Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PILOCARPINE 1 % EYE DROPS

Facility

$138.87

Service Code	NDC 61314020315
Hospital Charge Code	6279
Hospital Revenue Code	637
Min. Negotiated Rate	$87.49
Max. Negotiated Rate	$124.98
Rate for Payer: Aetna Commercial	$118.04
Rate for Payer: Aetna New Business (MI Preferred)	$90.27
Rate for Payer: Cash Price	$111.10
Rate for Payer: Cofinity Advantage	$97.21
Rate for Payer: Cofinity Commercial	$119.43
Rate for Payer: Encore Health Key Benefits Commercial	$111.10
Rate for Payer: Healthscope Commercial	$124.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.15
Rate for Payer: PHP Commercial	$118.04
Rate for Payer: Priority Health SBD	$87.49

PILOCARPINE 2 % EYE DROPS

Facility

$209.95

Service Code	NDC 69238174608
Hospital Charge Code	6280
Hospital Revenue Code	637
Min. Negotiated Rate	$132.27
Max. Negotiated Rate	$188.96
Rate for Payer: Aetna Commercial	$178.46
Rate for Payer: Aetna New Business (MI Preferred)	$136.47
Rate for Payer: Cash Price	$167.96
Rate for Payer: Cofinity Advantage	$146.97
Rate for Payer: Cofinity Commercial	$180.56
Rate for Payer: Encore Health Key Benefits Commercial	$167.96
Rate for Payer: Healthscope Commercial	$188.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$178.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.46
Rate for Payer: PHP Commercial	$178.46
Rate for Payer: Priority Health SBD	$132.27

PILOCARPINE 2 % EYE DROPS

Facility

$130.68

Service Code	NDC 61314020415
Hospital Charge Code	6280
Hospital Revenue Code	637
Min. Negotiated Rate	$51.36
Max. Negotiated Rate	$117.61
Rate for Payer: Aetna Commercial	$111.08
Rate for Payer: Aetna Medicare	$65.34
Rate for Payer: Aetna New Business (MI Preferred)	$84.94
Rate for Payer: BCBS Complete	$52.27
Rate for Payer: Cash Price	$104.54
Rate for Payer: Cofinity Advantage	$91.48
Rate for Payer: Cofinity Commercial	$112.38
Rate for Payer: Encore Health Key Benefits Commercial	$104.54
Rate for Payer: Healthscope Commercial	$117.61
Rate for Payer: MI Amish Medical Board Commercial	$104.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$98.01
Rate for Payer: PHP Commercial	$111.08
Rate for Payer: Priority Health SBD	$82.33
Rate for Payer: UHC All Payor (Choice/PPO)	$84.94
Rate for Payer: UHC Core	$68.08
Rate for Payer: UHC Exchange	$51.36

PILOCARPINE 2 % EYE DROPS

Facility

$130.68

Service Code	NDC 61314020415
Hospital Charge Code	6280
Hospital Revenue Code	637
Min. Negotiated Rate	$82.33
Max. Negotiated Rate	$117.61
Rate for Payer: Aetna Commercial	$111.08
Rate for Payer: Aetna New Business (MI Preferred)	$84.94
Rate for Payer: Cash Price	$104.54
Rate for Payer: Cofinity Advantage	$91.48
Rate for Payer: Cofinity Commercial	$112.38
Rate for Payer: Encore Health Key Benefits Commercial	$104.54
Rate for Payer: Healthscope Commercial	$117.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$98.01
Rate for Payer: PHP Commercial	$111.08
Rate for Payer: Priority Health SBD	$82.33

PILOCARPINE 2 % EYE DROPS

Facility

$209.95

Service Code	NDC 69238174608
Hospital Charge Code	6280
Hospital Revenue Code	637
Min. Negotiated Rate	$82.51
Max. Negotiated Rate	$188.96
Rate for Payer: Aetna Commercial	$178.46
Rate for Payer: Aetna Medicare	$104.97
Rate for Payer: Aetna New Business (MI Preferred)	$136.47
Rate for Payer: BCBS Complete	$83.98
Rate for Payer: Cash Price	$167.96
Rate for Payer: Cofinity Advantage	$146.97
Rate for Payer: Cofinity Commercial	$180.56
Rate for Payer: Encore Health Key Benefits Commercial	$167.96
Rate for Payer: Healthscope Commercial	$188.96
Rate for Payer: MI Amish Medical Board Commercial	$167.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$178.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.46
Rate for Payer: PHP Commercial	$178.46
Rate for Payer: Priority Health SBD	$132.27
Rate for Payer: UHC All Payor (Choice/PPO)	$136.47
Rate for Payer: UHC Core	$109.38
Rate for Payer: UHC Exchange	$82.51

