Commercial	$84.60
Rate for Payer: Cofinity Medicare Advantage	$84.60
Rate for Payer: Encore Health Key Benefits Commercial	$96.69
Rate for Payer: Healthscope Commercial	$108.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.73
Rate for Payer: PHP Commercial	$102.73
Rate for Payer: Priority Health Cigna Priority Health	$78.56
Rate for Payer: Priority Health SBD	$76.14

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$7.65

Service Code	NDC 60687080017
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna Medicare	$3.83
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: BCBS Complete	$3.06
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$7.65

Service Code	NDC 60687080040
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$6.50
Rate for Payer: Aetna New Business (MI Preferred)	$4.97
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cofinity Commercial	$5.36
Rate for Payer: Cofinity Commercial	$6.58
Rate for Payer: Cofinity Medicare Advantage	$5.36
Rate for Payer: Encore Health Key Benefits Commercial	$6.12
Rate for Payer: Healthscope Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.50
Rate for Payer: PHP Commercial	$6.50
Rate for Payer: Priority Health Cigna Priority Health	$4.97
Rate for Payer: Priority Health SBD	$4.82

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$6.48

Service Code	NDC 00121086805
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: Aetna Medicare	$3.24
Rate for Payer: Aetna New Business (MI Preferred)	$4.21
Rate for Payer: BCBS Complete	$2.59
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cofinity Commercial	$4.54
Rate for Payer: Cofinity Commercial	$5.57
Rate for Payer: Cofinity Medicare Advantage	$4.54
Rate for Payer: Encore Health Key Benefits Commercial	$5.18
Rate for Payer: Healthscope Commercial	$5.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.51
Rate for Payer: PHP Commercial	$5.51
Rate for Payer: Priority Health Cigna Priority Health	$4.21
Rate for Payer: Priority Health SBD	$4.08

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$6.48

Service Code	NDC 00121086805
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: Aetna New Business (MI Preferred)	$4.21
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cofinity Commercial	$4.54
Rate for Payer: Cofinity Commercial	$5.57
Rate for Payer: Cofinity Medicare Advantage	$4.54
Rate for Payer: Encore Health Key Benefits Commercial	$5.18
Rate for Payer: Healthscope Commercial	$5.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.51
Rate for Payer: PHP Commercial	$5.51
Rate for Payer: Priority Health Cigna Priority Health	$4.21
Rate for Payer: Priority Health SBD	$4.08

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.46

Service Code	NDC 68094059961
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$4.91
Rate for Payer: Aetna Commercial	$4.64
Rate for Payer: Aetna New Business (MI Preferred)	$3.55
Rate for Payer: Cash Price	$4.37
Rate for Payer: Cofinity Commercial	$3.82
Rate for Payer: Cofinity Commercial	$4.70
Rate for Payer: Cofinity Medicare Advantage	$3.82
Rate for Payer: Encore Health Key Benefits Commercial	$4.37
Rate for Payer: Healthscope Commercial	$4.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.64
Rate for Payer: PHP Commercial	$4.64
Rate for Payer: Priority Health Cigna Priority Health	$3.55
Rate for Payer: Priority Health SBD	$3.44

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$7.86

Service Code	NDC 68094059962
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$6.68
Rate for Payer: Aetna New Business (MI Preferred)	$5.11
Rate for Payer: Cash Price	$6.29
Rate for Payer: Cofinity Commercial	$5.50
Rate for Payer: Cofinity Commercial	$6.76
Rate for Payer: Cofinity Medicare Advantage	$5.50
Rate for Payer: Encore Health Key Benefits Commercial	$6.29
Rate for Payer: Healthscope Commercial	$7.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.68
Rate for Payer: PHP Commercial	$6.68
Rate for Payer: Priority Health Cigna Priority Health	$5.11
Rate for Payer: Priority Health SBD	$4.95

Know your out-of-pocket cost for care.

All Charges