Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 64380074106
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 68382018001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 64380074106
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$251.45

Service Code	NDC 51079098520
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$158.41
Max. Negotiated Rate	$226.30
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.02
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$176.02
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$158.41

BUSPIRONE 5 MG TABLET

Facility

$65.80

Service Code	NDC 16729020001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$59.22
Rate for Payer: Aetna Commercial	$55.93
Rate for Payer: Aetna Medicare	$32.90
Rate for Payer: Aetna New Business (MI Preferred)	$42.77
Rate for Payer: BCBS Complete	$26.32
Rate for Payer: Cash Price	$52.64
Rate for Payer: Cofinity Commercial	$46.06
Rate for Payer: Cofinity Commercial	$56.59
Rate for Payer: Cofinity Medicare Advantage	$46.06
Rate for Payer: Encore Health Key Benefits Commercial	$52.64
Rate for Payer: Healthscope Commercial	$59.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.93
Rate for Payer: PHP Commercial	$55.93
Rate for Payer: Priority Health Cigna Priority Health	$42.77
Rate for Payer: Priority Health SBD	$41.45

BUSPIRONE 5 MG TABLET

Facility

$329.00

Service Code	NDC 16729020016
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna Medicare	$164.50
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: BCBS Complete	$131.60
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Commercial	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Cofinity Medicare Advantage	$230.30
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health Cigna Priority Health	$213.85
Rate for Payer: Priority Health SBD	$207.27

BUSPIRONE 5 MG TABLET

Facility

$209.15

Service Code	NDC 00904712261
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$83.66
Max. Negotiated Rate	$188.24
Rate for Payer: Aetna Commercial	$177.78
Rate for Payer: Aetna Medicare	$104.58
Rate for Payer: Aetna New Business (MI Preferred)	$135.95
Rate for Payer: BCBS Complete	$83.66
Rate for Payer: Cash Price	$167.32
Rate for Payer: Cofinity Commercial	$146.40
Rate for Payer: Cofinity Commercial	$179.87
Rate for Payer: Cofinity Medicare Advantage	$146.40
Rate for Payer: Encore Health Key Benefits Commercial	$167.32
Rate for Payer: Healthscope Commercial	$188.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$177.78
Rate for Payer: PHP Commercial	$177.78
Rate for Payer: Priority Health Cigna Priority Health	$135.95
Rate for Payer: Priority Health SBD	$131.76

BUSPIRONE 5 MG TABLET

Facility

$94.00

Service Code	NDC 23155002301
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$37.60
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna Commercial	$79.90
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: Aetna New Business (MI Preferred)	$61.10
Rate for Payer: BCBS Complete	$37.60
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Cofinity Commercial	$80.84
Rate for Payer: Cofinity Medicare Advantage	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$75.20
Rate for Payer: Healthscope Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.90
Rate for Payer: PHP Commercial	$79.90
Rate for Payer: Priority Health Cigna Priority Health	$61.10
Rate for Payer: Priority Health SBD	$59.22

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 68382018001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$2.52

Service Code	NDC 51079098501
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare	$1.26
Rate for Payer: Aetna New Business (MI Preferred)	$1.64
Rate for Payer: BCBS Complete	$1.01
Rate for Payer: Cash Price	$2.02
Rate for Payer: Cofinity Commercial	$1.76
Rate for Payer: Cofinity Commercial	$2.17
Rate for Payer: Cofinity Medicare Advantage	$1.76
Rate for Payer: Encore Health Key Benefits Commercial	$2.02
Rate for Payer: Healthscope Commercial	$2.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.14
Rate for Payer: PHP Commercial	$2.14
Rate for Payer: Priority Health Cigna Priority Health	$1.64
Rate for Payer: Priority Health SBD	$1.59

BUSPIRONE 5 MG TABLET

Facility

$251.45

Service Code	NDC 51079098520
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$100.58
Max. Negotiated Rate	$226.30
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna Medicare	$125.72
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: BCBS Complete	$100.58
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.02
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$176.02
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$158.41

