Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PERMETHRIN 1 % TOPICAL LIQUID

Facility

$39.65

Service Code	NDC 63736012002
Hospital Charge Code	10918
Hospital Revenue Code	637
Min. Negotiated Rate	$15.58
Max. Negotiated Rate	$35.69
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare	$19.82
Rate for Payer: Aetna New Business (MI Preferred)	$25.77
Rate for Payer: BCBS Complete	$15.86
Rate for Payer: Cash Price	$31.72
Rate for Payer: Cofinity Advantage	$27.75
Rate for Payer: Cofinity Commercial	$34.10
Rate for Payer: Encore Health Key Benefits Commercial	$31.72
Rate for Payer: Healthscope Commercial	$35.69
Rate for Payer: MI Amish Medical Board Commercial	$31.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.74
Rate for Payer: PHP Commercial	$33.70
Rate for Payer: Priority Health SBD	$24.98
Rate for Payer: UHC All Payor (Choice/PPO)	$25.77
Rate for Payer: UHC Core	$20.66
Rate for Payer: UHC Exchange	$15.58

PERMETHRIN 1 % TOPICAL LIQUID

Facility

$39.65

Service Code	NDC 63736012002
Hospital Charge Code	10918
Hospital Revenue Code	637
Min. Negotiated Rate	$24.98
Max. Negotiated Rate	$35.69
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna New Business (MI Preferred)	$25.77
Rate for Payer: Cash Price	$31.72
Rate for Payer: Cofinity Advantage	$27.75
Rate for Payer: Cofinity Commercial	$34.10
Rate for Payer: Encore Health Key Benefits Commercial	$31.72
Rate for Payer: Healthscope Commercial	$35.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.74
Rate for Payer: PHP Commercial	$33.70
Rate for Payer: Priority Health SBD	$24.98

PERMETHRIN 5 % TOPICAL CREAM

Facility

$322.35

Service Code	NDC 00472024260
Hospital Charge Code	10917
Hospital Revenue Code	637
Min. Negotiated Rate	$126.68
Max. Negotiated Rate	$290.12
Rate for Payer: Aetna Commercial	$274.00
Rate for Payer: Aetna Medicare	$161.18
Rate for Payer: Aetna New Business (MI Preferred)	$209.53
Rate for Payer: BCBS Complete	$128.94
Rate for Payer: Cash Price	$257.88
Rate for Payer: Cofinity Advantage	$225.65
Rate for Payer: Cofinity Commercial	$277.22
Rate for Payer: Encore Health Key Benefits Commercial	$257.88
Rate for Payer: Healthscope Commercial	$290.12
Rate for Payer: MI Amish Medical Board Commercial	$257.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$274.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$241.76
Rate for Payer: PHP Commercial	$274.00
Rate for Payer: Priority Health SBD	$203.08
Rate for Payer: UHC All Payor (Choice/PPO)	$209.53
Rate for Payer: UHC Core	$167.94
Rate for Payer: UHC Exchange	$126.68

PERMETHRIN 5 % TOPICAL CREAM

Facility

$322.35

Service Code	NDC 00472024260
Hospital Charge Code	10917
Hospital Revenue Code	637
Min. Negotiated Rate	$203.08
Max. Negotiated Rate	$290.12
Rate for Payer: Aetna Commercial	$274.00
Rate for Payer: Aetna New Business (MI Preferred)	$209.53
Rate for Payer: Cash Price	$257.88
Rate for Payer: Cofinity Advantage	$225.65
Rate for Payer: Cofinity Commercial	$277.22
Rate for Payer: Encore Health Key Benefits Commercial	$257.88
Rate for Payer: Healthscope Commercial	$290.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$274.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$241.76
Rate for Payer: PHP Commercial	$274.00
Rate for Payer: Priority Health SBD	$203.08

