Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$83.67

Service Code	NDC 65862039010
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$52.71
Max. Negotiated Rate	$75.30
Rate for Payer: Aetna Commercial	$71.12
Rate for Payer: Aetna New Business (MI Preferred)	$54.39
Rate for Payer: Cash Price	$66.94
Rate for Payer: Cofinity Commercial	$58.57
Rate for Payer: Cofinity Commercial	$71.96
Rate for Payer: Cofinity Medicare Advantage	$58.57
Rate for Payer: Encore Health Key Benefits Commercial	$66.94
Rate for Payer: Healthscope Commercial	$75.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.12
Rate for Payer: PHP Commercial	$71.12
Rate for Payer: Priority Health Cigna Priority Health	$54.39
Rate for Payer: Priority Health SBD	$52.71

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$137.48

Service Code	NDC 68462015713
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$54.99
Max. Negotiated Rate	$123.73
Rate for Payer: Aetna Commercial	$116.86
Rate for Payer: Aetna Medicare	$68.74
Rate for Payer: Aetna New Business (MI Preferred)	$89.36
Rate for Payer: BCBS Complete	$54.99
Rate for Payer: Cash Price	$109.98
Rate for Payer: Cofinity Commercial	$118.23
Rate for Payer: Cofinity Commercial	$96.24
Rate for Payer: Cofinity Medicare Advantage	$96.24
Rate for Payer: Encore Health Key Benefits Commercial	$109.98
Rate for Payer: Healthscope Commercial	$123.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.86
Rate for Payer: PHP Commercial	$116.86
Rate for Payer: Priority Health Cigna Priority Health	$89.36
Rate for Payer: Priority Health SBD	$86.61

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$83.67

Service Code	NDC 65862039010
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$33.47
Max. Negotiated Rate	$75.30
Rate for Payer: Aetna Commercial	$71.12
Rate for Payer: Aetna Medicare	$41.84
Rate for Payer: Aetna New Business (MI Preferred)	$54.39
Rate for Payer: BCBS Complete	$33.47
Rate for Payer: Cash Price	$66.94
Rate for Payer: Cofinity Commercial	$58.57
Rate for Payer: Cofinity Commercial	$71.96
Rate for Payer: Cofinity Medicare Advantage	$58.57
Rate for Payer: Encore Health Key Benefits Commercial	$66.94
Rate for Payer: Healthscope Commercial	$75.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.12
Rate for Payer: PHP Commercial	$71.12
Rate for Payer: Priority Health Cigna Priority Health	$54.39
Rate for Payer: Priority Health SBD	$52.71

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$4.59

Service Code	NDC 68462015740
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$4.13
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna New Business (MI Preferred)	$2.98
Rate for Payer: Cash Price	$3.67
Rate for Payer: Cofinity Commercial	$3.21
Rate for Payer: Cofinity Commercial	$3.95
Rate for Payer: Cofinity Medicare Advantage	$3.21
Rate for Payer: Encore Health Key Benefits Commercial	$3.67
Rate for Payer: Healthscope Commercial	$4.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.90
Rate for Payer: PHP Commercial	$3.90
Rate for Payer: Priority Health Cigna Priority Health	$2.98
Rate for Payer: Priority Health SBD	$2.89

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 Commercial	$57.36
Rate for Payer: Cofinity Commercial	$70.47
Rate for Payer: Cofinity Medicare Advantage	$57.36
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: PHP Commercial	$69.65
Rate for Payer: Priority Health Cigna Priority Health	$53.26
Rate for Payer: Priority Health SBD	$51.62

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$4.59

Service Code	NDC 68462015740
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.13
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare	$2.29
Rate for Payer: Aetna New Business (MI Preferred)	$2.98
Rate for Payer: BCBS Complete	$1.84
Rate for Payer: Cash Price	$3.67
Rate for Payer: Cofinity Commercial	$3.21
Rate for Payer: Cofinity Commercial	$3.95
Rate for Payer: Cofinity Medicare Advantage	$3.21
Rate for Payer: Encore Health Key Benefits Commercial	$3.67
Rate for Payer: Healthscope Commercial	$4.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.90
Rate for Payer: PHP Commercial	$3.90
Rate for Payer: Priority Health Cigna Priority Health	$2.98
Rate for Payer: Priority Health SBD	$2.89

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 Commercial	$110.08
Rate for Payer: Cofinity Commercial	$89.60
Rate for Payer: Cofinity Medicare Advantage	$89.60
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: PHP Commercial	$108.80
Rate for Payer: Priority Health Cigna Priority Health	$83.20
Rate for Payer: Priority Health SBD	$80.64