PIMAVANSERIN 34 MG CAPSULE

Facility

$18,481.50

Service Code	NDC 63090034030
Hospital Charge Code	187560
Hospital Revenue Code	637
Min. Negotiated Rate	$7,263.23
Max. Negotiated Rate	$16,633.35
Rate for Payer: Aetna Commercial	$15,709.27
Rate for Payer: Aetna Medicare	$9,240.75
Rate for Payer: Aetna New Business (MI Preferred)	$12,012.98
Rate for Payer: BCBS Complete	$7,392.60
Rate for Payer: Cash Price	$14,785.20
Rate for Payer: Cofinity Advantage	$12,937.05
Rate for Payer: Cofinity Commercial	$15,894.09
Rate for Payer: Encore Health Key Benefits Commercial	$14,785.20
Rate for Payer: Healthscope Commercial	$16,633.35
Rate for Payer: MI Amish Medical Board Commercial	$14,785.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15,709.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$13,861.12
Rate for Payer: PHP Commercial	$15,709.27
Rate for Payer: Priority Health SBD	$11,643.34
Rate for Payer: UHC All Payor (Choice/PPO)	$12,012.98
Rate for Payer: UHC Core	$9,628.86
Rate for Payer: UHC Exchange	$7,263.23

PIMAVANSERIN 34 MG CAPSULE

Facility

$18,481.50

Service Code	NDC 63090034030
Hospital Charge Code	187560
Hospital Revenue Code	637
Min. Negotiated Rate	$11,643.34
Max. Negotiated Rate	$16,633.35
Rate for Payer: Aetna Commercial	$15,709.27
Rate for Payer: Aetna New Business (MI Preferred)	$12,012.98
Rate for Payer: Cash Price	$14,785.20
Rate for Payer: Cofinity Advantage	$12,937.05
Rate for Payer: Cofinity Commercial	$15,894.09
Rate for Payer: Encore Health Key Benefits Commercial	$14,785.20
Rate for Payer: Healthscope Commercial	$16,633.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15,709.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$13,861.12
Rate for Payer: PHP Commercial	$15,709.27
Rate for Payer: Priority Health SBD	$11,643.34

PIOGLITAZONE 15 MG TABLET

Facility

$264.38

Service Code	NDC 16729002015
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$166.56
Max. Negotiated Rate	$237.94
Rate for Payer: Aetna Commercial	$224.72
Rate for Payer: Aetna New Business (MI Preferred)	$171.85
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cofinity Advantage	$185.07
Rate for Payer: Cofinity Commercial	$227.37
Rate for Payer: Encore Health Key Benefits Commercial	$211.50
Rate for Payer: Healthscope Commercial	$237.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$224.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$198.28
Rate for Payer: PHP Commercial	$224.72
Rate for Payer: Priority Health SBD	$166.56

PIOGLITAZONE 15 MG TABLET

Facility

$4.96

Service Code	NDC 60687039111
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$4.46
Rate for Payer: Aetna Commercial	$4.22
Rate for Payer: Aetna Medicare	$2.48
Rate for Payer: Aetna New Business (MI Preferred)	$3.22
Rate for Payer: BCBS Complete	$1.98
Rate for Payer: Cash Price	$3.97
Rate for Payer: Cofinity Advantage	$3.47
Rate for Payer: Cofinity Commercial	$4.27
Rate for Payer: Encore Health Key Benefits Commercial	$3.97
Rate for Payer: Healthscope Commercial	$4.46
Rate for Payer: MI Amish Medical Board Commercial	$3.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.72
Rate for Payer: PHP Commercial	$4.22
Rate for Payer: Priority Health SBD	$3.12
Rate for Payer: UHC All Payor (Choice/PPO)	$3.22
Rate for Payer: UHC Core	$2.58
Rate for Payer: UHC Exchange	$1.95

PIOGLITAZONE 15 MG TABLET

Facility

$1,337.11

Service Code	NDC 64764015104
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$842.38
Max. Negotiated Rate	$1,203.40
Rate for Payer: Aetna Commercial	$1,136.54
Rate for Payer: Aetna New Business (MI Preferred)	$869.12
Rate for Payer: Cash Price	$1,069.69
Rate for Payer: Cofinity Advantage	$935.98
Rate for Payer: Cofinity Commercial	$1,149.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,069.69
Rate for Payer: Healthscope Commercial	$1,203.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,136.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,002.83
Rate for Payer: PHP Commercial	$1,136.54
Rate for Payer: Priority Health SBD	$842.38