PERPHENAZINE 4 MG TABLET

Facility

$493.44

Service Code	HCPCS Q0175
Hospital Charge Code	6158
Hospital Revenue Code	637
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$444.10
Rate for Payer: Aetna Commercial	$419.42
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Commercial	$381.07
Rate for Payer: Aetna Medicare	$246.72
Rate for Payer: Aetna Medicare	$224.16
Rate for Payer: Aetna Medicare	$2.47
Rate for Payer: Aetna New Business (MI Preferred)	$3.21
Rate for Payer: Aetna New Business (MI Preferred)	$291.41
Rate for Payer: Aetna New Business (MI Preferred)	$320.74
Rate for Payer: BCBS Complete	$179.33
Rate for Payer: BCBS Complete	$197.38
Rate for Payer: BCBS Complete	$1.98
Rate for Payer: BCBS Trust/PPO	$1.72
Rate for Payer: BCBS Trust/PPO	$1.72
Rate for Payer: BCBS Trust/PPO	$1.72
Rate for Payer: BCN Commercial	$1.72
Rate for Payer: BCN Commercial	$1.72
Rate for Payer: BCN Commercial	$1.72
Rate for Payer: Cash Price	$3.95
Rate for Payer: Cash Price	$3.95
Rate for Payer: Cash Price	$394.75
Rate for Payer: Cash Price	$358.66
Rate for Payer: Cash Price	$358.66
Rate for Payer: Cash Price	$394.75
Rate for Payer: Cofinity Advantage	$313.82
Rate for Payer: Cofinity Advantage	$3.46
Rate for Payer: Cofinity Advantage	$345.41
Rate for Payer: Cofinity Commercial	$424.36
Rate for Payer: Cofinity Commercial	$4.25
Rate for Payer: Cofinity Commercial	$385.56
Rate for Payer: Encore Health Key Benefits Commercial	$394.75
Rate for Payer: Encore Health Key Benefits Commercial	$358.66
Rate for Payer: Encore Health Key Benefits Commercial	$3.95
Rate for Payer: Healthscope Commercial	$444.10
Rate for Payer: Healthscope Commercial	$4.45
Rate for Payer: Healthscope Commercial	$403.49
Rate for Payer: MI Amish Medical Board Commercial	$394.75
Rate for Payer: MI Amish Medical Board Commercial	$3.95
Rate for Payer: MI Amish Medical Board Commercial	$358.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$419.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$381.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$336.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$370.08
Rate for Payer: PHP Commercial	$419.42
Rate for Payer: PHP Commercial	$4.20
Rate for Payer: PHP Commercial	$381.07
Rate for Payer: Priority Health SBD	$3.11
Rate for Payer: Priority Health SBD	$282.44
Rate for Payer: Priority Health SBD	$310.87
Rate for Payer: UHC All Payor (Choice/PPO)	$291.41
Rate for Payer: UHC All Payor (Choice/PPO)	$320.74
Rate for Payer: UHC All Payor (Choice/PPO)	$3.21
Rate for Payer: UHC Core	$233.57
Rate for Payer: UHC Core	$2.57
Rate for Payer: UHC Core	$257.08
Rate for Payer: UHC Exchange	$1.94
Rate for Payer: UHC Exchange	$193.92
Rate for Payer: UHC Exchange	$176.19

PERPHENAZINE 4 MG TABLET

Facility

$493.44

Service Code	HCPCS Q0175
Hospital Charge Code	6158
Hospital Revenue Code	637
Min. Negotiated Rate	$310.87
Max. Negotiated Rate	$444.10
Rate for Payer: Aetna Commercial	$419.42
Rate for Payer: Aetna Commercial	$381.07
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna New Business (MI Preferred)	$320.74
Rate for Payer: Aetna New Business (MI Preferred)	$3.21
Rate for Payer: Aetna New Business (MI Preferred)	$291.41
Rate for Payer: Cash Price	$3.95
Rate for Payer: Cash Price	$394.75
Rate for Payer: Cash Price	$358.66
Rate for Payer: Cofinity Advantage	$345.41
Rate for Payer: Cofinity Advantage	$313.82
Rate for Payer: Cofinity Advantage	$3.46
Rate for Payer: Cofinity Commercial	$4.25
Rate for Payer: Cofinity Commercial	$385.56
Rate for Payer: Cofinity Commercial	$424.36
Rate for Payer: Encore Health Key Benefits Commercial	$394.75
Rate for Payer: Encore Health Key Benefits Commercial	$358.66
Rate for Payer: Encore Health Key Benefits Commercial	$3.95
Rate for Payer: Healthscope Commercial	$403.49
Rate for Payer: Healthscope Commercial	$444.10
Rate for Payer: Healthscope Commercial	$4.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$381.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$419.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$336.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$370.08
Rate for Payer: PHP Commercial	$381.07
Rate for Payer: PHP Commercial	$4.20
Rate for Payer: PHP Commercial	$419.42
Rate for Payer: Priority Health SBD	$3.11
Rate for Payer: Priority Health SBD	$282.44
Rate for Payer: Priority Health SBD	$310.87

