Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY

Facility

$100.09

Service Code	NDC 00283067902
Hospital Charge Code	19696
Hospital Revenue Code	637
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$90.08
Rate for Payer: Aetna Commercial	$85.08
Rate for Payer: Aetna Medicare	$50.05
Rate for Payer: Aetna New Business (MI Preferred)	$65.06
Rate for Payer: BCBS Complete	$40.04
Rate for Payer: Cash Price	$80.07
Rate for Payer: Cofinity Commercial	$70.06
Rate for Payer: Cofinity Commercial	$86.08
Rate for Payer: Cofinity Medicare Advantage	$70.06
Rate for Payer: Encore Health Key Benefits Commercial	$80.07
Rate for Payer: Healthscope Commercial	$90.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.08
Rate for Payer: PHP Commercial	$85.08
Rate for Payer: Priority Health Cigna Priority Health	$65.06
Rate for Payer: Priority Health SBD	$63.06

BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY

Facility

$199.55

Service Code	NDC 00699310002
Hospital Charge Code	19696
Hospital Revenue Code	637
Min. Negotiated Rate	$125.72
Max. Negotiated Rate	$179.59
Rate for Payer: Aetna Commercial	$169.62
Rate for Payer: Aetna New Business (MI Preferred)	$129.71
Rate for Payer: Cash Price	$159.64
Rate for Payer: Cofinity Commercial	$139.69
Rate for Payer: Cofinity Commercial	$171.61
Rate for Payer: Cofinity Medicare Advantage	$139.69
Rate for Payer: Encore Health Key Benefits Commercial	$159.64
Rate for Payer: Healthscope Commercial	$179.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.62
Rate for Payer: PHP Commercial	$169.62
Rate for Payer: Priority Health Cigna Priority Health	$129.71
Rate for Payer: Priority Health SBD	$125.72

BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY

Facility

$129.14

Service Code	NDC 00283067960
Hospital Charge Code	19696
Hospital Revenue Code	637
Min. Negotiated Rate	$51.66
Max. Negotiated Rate	$116.23
Rate for Payer: Aetna Commercial	$109.77
Rate for Payer: Aetna Medicare	$64.57
Rate for Payer: Aetna New Business (MI Preferred)	$83.94
Rate for Payer: BCBS Complete	$51.66
Rate for Payer: Cash Price	$103.31
Rate for Payer: Cofinity Commercial	$111.06
Rate for Payer: Cofinity Commercial	$90.40
Rate for Payer: Cofinity Medicare Advantage	$90.40
Rate for Payer: Encore Health Key Benefits Commercial	$103.31
Rate for Payer: Healthscope Commercial	$116.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.77
Rate for Payer: PHP Commercial	$109.77
Rate for Payer: Priority Health Cigna Priority Health	$83.94
Rate for Payer: Priority Health SBD	$81.36

BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY

Facility

$199.55

Service Code	NDC 00699310002
Hospital Charge Code	19696
Hospital Revenue Code	637
Min. Negotiated Rate	$79.82
Max. Negotiated Rate	$179.59
Rate for Payer: Aetna Commercial	$169.62
Rate for Payer: Aetna Medicare	$99.78
Rate for Payer: Aetna New Business (MI Preferred)	$129.71
Rate for Payer: BCBS Complete	$79.82
Rate for Payer: Cash Price	$159.64
Rate for Payer: Cofinity Commercial	$139.69
Rate for Payer: Cofinity Commercial	$171.61
Rate for Payer: Cofinity Medicare Advantage	$139.69
Rate for Payer: Encore Health Key Benefits Commercial	$159.64
Rate for Payer: Healthscope Commercial	$179.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.62
Rate for Payer: PHP Commercial	$169.62
Rate for Payer: Priority Health Cigna Priority Health	$129.71
Rate for Payer: Priority Health SBD	$125.72

BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY

Facility

$129.14

Service Code	NDC 00283067960
Hospital Charge Code	19696
Hospital Revenue Code	637
Min. Negotiated Rate	$81.36
Max. Negotiated Rate	$116.23
Rate for Payer: Aetna Commercial	$109.77
Rate for Payer: Aetna New Business (MI Preferred)	$83.94
Rate for Payer: Cash Price	$103.31
Rate for Payer: Cofinity Commercial	$111.06
Rate for Payer: Cofinity Commercial	$90.40
Rate for Payer: Cofinity Medicare Advantage	$90.40
Rate for Payer: Encore Health Key Benefits Commercial	$103.31
Rate for Payer: Healthscope Commercial	$116.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.77
Rate for Payer: PHP Commercial	$109.77
Rate for Payer: Priority Health Cigna Priority Health	$83.94
Rate for Payer: Priority Health SBD	$81.36

BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY

Facility

$100.09

Service Code	NDC 00283067902
Hospital Charge Code	19696
Hospital Revenue Code	637
Min. Negotiated Rate	$63.06
Max. Negotiated Rate	$90.08
Rate for Payer: Aetna Commercial	$85.08
Rate for Payer: Aetna New Business (MI Preferred)	$65.06
Rate for Payer: Cash Price	$80.07
Rate for Payer: Cofinity Commercial	$70.06
Rate for Payer: Cofinity Commercial	$86.08
Rate for Payer: Cofinity Medicare Advantage	$70.06
Rate for Payer: Encore Health Key Benefits Commercial	$80.07
Rate for Payer: Healthscope Commercial	$90.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.08
Rate for Payer: PHP Commercial	$85.08
Rate for Payer: Priority Health Cigna Priority Health	$65.06
Rate for Payer: Priority Health SBD	$63.06

BENZOCAINE 20 % TOPICAL AEROSOL

Facility

$59.51

Service Code	NDC 63736037882
Hospital Charge Code	108881
Hospital Revenue Code	637
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$53.56
Rate for Payer: Aetna Commercial	$50.58
Rate for Payer: Aetna Medicare	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$38.68
Rate for Payer: BCBS Complete	$23.80
Rate for Payer: Cash Price	$47.61
Rate for Payer: Cofinity Commercial	$41.66
Rate for Payer: Cofinity Commercial	$51.18
Rate for Payer: Cofinity Medicare Advantage	$41.66
Rate for Payer: Encore Health Key Benefits Commercial	$47.61
Rate for Payer: Healthscope Commercial	$53.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.58
Rate for Payer: PHP Commercial	$50.58
Rate for Payer: Priority Health Cigna Priority Health	$38.68
Rate for Payer: Priority Health SBD	$37.49

BENZOCAINE 20 % TOPICAL AEROSOL

Facility

$59.51

Service Code	NDC 63736037882
Hospital Charge Code	108881
Hospital Revenue Code	637
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$53.56
Rate for Payer: Aetna Commercial	$50.58
Rate for Payer: Aetna New Business (MI Preferred)	$38.68
Rate for Payer: Cash Price	$47.61
Rate for Payer: Cofinity Commercial	$41.66
Rate for Payer: Cofinity Commercial	$51.18
Rate for Payer: Cofinity Medicare Advantage	$41.66
Rate for Payer: Encore Health Key Benefits Commercial	$47.61
Rate for Payer: Healthscope Commercial	$53.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.58
Rate for Payer: PHP Commercial	$50.58
Rate for Payer: Priority Health Cigna Priority Health	$38.68
Rate for Payer: Priority Health SBD	$37.49

BENZONATATE 100 MG CAPSULE

Facility

$302.10

Service Code	NDC 00904656461
Hospital Charge Code	988
Hospital Revenue Code	637
Min. Negotiated Rate	$190.32
Max. Negotiated Rate	$271.89
Rate for Payer: Aetna Commercial	$256.79
Rate for Payer: Aetna New Business (MI Preferred)	$196.37
Rate for Payer: Cash Price	$241.68
Rate for Payer: Cofinity Commercial	$211.47
Rate for Payer: Cofinity Commercial	$259.81
Rate for Payer: Cofinity Medicare Advantage	$211.47
Rate for Payer: Encore Health Key Benefits Commercial	$241.68
Rate for Payer: Healthscope Commercial	$271.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.79
Rate for Payer: PHP Commercial	$256.79
Rate for Payer: Priority Health Cigna Priority Health	$196.37
Rate for Payer: Priority Health SBD	$190.32

