Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$673.70

Service Code	NDC 45802-580-46
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$424.43
Max. Negotiated Rate	$606.33
Rate for Payer: Aetna Commercial	$572.64
Rate for Payer: Aetna New Business (MI Preferred)	$437.90
Rate for Payer: Cash Price	$538.96
Rate for Payer: Cofinity Commercial	$471.59
Rate for Payer: Cofinity Commercial	$579.38
Rate for Payer: Healthscope Commercial	$606.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$572.64
Rate for Payer: PHP Commercial	$572.64
Rate for Payer: Priority Health Cigna Priority Health	$471.59
Rate for Payer: Priority Health SBD	$424.43

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$438.05

Service Code	NDC 10019-553-03
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$275.97
Max. Negotiated Rate	$394.24
Rate for Payer: Aetna Commercial	$372.34
Rate for Payer: Aetna New Business (MI Preferred)	$284.73
Rate for Payer: Cash Price	$350.44
Rate for Payer: Cofinity Commercial	$306.64
Rate for Payer: Cofinity Commercial	$376.72
Rate for Payer: Healthscope Commercial	$394.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$372.34
Rate for Payer: PHP Commercial	$372.34
Rate for Payer: Priority Health Cigna Priority Health	$306.64
Rate for Payer: Priority Health SBD	$275.97

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$237.14

Service Code	NDC 50742-505-10
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$213.43
Rate for Payer: Aetna Commercial	$201.57
Rate for Payer: Aetna New Business (MI Preferred)	$154.14
Rate for Payer: Cash Price	$189.71
Rate for Payer: Cofinity Commercial	$166.00
Rate for Payer: Cofinity Commercial	$203.94
Rate for Payer: Healthscope Commercial	$213.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$201.57
Rate for Payer: PHP Commercial	$201.57
Rate for Payer: Priority Health Cigna Priority Health	$166.00
Rate for Payer: Priority Health SBD	$149.40

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$632.41

Service Code	NDC 0378-6470-97
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$398.42
Max. Negotiated Rate	$569.17
Rate for Payer: Aetna Commercial	$537.55
Rate for Payer: Aetna New Business (MI Preferred)	$411.07
Rate for Payer: Cash Price	$505.93
Rate for Payer: Cofinity Commercial	$442.69
Rate for Payer: Cofinity Commercial	$543.87
Rate for Payer: Healthscope Commercial	$569.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$537.55
Rate for Payer: PHP Commercial	$537.55
Rate for Payer: Priority Health Cigna Priority Health	$442.69
Rate for Payer: Priority Health SBD	$398.42

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$257.75

Service Code	NDC 66758-208-54
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$162.38
Max. Negotiated Rate	$231.98
Rate for Payer: Aetna Commercial	$219.09
Rate for Payer: Aetna New Business (MI Preferred)	$167.54
Rate for Payer: Cash Price	$206.20
Rate for Payer: Cofinity Commercial	$180.42
Rate for Payer: Cofinity Commercial	$221.66
Rate for Payer: Healthscope Commercial	$231.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$219.09
Rate for Payer: PHP Commercial	$219.09
Rate for Payer: Priority Health Cigna Priority Health	$180.42
Rate for Payer: Priority Health SBD	$162.38

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$187.64

Service Code	NDC 0067-4345-09
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$118.21
Max. Negotiated Rate	$168.88
Rate for Payer: Aetna Commercial	$159.49
Rate for Payer: Aetna New Business (MI Preferred)	$121.97
Rate for Payer: Cash Price	$150.11
Rate for Payer: Cofinity Commercial	$131.35
Rate for Payer: Cofinity Commercial	$161.37
Rate for Payer: Healthscope Commercial	$168.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$159.49
Rate for Payer: PHP Commercial	$159.49
Rate for Payer: Priority Health Cigna Priority Health	$131.35
Rate for Payer: Priority Health SBD	$118.21

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$43.81

Service Code	NDC 10019-553-90
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$39.43
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna New Business (MI Preferred)	$28.48
Rate for Payer: Cash Price	$35.05
Rate for Payer: Cofinity Commercial	$30.67
Rate for Payer: Cofinity Commercial	$37.68
Rate for Payer: Healthscope Commercial	$39.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.24
Rate for Payer: PHP Commercial	$37.24
Rate for Payer: Priority Health Cigna Priority Health	$30.67
Rate for Payer: Priority Health SBD	$27.60

