Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ALLOPURINOL 100 MG TABLET

Facility

$2.06

Service Code	NDC 60687067711
Hospital Charge Code	310
Hospital Revenue Code	637
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.85
Rate for Payer: Aetna Commercial	$1.75
Rate for Payer: Aetna New Business (MI Preferred)	$1.34
Rate for Payer: Cash Price	$1.65
Rate for Payer: Cofinity Commercial	$1.44
Rate for Payer: Cofinity Commercial	$1.77
Rate for Payer: Cofinity Medicare Advantage	$1.44
Rate for Payer: Encore Health Key Benefits Commercial	$1.65
Rate for Payer: Healthscope Commercial	$1.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.75
Rate for Payer: PHP Commercial	$1.75
Rate for Payer: Priority Health Cigna Priority Health	$1.34
Rate for Payer: Priority Health SBD	$1.30

ALLOPURINOL 300 MG TABLET

Facility

$267.84

Service Code	NDC 00603211621
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$107.14
Max. Negotiated Rate	$241.06
Rate for Payer: Aetna Commercial	$227.66
Rate for Payer: Aetna Medicare	$133.92
Rate for Payer: Aetna New Business (MI Preferred)	$174.10
Rate for Payer: BCBS Complete	$107.14
Rate for Payer: Cash Price	$214.27
Rate for Payer: Cofinity Commercial	$187.49
Rate for Payer: Cofinity Commercial	$230.34
Rate for Payer: Cofinity Medicare Advantage	$187.49
Rate for Payer: Encore Health Key Benefits Commercial	$214.27
Rate for Payer: Healthscope Commercial	$241.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.66
Rate for Payer: PHP Commercial	$227.66
Rate for Payer: Priority Health Cigna Priority Health	$174.10
Rate for Payer: Priority Health SBD	$168.74

ALLOPURINOL 300 MG TABLET

Facility

$458.25

Service Code	NDC 70710121001
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$288.70
Max. Negotiated Rate	$412.42
Rate for Payer: Aetna Commercial	$389.51
Rate for Payer: Aetna New Business (MI Preferred)	$297.86
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Commercial	$320.78
Rate for Payer: Cofinity Commercial	$394.10
Rate for Payer: Cofinity Medicare Advantage	$320.78
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$412.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: PHP Commercial	$389.51
Rate for Payer: Priority Health Cigna Priority Health	$297.86
Rate for Payer: Priority Health SBD	$288.70

ALLOPURINOL 300 MG TABLET

Facility

$337.25

Service Code	NDC 00904657261
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$303.52
Rate for Payer: Aetna Commercial	$286.66
Rate for Payer: Aetna Medicare	$168.62
Rate for Payer: Aetna New Business (MI Preferred)	$219.21
Rate for Payer: BCBS Complete	$134.90
Rate for Payer: Cash Price	$269.80
Rate for Payer: Cofinity Commercial	$236.08
Rate for Payer: Cofinity Commercial	$290.04
Rate for Payer: Cofinity Medicare Advantage	$236.08
Rate for Payer: Encore Health Key Benefits Commercial	$269.80
Rate for Payer: Healthscope Commercial	$303.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$286.66
Rate for Payer: PHP Commercial	$286.66
Rate for Payer: Priority Health Cigna Priority Health	$219.21
Rate for Payer: Priority Health SBD	$212.47

ALLOPURINOL 300 MG TABLET

Facility

$458.25

Service Code	NDC 70710121001
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$183.30
Max. Negotiated Rate	$412.42
Rate for Payer: Aetna Commercial	$389.51
Rate for Payer: Aetna Medicare	$229.12
Rate for Payer: Aetna New Business (MI Preferred)	$297.86
Rate for Payer: BCBS Complete	$183.30
Rate for Payer: Cash Price	$366.60
Rate for Payer: Cofinity Commercial	$320.78
Rate for Payer: Cofinity Commercial	$394.10
Rate for Payer: Cofinity Medicare Advantage	$320.78
Rate for Payer: Encore Health Key Benefits Commercial	$366.60
Rate for Payer: Healthscope Commercial	$412.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.51
Rate for Payer: PHP Commercial	$389.51
Rate for Payer: Priority Health Cigna Priority Health	$297.86
Rate for Payer: Priority Health SBD	$288.70