PERSONALITY DISORDERS

Facility

$2,579.28

Service Code	APR-DRG 7521
Min. Negotiated Rate	$2,456.45
Max. Negotiated Rate	$2,579.28
Rate for Payer: BCBS Complete	$2,579.28
Rate for Payer: Mclaren Medicaid	$2,456.45
Rate for Payer: Meridian Medicaid	$2,579.28
Rate for Payer: Priority Health Choice Medicaid	$2,456.45
Rate for Payer: UHC Medicaid	$2,456.45
Rate for Payer: UHCCP Medicaid	$2,456.45

PERSONALITY DISORDERS

Facility

$3,219.65

Service Code	APR-DRG 7522
Min. Negotiated Rate	$3,066.34
Max. Negotiated Rate	$3,219.65
Rate for Payer: BCBS Complete	$3,219.65
Rate for Payer: Mclaren Medicaid	$3,066.34
Rate for Payer: Meridian Medicaid	$3,219.65
Rate for Payer: Priority Health Choice Medicaid	$3,066.34
Rate for Payer: UHC Medicaid	$3,066.34
Rate for Payer: UHCCP Medicaid	$3,066.34

PERSONALITY DISORDERS

Facility

$16,486.96

Service Code	APR-DRG 7524
Min. Negotiated Rate	$15,701.87
Max. Negotiated Rate	$16,486.96
Rate for Payer: BCBS Complete	$16,486.96
Rate for Payer: Mclaren Medicaid	$15,701.87
Rate for Payer: Meridian Medicaid	$16,486.96
Rate for Payer: Priority Health Choice Medicaid	$15,701.87
Rate for Payer: UHC Medicaid	$15,701.87
Rate for Payer: UHCCP Medicaid	$15,701.87

PERSONALITY DISORDERS

Facility

$7,472.39

Service Code	APR-DRG 7523
Min. Negotiated Rate	$7,116.56
Max. Negotiated Rate	$7,472.39
Rate for Payer: BCBS Complete	$7,472.39
Rate for Payer: Mclaren Medicaid	$7,116.56
Rate for Payer: Meridian Medicaid	$7,472.39
Rate for Payer: Priority Health Choice Medicaid	$7,116.56
Rate for Payer: UHC Medicaid	$7,116.56
Rate for Payer: UHCCP Medicaid	$7,116.56

PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION

Facility

$30,930.21

Service Code	HCPCS J9306
Hospital Charge Code	160029
Hospital Revenue Code	636
Min. Negotiated Rate	$19,486.03
Max. Negotiated Rate	$27,837.19
Rate for Payer: Aetna Commercial	$26,290.68
Rate for Payer: Aetna New Business (MI Preferred)	$20,104.64
Rate for Payer: Cash Price	$24,744.17
Rate for Payer: Cofinity Advantage	$21,651.15
Rate for Payer: Cofinity Commercial	$26,599.98
Rate for Payer: Encore Health Key Benefits Commercial	$24,744.17
Rate for Payer: Healthscope Commercial	$27,837.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26,290.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$23,197.66
Rate for Payer: PHP Commercial	$26,290.68
Rate for Payer: Priority Health SBD	$19,486.03

PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS SOLUTION

Facility

$30,930.21

Service Code	HCPCS J9306
Hospital Charge Code	160029
Hospital Revenue Code	636
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$27,837.19
Rate for Payer: Aetna Commercial	$26,290.68
Rate for Payer: Aetna Medicare	$17.70
Rate for Payer: Aetna New Business (MI Preferred)	$20,104.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$21.27
Rate for Payer: Amish Plain Church Group Commercial	$21.27
Rate for Payer: BCBS Complete	$9.35
Rate for Payer: BCBS MAPPO	$17.02
Rate for Payer: BCBS Trust/PPO	$41.89
Rate for Payer: BCN Commercial	$41.89
Rate for Payer: BCN Medicare Advantage	$17.02
Rate for Payer: Cash Price	$24,744.17
Rate for Payer: Cash Price	$24,744.17
Rate for Payer: Cofinity Advantage	$21,651.15
Rate for Payer: Cofinity Commercial	$26,599.98
Rate for Payer: Encore Health Key Benefits Commercial	$24,744.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$17.02
Rate for Payer: Healthscope Commercial	$27,837.19
Rate for Payer: Mclaren Medicaid	$8.90
Rate for Payer: Mclaren Medicare	$17.02
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17.87
Rate for Payer: Meridian Medicaid	$17.87
Rate for Payer: MI Amish Medical Board Commercial	$19.57
Rate for Payer: Molina Medicare/Medicaid	$18.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26,290.68
Rate for Payer: Nomi Health Commercial	$51.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$23,197.66
Rate for Payer: PACE Medicare	$16.17
Rate for Payer: PACE SWMI	$17.02
Rate for Payer: PHP Commercial	$26,290.68
Rate for Payer: PHP Medicare Advantage	$17.02
Rate for Payer: Priority Health Choice Medicaid	$8.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$53.69
Rate for Payer: Priority Health Medicare	$17.02
Rate for Payer: Priority Health SBD	$19,486.03
Rate for Payer: Priority Health Tiered Network	$42.95
Rate for Payer: Railroad Medicare Medicare	$17.02
Rate for Payer: UHC All Payor (Choice/PPO)	$28.07
Rate for Payer: UHC Core	$28.07
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$17.02
Rate for Payer: UHC Exchange	$28.07
Rate for Payer: UHC Medicaid	$8.90
Rate for Payer: UHCCP Medicaid	$8.90
Rate for Payer: VA VA	$17.02

PHENAZOPYRIDINE 100 MG TABLET

Facility

$240.35

Service Code	NDC 65162068110
Hospital Charge Code	6193
Hospital Revenue Code	637
Min. Negotiated Rate	$151.42
Max. Negotiated Rate	$216.31
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Aetna New Business (MI Preferred)	$156.23
Rate for Payer: Cash Price	$192.28
Rate for Payer: Cofinity Advantage	$168.25
Rate for Payer: Cofinity Commercial	$206.70
Rate for Payer: Encore Health Key Benefits Commercial	$192.28
Rate for Payer: Healthscope Commercial	$216.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$180.26
Rate for Payer: PHP Commercial	$204.30
Rate for Payer: Priority Health SBD	$151.42

PHENAZOPYRIDINE 100 MG TABLET

Facility

$238.45

Service Code	NDC 75826011410
Hospital Charge Code	6193
Hospital Revenue Code	637
Min. Negotiated Rate	$150.22
Max. Negotiated Rate	$214.60
Rate for Payer: Aetna Commercial	$202.68
Rate for Payer: Aetna New Business (MI Preferred)	$154.99
Rate for Payer: Cash Price	$190.76
Rate for Payer: Cofinity Advantage	$166.91
Rate for Payer: Cofinity Commercial	$205.07
Rate for Payer: Encore Health Key Benefits Commercial	$190.76
Rate for Payer: Healthscope Commercial	$214.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$178.84
Rate for Payer: PHP Commercial	$202.68
Rate for Payer: Priority Health SBD	$150.22

PHENAZOPYRIDINE 100 MG TABLET

Facility

$240.35

Service Code	NDC 65162068110
Hospital Charge Code	6193
Hospital Revenue Code	637
Min. Negotiated Rate	$94.46
Max. Negotiated Rate	$216.31
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Aetna Medicare	$120.17
Rate for Payer: Aetna New Business (MI Preferred)	$156.23
Rate for Payer: BCBS Complete	$96.14
Rate for Payer: Cash Price	$192.28
Rate for Payer: Cofinity Advantage	$168.25
Rate for Payer: Cofinity Commercial	$206.70
Rate for Payer: Encore Health Key Benefits Commercial	$192.28
Rate for Payer: Healthscope Commercial	$216.31
Rate for Payer: MI Amish Medical Board Commercial	$192.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$180.26
Rate for Payer: PHP Commercial	$204.30
Rate for Payer: Priority Health SBD	$151.42
Rate for Payer: UHC All Payor (Choice/PPO)	$156.23
Rate for Payer: UHC Core	$125.22
Rate for Payer: UHC Exchange	$94.46