PIOGLITAZONE 15 MG TABLET

Facility

$495.36

Service Code	NDC 60687039101
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$312.08
Max. Negotiated Rate	$445.82
Rate for Payer: Aetna Commercial	$421.06
Rate for Payer: Aetna New Business (MI Preferred)	$321.98
Rate for Payer: Cash Price	$396.29
Rate for Payer: Cofinity Advantage	$346.75
Rate for Payer: Cofinity Commercial	$426.01
Rate for Payer: Encore Health Key Benefits Commercial	$396.29
Rate for Payer: Healthscope Commercial	$445.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$421.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$371.52
Rate for Payer: PHP Commercial	$421.06
Rate for Payer: Priority Health SBD	$312.08

PIOGLITAZONE 15 MG TABLET

Facility

$264.38

Service Code	NDC 16729002015
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$103.90
Max. Negotiated Rate	$237.94
Rate for Payer: Aetna Commercial	$224.72
Rate for Payer: Aetna Medicare	$132.19
Rate for Payer: Aetna New Business (MI Preferred)	$171.85
Rate for Payer: BCBS Complete	$105.75
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cofinity Advantage	$185.07
Rate for Payer: Cofinity Commercial	$227.37
Rate for Payer: Encore Health Key Benefits Commercial	$211.50
Rate for Payer: Healthscope Commercial	$237.94
Rate for Payer: MI Amish Medical Board Commercial	$211.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$224.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$198.28
Rate for Payer: PHP Commercial	$224.72
Rate for Payer: Priority Health SBD	$166.56
Rate for Payer: UHC All Payor (Choice/PPO)	$171.85
Rate for Payer: UHC Core	$137.74
Rate for Payer: UHC Exchange	$103.90

PIOGLITAZONE 15 MG TABLET

Facility

$542.88

Service Code	NDC 51079051320
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$213.35
Max. Negotiated Rate	$488.59
Rate for Payer: Aetna Commercial	$461.45
Rate for Payer: Aetna Medicare	$271.44
Rate for Payer: Aetna New Business (MI Preferred)	$352.87
Rate for Payer: BCBS Complete	$217.15
Rate for Payer: Cash Price	$434.30
Rate for Payer: Cofinity Advantage	$380.02
Rate for Payer: Cofinity Commercial	$466.88
Rate for Payer: Encore Health Key Benefits Commercial	$434.30
Rate for Payer: Healthscope Commercial	$488.59
Rate for Payer: MI Amish Medical Board Commercial	$434.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$461.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$407.16
Rate for Payer: PHP Commercial	$461.45
Rate for Payer: Priority Health SBD	$342.01
Rate for Payer: UHC All Payor (Choice/PPO)	$352.87
Rate for Payer: UHC Core	$282.84
Rate for Payer: UHC Exchange	$213.35

PIOGLITAZONE 15 MG TABLET

Facility

$495.36

Service Code	NDC 60687039101
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$194.68
Max. Negotiated Rate	$445.82
Rate for Payer: Aetna Commercial	$421.06
Rate for Payer: Aetna Medicare	$247.68
Rate for Payer: Aetna New Business (MI Preferred)	$321.98
Rate for Payer: BCBS Complete	$198.14
Rate for Payer: Cash Price	$396.29
Rate for Payer: Cofinity Advantage	$346.75
Rate for Payer: Cofinity Commercial	$426.01
Rate for Payer: Encore Health Key Benefits Commercial	$396.29
Rate for Payer: Healthscope Commercial	$445.82
Rate for Payer: MI Amish Medical Board Commercial	$396.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$421.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$371.52
Rate for Payer: PHP Commercial	$421.06
Rate for Payer: Priority Health SBD	$312.08
Rate for Payer: UHC All Payor (Choice/PPO)	$321.98
Rate for Payer: UHC Core	$258.08
Rate for Payer: UHC Exchange	$194.68

PIOGLITAZONE 15 MG TABLET

Facility

$542.88

Service Code	NDC 51079051320
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$342.01
Max. Negotiated Rate	$488.59
Rate for Payer: Aetna Commercial	$461.45
Rate for Payer: Aetna New Business (MI Preferred)	$352.87
Rate for Payer: Cash Price	$434.30
Rate for Payer: Cofinity Advantage	$380.02
Rate for Payer: Cofinity Commercial	$466.88
Rate for Payer: Encore Health Key Benefits Commercial	$434.30
Rate for Payer: Healthscope Commercial	$488.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$461.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$407.16
Rate for Payer: PHP Commercial	$461.45
Rate for Payer: Priority Health SBD	$342.01

