Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PHENOBARBITAL 32.4 MG TABLET

Facility

$279.30

Service Code	NDC 00904657561
Hospital Charge Code	6217
Hospital Revenue Code	637
Min. Negotiated Rate	$111.72
Max. Negotiated Rate	$251.37
Rate for Payer: Aetna Commercial	$237.40
Rate for Payer: Aetna Medicare	$139.65
Rate for Payer: Aetna New Business (MI Preferred)	$181.54
Rate for Payer: BCBS Complete	$111.72
Rate for Payer: Cash Price	$223.44
Rate for Payer: Cofinity Commercial	$195.51
Rate for Payer: Cofinity Commercial	$240.20
Rate for Payer: Cofinity Medicare Advantage	$195.51
Rate for Payer: Encore Health Key Benefits Commercial	$223.44
Rate for Payer: Healthscope Commercial	$251.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$237.40
Rate for Payer: PHP Commercial	$237.40
Rate for Payer: Priority Health Cigna Priority Health	$181.54
Rate for Payer: Priority Health SBD	$175.96

PHENOBARBITAL 97.2 MG TABLET

Facility

$209.00

Service Code	NDC 16571066801
Hospital Charge Code	6220
Hospital Revenue Code	637
Min. Negotiated Rate	$131.67
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna New Business (MI Preferred)	$135.85
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cofinity Commercial	$146.30
Rate for Payer: Cofinity Commercial	$179.74
Rate for Payer: Cofinity Medicare Advantage	$146.30
Rate for Payer: Encore Health Key Benefits Commercial	$167.20
Rate for Payer: Healthscope Commercial	$188.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$177.65
Rate for Payer: PHP Commercial	$177.65
Rate for Payer: Priority Health Cigna Priority Health	$135.85
Rate for Payer: Priority Health SBD	$131.67

PHENOBARBITAL 97.2 MG TABLET

Facility

$209.00

Service Code	NDC 16571066801
Hospital Charge Code	6220
Hospital Revenue Code	637
Min. Negotiated Rate	$83.60
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$104.50
Rate for Payer: Aetna New Business (MI Preferred)	$135.85
Rate for Payer: BCBS Complete	$83.60
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cofinity Commercial	$146.30
Rate for Payer: Cofinity Commercial	$179.74
Rate for Payer: Cofinity Medicare Advantage	$146.30
Rate for Payer: Encore Health Key Benefits Commercial	$167.20
Rate for Payer: Healthscope Commercial	$188.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$177.65
Rate for Payer: PHP Commercial	$177.65
Rate for Payer: Priority Health Cigna Priority Health	$135.85
Rate for Payer: Priority Health SBD	$131.67

PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION

Facility

$130.02

Service Code	HCPCS J2560
Hospital Charge Code	6221
Hospital Revenue Code	636
Min. Negotiated Rate	$81.91
Max. Negotiated Rate	$117.02
Rate for Payer: Aetna Commercial	$110.52
Rate for Payer: Aetna Commercial	$154.94
Rate for Payer: Aetna New Business (MI Preferred)	$84.51
Rate for Payer: Aetna New Business (MI Preferred)	$118.48
Rate for Payer: Cash Price	$104.02
Rate for Payer: Cash Price	$145.82
Rate for Payer: Cofinity Commercial	$111.82
Rate for Payer: Cofinity Commercial	$127.60
Rate for Payer: Cofinity Commercial	$156.76
Rate for Payer: Cofinity Commercial	$91.01
Rate for Payer: Cofinity Medicare Advantage	$127.60
Rate for Payer: Cofinity Medicare Advantage	$91.01
Rate for Payer: Encore Health Key Benefits Commercial	$104.02
Rate for Payer: Encore Health Key Benefits Commercial	$145.82
Rate for Payer: Healthscope Commercial	$117.02
Rate for Payer: Healthscope Commercial	$164.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.94
Rate for Payer: PHP Commercial	$110.52
Rate for Payer: PHP Commercial	$154.94
Rate for Payer: Priority Health Cigna Priority Health	$118.48
Rate for Payer: Priority Health Cigna Priority Health	$84.51
Rate for Payer: Priority Health SBD	$114.84
Rate for Payer: Priority Health SBD	$81.91

PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION

Facility

$130.02

Service Code	HCPCS J2560
Hospital Charge Code	6221
Hospital Revenue Code	636
Min. Negotiated Rate	$52.01
Max. Negotiated Rate	$117.02
Rate for Payer: Aetna Commercial	$110.52
Rate for Payer: Aetna Commercial	$154.94
Rate for Payer: Aetna Medicare	$91.14
Rate for Payer: Aetna Medicare	$65.01
Rate for Payer: Aetna New Business (MI Preferred)	$84.51
Rate for Payer: Aetna New Business (MI Preferred)	$118.48
Rate for Payer: BCBS Complete	$72.91
Rate for Payer: BCBS Complete	$52.01
Rate for Payer: BCBS Trust/PPO	$88.64
Rate for Payer: BCBS Trust/PPO	$88.64
Rate for Payer: BCN Commercial	$88.64
Rate for Payer: BCN Commercial	$88.64
Rate for Payer: Cash Price	$145.82
Rate for Payer: Cash Price	$104.02
Rate for Payer: Cash Price	$104.02
Rate for Payer: Cash Price	$145.82
Rate for Payer: Cofinity Commercial	$91.01
Rate for Payer: Cofinity Commercial	$111.82
Rate for Payer: Cofinity Commercial	$127.60
Rate for Payer: Cofinity Commercial	$156.76
Rate for Payer: Cofinity Medicare Advantage	$91.01
Rate for Payer: Cofinity Medicare Advantage	$127.60
Rate for Payer: Encore Health Key Benefits Commercial	$104.02
Rate for Payer: Encore Health Key Benefits Commercial	$145.82
Rate for Payer: Healthscope Commercial	$164.05
Rate for Payer: Healthscope Commercial	$117.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.52
Rate for Payer: PHP Commercial	$154.94
Rate for Payer: PHP Commercial	$110.52
Rate for Payer: Priority Health Cigna Priority Health	$118.48
Rate for Payer: Priority Health Cigna Priority Health	$84.51
Rate for Payer: Priority Health SBD	$114.84
Rate for Payer: Priority Health SBD	$81.91

PHENOL 1.4 % MUCOSAL AEROSOL SPRAY

Facility

$9.56

Service Code	NDC 96295013644
Hospital Charge Code	27889
Hospital Revenue Code	637
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$8.60
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna New Business (MI Preferred)	$6.21
Rate for Payer: Cash Price	$7.65
Rate for Payer: Cofinity Commercial	$6.69
Rate for Payer: Cofinity Commercial	$8.22
Rate for Payer: Cofinity Medicare Advantage	$6.69
Rate for Payer: Encore Health Key Benefits Commercial	$7.65
Rate for Payer: Healthscope Commercial	$8.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.13
Rate for Payer: PHP Commercial	$8.13
Rate for Payer: Priority Health Cigna Priority Health	$6.21
Rate for Payer: Priority Health SBD	$6.02

PHENOL 1.4 % MUCOSAL AEROSOL SPRAY

Facility

$10.62

Service Code	NDC 70000045801
Hospital Charge Code	27889
Hospital Revenue Code	637
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$9.56
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna New Business (MI Preferred)	$6.90
Rate for Payer: Cash Price	$8.50
Rate for Payer: Cofinity Commercial	$7.43
Rate for Payer: Cofinity Commercial	$9.13
Rate for Payer: Cofinity Medicare Advantage	$7.43
Rate for Payer: Encore Health Key Benefits Commercial	$8.50
Rate for Payer: Healthscope Commercial	$9.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.03
Rate for Payer: PHP Commercial	$9.03
Rate for Payer: Priority Health Cigna Priority Health	$6.90
Rate for Payer: Priority Health SBD	$6.69