BENZONATATE 100 MG CAPSULE

Facility

$312.55

Service Code	NDC 68382024701
Hospital Charge Code	988
Hospital Revenue Code	637
Min. Negotiated Rate	$196.91
Max. Negotiated Rate	$281.30
Rate for Payer: Aetna Commercial	$265.67
Rate for Payer: Aetna New Business (MI Preferred)	$203.16
Rate for Payer: Cash Price	$250.04
Rate for Payer: Cofinity Commercial	$218.78
Rate for Payer: Cofinity Commercial	$268.79
Rate for Payer: Cofinity Medicare Advantage	$218.78
Rate for Payer: Encore Health Key Benefits Commercial	$250.04
Rate for Payer: Healthscope Commercial	$281.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$265.67
Rate for Payer: PHP Commercial	$265.67
Rate for Payer: Priority Health Cigna Priority Health	$203.16
Rate for Payer: Priority Health SBD	$196.91

BENZONATATE 100 MG CAPSULE

Facility

$195.05

Service Code	NDC 42806071401
Hospital Charge Code	988
Hospital Revenue Code	637
Min. Negotiated Rate	$78.02
Max. Negotiated Rate	$175.54
Rate for Payer: Aetna Commercial	$165.79
Rate for Payer: Aetna Medicare	$97.53
Rate for Payer: Aetna New Business (MI Preferred)	$126.78
Rate for Payer: BCBS Complete	$78.02
Rate for Payer: Cash Price	$156.04
Rate for Payer: Cofinity Commercial	$136.53
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Cofinity Medicare Advantage	$136.53
Rate for Payer: Encore Health Key Benefits Commercial	$156.04
Rate for Payer: Healthscope Commercial	$175.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.79
Rate for Payer: PHP Commercial	$165.79
Rate for Payer: Priority Health Cigna Priority Health	$126.78
Rate for Payer: Priority Health SBD	$122.88

BENZONATATE 100 MG CAPSULE

Facility

$195.05

Service Code	NDC 42806071401
Hospital Charge Code	988
Hospital Revenue Code	637
Min. Negotiated Rate	$122.88
Max. Negotiated Rate	$175.54
Rate for Payer: Aetna Commercial	$165.79
Rate for Payer: Aetna New Business (MI Preferred)	$126.78
Rate for Payer: Cash Price	$156.04
Rate for Payer: Cofinity Commercial	$136.53
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Cofinity Medicare Advantage	$136.53
Rate for Payer: Encore Health Key Benefits Commercial	$156.04
Rate for Payer: Healthscope Commercial	$175.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.79
Rate for Payer: PHP Commercial	$165.79
Rate for Payer: Priority Health Cigna Priority Health	$126.78
Rate for Payer: Priority Health SBD	$122.88

BENZONATATE 100 MG CAPSULE

Facility

$302.10

Service Code	NDC 00904656461
Hospital Charge Code	988
Hospital Revenue Code	637
Min. Negotiated Rate	$120.84
Max. Negotiated Rate	$271.89
Rate for Payer: Aetna Commercial	$256.79
Rate for Payer: Aetna Medicare	$151.05
Rate for Payer: Aetna New Business (MI Preferred)	$196.37
Rate for Payer: BCBS Complete	$120.84
Rate for Payer: Cash Price	$241.68
Rate for Payer: Cofinity Commercial	$211.47
Rate for Payer: Cofinity Commercial	$259.81
Rate for Payer: Cofinity Medicare Advantage	$211.47
Rate for Payer: Encore Health Key Benefits Commercial	$241.68
Rate for Payer: Healthscope Commercial	$271.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.79
Rate for Payer: PHP Commercial	$256.79
Rate for Payer: Priority Health Cigna Priority Health	$196.37
Rate for Payer: Priority Health SBD	$190.32

BENZONATATE 100 MG CAPSULE

Facility

$312.55

Service Code	NDC 68382024701
Hospital Charge Code	988
Hospital Revenue Code	637
Min. Negotiated Rate	$125.02
Max. Negotiated Rate	$281.30
Rate for Payer: Aetna Commercial	$265.67
Rate for Payer: Aetna Medicare	$156.28
Rate for Payer: Aetna New Business (MI Preferred)	$203.16
Rate for Payer: BCBS Complete	$125.02
Rate for Payer: Cash Price	$250.04
Rate for Payer: Cofinity Commercial	$218.78
Rate for Payer: Cofinity Commercial	$268.79
Rate for Payer: Cofinity Medicare Advantage	$218.78
Rate for Payer: Encore Health Key Benefits Commercial	$250.04
Rate for Payer: Healthscope Commercial	$281.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$265.67
Rate for Payer: PHP Commercial	$265.67
Rate for Payer: Priority Health Cigna Priority Health	$203.16
Rate for Payer: Priority Health SBD	$196.91

