Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

BENZTROPINE 1 MG/ML INJECTION SOLUTION

Facility

$189.80

Service Code	HCPCS J0515
Hospital Charge Code	9259
Hospital Revenue Code	636
Min. Negotiated Rate	$115.76
Max. Negotiated Rate	$170.82
Rate for Payer: Aetna Commercial	$161.33
Rate for Payer: BCBS Trust/PPO	$146.68
Rate for Payer: BCN Commercial	$146.68
Rate for Payer: Cash Price	$151.84
Rate for Payer: Cofinity Commercial	$163.23
Rate for Payer: Encore Health Key Benefits Commercial	$151.84
Rate for Payer: Healthscope Commercial	$170.82
Rate for Payer: Lakeland Regional Health Systems Commercial	$142.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$161.33
Rate for Payer: PHP Commercial	$161.33
Rate for Payer: Priority Health Cigna Priority Health	$132.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.13
Rate for Payer: Priority Health Narrow/Tiered Network	$115.76
Rate for Payer: UHC All Payor (Choice/PPO)	$167.02
Rate for Payer: UHC Core	$158.48
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$142.35

BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION

Facility

$153.53

Service Code	HCPCS J0702
Hospital Charge Code	9266
Hospital Revenue Code	636
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$138.18
Rate for Payer: Aetna Commercial	$130.50
Rate for Payer: BCBS Trust/PPO	$118.65
Rate for Payer: BCN Commercial	$118.65
Rate for Payer: Cash Price	$122.82
Rate for Payer: Cofinity Commercial	$132.04
Rate for Payer: Encore Health Key Benefits Commercial	$122.82
Rate for Payer: Healthscope Commercial	$138.18
Rate for Payer: Lakeland Regional Health Systems Commercial	$115.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$130.50
Rate for Payer: PHP Commercial	$130.50
Rate for Payer: Priority Health Cigna Priority Health	$107.47
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$133.57
Rate for Payer: Priority Health Narrow/Tiered Network	$93.64
Rate for Payer: UHC All Payor (Choice/PPO)	$135.11
Rate for Payer: UHC Core	$128.20
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$115.15

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM

Facility

$137.55

Service Code	NDC 0168-0055-15
Hospital Charge Code	1027
Hospital Revenue Code	637
Min. Negotiated Rate	$83.89
Max. Negotiated Rate	$123.80
Rate for Payer: Aetna Commercial	$116.92
Rate for Payer: BCBS Trust/PPO	$106.30
Rate for Payer: BCN Commercial	$106.30
Rate for Payer: Cash Price	$110.04
Rate for Payer: Cofinity Commercial	$118.29
Rate for Payer: Encore Health Key Benefits Commercial	$110.04
Rate for Payer: Healthscope Commercial	$123.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$103.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$116.92
Rate for Payer: PHP Commercial	$116.92
Rate for Payer: Priority Health Cigna Priority Health	$96.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$119.67
Rate for Payer: Priority Health Narrow/Tiered Network	$83.89
Rate for Payer: UHC All Payor (Choice/PPO)	$121.04
Rate for Payer: UHC Core	$114.85
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$103.16

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM

Facility

$49.41

Service Code	NDC 70710-1233-1
Hospital Charge Code	1027
Hospital Revenue Code	637
Min. Negotiated Rate	$30.14
Max. Negotiated Rate	$44.47
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: BCBS Trust/PPO	$38.18
Rate for Payer: BCN Commercial	$38.18
Rate for Payer: Cash Price	$39.53
Rate for Payer: Cofinity Commercial	$42.49
Rate for Payer: Encore Health Key Benefits Commercial	$39.53
Rate for Payer: Healthscope Commercial	$44.47
Rate for Payer: Lakeland Regional Health Systems Commercial	$37.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$42.00
Rate for Payer: PHP Commercial	$42.00
Rate for Payer: Priority Health Cigna Priority Health	$34.59
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$42.99
Rate for Payer: Priority Health Narrow/Tiered Network	$30.14
Rate for Payer: UHC All Payor (Choice/PPO)	$43.48
Rate for Payer: UHC Core	$41.26
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$37.06