PHENOL 1.4 % MUCOSAL AEROSOL SPRAY

Facility

$25.49

Service Code	NDC 78112001103
Hospital Charge Code	27889
Hospital Revenue Code	637
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$22.94
Rate for Payer: Aetna Commercial	$21.67
Rate for Payer: Aetna Medicare	$12.74
Rate for Payer: Aetna New Business (MI Preferred)	$16.57
Rate for Payer: BCBS Complete	$10.20
Rate for Payer: Cash Price	$20.39
Rate for Payer: Cofinity Commercial	$17.84
Rate for Payer: Cofinity Commercial	$21.92
Rate for Payer: Cofinity Medicare Advantage	$17.84
Rate for Payer: Encore Health Key Benefits Commercial	$20.39
Rate for Payer: Healthscope Commercial	$22.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.67
Rate for Payer: PHP Commercial	$21.67
Rate for Payer: Priority Health Cigna Priority Health	$16.57
Rate for Payer: Priority Health SBD	$16.06

PHENOL 1.4 % MUCOSAL AEROSOL SPRAY

Facility

$25.49

Service Code	NDC 78112001103
Hospital Charge Code	27889
Hospital Revenue Code	637
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$22.94
Rate for Payer: Aetna Commercial	$21.67
Rate for Payer: Aetna New Business (MI Preferred)	$16.57
Rate for Payer: Cash Price	$20.39
Rate for Payer: Cofinity Commercial	$17.84
Rate for Payer: Cofinity Commercial	$21.92
Rate for Payer: Cofinity Medicare Advantage	$17.84
Rate for Payer: Encore Health Key Benefits Commercial	$20.39
Rate for Payer: Healthscope Commercial	$22.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.67
Rate for Payer: PHP Commercial	$21.67
Rate for Payer: Priority Health Cigna Priority Health	$16.57
Rate for Payer: Priority Health SBD	$16.06

PHENOL 1.4 % MUCOSAL AEROSOL SPRAY

Facility

$10.62

Service Code	NDC 70000045801
Hospital Charge Code	27889
Hospital Revenue Code	637
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$9.56
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare	$5.31
Rate for Payer: Aetna New Business (MI Preferred)	$6.90
Rate for Payer: BCBS Complete	$4.25
Rate for Payer: Cash Price	$8.50
Rate for Payer: Cofinity Commercial	$7.43
Rate for Payer: Cofinity Commercial	$9.13
Rate for Payer: Cofinity Medicare Advantage	$7.43
Rate for Payer: Encore Health Key Benefits Commercial	$8.50
Rate for Payer: Healthscope Commercial	$9.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.03
Rate for Payer: PHP Commercial	$9.03
Rate for Payer: Priority Health Cigna Priority Health	$6.90
Rate for Payer: Priority Health SBD	$6.69

PHENOL 1.4 % MUCOSAL AEROSOL SPRAY

Facility

$9.56

Service Code	NDC 96295013644
Hospital Charge Code	27889
Hospital Revenue Code	637
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$8.60
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna Medicare	$4.78
Rate for Payer: Aetna New Business (MI Preferred)	$6.21
Rate for Payer: BCBS Complete	$3.82
Rate for Payer: Cash Price	$7.65
Rate for Payer: Cofinity Commercial	$6.69
Rate for Payer: Cofinity Commercial	$8.22
Rate for Payer: Cofinity Medicare Advantage	$6.69
Rate for Payer: Encore Health Key Benefits Commercial	$7.65
Rate for Payer: Healthscope Commercial	$8.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.13
Rate for Payer: PHP Commercial	$8.13
Rate for Payer: Priority Health Cigna Priority Health	$6.21
Rate for Payer: Priority Health SBD	$6.02

PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM

Facility

$309.10

Service Code	NDC 09900001943
Hospital Charge Code	150967
Hospital Revenue Code	250
Min. Negotiated Rate	$194.73
Max. Negotiated Rate	$278.19
Rate for Payer: Aetna Commercial	$262.74
Rate for Payer: Aetna New Business (MI Preferred)	$200.92
Rate for Payer: Cash Price	$247.28
Rate for Payer: Cofinity Commercial	$216.37
Rate for Payer: Cofinity Commercial	$265.83
Rate for Payer: Cofinity Medicare Advantage	$216.37
Rate for Payer: Encore Health Key Benefits Commercial	$247.28
Rate for Payer: Healthscope Commercial	$278.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$262.74
Rate for Payer: PHP Commercial	$262.74
Rate for Payer: Priority Health Cigna Priority Health	$200.92
Rate for Payer: Priority Health SBD	$194.73

PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM

Facility

$309.10

Service Code	NDC 09900001943
Hospital Charge Code	150967
Hospital Revenue Code	250
Min. Negotiated Rate	$123.64
Max. Negotiated Rate	$278.19
Rate for Payer: Aetna Commercial	$262.74
Rate for Payer: Aetna Medicare	$154.55
Rate for Payer: Aetna New Business (MI Preferred)	$200.92
Rate for Payer: BCBS Complete	$123.64
Rate for Payer: Cash Price	$247.28
Rate for Payer: Cofinity Commercial	$216.37
Rate for Payer: Cofinity Commercial	$265.83
Rate for Payer: Cofinity Medicare Advantage	$216.37
Rate for Payer: Encore Health Key Benefits Commercial	$247.28
Rate for Payer: Healthscope Commercial	$278.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$262.74
Rate for Payer: PHP Commercial	$262.74
Rate for Payer: Priority Health Cigna Priority Health	$200.92
Rate for Payer: Priority Health SBD	$194.73

PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM

Facility

$618.20

Service Code	NDC 09900001944
Hospital Charge Code	301530
Hospital Revenue Code	250
Min. Negotiated Rate	$389.47
Max. Negotiated Rate	$556.38
Rate for Payer: Aetna Commercial	$525.47
Rate for Payer: Aetna New Business (MI Preferred)	$401.83
Rate for Payer: Cash Price	$494.56
Rate for Payer: Cofinity Commercial	$432.74
Rate for Payer: Cofinity Commercial	$531.65
Rate for Payer: Cofinity Medicare Advantage	$432.74
Rate for Payer: Encore Health Key Benefits Commercial	$494.56
Rate for Payer: Healthscope Commercial	$556.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$525.47
Rate for Payer: PHP Commercial	$525.47
Rate for Payer: Priority Health Cigna Priority Health	$401.83
Rate for Payer: Priority Health SBD	$389.47

PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM

Facility

$1,671.75

Service Code	NDC 09900001945
Hospital Charge Code	301530
Hospital Revenue Code	250
Min. Negotiated Rate	$1,053.20
Max. Negotiated Rate	$1,504.58
Rate for Payer: Aetna Commercial	$1,420.99
Rate for Payer: Aetna New Business (MI Preferred)	$1,086.64
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: Cofinity Commercial	$1,170.22
Rate for Payer: Cofinity Commercial	$1,437.70
Rate for Payer: Cofinity Medicare Advantage	$1,170.22
Rate for Payer: Encore Health Key Benefits Commercial	$1,337.40
Rate for Payer: Healthscope Commercial	$1,504.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,420.99
Rate for Payer: PHP Commercial	$1,420.99
Rate for Payer: Priority Health Cigna Priority Health	$1,086.64
Rate for Payer: Priority Health SBD	$1,053.20

PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM

Facility

$618.20

Service Code	NDC 09900001944
Hospital Charge Code	301530
Hospital Revenue Code	250
Min. Negotiated Rate	$247.28
Max. Negotiated Rate	$556.38
Rate for Payer: Aetna Commercial	$525.47
Rate for Payer: Aetna Medicare	$309.10
Rate for Payer: Aetna New Business (MI Preferred)	$401.83
Rate for Payer: BCBS Complete	$247.28
Rate for Payer: Cash Price	$494.56
Rate for Payer: Cofinity Commercial	$432.74
Rate for Payer: Cofinity Commercial	$531.65
Rate for Payer: Cofinity Medicare Advantage	$432.74
Rate for Payer: Encore Health Key Benefits Commercial	$494.56
Rate for Payer: Healthscope Commercial	$556.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$525.47
Rate for Payer: PHP Commercial	$525.47
Rate for Payer: Priority Health Cigna Priority Health	$401.83
Rate for Payer: Priority Health SBD	$389.47

PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM

Facility

$1,671.75

Service Code	NDC 09900001945
Hospital Charge Code	301530
Hospital Revenue Code	250
Min. Negotiated Rate	$668.70
Max. Negotiated Rate	$1,504.58
Rate for Payer: Aetna Commercial	$1,420.99
Rate for Payer: Aetna Medicare	$835.88
Rate for Payer: Aetna New Business (MI Preferred)	$1,086.64
Rate for Payer: BCBS Complete	$668.70
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: Cofinity Commercial	$1,170.22
Rate for Payer: Cofinity Commercial	$1,437.70
Rate for Payer: Cofinity Medicare Advantage	$1,170.22
Rate for Payer: Encore Health Key Benefits Commercial	$1,337.40
Rate for Payer: Healthscope Commercial	$1,504.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,420.99
Rate for Payer: PHP Commercial	$1,420.99
Rate for Payer: Priority Health Cigna Priority Health	$1,086.64
Rate for Payer: Priority Health SBD	$1,053.20