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	$51.20
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: Cash Price	$102.40
Rate for Payer: Cofinity Commercial	$110.08
Rate for Payer: Cofinity Commercial	$89.60
Rate for Payer: Cofinity Medicare Advantage	$89.60
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: PHP Commercial	$108.80
Rate for Payer: Priority Health Cigna Priority Health	$83.20
Rate for Payer: Priority Health SBD	$80.64

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$115.43

Service Code	NDC 65162069179
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$72.72
Max. Negotiated Rate	$103.89
Rate for Payer: Aetna Commercial	$98.12
Rate for Payer: Aetna New Business (MI Preferred)	$75.03
Rate for Payer: Cash Price	$92.34
Rate for Payer: Cofinity Commercial	$80.80
Rate for Payer: Cofinity Commercial	$99.27
Rate for Payer: Cofinity Medicare Advantage	$80.80
Rate for Payer: Encore Health Key Benefits Commercial	$92.34
Rate for Payer: Healthscope Commercial	$103.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.12
Rate for Payer: PHP Commercial	$98.12
Rate for Payer: Priority Health Cigna Priority Health	$75.03
Rate for Payer: Priority Health SBD	$72.72

ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION

Facility

$115.43

Service Code	NDC 65162069179
Hospital Charge Code	18877
Hospital Revenue Code	637
Min. Negotiated Rate	$46.17
Max. Negotiated Rate	$103.89
Rate for Payer: Aetna Commercial	$98.12
Rate for Payer: Aetna Medicare	$57.72
Rate for Payer: Aetna New Business (MI Preferred)	$75.03
Rate for Payer: BCBS Complete	$46.17
Rate for Payer: Cash Price	$92.34
Rate for Payer: Cofinity Commercial	$80.80
Rate for Payer: Cofinity Commercial	$99.27
Rate for Payer: Cofinity Medicare Advantage	$80.80
Rate for Payer: Encore Health Key Benefits Commercial	$92.34
Rate for Payer: Healthscope Commercial	$103.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.12
Rate for Payer: PHP Commercial	$98.12
Rate for Payer: Priority Health Cigna Priority Health	$75.03
Rate for Payer: Priority Health SBD	$72.72

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	$60.61
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 Commercial	$106.07
Rate for Payer: Cofinity Commercial	$130.32
Rate for Payer: Cofinity Medicare Advantage	$106.07
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: PHP Commercial	$128.80
Rate for Payer: Priority Health Cigna Priority Health	$98.49
Rate for Payer: Priority Health SBD	$95.46

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 Commercial	$106.07
Rate for Payer: Cofinity Commercial	$130.32
Rate for Payer: Cofinity Medicare Advantage	$106.07
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: PHP Commercial	$128.80
Rate for Payer: Priority Health Cigna Priority Health	$98.49
Rate for Payer: Priority Health SBD	$95.46

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	$5.72
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 Commercial	$10.01
Rate for Payer: Cofinity Commercial	$12.30
Rate for Payer: Cofinity Medicare Advantage	$10.01
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: PHP Commercial	$12.15
Rate for Payer: Priority Health Cigna Priority Health	$9.29
Rate for Payer: Priority Health SBD	$9.01

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 Commercial	$10.01
Rate for Payer: Cofinity Commercial	$12.30
Rate for Payer: Cofinity Medicare Advantage	$10.01
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: PHP Commercial	$12.15
Rate for Payer: Priority Health Cigna Priority Health	$9.29
Rate for Payer: Priority Health SBD	$9.01

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	$19.12
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 Commercial	$33.47
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Medicare Advantage	$33.47
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: PHP Commercial	$40.64
Rate for Payer: Priority Health Cigna Priority Health	$31.08
Rate for Payer: Priority Health SBD	$30.12

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 Commercial	$33.47
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Medicare Advantage	$33.47
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: PHP Commercial	$40.64
Rate for Payer: Priority Health Cigna Priority Health	$31.08
Rate for Payer: Priority Health SBD	$30.12

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 Commercial	$33.47
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Medicare Advantage	$33.47
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: PHP Commercial	$40.64
Rate for Payer: Priority Health Cigna Priority Health	$31.08
Rate for Payer: Priority Health SBD	$30.12

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	$19.12
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 Commercial	$33.47
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Medicare Advantage	$33.47
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: PHP Commercial	$40.64
Rate for Payer: Priority Health Cigna Priority Health	$31.08
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 Commercial	$154.62
Rate for Payer: Cofinity Commercial	$189.96
Rate for Payer: Cofinity Medicare Advantage	$154.62
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: PHP Commercial	$187.75
Rate for Payer: Priority Health Cigna Priority Health	$143.57
Rate for Payer: Priority Health SBD	$139.15