ALLOPURINOL 300 MG TABLET

Facility

$267.84

Service Code	NDC 00603211621
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$168.74
Max. Negotiated Rate	$241.06
Rate for Payer: Aetna Commercial	$227.66
Rate for Payer: Aetna New Business (MI Preferred)	$174.10
Rate for Payer: Cash Price	$214.27
Rate for Payer: Cofinity Commercial	$187.49
Rate for Payer: Cofinity Commercial	$230.34
Rate for Payer: Cofinity Medicare Advantage	$187.49
Rate for Payer: Encore Health Key Benefits Commercial	$214.27
Rate for Payer: Healthscope Commercial	$241.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.66
Rate for Payer: PHP Commercial	$227.66
Rate for Payer: Priority Health Cigna Priority Health	$174.10
Rate for Payer: Priority Health SBD	$168.74

ALLOPURINOL 300 MG TABLET

Facility

$240.96

Service Code	NDC 62584071301
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$96.38
Max. Negotiated Rate	$216.86
Rate for Payer: Aetna Commercial	$204.82
Rate for Payer: Aetna Medicare	$120.48
Rate for Payer: Aetna New Business (MI Preferred)	$156.62
Rate for Payer: BCBS Complete	$96.38
Rate for Payer: Cash Price	$192.77
Rate for Payer: Cofinity Commercial	$168.67
Rate for Payer: Cofinity Commercial	$207.23
Rate for Payer: Cofinity Medicare Advantage	$168.67
Rate for Payer: Encore Health Key Benefits Commercial	$192.77
Rate for Payer: Healthscope Commercial	$216.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.82
Rate for Payer: PHP Commercial	$204.82
Rate for Payer: Priority Health Cigna Priority Health	$156.62
Rate for Payer: Priority Health SBD	$151.80

ALLOPURINOL 300 MG TABLET

Facility

$240.96

Service Code	NDC 62584071301
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$151.80
Max. Negotiated Rate	$216.86
Rate for Payer: Aetna Commercial	$204.82
Rate for Payer: Aetna New Business (MI Preferred)	$156.62
Rate for Payer: Cash Price	$192.77
Rate for Payer: Cofinity Commercial	$168.67
Rate for Payer: Cofinity Commercial	$207.23
Rate for Payer: Cofinity Medicare Advantage	$168.67
Rate for Payer: Encore Health Key Benefits Commercial	$192.77
Rate for Payer: Healthscope Commercial	$216.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.82
Rate for Payer: PHP Commercial	$204.82
Rate for Payer: Priority Health Cigna Priority Health	$156.62
Rate for Payer: Priority Health SBD	$151.80

ALLOPURINOL 300 MG TABLET

Facility

$2.41

Service Code	NDC 62584071311
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.17
Rate for Payer: Aetna Commercial	$2.05
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: Cash Price	$1.93
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.07
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.93
Rate for Payer: Healthscope Commercial	$2.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.05
Rate for Payer: PHP Commercial	$2.05
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

ALLOPURINOL 300 MG TABLET

Facility

$2.41

Service Code	NDC 62584071311
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.17
Rate for Payer: Aetna Commercial	$2.05
Rate for Payer: Aetna Medicare	$1.20
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: BCBS Complete	$0.96
Rate for Payer: Cash Price	$1.93
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.07
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.93
Rate for Payer: Healthscope Commercial	$2.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.05
Rate for Payer: PHP Commercial	$2.05
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

ALLOPURINOL 300 MG TABLET

Facility

$337.25

Service Code	NDC 00904657261
Hospital Charge Code	311
Hospital Revenue Code	637
Min. Negotiated Rate	$212.47
Max. Negotiated Rate	$303.52
Rate for Payer: Aetna Commercial	$286.66
Rate for Payer: Aetna New Business (MI Preferred)	$219.21
Rate for Payer: Cash Price	$269.80
Rate for Payer: Cofinity Commercial	$236.08
Rate for Payer: Cofinity Commercial	$290.04
Rate for Payer: Cofinity Medicare Advantage	$236.08
Rate for Payer: Encore Health Key Benefits Commercial	$269.80
Rate for Payer: Healthscope Commercial	$303.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$286.66
Rate for Payer: PHP Commercial	$286.66
Rate for Payer: Priority Health Cigna Priority Health	$219.21
Rate for Payer: Priority Health SBD	$212.47