BUSPIRONE 5 MG TABLET

Facility

$564.00

Service Code	NDC 00093005305
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$225.60
Max. Negotiated Rate	$507.60
Rate for Payer: Aetna Commercial	$479.40
Rate for Payer: Aetna Medicare	$282.00
Rate for Payer: Aetna New Business (MI Preferred)	$366.60
Rate for Payer: BCBS Complete	$225.60
Rate for Payer: Cash Price	$451.20
Rate for Payer: Cofinity Commercial	$394.80
Rate for Payer: Cofinity Commercial	$485.04
Rate for Payer: Cofinity Medicare Advantage	$394.80
Rate for Payer: Encore Health Key Benefits Commercial	$451.20
Rate for Payer: Healthscope Commercial	$507.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$479.40
Rate for Payer: PHP Commercial	$479.40
Rate for Payer: Priority Health Cigna Priority Health	$366.60
Rate for Payer: Priority Health SBD	$355.32

BUSPIRONE 5 MG TABLET

Facility

$209.15

Service Code	NDC 00904712261
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$131.76
Max. Negotiated Rate	$188.24
Rate for Payer: Aetna Commercial	$177.78
Rate for Payer: Aetna New Business (MI Preferred)	$135.95
Rate for Payer: Cash Price	$167.32
Rate for Payer: Cofinity Commercial	$146.40
Rate for Payer: Cofinity Commercial	$179.87
Rate for Payer: Cofinity Medicare Advantage	$146.40
Rate for Payer: Encore Health Key Benefits Commercial	$167.32
Rate for Payer: Healthscope Commercial	$188.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$177.78
Rate for Payer: PHP Commercial	$177.78
Rate for Payer: Priority Health Cigna Priority Health	$135.95
Rate for Payer: Priority Health SBD	$131.76

BUSPIRONE 5 MG TABLET

Facility

$65.80

Service Code	NDC 16729020001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$41.45
Max. Negotiated Rate	$59.22
Rate for Payer: Aetna Commercial	$55.93
Rate for Payer: Aetna New Business (MI Preferred)	$42.77
Rate for Payer: Cash Price	$52.64
Rate for Payer: Cofinity Commercial	$46.06
Rate for Payer: Cofinity Commercial	$56.59
Rate for Payer: Cofinity Medicare Advantage	$46.06
Rate for Payer: Encore Health Key Benefits Commercial	$52.64
Rate for Payer: Healthscope Commercial	$59.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.93
Rate for Payer: PHP Commercial	$55.93
Rate for Payer: Priority Health Cigna Priority Health	$42.77
Rate for Payer: Priority Health SBD	$41.45

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 24689078101
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$329.00

Service Code	NDC 16729020016
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$207.27
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Commercial	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Cofinity Medicare Advantage	$230.30
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health Cigna Priority Health	$213.85
Rate for Payer: Priority Health SBD	$207.27

BUSPIRONE 5 MG TABLET

Facility

$94.00

Service Code	NDC 23155002301
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna Commercial	$79.90
Rate for Payer: Aetna New Business (MI Preferred)	$61.10
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Cofinity Commercial	$80.84
Rate for Payer: Cofinity Medicare Advantage	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$75.20
Rate for Payer: Healthscope Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.90
Rate for Payer: PHP Commercial	$79.90
Rate for Payer: Priority Health Cigna Priority Health	$61.10
Rate for Payer: Priority Health SBD	$59.22

BUSPIRONE 5 MG TABLET

Facility

$564.00

Service Code	NDC 00093005305
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$355.32
Max. Negotiated Rate	$507.60
Rate for Payer: Aetna Commercial	$479.40
Rate for Payer: Aetna New Business (MI Preferred)	$366.60
Rate for Payer: Cash Price	$451.20
Rate for Payer: Cofinity Commercial	$394.80
Rate for Payer: Cofinity Commercial	$485.04
Rate for Payer: Cofinity Medicare Advantage	$394.80
Rate for Payer: Encore Health Key Benefits Commercial	$451.20
Rate for Payer: Healthscope Commercial	$507.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$479.40
Rate for Payer: PHP Commercial	$479.40
Rate for Payer: Priority Health Cigna Priority Health	$366.60
Rate for Payer: Priority Health SBD	$355.32

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 24689078101
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.02
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$735.70

Service Code	NDC 00603254421
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$294.28
Max. Negotiated Rate	$662.13
Rate for Payer: Aetna Commercial	$625.34
Rate for Payer: Aetna Medicare	$367.85
Rate for Payer: Aetna New Business (MI Preferred)	$478.20
Rate for Payer: BCBS Complete	$294.28
Rate for Payer: Cash Price	$588.56
Rate for Payer: Cofinity Commercial	$514.99
Rate for Payer: Cofinity Commercial	$632.70
Rate for Payer: Cofinity Medicare Advantage	$514.99
Rate for Payer: Encore Health Key Benefits Commercial	$588.56
Rate for Payer: Healthscope Commercial	$662.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$625.34
Rate for Payer: PHP Commercial	$625.34
Rate for Payer: Priority Health Cigna Priority Health	$478.20
Rate for Payer: Priority Health SBD	$463.49