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT

Facility

$76.13

Service Code	NDC 72578-093-01
Hospital Charge Code	1029
Hospital Revenue Code	637
Min. Negotiated Rate	$46.43
Max. Negotiated Rate	$68.52
Rate for Payer: Aetna Commercial	$64.71
Rate for Payer: BCBS Trust/PPO	$58.83
Rate for Payer: BCN Commercial	$58.83
Rate for Payer: Cash Price	$60.90
Rate for Payer: Cofinity Commercial	$65.47
Rate for Payer: Encore Health Key Benefits Commercial	$60.90
Rate for Payer: Healthscope Commercial	$68.52
Rate for Payer: Lakeland Regional Health Systems Commercial	$57.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$64.71
Rate for Payer: PHP Commercial	$64.71
Rate for Payer: Priority Health Cigna Priority Health	$53.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$66.23
Rate for Payer: Priority Health Narrow/Tiered Network	$46.43
Rate for Payer: UHC All Payor (Choice/PPO)	$66.99
Rate for Payer: UHC Core	$63.57
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$57.10

BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT

Facility

$160.13

Service Code	NDC 0168-0056-15
Hospital Charge Code	1029
Hospital Revenue Code	637
Min. Negotiated Rate	$97.66
Max. Negotiated Rate	$144.12
Rate for Payer: Aetna Commercial	$136.11
Rate for Payer: BCBS Trust/PPO	$123.75
Rate for Payer: BCN Commercial	$123.75
Rate for Payer: Cash Price	$128.10
Rate for Payer: Cofinity Commercial	$137.71
Rate for Payer: Encore Health Key Benefits Commercial	$128.10
Rate for Payer: Healthscope Commercial	$144.12
Rate for Payer: Lakeland Regional Health Systems Commercial	$120.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$136.11
Rate for Payer: PHP Commercial	$136.11
Rate for Payer: Priority Health Cigna Priority Health	$112.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$139.31
Rate for Payer: Priority Health Narrow/Tiered Network	$97.66
Rate for Payer: UHC All Payor (Choice/PPO)	$140.91
Rate for Payer: UHC Core	$133.71
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$120.10

BIOPSY, MUSCLE; SUPERFICIAL

Facility

$1,116.73

Service Code	CPT 20200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,063.55
Max. Negotiated Rate	$1,116.73
Rate for Payer: BCBS Complete	$1,116.73
Rate for Payer: Mclaren Medicaid	$1,063.55
Rate for Payer: Meridian Medicaid	$1,116.73
Rate for Payer: Priority Health Choice Medicaid	$1,063.55

BIOPSY OF CERVIX, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE PROCEDURE)

Facility

$553.73

Service Code	CPT 57500
Hospital Revenue Code	360
Min. Negotiated Rate	$527.36
Max. Negotiated Rate	$553.73
Rate for Payer: BCBS Complete	$553.73
Rate for Payer: Mclaren Medicaid	$527.36
Rate for Payer: Meridian Medicaid	$553.73
Rate for Payer: Priority Health Choice Medicaid	$527.36

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION

Facility

$553.73

Service Code	CPT 56605
Hospital Revenue Code	360
Min. Negotiated Rate	$527.36
Max. Negotiated Rate	$553.73
Rate for Payer: BCBS Complete	$553.73
Rate for Payer: Mclaren Medicaid	$527.36
Rate for Payer: Meridian Medicaid	$553.73
Rate for Payer: Priority Health Choice Medicaid	$527.36

BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)

Facility

$2,625.49

Service Code	CPT 38510
Hospital Revenue Code	360
Min. Negotiated Rate	$2,500.47
Max. Negotiated Rate	$2,625.49
Rate for Payer: BCBS Complete	$2,625.49
Rate for Payer: Mclaren Medicaid	$2,500.47
Rate for Payer: Meridian Medicaid	$2,625.49
Rate for Payer: Priority Health Choice Medicaid	$2,500.47

BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL

Facility

$2,625.49

Service Code	CPT 38500
Hospital Revenue Code	360
Min. Negotiated Rate	$2,500.47
Max. Negotiated Rate	$2,625.49
Rate for Payer: BCBS Complete	$2,625.49
Rate for Payer: Mclaren Medicaid	$2,500.47
Rate for Payer: Meridian Medicaid	$2,625.49
Rate for Payer: Priority Health Choice Medicaid	$2,500.47

BISACODYL 10 MG RECTAL SUPPOSITORY

Facility

$52.46

Service Code	NDC 0904-7142-12
Hospital Charge Code	1080
Hospital Revenue Code	637
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$47.21
Rate for Payer: Aetna Commercial	$44.59
Rate for Payer: BCBS Trust/PPO	$40.54
Rate for Payer: BCN Commercial	$40.54
Rate for Payer: Cash Price	$41.97
Rate for Payer: Cofinity Commercial	$45.12
Rate for Payer: Encore Health Key Benefits Commercial	$41.97
Rate for Payer: Healthscope Commercial	$47.21
Rate for Payer: Lakeland Regional Health Systems Commercial	$39.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$44.59
Rate for Payer: PHP Commercial	$44.59
Rate for Payer: Priority Health Cigna Priority Health	$36.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.64
Rate for Payer: Priority Health Narrow/Tiered Network	$32.00
Rate for Payer: UHC All Payor (Choice/PPO)	$46.16
Rate for Payer: UHC Core	$43.80
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$39.34

BISACODYL 10 MG RECTAL SUPPOSITORY

Facility

$124.06

Service Code	NDC 8142102105
Hospital Charge Code	1080
Hospital Revenue Code	637
Min. Negotiated Rate	$75.66
Max. Negotiated Rate	$111.65
Rate for Payer: Aetna Commercial	$105.45
Rate for Payer: BCBS Trust/PPO	$95.87
Rate for Payer: BCN Commercial	$95.87
Rate for Payer: Cash Price	$99.25
Rate for Payer: Cofinity Commercial	$106.69
Rate for Payer: Encore Health Key Benefits Commercial	$99.25
Rate for Payer: Healthscope Commercial	$111.65
Rate for Payer: Lakeland Regional Health Systems Commercial	$93.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$105.45
Rate for Payer: PHP Commercial	$105.45
Rate for Payer: Priority Health Cigna Priority Health	$86.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.93
Rate for Payer: Priority Health Narrow/Tiered Network	$75.66
Rate for Payer: UHC All Payor (Choice/PPO)	$109.17
Rate for Payer: UHC Core	$103.59
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$93.04

BISACODYL 10 MG RECTAL SUPPOSITORY

Facility

$25.43

Service Code	NDC 0574-7050-12
Hospital Charge Code	1080
Hospital Revenue Code	637
Min. Negotiated Rate	$15.51
Max. Negotiated Rate	$22.89
Rate for Payer: Aetna Commercial	$21.62
Rate for Payer: BCBS Trust/PPO	$19.65
Rate for Payer: BCN Commercial	$19.65
Rate for Payer: Cash Price	$20.34
Rate for Payer: Cofinity Commercial	$21.87
Rate for Payer: Encore Health Key Benefits Commercial	$20.34
Rate for Payer: Healthscope Commercial	$22.89
Rate for Payer: Lakeland Regional Health Systems Commercial	$19.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.62
Rate for Payer: PHP Commercial	$21.62
Rate for Payer: Priority Health Cigna Priority Health	$17.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22.12
Rate for Payer: Priority Health Narrow/Tiered Network	$15.51
Rate for Payer: UHC All Payor (Choice/PPO)	$22.38
Rate for Payer: UHC Core	$21.23
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$19.07