PHENAZOPYRIDINE 100 MG TABLET

Facility

$238.45

Service Code	NDC 75826011410
Hospital Charge Code	6193
Hospital Revenue Code	637
Min. Negotiated Rate	$93.71
Max. Negotiated Rate	$214.60
Rate for Payer: Aetna Commercial	$202.68
Rate for Payer: Aetna Medicare	$119.22
Rate for Payer: Aetna New Business (MI Preferred)	$154.99
Rate for Payer: BCBS Complete	$95.38
Rate for Payer: Cash Price	$190.76
Rate for Payer: Cofinity Advantage	$166.91
Rate for Payer: Cofinity Commercial	$205.07
Rate for Payer: Encore Health Key Benefits Commercial	$190.76
Rate for Payer: Healthscope Commercial	$214.60
Rate for Payer: MI Amish Medical Board Commercial	$190.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$178.84
Rate for Payer: PHP Commercial	$202.68
Rate for Payer: Priority Health SBD	$150.22
Rate for Payer: UHC All Payor (Choice/PPO)	$154.99
Rate for Payer: UHC Core	$124.23
Rate for Payer: UHC Exchange	$93.71

PHENAZOPYRIDINE 200 MG TABLET

Facility

$535.68

Service Code	NDC 69367016304
Hospital Charge Code	6194
Hospital Revenue Code	637
Min. Negotiated Rate	$210.52
Max. Negotiated Rate	$482.11
Rate for Payer: Aetna Commercial	$455.33
Rate for Payer: Aetna Medicare	$267.84
Rate for Payer: Aetna New Business (MI Preferred)	$348.19
Rate for Payer: BCBS Complete	$214.27
Rate for Payer: Cash Price	$428.54
Rate for Payer: Cofinity Advantage	$374.98
Rate for Payer: Cofinity Commercial	$460.68
Rate for Payer: Encore Health Key Benefits Commercial	$428.54
Rate for Payer: Healthscope Commercial	$482.11
Rate for Payer: MI Amish Medical Board Commercial	$428.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$455.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$401.76
Rate for Payer: PHP Commercial	$455.33
Rate for Payer: Priority Health SBD	$337.48
Rate for Payer: UHC All Payor (Choice/PPO)	$348.19
Rate for Payer: UHC Core	$279.09
Rate for Payer: UHC Exchange	$210.52

PHENAZOPYRIDINE 200 MG TABLET

Facility

$326.80

Service Code	NDC 75826011510
Hospital Charge Code	6194
Hospital Revenue Code	637
Min. Negotiated Rate	$205.88
Max. Negotiated Rate	$294.12
Rate for Payer: Aetna Commercial	$277.78
Rate for Payer: Aetna New Business (MI Preferred)	$212.42
Rate for Payer: Cash Price	$261.44
Rate for Payer: Cofinity Advantage	$228.76
Rate for Payer: Cofinity Commercial	$281.05
Rate for Payer: Encore Health Key Benefits Commercial	$261.44
Rate for Payer: Healthscope Commercial	$294.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.10
Rate for Payer: PHP Commercial	$277.78
Rate for Payer: Priority Health SBD	$205.88

PHENAZOPYRIDINE 200 MG TABLET

Facility

$535.68

Service Code	NDC 69367016304
Hospital Charge Code	6194
Hospital Revenue Code	637
Min. Negotiated Rate	$337.48
Max. Negotiated Rate	$482.11
Rate for Payer: Aetna Commercial	$455.33
Rate for Payer: Aetna New Business (MI Preferred)	$348.19
Rate for Payer: Cash Price	$428.54
Rate for Payer: Cofinity Advantage	$374.98
Rate for Payer: Cofinity Commercial	$460.68
Rate for Payer: Encore Health Key Benefits Commercial	$428.54
Rate for Payer: Healthscope Commercial	$482.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$455.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$401.76
Rate for Payer: PHP Commercial	$455.33
Rate for Payer: Priority Health SBD	$337.48

PHENAZOPYRIDINE 200 MG TABLET

Facility

$326.80

Service Code	NDC 75826011510
Hospital Charge Code	6194
Hospital Revenue Code	637
Min. Negotiated Rate	$128.43
Max. Negotiated Rate	$294.12
Rate for Payer: Aetna Commercial	$277.78
Rate for Payer: Aetna Medicare	$163.40
Rate for Payer: Aetna New Business (MI Preferred)	$212.42
Rate for Payer: BCBS Complete	$130.72
Rate for Payer: Cash Price	$261.44
Rate for Payer: Cofinity Advantage	$228.76
Rate for Payer: Cofinity Commercial	$281.05
Rate for Payer: Encore Health Key Benefits Commercial	$261.44
Rate for Payer: Healthscope Commercial	$294.12
Rate for Payer: MI Amish Medical Board Commercial	$261.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.10
Rate for Payer: PHP Commercial	$277.78
Rate for Payer: Priority Health SBD	$205.88
Rate for Payer: UHC All Payor (Choice/PPO)	$212.42
Rate for Payer: UHC Core	$170.26
Rate for Payer: UHC Exchange	$128.43

PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR

Facility

$216.97

Service Code	NDC 00603150858
Hospital Charge Code	6212
Hospital Revenue Code	637
Min. Negotiated Rate	$85.27
Max. Negotiated Rate	$195.27
Rate for Payer: Aetna Commercial	$184.42
Rate for Payer: Aetna Medicare	$108.48
Rate for Payer: Aetna New Business (MI Preferred)	$141.03
Rate for Payer: BCBS Complete	$86.79
Rate for Payer: Cash Price	$173.58
Rate for Payer: Cofinity Advantage	$151.88
Rate for Payer: Cofinity Commercial	$186.59
Rate for Payer: Encore Health Key Benefits Commercial	$173.58
Rate for Payer: Healthscope Commercial	$195.27
Rate for Payer: MI Amish Medical Board Commercial	$173.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$184.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$162.73
Rate for Payer: PHP Commercial	$184.42
Rate for Payer: Priority Health SBD	$136.69
Rate for Payer: UHC All Payor (Choice/PPO)	$141.03
Rate for Payer: UHC Core	$113.04
Rate for Payer: UHC Exchange	$85.27

PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR

Facility

$212.29

Service Code	NDC 13517010716
Hospital Charge Code	6212
Hospital Revenue Code	637
Min. Negotiated Rate	$133.74
Max. Negotiated Rate	$191.06
Rate for Payer: Aetna Commercial	$180.45
Rate for Payer: Aetna New Business (MI Preferred)	$137.99
Rate for Payer: Cash Price	$169.83
Rate for Payer: Cofinity Advantage	$148.60
Rate for Payer: Cofinity Commercial	$182.57
Rate for Payer: Encore Health Key Benefits Commercial	$169.83
Rate for Payer: Healthscope Commercial	$191.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.22
Rate for Payer: PHP Commercial	$180.45
Rate for Payer: Priority Health SBD	$133.74

PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR

Facility

$216.97

Service Code	NDC 00603150858
Hospital Charge Code	6212
Hospital Revenue Code	637
Min. Negotiated Rate	$136.69
Max. Negotiated Rate	$195.27
Rate for Payer: Aetna Commercial	$184.42
Rate for Payer: Aetna New Business (MI Preferred)	$141.03
Rate for Payer: Cash Price	$173.58
Rate for Payer: Cofinity Advantage	$151.88
Rate for Payer: Cofinity Commercial	$186.59
Rate for Payer: Encore Health Key Benefits Commercial	$173.58
Rate for Payer: Healthscope Commercial	$195.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$184.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$162.73
Rate for Payer: PHP Commercial	$184.42
Rate for Payer: Priority Health SBD	$136.69

PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR

Facility

$212.29

Service Code	NDC 13517010716
Hospital Charge Code	6212
Hospital Revenue Code	637
Min. Negotiated Rate	$83.43
Max. Negotiated Rate	$191.06
Rate for Payer: Aetna Commercial	$180.45
Rate for Payer: Aetna Medicare	$106.14
Rate for Payer: Aetna New Business (MI Preferred)	$137.99
Rate for Payer: BCBS Complete	$84.92
Rate for Payer: Cash Price	$169.83
Rate for Payer: Cofinity Advantage	$148.60
Rate for Payer: Cofinity Commercial	$182.57
Rate for Payer: Encore Health Key Benefits Commercial	$169.83
Rate for Payer: Healthscope Commercial	$191.06
Rate for Payer: MI Amish Medical Board Commercial	$169.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$180.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.22
Rate for Payer: PHP Commercial	$180.45
Rate for Payer: Priority Health SBD	$133.74
Rate for Payer: UHC All Payor (Choice/PPO)	$137.99
Rate for Payer: UHC Core	$110.60
Rate for Payer: UHC Exchange	$83.43

PHENOBARBITAL 32.4 MG TABLET

Facility

$374.30

Service Code	NDC 00904657561
Hospital Charge Code	6217
Hospital Revenue Code	637
Min. Negotiated Rate	$235.81
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Advantage	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.73
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health SBD	$235.81

Know your out-of-pocket cost for care.

All Charges