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$532.35

Service Code	NDC 68084039665
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$212.94
Max. Negotiated Rate	$479.12
Rate for Payer: Aetna Commercial	$452.50
Rate for Payer: Aetna Medicare	$266.18
Rate for Payer: Aetna New Business (MI Preferred)	$346.03
Rate for Payer: BCBS Complete	$212.94
Rate for Payer: Cash Price	$425.88
Rate for Payer: Cofinity Commercial	$372.64
Rate for Payer: Cofinity Commercial	$457.82
Rate for Payer: Cofinity Medicare Advantage	$372.64
Rate for Payer: Encore Health Key Benefits Commercial	$425.88
Rate for Payer: Healthscope Commercial	$479.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$452.50
Rate for Payer: PHP Commercial	$452.50
Rate for Payer: Priority Health Cigna Priority Health	$346.03
Rate for Payer: Priority Health SBD	$335.38

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$8.17

Service Code	NDC 60687067211
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$7.35
Rate for Payer: Aetna Commercial	$6.94
Rate for Payer: Aetna New Business (MI Preferred)	$5.31
Rate for Payer: Cash Price	$6.54
Rate for Payer: Cofinity Commercial	$5.72
Rate for Payer: Cofinity Commercial	$7.03
Rate for Payer: Cofinity Medicare Advantage	$5.72
Rate for Payer: Encore Health Key Benefits Commercial	$6.54
Rate for Payer: Healthscope Commercial	$7.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.94
Rate for Payer: PHP Commercial	$6.94
Rate for Payer: Priority Health Cigna Priority Health	$5.31
Rate for Payer: Priority Health SBD	$5.15

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$371.35

Service Code	NDC 00904693806
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$148.54
Max. Negotiated Rate	$334.22
Rate for Payer: Aetna Commercial	$315.65
Rate for Payer: Aetna Medicare	$185.68
Rate for Payer: Aetna New Business (MI Preferred)	$241.38
Rate for Payer: BCBS Complete	$148.54
Rate for Payer: Cash Price	$297.08
Rate for Payer: Cofinity Commercial	$259.94
Rate for Payer: Cofinity Commercial	$319.36
Rate for Payer: Cofinity Medicare Advantage	$259.94
Rate for Payer: Encore Health Key Benefits Commercial	$297.08
Rate for Payer: Healthscope Commercial	$334.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.65
Rate for Payer: PHP Commercial	$315.65
Rate for Payer: Priority Health Cigna Priority Health	$241.38
Rate for Payer: Priority Health SBD	$233.95

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$10.65

Service Code	NDC 68084039611
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$9.58
Rate for Payer: Aetna Commercial	$9.05
Rate for Payer: Aetna New Business (MI Preferred)	$6.92
Rate for Payer: Cash Price	$8.52
Rate for Payer: Cofinity Commercial	$7.46
Rate for Payer: Cofinity Commercial	$9.16
Rate for Payer: Cofinity Medicare Advantage	$7.46
Rate for Payer: Encore Health Key Benefits Commercial	$8.52
Rate for Payer: Healthscope Commercial	$9.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.05
Rate for Payer: PHP Commercial	$9.05
Rate for Payer: Priority Health Cigna Priority Health	$6.92
Rate for Payer: Priority Health SBD	$6.71

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$408.45

Service Code	NDC 60687067265
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$163.38
Max. Negotiated Rate	$367.60
Rate for Payer: Aetna Commercial	$347.18
Rate for Payer: Aetna Medicare	$204.22
Rate for Payer: Aetna New Business (MI Preferred)	$265.49
Rate for Payer: BCBS Complete	$163.38
Rate for Payer: Cash Price	$326.76
Rate for Payer: Cofinity Commercial	$285.92
Rate for Payer: Cofinity Commercial	$351.27
Rate for Payer: Cofinity Medicare Advantage	$285.92
Rate for Payer: Encore Health Key Benefits Commercial	$326.76
Rate for Payer: Healthscope Commercial	$367.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$347.18
Rate for Payer: PHP Commercial	$347.18
Rate for Payer: Priority Health Cigna Priority Health	$265.49
Rate for Payer: Priority Health SBD	$257.32

Know your out-of-pocket cost for care.

All Charges