PHENTOLAMINE 5 MG INJECTION SOLUTION

Facility

$1,385.25

Service Code	HCPCS J2760
Hospital Charge Code	10947
Hospital Revenue Code	636
Min. Negotiated Rate	$211.52
Max. Negotiated Rate	$1,246.72
Rate for Payer: Aetna Commercial	$1,177.46
Rate for Payer: Aetna Medicare	$410.42
Rate for Payer: Aetna New Business (MI Preferred)	$900.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$493.29
Rate for Payer: Amish Plain Church Group Commercial	$493.29
Rate for Payer: BCBS Complete	$222.10
Rate for Payer: BCBS MAPPO	$394.63
Rate for Payer: BCBS Trust/PPO	$1,037.03
Rate for Payer: BCN Commercial	$1,037.03
Rate for Payer: BCN Medicare Advantage	$394.63
Rate for Payer: Cash Price	$1,108.20
Rate for Payer: Cash Price	$1,108.20
Rate for Payer: Cofinity Commercial	$1,191.32
Rate for Payer: Cofinity Commercial	$969.68
Rate for Payer: Cofinity Medicare Advantage	$969.68
Rate for Payer: Encore Health Key Benefits Commercial	$1,108.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$394.63
Rate for Payer: Healthscope Commercial	$1,246.72
Rate for Payer: Mclaren Medicaid	$211.52
Rate for Payer: Mclaren Medicare	$394.63
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$414.36
Rate for Payer: Meridian Medicaid	$222.10
Rate for Payer: MI Amish Medical Board Commercial	$453.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,177.46
Rate for Payer: Nomi Health Commercial	$1,183.89
Rate for Payer: PACE Medicare	$374.90
Rate for Payer: PACE SWMI	$394.63
Rate for Payer: PHP Commercial	$1,177.46
Rate for Payer: PHP Medicare Advantage	$394.63
Rate for Payer: Priority Health Choice Medicaid	$211.52
Rate for Payer: Priority Health Cigna Priority Health	$900.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,056.57
Rate for Payer: Priority Health Medicare	$394.63
Rate for Payer: Priority Health Narrow Network	$845.26
Rate for Payer: Priority Health SBD	$872.71
Rate for Payer: Railroad Medicare Medicare	$394.63
Rate for Payer: UHC All Payor (Choice/PPO)	$1,110.84
Rate for Payer: UHC Dual Complete DSNP	$394.63
Rate for Payer: UHC Medicare Advantage	$394.63
Rate for Payer: UHCCP Medicaid	$222.18
Rate for Payer: VA VA	$394.63

PHENTOLAMINE 5 MG INJECTION SOLUTION

Facility

$1,385.25

Service Code	HCPCS J2760
Hospital Charge Code	10947
Hospital Revenue Code	636
Min. Negotiated Rate	$872.71
Max. Negotiated Rate	$1,246.72
Rate for Payer: Aetna Commercial	$1,177.46
Rate for Payer: Aetna New Business (MI Preferred)	$900.41
Rate for Payer: Cash Price	$1,108.20
Rate for Payer: Cofinity Commercial	$1,191.32
Rate for Payer: Cofinity Commercial	$969.68
Rate for Payer: Cofinity Medicare Advantage	$969.68
Rate for Payer: Encore Health Key Benefits Commercial	$1,108.20
Rate for Payer: Healthscope Commercial	$1,246.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,177.46
Rate for Payer: PHP Commercial	$1,177.46
Rate for Payer: Priority Health Cigna Priority Health	$900.41
Rate for Payer: Priority Health SBD	$872.71