BENZTROPINE 1 MG/ML INJECTION SOLUTION

Facility

$101.40

Service Code	HCPCS J0515
Hospital Charge Code	9259
Hospital Revenue Code	636
Min. Negotiated Rate	$40.56
Max. Negotiated Rate	$91.26
Rate for Payer: Aetna Commercial	$86.19
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: Aetna Commercial	$87.95
Rate for Payer: Aetna Medicare	$40.95
Rate for Payer: Aetna Medicare	$50.70
Rate for Payer: Aetna Medicare	$51.73
Rate for Payer: Aetna New Business (MI Preferred)	$53.23
Rate for Payer: Aetna New Business (MI Preferred)	$65.91
Rate for Payer: Aetna New Business (MI Preferred)	$67.26
Rate for Payer: BCBS Complete	$41.39
Rate for Payer: BCBS Complete	$40.56
Rate for Payer: BCBS Complete	$32.76
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cash Price	$81.12
Rate for Payer: Cash Price	$82.78
Rate for Payer: Cofinity Commercial	$70.43
Rate for Payer: Cofinity Commercial	$87.20
Rate for Payer: Cofinity Commercial	$70.98
Rate for Payer: Cofinity Commercial	$88.98
Rate for Payer: Cofinity Commercial	$72.43
Rate for Payer: Cofinity Commercial	$57.33
Rate for Payer: Cofinity Medicare Advantage	$72.43
Rate for Payer: Cofinity Medicare Advantage	$70.98
Rate for Payer: Cofinity Medicare Advantage	$57.33
Rate for Payer: Encore Health Key Benefits Commercial	$82.78
Rate for Payer: Encore Health Key Benefits Commercial	$65.52
Rate for Payer: Encore Health Key Benefits Commercial	$81.12
Rate for Payer: Healthscope Commercial	$93.12
Rate for Payer: Healthscope Commercial	$91.26
Rate for Payer: Healthscope Commercial	$73.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.19
Rate for Payer: PHP Commercial	$87.95
Rate for Payer: PHP Commercial	$86.19
Rate for Payer: PHP Commercial	$69.61
Rate for Payer: Priority Health Cigna Priority Health	$65.91
Rate for Payer: Priority Health Cigna Priority Health	$53.23
Rate for Payer: Priority Health Cigna Priority Health	$67.26
Rate for Payer: Priority Health SBD	$51.60
Rate for Payer: Priority Health SBD	$65.19
Rate for Payer: Priority Health SBD	$63.88

BENZTROPINE 1 MG/ML INJECTION SOLUTION

Facility

$103.47

Service Code	HCPCS J0515
Hospital Charge Code	9259
Hospital Revenue Code	636
Min. Negotiated Rate	$65.19
Max. Negotiated Rate	$93.12
Rate for Payer: Aetna Commercial	$87.95
Rate for Payer: Aetna Commercial	$86.19
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: Aetna New Business (MI Preferred)	$67.26
Rate for Payer: Aetna New Business (MI Preferred)	$65.91
Rate for Payer: Aetna New Business (MI Preferred)	$53.23
Rate for Payer: Cash Price	$81.12
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cash Price	$82.78
Rate for Payer: Cofinity Commercial	$70.98
Rate for Payer: Cofinity Commercial	$87.20
Rate for Payer: Cofinity Commercial	$72.43
Rate for Payer: Cofinity Commercial	$88.98
Rate for Payer: Cofinity Commercial	$57.33
Rate for Payer: Cofinity Commercial	$70.43
Rate for Payer: Cofinity Medicare Advantage	$70.98
Rate for Payer: Cofinity Medicare Advantage	$57.33
Rate for Payer: Cofinity Medicare Advantage	$72.43
Rate for Payer: Encore Health Key Benefits Commercial	$81.12
Rate for Payer: Encore Health Key Benefits Commercial	$82.78
Rate for Payer: Encore Health Key Benefits Commercial	$65.52
Rate for Payer: Healthscope Commercial	$91.26
Rate for Payer: Healthscope Commercial	$93.12
Rate for Payer: Healthscope Commercial	$73.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.61
Rate for Payer: PHP Commercial	$87.95
Rate for Payer: PHP Commercial	$69.61
Rate for Payer: PHP Commercial	$86.19
Rate for Payer: Priority Health Cigna Priority Health	$53.23
Rate for Payer: Priority Health Cigna Priority Health	$67.26
Rate for Payer: Priority Health Cigna Priority Health	$65.91
Rate for Payer: Priority Health SBD	$51.60
Rate for Payer: Priority Health SBD	$65.19
Rate for Payer: Priority Health SBD	$63.88