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	$88.35
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 Commercial	$154.62
Rate for Payer: Cofinity Commercial	$189.96
Rate for Payer: Cofinity Medicare Advantage	$154.62
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: PHP Commercial	$187.75
Rate for Payer: Priority Health Cigna Priority Health	$143.57
Rate for Payer: Priority Health SBD	$139.15

ONDANSETRON HCL 4 MG TABLET

Facility

$87.42

Service Code	NDC 65862018730
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$78.68
Rate for Payer: Aetna Commercial	$74.31
Rate for Payer: Aetna Medicare	$43.71
Rate for Payer: Aetna New Business (MI Preferred)	$56.82
Rate for Payer: BCBS Complete	$34.97
Rate for Payer: Cash Price	$69.94
Rate for Payer: Cofinity Commercial	$61.19
Rate for Payer: Cofinity Commercial	$75.18
Rate for Payer: Cofinity Medicare Advantage	$61.19
Rate for Payer: Encore Health Key Benefits Commercial	$69.94
Rate for Payer: Healthscope Commercial	$78.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.31
Rate for Payer: PHP Commercial	$74.31
Rate for Payer: Priority Health Cigna Priority Health	$56.82
Rate for Payer: Priority Health SBD	$55.07

ONDANSETRON HCL 4 MG TABLET

Facility

$3.91

Service Code	NDC 50268062111
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$3.32
Rate for Payer: Aetna Medicare	$1.96
Rate for Payer: Aetna New Business (MI Preferred)	$2.54
Rate for Payer: BCBS Complete	$1.56
Rate for Payer: Cash Price	$3.13
Rate for Payer: Cofinity Commercial	$2.74
Rate for Payer: Cofinity Commercial	$3.36
Rate for Payer: Cofinity Medicare Advantage	$2.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.13
Rate for Payer: Healthscope Commercial	$3.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.32
Rate for Payer: PHP Commercial	$3.32
Rate for Payer: Priority Health Cigna Priority Health	$2.54
Rate for Payer: Priority Health SBD	$2.46

ONDANSETRON HCL 4 MG TABLET

Facility

$195.23

Service Code	NDC 50268062115
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$122.99
Max. Negotiated Rate	$175.71
Rate for Payer: Aetna Commercial	$165.95
Rate for Payer: Aetna New Business (MI Preferred)	$126.90
Rate for Payer: Cash Price	$156.18
Rate for Payer: Cofinity Commercial	$136.66
Rate for Payer: Cofinity Commercial	$167.90
Rate for Payer: Cofinity Medicare Advantage	$136.66
Rate for Payer: Encore Health Key Benefits Commercial	$156.18
Rate for Payer: Healthscope Commercial	$175.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.95
Rate for Payer: PHP Commercial	$165.95
Rate for Payer: Priority Health Cigna Priority Health	$126.90
Rate for Payer: Priority Health SBD	$122.99

ONDANSETRON HCL 4 MG TABLET

Facility

$195.23

Service Code	NDC 50268062115
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$78.09
Max. Negotiated Rate	$175.71
Rate for Payer: Aetna Commercial	$165.95
Rate for Payer: Aetna Medicare	$97.61
Rate for Payer: Aetna New Business (MI Preferred)	$126.90
Rate for Payer: BCBS Complete	$78.09
Rate for Payer: Cash Price	$156.18
Rate for Payer: Cofinity Commercial	$136.66
Rate for Payer: Cofinity Commercial	$167.90
Rate for Payer: Cofinity Medicare Advantage	$136.66
Rate for Payer: Encore Health Key Benefits Commercial	$156.18
Rate for Payer: Healthscope Commercial	$175.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.95
Rate for Payer: PHP Commercial	$165.95
Rate for Payer: Priority Health Cigna Priority Health	$126.90
Rate for Payer: Priority Health SBD	$122.99

ONDANSETRON HCL 4 MG TABLET

Facility

$285.00

Service Code	NDC 00904655161
Hospital Charge Code	10778
Hospital Revenue Code	637
Min. Negotiated Rate	$179.55
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Commercial	$242.25
Rate for Payer: Aetna New Business (MI Preferred)	$185.25
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cofinity Commercial	$199.50
Rate for Payer: Cofinity Commercial	$245.10
Rate for Payer: Cofinity Medicare Advantage	$199.50
Rate for Payer: Encore Health Key Benefits Commercial	$228.00
Rate for Payer: Healthscope Commercial	$256.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.25
Rate for Payer: PHP Commercial	$242.25
Rate for Payer: Priority Health Cigna Priority Health	$185.25
Rate for Payer: Priority Health SBD	$179.55

Know your out-of-pocket cost for care.

All Charges