PIOGLITAZONE 15 MG TABLET

Facility

$74.39

Service Code	NDC 00093727156
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$46.87
Max. Negotiated Rate	$66.95
Rate for Payer: Aetna Commercial	$63.23
Rate for Payer: Aetna New Business (MI Preferred)	$48.35
Rate for Payer: Cash Price	$59.51
Rate for Payer: Cofinity Advantage	$52.07
Rate for Payer: Cofinity Commercial	$63.98
Rate for Payer: Encore Health Key Benefits Commercial	$59.51
Rate for Payer: Healthscope Commercial	$66.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.79
Rate for Payer: PHP Commercial	$63.23
Rate for Payer: Priority Health SBD	$46.87

PIOGLITAZONE 15 MG TABLET

Facility

$1,337.11

Service Code	NDC 64764015104
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$525.48
Max. Negotiated Rate	$1,203.40
Rate for Payer: Aetna Commercial	$1,136.54
Rate for Payer: Aetna Medicare	$668.55
Rate for Payer: Aetna New Business (MI Preferred)	$869.12
Rate for Payer: BCBS Complete	$534.84
Rate for Payer: Cash Price	$1,069.69
Rate for Payer: Cofinity Advantage	$935.98
Rate for Payer: Cofinity Commercial	$1,149.91
Rate for Payer: Encore Health Key Benefits Commercial	$1,069.69
Rate for Payer: Healthscope Commercial	$1,203.40
Rate for Payer: MI Amish Medical Board Commercial	$1,069.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,136.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,002.83
Rate for Payer: PHP Commercial	$1,136.54
Rate for Payer: Priority Health SBD	$842.38
Rate for Payer: UHC All Payor (Choice/PPO)	$869.12
Rate for Payer: UHC Core	$696.63
Rate for Payer: UHC Exchange	$525.48

PIOGLITAZONE 15 MG TABLET

Facility

$5.43

Service Code	NDC 51079051301
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$4.89
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna New Business (MI Preferred)	$3.53
Rate for Payer: Cash Price	$4.34
Rate for Payer: Cofinity Advantage	$3.80
Rate for Payer: Cofinity Commercial	$4.67
Rate for Payer: Encore Health Key Benefits Commercial	$4.34
Rate for Payer: Healthscope Commercial	$4.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.07
Rate for Payer: PHP Commercial	$4.62
Rate for Payer: Priority Health SBD	$3.42

PIOGLITAZONE 15 MG TABLET

Facility

$450.24

Service Code	NDC 00904709061
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$176.94
Max. Negotiated Rate	$405.22
Rate for Payer: Aetna Commercial	$382.70
Rate for Payer: Aetna Medicare	$225.12
Rate for Payer: Aetna New Business (MI Preferred)	$292.66
Rate for Payer: BCBS Complete	$180.10
Rate for Payer: Cash Price	$360.19
Rate for Payer: Cofinity Advantage	$315.17
Rate for Payer: Cofinity Commercial	$387.21
Rate for Payer: Encore Health Key Benefits Commercial	$360.19
Rate for Payer: Healthscope Commercial	$405.22
Rate for Payer: MI Amish Medical Board Commercial	$360.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$382.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$337.68
Rate for Payer: PHP Commercial	$382.70
Rate for Payer: Priority Health SBD	$283.65
Rate for Payer: UHC All Payor (Choice/PPO)	$292.66
Rate for Payer: UHC Core	$234.58
Rate for Payer: UHC Exchange	$176.94

PIOGLITAZONE 15 MG TABLET

Facility

$450.24

Service Code	NDC 00904709061
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$283.65
Max. Negotiated Rate	$405.22
Rate for Payer: Aetna Commercial	$382.70
Rate for Payer: Aetna New Business (MI Preferred)	$292.66
Rate for Payer: Cash Price	$360.19
Rate for Payer: Cofinity Advantage	$315.17
Rate for Payer: Cofinity Commercial	$387.21
Rate for Payer: Encore Health Key Benefits Commercial	$360.19
Rate for Payer: Healthscope Commercial	$405.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$382.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$337.68
Rate for Payer: PHP Commercial	$382.70
Rate for Payer: Priority Health SBD	$283.65