BENZTROPINE 1 MG TABLET

Facility

$437.00

Service Code	NDC 68084038801
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$275.31
Max. Negotiated Rate	$393.30
Rate for Payer: Aetna Commercial	$371.45
Rate for Payer: Aetna New Business (MI Preferred)	$284.05
Rate for Payer: Cash Price	$349.60
Rate for Payer: Cofinity Commercial	$305.90
Rate for Payer: Cofinity Commercial	$375.82
Rate for Payer: Cofinity Medicare Advantage	$305.90
Rate for Payer: Encore Health Key Benefits Commercial	$349.60
Rate for Payer: Healthscope Commercial	$393.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$371.45
Rate for Payer: PHP Commercial	$371.45
Rate for Payer: Priority Health Cigna Priority Health	$284.05
Rate for Payer: Priority Health SBD	$275.31

BENZTROPINE 1 MG TABLET

Facility

$166.85

Service Code	NDC 69315013701
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$66.74
Max. Negotiated Rate	$150.16
Rate for Payer: Aetna Commercial	$141.82
Rate for Payer: Aetna Medicare	$83.42
Rate for Payer: Aetna New Business (MI Preferred)	$108.45
Rate for Payer: BCBS Complete	$66.74
Rate for Payer: Cash Price	$133.48
Rate for Payer: Cofinity Commercial	$116.80
Rate for Payer: Cofinity Commercial	$143.49
Rate for Payer: Cofinity Medicare Advantage	$116.80
Rate for Payer: Encore Health Key Benefits Commercial	$133.48
Rate for Payer: Healthscope Commercial	$150.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.82
Rate for Payer: PHP Commercial	$141.82
Rate for Payer: Priority Health Cigna Priority Health	$108.45
Rate for Payer: Priority Health SBD	$105.12

BENZTROPINE 1 MG TABLET

Facility

$166.85

Service Code	NDC 69315013701
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$105.12
Max. Negotiated Rate	$150.16
Rate for Payer: Aetna Commercial	$141.82
Rate for Payer: Aetna New Business (MI Preferred)	$108.45
Rate for Payer: Cash Price	$133.48
Rate for Payer: Cofinity Commercial	$116.80
Rate for Payer: Cofinity Commercial	$143.49
Rate for Payer: Cofinity Medicare Advantage	$116.80
Rate for Payer: Encore Health Key Benefits Commercial	$133.48
Rate for Payer: Healthscope Commercial	$150.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.82
Rate for Payer: PHP Commercial	$141.82
Rate for Payer: Priority Health Cigna Priority Health	$108.45
Rate for Payer: Priority Health SBD	$105.12

BENZTROPINE 1 MG TABLET

Facility

$433.20

Service Code	NDC 60687036801
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$173.28
Max. Negotiated Rate	$389.88
Rate for Payer: Aetna Commercial	$368.22
Rate for Payer: Aetna Medicare	$216.60
Rate for Payer: Aetna New Business (MI Preferred)	$281.58
Rate for Payer: BCBS Complete	$173.28
Rate for Payer: Cash Price	$346.56
Rate for Payer: Cofinity Commercial	$303.24
Rate for Payer: Cofinity Commercial	$372.55
Rate for Payer: Cofinity Medicare Advantage	$303.24
Rate for Payer: Encore Health Key Benefits Commercial	$346.56
Rate for Payer: Healthscope Commercial	$389.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.22
Rate for Payer: PHP Commercial	$368.22
Rate for Payer: Priority Health Cigna Priority Health	$281.58
Rate for Payer: Priority Health SBD	$272.92