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$558.11

Service Code	NDC 50742-505-24
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$351.61
Max. Negotiated Rate	$502.30
Rate for Payer: Aetna Commercial	$474.39
Rate for Payer: Aetna New Business (MI Preferred)	$362.77
Rate for Payer: Cash Price	$446.49
Rate for Payer: Cofinity Commercial	$390.68
Rate for Payer: Cofinity Commercial	$479.97
Rate for Payer: Healthscope Commercial	$502.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$474.39
Rate for Payer: PHP Commercial	$474.39
Rate for Payer: Priority Health Cigna Priority Health	$390.68
Rate for Payer: Priority Health SBD	$351.61

SCREENING OF A PATIENT

Professional

Both

$15.00

Service Code	HCPCS D0190
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$20.16
Rate for Payer: Aetna Commercial	$13.35
Rate for Payer: BCBS Complete	$20.16
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Mclaren Medicaid	$19.20
Rate for Payer: Meridian Medicaid	$20.16
Rate for Payer: Priority Health Choice Medicaid	$19.20
Rate for Payer: Priority Health Cigna Priority Health	$10.50

SCROTAL EXPLORATION

Facility

$9,573.02

Service Code	CPT 55110
Hospital Revenue Code	360
Min. Negotiated Rate	$382.78
Max. Negotiated Rate	$9,573.02
Rate for Payer: Aetna Medicare	$3,226.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,877.45
Rate for Payer: Amish Plain Church Group Commercial	$3,877.45
Rate for Payer: BCBS Complete	$1,781.77
Rate for Payer: BCBS MAPPO	$3,101.96
Rate for Payer: BCBS Trust/PPO	$888.39
Rate for Payer: BCN Medicare Advantage	$3,101.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,101.96
Rate for Payer: Mclaren Medicaid	$1,696.77
Rate for Payer: Mclaren Medicare	$3,101.96
Rate for Payer: Meridian Medicaid	$1,781.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,257.06
Rate for Payer: MI Amish Medical Board Commercial	$3,567.25
Rate for Payer: PACE Medicare	$2,946.86
Rate for Payer: PACE SWMI	$3,101.96
Rate for Payer: PHP Medicare Advantage	$3,101.96
Rate for Payer: Priority Health Choice Medicaid	$1,696.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,573.02
Rate for Payer: Priority Health Medicare	$3,101.96
Rate for Payer: Priority Health Narrow Network	$7,658.42
Rate for Payer: Railroad Medicare Medicare	$3,101.96
Rate for Payer: UHC All Payor (Choice/PPO)	$421.06
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,101.96
Rate for Payer: UHC Exchange	$382.78
Rate for Payer: UHC Medicare Advantage	$3,195.02
Rate for Payer: VA VA	$3,101.96

SCROTOPLASTY; SIMPLE

Facility

$9,573.02

Service Code	CPT 55175
Hospital Revenue Code	360
Min. Negotiated Rate	$360.19
Max. Negotiated Rate	$9,573.02
Rate for Payer: Aetna Medicare	$3,226.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,877.45
Rate for Payer: Amish Plain Church Group Commercial	$3,877.45
Rate for Payer: BCBS Complete	$1,781.77
Rate for Payer: BCBS MAPPO	$3,101.96
Rate for Payer: BCBS Trust/PPO	$1,281.32
Rate for Payer: BCN Medicare Advantage	$3,101.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,101.96
Rate for Payer: Mclaren Medicaid	$1,696.77
Rate for Payer: Mclaren Medicare	$3,101.96
Rate for Payer: Meridian Medicaid	$1,781.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,257.06
Rate for Payer: MI Amish Medical Board Commercial	$3,567.25
Rate for Payer: PACE Medicare	$2,946.86
Rate for Payer: PACE SWMI	$3,101.96
Rate for Payer: PHP Medicare Advantage	$3,101.96
Rate for Payer: Priority Health Choice Medicaid	$1,696.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,573.02
Rate for Payer: Priority Health Medicare	$3,101.96
Rate for Payer: Priority Health Narrow Network	$7,658.42
Rate for Payer: Railroad Medicare Medicare	$3,101.96
Rate for Payer: UHC All Payor (Choice/PPO)	$396.21
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$3,101.96
Rate for Payer: UHC Exchange	$360.19
Rate for Payer: UHC Medicare Advantage	$3,195.02
Rate for Payer: VA VA	$3,101.96

SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED

Facility

$5,175.07

Service Code	CPT 13160
Hospital Revenue Code	360
Min. Negotiated Rate	$782.26
Max. Negotiated Rate	$5,175.07
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$2,063.51
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,175.07
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,140.06
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$860.49
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$782.26
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