ALOE VERA-COLLAGEN TOPICAL FOAM

Facility

$28.09

Service Code	NDC 68455010841
Hospital Charge Code	108259
Hospital Revenue Code	637
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$25.28
Rate for Payer: Aetna Commercial	$23.88
Rate for Payer: Aetna New Business (MI Preferred)	$18.26
Rate for Payer: Cash Price	$22.47
Rate for Payer: Cofinity Commercial	$19.66
Rate for Payer: Cofinity Commercial	$24.16
Rate for Payer: Cofinity Medicare Advantage	$19.66
Rate for Payer: Encore Health Key Benefits Commercial	$22.47
Rate for Payer: Healthscope Commercial	$25.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.88
Rate for Payer: PHP Commercial	$23.88
Rate for Payer: Priority Health Cigna Priority Health	$18.26
Rate for Payer: Priority Health SBD	$17.70

ALOE VERA-COLLAGEN TOPICAL FOAM

Facility

$28.09

Service Code	NDC 68455010841
Hospital Charge Code	108259
Hospital Revenue Code	637
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$25.28
Rate for Payer: Aetna Commercial	$23.88
Rate for Payer: Aetna Medicare	$14.04
Rate for Payer: Aetna New Business (MI Preferred)	$18.26
Rate for Payer: BCBS Complete	$11.24
Rate for Payer: Cash Price	$22.47
Rate for Payer: Cofinity Commercial	$19.66
Rate for Payer: Cofinity Commercial	$24.16
Rate for Payer: Cofinity Medicare Advantage	$19.66
Rate for Payer: Encore Health Key Benefits Commercial	$22.47
Rate for Payer: Healthscope Commercial	$25.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.88
Rate for Payer: PHP Commercial	$23.88
Rate for Payer: Priority Health Cigna Priority Health	$18.26
Rate for Payer: Priority Health SBD	$17.70

ALOE VERA-SOAP

Facility

$9.21

Service Code	NDC 68455010835
Hospital Charge Code	114141
Hospital Revenue Code	637
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$8.29
Rate for Payer: Aetna Commercial	$7.83
Rate for Payer: Aetna Medicare	$4.60
Rate for Payer: Aetna New Business (MI Preferred)	$5.99
Rate for Payer: BCBS Complete	$3.68
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cofinity Commercial	$6.45
Rate for Payer: Cofinity Commercial	$7.92
Rate for Payer: Cofinity Medicare Advantage	$6.45
Rate for Payer: Encore Health Key Benefits Commercial	$7.37
Rate for Payer: Healthscope Commercial	$8.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.83
Rate for Payer: PHP Commercial	$7.83
Rate for Payer: Priority Health Cigna Priority Health	$5.99
Rate for Payer: Priority Health SBD	$5.80

ALOE VERA-SOAP

Facility

$9.21

Service Code	NDC 68455010835
Hospital Charge Code	114141
Hospital Revenue Code	637
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$8.29
Rate for Payer: Aetna Commercial	$7.83
Rate for Payer: Aetna New Business (MI Preferred)	$5.99
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cofinity Commercial	$6.45
Rate for Payer: Cofinity Commercial	$7.92
Rate for Payer: Cofinity Medicare Advantage	$6.45
Rate for Payer: Encore Health Key Benefits Commercial	$7.37
Rate for Payer: Healthscope Commercial	$8.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.83
Rate for Payer: PHP Commercial	$7.83
Rate for Payer: Priority Health Cigna Priority Health	$5.99
Rate for Payer: Priority Health SBD	$5.80

ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION

Facility

$1.48

Service Code	HCPCS J0256
Hospital Charge Code	185673
Hospital Revenue Code	636
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.33
Rate for Payer: Aetna Commercial	$1.26
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Commercial	$1.04
Rate for Payer: Cofinity Commercial	$1.27
Rate for Payer: Cofinity Medicare Advantage	$1.04
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Healthscope Commercial	$1.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.26
Rate for Payer: PHP Commercial	$1.26
Rate for Payer: Priority Health Cigna Priority Health	$0.96
Rate for Payer: Priority Health SBD	$0.93

ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION

Facility

$1.48

Service Code	HCPCS J0256
Hospital Charge Code	185673
Hospital Revenue Code	636
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$15.27
Rate for Payer: Aetna Commercial	$1.26
Rate for Payer: Aetna Medicare	$5.29
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.36
Rate for Payer: Amish Plain Church Group Commercial	$6.36
Rate for Payer: BCBS Complete	$2.86
Rate for Payer: BCBS MAPPO	$5.09
Rate for Payer: BCBS Trust/PPO	$14.14
Rate for Payer: BCN Commercial	$14.14
Rate for Payer: BCN Medicare Advantage	$5.09
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Commercial	$1.27
Rate for Payer: Cofinity Commercial	$1.04
Rate for Payer: Cofinity Medicare Advantage	$1.04
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.09
Rate for Payer: Healthscope Commercial	$1.33
Rate for Payer: Mclaren Medicaid	$2.73
Rate for Payer: Mclaren Medicare	$5.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.34
Rate for Payer: Meridian Medicaid	$2.86
Rate for Payer: MI Amish Medical Board Commercial	$5.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.26
Rate for Payer: Nomi Health Commercial	$15.27
Rate for Payer: PACE Medicare	$4.84
Rate for Payer: PACE SWMI	$5.09
Rate for Payer: PHP Commercial	$1.26
Rate for Payer: PHP Medicare Advantage	$5.09
Rate for Payer: Priority Health Choice Medicaid	$2.73
Rate for Payer: Priority Health Cigna Priority Health	$0.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.19
Rate for Payer: Priority Health Medicare	$5.09
Rate for Payer: Priority Health Narrow Network	$11.35
Rate for Payer: Priority Health SBD	$0.93
Rate for Payer: Railroad Medicare Medicare	$5.09
Rate for Payer: UHC All Payor (Choice/PPO)	$14.33
Rate for Payer: UHC Dual Complete DSNP	$5.09
Rate for Payer: UHC Medicare Advantage	$5.09
Rate for Payer: UHCCP Medicaid	$2.87
Rate for Payer: VA VA	$5.09

ALPRAZOLAM 0.25 MG TABLET

Facility

$1.05

Service Code	NDC 51079078801
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna Commercial	$0.89
Rate for Payer: Aetna New Business (MI Preferred)	$0.68
Rate for Payer: Cash Price	$0.84
Rate for Payer: Cofinity Commercial	$0.74
Rate for Payer: Cofinity Commercial	$0.90
Rate for Payer: Cofinity Medicare Advantage	$0.74
Rate for Payer: Encore Health Key Benefits Commercial	$0.84
Rate for Payer: Healthscope Commercial	$0.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.89
Rate for Payer: PHP Commercial	$0.89
Rate for Payer: Priority Health Cigna Priority Health	$0.68
Rate for Payer: Priority Health SBD	$0.66

ALPRAZOLAM 0.25 MG TABLET

Facility

$54.25

Service Code	NDC 51991070401
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$48.82
Rate for Payer: Aetna Commercial	$46.11
Rate for Payer: Aetna New Business (MI Preferred)	$35.26
Rate for Payer: Cash Price	$43.40
Rate for Payer: Cofinity Commercial	$37.98
Rate for Payer: Cofinity Commercial	$46.66
Rate for Payer: Cofinity Medicare Advantage	$37.98
Rate for Payer: Encore Health Key Benefits Commercial	$43.40
Rate for Payer: Healthscope Commercial	$48.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.11
Rate for Payer: PHP Commercial	$46.11
Rate for Payer: Priority Health Cigna Priority Health	$35.26
Rate for Payer: Priority Health SBD	$34.18

ALPRAZOLAM 0.25 MG TABLET

Facility

$495.25

Service Code	NDC 60687037701
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$198.10
Max. Negotiated Rate	$445.72
Rate for Payer: Aetna Commercial	$420.96
Rate for Payer: Aetna Medicare	$247.62
Rate for Payer: Aetna New Business (MI Preferred)	$321.91
Rate for Payer: BCBS Complete	$198.10
Rate for Payer: Cash Price	$396.20
Rate for Payer: Cofinity Commercial	$346.68
Rate for Payer: Cofinity Commercial	$425.92
Rate for Payer: Cofinity Medicare Advantage	$346.68
Rate for Payer: Encore Health Key Benefits Commercial	$396.20
Rate for Payer: Healthscope Commercial	$445.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.96
Rate for Payer: PHP Commercial	$420.96
Rate for Payer: Priority Health Cigna Priority Health	$321.91
Rate for Payer: Priority Health SBD	$312.01