PIOGLITAZONE 15 MG TABLET

Facility

$4.96

Service Code	NDC 60687039111
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$4.46
Rate for Payer: Aetna Commercial	$4.22
Rate for Payer: Aetna New Business (MI Preferred)	$3.22
Rate for Payer: Cash Price	$3.97
Rate for Payer: Cofinity Advantage	$3.47
Rate for Payer: Cofinity Commercial	$4.27
Rate for Payer: Encore Health Key Benefits Commercial	$3.97
Rate for Payer: Healthscope Commercial	$4.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.72
Rate for Payer: PHP Commercial	$4.22
Rate for Payer: Priority Health SBD	$3.12

PIOGLITAZONE 15 MG TABLET

Facility

$74.39

Service Code	NDC 00093727156
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$66.95
Rate for Payer: Aetna Commercial	$63.23
Rate for Payer: Aetna Medicare	$37.20
Rate for Payer: Aetna New Business (MI Preferred)	$48.35
Rate for Payer: BCBS Complete	$29.76
Rate for Payer: Cash Price	$59.51
Rate for Payer: Cofinity Advantage	$52.07
Rate for Payer: Cofinity Commercial	$63.98
Rate for Payer: Encore Health Key Benefits Commercial	$59.51
Rate for Payer: Healthscope Commercial	$66.95
Rate for Payer: MI Amish Medical Board Commercial	$59.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.79
Rate for Payer: PHP Commercial	$63.23
Rate for Payer: Priority Health SBD	$46.87
Rate for Payer: UHC All Payor (Choice/PPO)	$48.35
Rate for Payer: UHC Core	$38.76
Rate for Payer: UHC Exchange	$29.24

PIOGLITAZONE 15 MG TABLET

Facility

$5.43

Service Code	NDC 51079051301
Hospital Charge Code	25528
Hospital Revenue Code	637
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.89
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare	$2.71
Rate for Payer: Aetna New Business (MI Preferred)	$3.53
Rate for Payer: BCBS Complete	$2.17
Rate for Payer: Cash Price	$4.34
Rate for Payer: Cofinity Advantage	$3.80
Rate for Payer: Cofinity Commercial	$4.67
Rate for Payer: Encore Health Key Benefits Commercial	$4.34
Rate for Payer: Healthscope Commercial	$4.89
Rate for Payer: MI Amish Medical Board Commercial	$4.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.07
Rate for Payer: PHP Commercial	$4.62
Rate for Payer: Priority Health SBD	$3.42
Rate for Payer: UHC All Payor (Choice/PPO)	$3.53
Rate for Payer: UHC Core	$2.83
Rate for Payer: UHC Exchange	$2.13

PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM

Facility

$25.97

Service Code	HCPCS J2543
Hospital Charge Code	301719
Hospital Revenue Code	636
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$23.37
Rate for Payer: Aetna Commercial	$22.07
Rate for Payer: Aetna Medicare	$12.98
Rate for Payer: Aetna New Business (MI Preferred)	$16.88
Rate for Payer: BCBS Complete	$10.39
Rate for Payer: BCBS Trust/PPO	$2.73
Rate for Payer: BCN Commercial	$2.73
Rate for Payer: Cash Price	$20.78
Rate for Payer: Cash Price	$20.78
Rate for Payer: Cofinity Advantage	$18.18
Rate for Payer: Cofinity Commercial	$22.33
Rate for Payer: Encore Health Key Benefits Commercial	$20.78
Rate for Payer: Healthscope Commercial	$23.37
Rate for Payer: MI Amish Medical Board Commercial	$20.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.48
Rate for Payer: PHP Commercial	$22.07
Rate for Payer: Priority Health SBD	$16.36
Rate for Payer: UHC All Payor (Choice/PPO)	$1.80
Rate for Payer: UHC Core	$1.80
Rate for Payer: UHC Exchange	$1.80

PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS MINI-BAG PLUS COMPONENT CUSTOM

Facility

$25.97

Service Code	HCPCS J2543
Hospital Charge Code	301719
Hospital Revenue Code	636
Min. Negotiated Rate	$16.36
Max. Negotiated Rate	$23.37
Rate for Payer: Aetna Commercial	$22.07
Rate for Payer: Aetna New Business (MI Preferred)	$16.88
Rate for Payer: Cash Price	$20.78
Rate for Payer: Cofinity Advantage	$18.18
Rate for Payer: Cofinity Commercial	$22.33
Rate for Payer: Encore Health Key Benefits Commercial	$20.78
Rate for Payer: Healthscope Commercial	$23.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.48
Rate for Payer: PHP Commercial	$22.07
Rate for Payer: Priority Health SBD	$16.36

Know your out-of-pocket cost for care.

All Charges