PHENYLEPHRINE 0.25 %-PRAMOXINE 1 %-GLYCERIN-WH.PETROLATUM RECTAL CREAM

Facility

$25.94

Service Code	NDC 00573286893
Hospital Charge Code	77868
Hospital Revenue Code	637
Min. Negotiated Rate	$16.34
Max. Negotiated Rate	$23.35
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna New Business (MI Preferred)	$16.86
Rate for Payer: Cash Price	$20.75
Rate for Payer: Cofinity Commercial	$18.16
Rate for Payer: Cofinity Commercial	$22.31
Rate for Payer: Cofinity Medicare Advantage	$18.16
Rate for Payer: Encore Health Key Benefits Commercial	$20.75
Rate for Payer: Healthscope Commercial	$23.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.05
Rate for Payer: PHP Commercial	$22.05
Rate for Payer: Priority Health Cigna Priority Health	$16.86
Rate for Payer: Priority Health SBD	$16.34

PHENYLEPHRINE 0.25 %-PRAMOXINE 1 %-GLYCERIN-WH.PETROLATUM RECTAL CREAM

Facility

$25.94

Service Code	NDC 00573286893
Hospital Charge Code	77868
Hospital Revenue Code	637
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$23.35
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna Medicare	$12.97
Rate for Payer: Aetna New Business (MI Preferred)	$16.86
Rate for Payer: BCBS Complete	$10.38
Rate for Payer: Cash Price	$20.75
Rate for Payer: Cofinity Commercial	$18.16
Rate for Payer: Cofinity Commercial	$22.31
Rate for Payer: Cofinity Medicare Advantage	$18.16
Rate for Payer: Encore Health Key Benefits Commercial	$20.75
Rate for Payer: Healthscope Commercial	$23.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.05
Rate for Payer: PHP Commercial	$22.05
Rate for Payer: Priority Health Cigna Priority Health	$16.86
Rate for Payer: Priority Health SBD	$16.34

PHENYLEPHRINE 0.5 % NASAL SPRAY

Facility

$19.78

Service Code	NDC 00225080547
Hospital Charge Code	6244
Hospital Revenue Code	637
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$16.81
Rate for Payer: Aetna Medicare	$9.89
Rate for Payer: Aetna New Business (MI Preferred)	$12.86
Rate for Payer: BCBS Complete	$7.91
Rate for Payer: Cash Price	$15.82
Rate for Payer: Cofinity Commercial	$13.85
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Cofinity Medicare Advantage	$13.85
Rate for Payer: Encore Health Key Benefits Commercial	$15.82
Rate for Payer: Healthscope Commercial	$17.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.81
Rate for Payer: PHP Commercial	$16.81
Rate for Payer: Priority Health Cigna Priority Health	$12.86
Rate for Payer: Priority Health SBD	$12.46

PHENYLEPHRINE 0.5 % NASAL SPRAY

Facility

$19.78

Service Code	NDC 00225080547
Hospital Charge Code	6244
Hospital Revenue Code	637
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$16.81
Rate for Payer: Aetna New Business (MI Preferred)	$12.86
Rate for Payer: Cash Price	$15.82
Rate for Payer: Cofinity Commercial	$13.85
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Cofinity Medicare Advantage	$13.85
Rate for Payer: Encore Health Key Benefits Commercial	$15.82
Rate for Payer: Healthscope Commercial	$17.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.81
Rate for Payer: PHP Commercial	$16.81
Rate for Payer: Priority Health Cigna Priority Health	$12.86
Rate for Payer: Priority Health SBD	$12.46

PHENYLEPHRINE 10 MG IN NS 200 ML

Facility

$35.00

Service Code	NDC 99000000209
Hospital Charge Code	155016
Hospital Revenue Code	250
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Cofinity Medicare Advantage	$24.50
Rate for Payer: Encore Health Key Benefits Commercial	$28.00
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.75
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$22.75
Rate for Payer: Priority Health SBD	$22.05

PHENYLEPHRINE 10 MG IN NS 200 ML

Facility

$35.00

Service Code	NDC 99000000209
Hospital Charge Code	155016
Hospital Revenue Code	250
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Cofinity Medicare Advantage	$24.50
Rate for Payer: Encore Health Key Benefits Commercial	$28.00
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.75
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$22.75
Rate for Payer: Priority Health SBD	$22.05

Know your out-of-pocket cost for care.

All Charges