BENZTROPINE 1 MG TABLET

Facility

$4.34

Service Code	NDC 60687036811
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.91
Rate for Payer: Aetna Commercial	$3.69
Rate for Payer: Aetna Medicare	$2.17
Rate for Payer: Aetna New Business (MI Preferred)	$2.82
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: Cash Price	$3.47
Rate for Payer: Cofinity Commercial	$3.04
Rate for Payer: Cofinity Commercial	$3.73
Rate for Payer: Cofinity Medicare Advantage	$3.04
Rate for Payer: Encore Health Key Benefits Commercial	$3.47
Rate for Payer: Healthscope Commercial	$3.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.69
Rate for Payer: PHP Commercial	$3.69
Rate for Payer: Priority Health Cigna Priority Health	$2.82
Rate for Payer: Priority Health SBD	$2.73

BENZTROPINE 1 MG TABLET

Facility

$350.15

Service Code	NDC 00603243821
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$140.06
Max. Negotiated Rate	$315.13
Rate for Payer: Aetna Commercial	$297.63
Rate for Payer: Aetna Medicare	$175.07
Rate for Payer: Aetna New Business (MI Preferred)	$227.60
Rate for Payer: BCBS Complete	$140.06
Rate for Payer: Cash Price	$280.12
Rate for Payer: Cofinity Commercial	$245.10
Rate for Payer: Cofinity Commercial	$301.13
Rate for Payer: Cofinity Medicare Advantage	$245.10
Rate for Payer: Encore Health Key Benefits Commercial	$280.12
Rate for Payer: Healthscope Commercial	$315.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.63
Rate for Payer: PHP Commercial	$297.63
Rate for Payer: Priority Health Cigna Priority Health	$227.60
Rate for Payer: Priority Health SBD	$220.59

BENZTROPINE 1 MG TABLET

Facility

$4.37

Service Code	NDC 68084038811
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$3.93
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna New Business (MI Preferred)	$2.84
Rate for Payer: Cash Price	$3.50
Rate for Payer: Cofinity Commercial	$3.06
Rate for Payer: Cofinity Commercial	$3.76
Rate for Payer: Cofinity Medicare Advantage	$3.06
Rate for Payer: Encore Health Key Benefits Commercial	$3.50
Rate for Payer: Healthscope Commercial	$3.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.71
Rate for Payer: PHP Commercial	$3.71
Rate for Payer: Priority Health Cigna Priority Health	$2.84
Rate for Payer: Priority Health SBD	$2.75

BENZTROPINE 1 MG TABLET

Facility

$287.85

Service Code	NDC 00904679061
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$181.35
Max. Negotiated Rate	$259.06
Rate for Payer: Aetna Commercial	$244.67
Rate for Payer: Aetna New Business (MI Preferred)	$187.10
Rate for Payer: Cash Price	$230.28
Rate for Payer: Cofinity Commercial	$201.50
Rate for Payer: Cofinity Commercial	$247.55
Rate for Payer: Cofinity Medicare Advantage	$201.50
Rate for Payer: Encore Health Key Benefits Commercial	$230.28
Rate for Payer: Healthscope Commercial	$259.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.67
Rate for Payer: PHP Commercial	$244.67
Rate for Payer: Priority Health Cigna Priority Health	$187.10
Rate for Payer: Priority Health SBD	$181.35

BENZTROPINE 1 MG TABLET

Facility

$4.37

Service Code	NDC 68084038811
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$3.93
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna Medicare	$2.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.84
Rate for Payer: BCBS Complete	$1.75
Rate for Payer: Cash Price	$3.50
Rate for Payer: Cofinity Commercial	$3.06
Rate for Payer: Cofinity Commercial	$3.76
Rate for Payer: Cofinity Medicare Advantage	$3.06
Rate for Payer: Encore Health Key Benefits Commercial	$3.50
Rate for Payer: Healthscope Commercial	$3.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.71
Rate for Payer: PHP Commercial	$3.71
Rate for Payer: Priority Health Cigna Priority Health	$2.84
Rate for Payer: Priority Health SBD	$2.75

Know your out-of-pocket cost for care.

All Charges