SEIZURES WITH MCC

Facility

$30,241.06

Service Code	MS-DRG 100
Min. Negotiated Rate	$14,031.77
Max. Negotiated Rate	$30,241.06
Rate for Payer: Aetna Medicare	$15,361.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,462.85
Rate for Payer: Amish Plain Church Group Commercial	$18,462.85
Rate for Payer: BCBS MAPPO	$14,770.28
Rate for Payer: BCBS Trust/PPO	$27,398.24
Rate for Payer: BCN Medicare Advantage	$14,770.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,770.28
Rate for Payer: Mclaren Medicare	$14,770.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,508.79
Rate for Payer: MI Amish Medical Board Commercial	$16,985.82
Rate for Payer: PACE Medicare	$14,031.77
Rate for Payer: PACE SWMI	$14,770.28
Rate for Payer: PHP Medicare Advantage	$14,770.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28,448.72
Rate for Payer: Priority Health Medicare	$14,770.28
Rate for Payer: Priority Health Narrow Network	$22,758.98
Rate for Payer: Railroad Medicare Medicare	$14,770.28
Rate for Payer: UHC All Payor (Choice/PPO)	$30,241.06
Rate for Payer: UHC Core	$18,556.20
Rate for Payer: UHC Dual Complete DSNP	$14,770.28
Rate for Payer: UHC Exchange	$19,874.56
Rate for Payer: UHC Medicare Advantage	$15,213.39
Rate for Payer: VA VA	$14,770.28

SEIZURES WITHOUT MCC

Facility

$13,875.04

Service Code	MS-DRG 101
Min. Negotiated Rate	$6,691.31
Max. Negotiated Rate	$13,875.04
Rate for Payer: Aetna Medicare	$7,325.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,804.35
Rate for Payer: Amish Plain Church Group Commercial	$8,804.35
Rate for Payer: BCBS MAPPO	$7,043.48
Rate for Payer: BCBS Trust/PPO	$12,753.79
Rate for Payer: BCN Medicare Advantage	$7,043.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,043.48
Rate for Payer: Mclaren Medicare	$7,043.48
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,395.65
Rate for Payer: MI Amish Medical Board Commercial	$8,100.00
Rate for Payer: PACE Medicare	$6,691.31
Rate for Payer: PACE SWMI	$7,043.48
Rate for Payer: PHP Medicare Advantage	$7,043.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,052.69
Rate for Payer: Priority Health Medicare	$7,043.48
Rate for Payer: Priority Health Narrow Network	$10,442.15
Rate for Payer: Railroad Medicare Medicare	$7,043.48
Rate for Payer: UHC All Payor (Choice/PPO)	$13,875.04
Rate for Payer: UHC Core	$8,513.86
Rate for Payer: UHC Dual Complete DSNP	$7,043.48
Rate for Payer: UHC Exchange	$9,118.74
Rate for Payer: UHC Medicare Advantage	$7,254.78
Rate for Payer: VA VA	$7,043.48

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY

Facility

$2,565.06

Service Code	CPT 36247
Hospital Revenue Code	360
Min. Negotiated Rate	$284.55
Max. Negotiated Rate	$2,565.06
Rate for Payer: BCBS Trust/PPO	$2,565.06
Rate for Payer: UHC All Payor (Choice/PPO)	$313.00
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$284.55

SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; FIRST ORDER BRANCH (EG, RENAL VEIN, JUGULAR VEIN)

Facility

$2,014.24

Service Code	CPT 36011
Hospital Revenue Code	360
Min. Negotiated Rate	$148.99
Max. Negotiated Rate	$2,014.24
Rate for Payer: BCBS Trust/PPO	$2,014.24
Rate for Payer: UHC All Payor (Choice/PPO)	$163.89
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$148.99

SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND ORDER, OR MORE SELECTIVE, BRANCH (EG, LEFT ADRENAL VEIN, PETROSAL SINUS)

Facility

$2,053.83

Service Code	CPT 36012
Hospital Revenue Code	360
Min. Negotiated Rate	$166.01
Max. Negotiated Rate	$2,053.83
Rate for Payer: BCBS Trust/PPO	$2,053.83
Rate for Payer: UHC All Payor (Choice/PPO)	$182.61
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$166.01

SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION

Facility

$705.82

Service Code	NDC 0517-6560-25
Hospital Charge Code	190643
Hospital Revenue Code	250
Min. Negotiated Rate	$444.67
Max. Negotiated Rate	$635.24
Rate for Payer: Aetna Commercial	$599.95
Rate for Payer: Aetna New Business (MI Preferred)	$458.78
Rate for Payer: Cash Price	$564.66
Rate for Payer: Cofinity Commercial	$494.07
Rate for Payer: Cofinity Commercial	$607.01
Rate for Payer: Healthscope Commercial	$635.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$599.95
Rate for Payer: PHP Commercial	$599.95
Rate for Payer: Priority Health Cigna Priority Health	$494.07
Rate for Payer: Priority Health SBD	$444.67

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$1,228.50

Service Code	NDC 63739-432-01
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$773.96
Max. Negotiated Rate	$1,105.65
Rate for Payer: Aetna Commercial	$1,044.22
Rate for Payer: Aetna New Business (MI Preferred)	$798.52
Rate for Payer: Cash Price	$982.80
Rate for Payer: Cofinity Commercial	$1,056.51
Rate for Payer: Cofinity Commercial	$859.95
Rate for Payer: Healthscope Commercial	$1,105.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,044.22
Rate for Payer: PHP Commercial	$1,044.22
Rate for Payer: Priority Health Cigna Priority Health	$859.95
Rate for Payer: Priority Health SBD	$773.96

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$1.46

Service Code	NDC 60687-622-11
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.31
Rate for Payer: Aetna Commercial	$1.24
Rate for Payer: Aetna New Business (MI Preferred)	$0.95
Rate for Payer: Cash Price	$1.17
Rate for Payer: Cofinity Commercial	$1.02
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Healthscope Commercial	$1.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.24
Rate for Payer: PHP Commercial	$1.24
Rate for Payer: Priority Health Cigna Priority Health	$1.02
Rate for Payer: Priority Health SBD	$0.92

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$43.10

Service Code	NDC 67618-310-30
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$38.79
Rate for Payer: Aetna Commercial	$36.64
Rate for Payer: Aetna New Business (MI Preferred)	$28.02
Rate for Payer: Cash Price	$34.48
Rate for Payer: Cofinity Commercial	$30.17
Rate for Payer: Cofinity Commercial	$37.07
Rate for Payer: Healthscope Commercial	$38.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.64
Rate for Payer: PHP Commercial	$36.64
Rate for Payer: Priority Health Cigna Priority Health	$30.17
Rate for Payer: Priority Health SBD	$27.15

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$122.10

Service Code	NDC 57896-303-01
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$76.92
Max. Negotiated Rate	$109.89
Rate for Payer: Aetna Commercial	$103.78
Rate for Payer: Aetna New Business (MI Preferred)	$79.36
Rate for Payer: Cash Price	$97.68
Rate for Payer: Cofinity Commercial	$105.01
Rate for Payer: Cofinity Commercial	$85.47
Rate for Payer: Healthscope Commercial	$109.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$103.78
Rate for Payer: PHP Commercial	$103.78
Rate for Payer: Priority Health Cigna Priority Health	$85.47
Rate for Payer: Priority Health SBD	$76.92

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$88.20

Service Code	NDC 96295-13881
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$74.97
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$61.74
Rate for Payer: Priority Health SBD	$55.57

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$84.63

Service Code	NDC 67618-110-30
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$53.32
Max. Negotiated Rate	$76.17
Rate for Payer: Aetna Commercial	$71.94
Rate for Payer: Aetna New Business (MI Preferred)	$55.01
Rate for Payer: Cash Price	$67.70
Rate for Payer: Cofinity Commercial	$59.24
Rate for Payer: Cofinity Commercial	$72.78
Rate for Payer: Healthscope Commercial	$76.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.94
Rate for Payer: PHP Commercial	$71.94
Rate for Payer: Priority Health Cigna Priority Health	$59.24
Rate for Payer: Priority Health SBD	$53.32

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$183.96

Service Code	NDC 67618-310-60
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$115.89
Max. Negotiated Rate	$165.56
Rate for Payer: Aetna Commercial	$156.37
Rate for Payer: Aetna New Business (MI Preferred)	$119.57
Rate for Payer: Cash Price	$147.17
Rate for Payer: Cofinity Commercial	$128.77
Rate for Payer: Cofinity Commercial	$158.21
Rate for Payer: Healthscope Commercial	$165.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$156.37
Rate for Payer: PHP Commercial	$156.37
Rate for Payer: Priority Health Cigna Priority Health	$128.77
Rate for Payer: Priority Health SBD	$115.89

Know your out-of-pocket cost for care.

All Charges