ALPRAZOLAM 0.25 MG TABLET

Facility

$42.00

Service Code	NDC 00781106101
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$37.80
Rate for Payer: Aetna Commercial	$35.70
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: Aetna New Business (MI Preferred)	$27.30
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cofinity Commercial	$29.40
Rate for Payer: Cofinity Commercial	$36.12
Rate for Payer: Cofinity Medicare Advantage	$29.40
Rate for Payer: Encore Health Key Benefits Commercial	$33.60
Rate for Payer: Healthscope Commercial	$37.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.70
Rate for Payer: PHP Commercial	$35.70
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health SBD	$26.46

ALPRAZOLAM 0.25 MG TABLET

Facility

$80.50

Service Code	NDC 00228202710
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$32.20
Max. Negotiated Rate	$72.45
Rate for Payer: Aetna Commercial	$68.42
Rate for Payer: Aetna Medicare	$40.25
Rate for Payer: Aetna New Business (MI Preferred)	$52.32
Rate for Payer: BCBS Complete	$32.20
Rate for Payer: Cash Price	$64.40
Rate for Payer: Cofinity Commercial	$56.35
Rate for Payer: Cofinity Commercial	$69.23
Rate for Payer: Cofinity Medicare Advantage	$56.35
Rate for Payer: Encore Health Key Benefits Commercial	$64.40
Rate for Payer: Healthscope Commercial	$72.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$68.42
Rate for Payer: PHP Commercial	$68.42
Rate for Payer: Priority Health Cigna Priority Health	$52.32
Rate for Payer: Priority Health SBD	$50.72

ALPRAZOLAM 0.25 MG TABLET

Facility

$54.25

Service Code	NDC 51991070401
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$48.82
Rate for Payer: Aetna Commercial	$46.11
Rate for Payer: Aetna Medicare	$27.12
Rate for Payer: Aetna New Business (MI Preferred)	$35.26
Rate for Payer: BCBS Complete	$21.70
Rate for Payer: Cash Price	$43.40
Rate for Payer: Cofinity Commercial	$37.98
Rate for Payer: Cofinity Commercial	$46.66
Rate for Payer: Cofinity Medicare Advantage	$37.98
Rate for Payer: Encore Health Key Benefits Commercial	$43.40
Rate for Payer: Healthscope Commercial	$48.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.11
Rate for Payer: PHP Commercial	$46.11
Rate for Payer: Priority Health Cigna Priority Health	$35.26
Rate for Payer: Priority Health SBD	$34.18

ALPRAZOLAM 0.25 MG TABLET

Facility

$1.05

Service Code	NDC 51079078801
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.95
Rate for Payer: Aetna Commercial	$0.89
Rate for Payer: Aetna Medicare	$0.53
Rate for Payer: Aetna New Business (MI Preferred)	$0.68
Rate for Payer: BCBS Complete	$0.42
Rate for Payer: Cash Price	$0.84
Rate for Payer: Cofinity Commercial	$0.74
Rate for Payer: Cofinity Commercial	$0.90
Rate for Payer: Cofinity Medicare Advantage	$0.74
Rate for Payer: Encore Health Key Benefits Commercial	$0.84
Rate for Payer: Healthscope Commercial	$0.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.89
Rate for Payer: PHP Commercial	$0.89
Rate for Payer: Priority Health Cigna Priority Health	$0.68
Rate for Payer: Priority Health SBD	$0.66

ALPRAZOLAM 0.25 MG TABLET

Facility

$64.75

Service Code	NDC 65862067601
Hospital Charge Code	324
Hospital Revenue Code	637
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$58.28
Rate for Payer: Aetna Commercial	$55.04
Rate for Payer: Aetna Medicare	$32.38
Rate for Payer: Aetna New Business (MI Preferred)	$42.09
Rate for Payer: BCBS Complete	$25.90
Rate for Payer: Cash Price	$51.80
Rate for Payer: Cofinity Commercial	$45.32
Rate for Payer: Cofinity Commercial	$55.68
Rate for Payer: Cofinity Medicare Advantage	$45.32
Rate for Payer: Encore Health Key Benefits Commercial	$51.80
Rate for Payer: Healthscope Commercial	$58.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.04
Rate for Payer: PHP Commercial	$55.04
Rate for Payer: Priority Health Cigna Priority Health	$42.09
Rate for Payer: Priority Health SBD	$40.79

Know your out-of-pocket cost for care.

All Charges