BISACODYL 5 MG TABLET,DELAYED RELEASE

Facility

$5.88

Service Code	NDC 0904-6407-61
Hospital Charge Code	1079
Hospital Revenue Code	637
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$5.29
Rate for Payer: Aetna Commercial	$5.00
Rate for Payer: BCBS Trust/PPO	$4.54
Rate for Payer: BCN Commercial	$4.54
Rate for Payer: Cash Price	$4.70
Rate for Payer: Cofinity Commercial	$5.06
Rate for Payer: Encore Health Key Benefits Commercial	$4.70
Rate for Payer: Healthscope Commercial	$5.29
Rate for Payer: Lakeland Regional Health Systems Commercial	$4.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.00
Rate for Payer: PHP Commercial	$5.00
Rate for Payer: Priority Health Cigna Priority Health	$4.12
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.12
Rate for Payer: Priority Health Narrow/Tiered Network	$3.59
Rate for Payer: UHC All Payor (Choice/PPO)	$5.17
Rate for Payer: UHC Core	$4.91
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$4.41

BISOPROLOL FUMARATE 5 MG TABLET

Facility

$77.04

Service Code	NDC 52817-270-30
Hospital Charge Code	18288
Hospital Revenue Code	637
Min. Negotiated Rate	$46.99
Max. Negotiated Rate	$69.34
Rate for Payer: Aetna Commercial	$65.48
Rate for Payer: BCBS Trust/PPO	$59.54
Rate for Payer: BCN Commercial	$59.54
Rate for Payer: Cash Price	$61.63
Rate for Payer: Cofinity Commercial	$66.25
Rate for Payer: Encore Health Key Benefits Commercial	$61.63
Rate for Payer: Healthscope Commercial	$69.34
Rate for Payer: Lakeland Regional Health Systems Commercial	$57.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.48
Rate for Payer: PHP Commercial	$65.48
Rate for Payer: Priority Health Cigna Priority Health	$53.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.02
Rate for Payer: Priority Health Narrow/Tiered Network	$46.99
Rate for Payer: UHC All Payor (Choice/PPO)	$67.80
Rate for Payer: UHC Core	$64.33
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$57.78

BISOPROLOL FUMARATE 5 MG TABLET

Facility

$82.80

Service Code	NDC 29300-126-13
Hospital Charge Code	18288
Hospital Revenue Code	637
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$74.52
Rate for Payer: Aetna Commercial	$70.38
Rate for Payer: BCBS Trust/PPO	$63.99
Rate for Payer: BCN Commercial	$63.99
Rate for Payer: Cash Price	$66.24
Rate for Payer: Cofinity Commercial	$71.21
Rate for Payer: Encore Health Key Benefits Commercial	$66.24
Rate for Payer: Healthscope Commercial	$74.52
Rate for Payer: Lakeland Regional Health Systems Commercial	$62.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.38
Rate for Payer: PHP Commercial	$70.38
Rate for Payer: Priority Health Cigna Priority Health	$57.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$72.04
Rate for Payer: Priority Health Narrow/Tiered Network	$50.50
Rate for Payer: UHC All Payor (Choice/PPO)	$72.86
Rate for Payer: UHC Core	$69.14
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$62.10

BREAST REDUCTION

Facility

$4,491.68

Service Code	CPT 19318
Hospital Revenue Code	360
Min. Negotiated Rate	$4,277.79
Max. Negotiated Rate	$4,491.68
Rate for Payer: BCBS Complete	$4,491.68
Rate for Payer: Mclaren Medicaid	$4,277.79
Rate for Payer: Meridian Medicaid	$4,491.68
Rate for Payer: Priority Health Choice Medicaid	$4,277.79

BRIMONIDINE 0.1 % EYE DROPS

Facility

$632.59

Service Code	NDC 0023-9321-05
Hospital Charge Code	70262
Hospital Revenue Code	637
Min. Negotiated Rate	$385.82
Max. Negotiated Rate	$569.33
Rate for Payer: Aetna Commercial	$537.70
Rate for Payer: BCBS Trust/PPO	$488.87
Rate for Payer: BCN Commercial	$488.87
Rate for Payer: Cash Price	$506.07
Rate for Payer: Cofinity Commercial	$544.03
Rate for Payer: Encore Health Key Benefits Commercial	$506.07
Rate for Payer: Healthscope Commercial	$569.33
Rate for Payer: Lakeland Regional Health Systems Commercial	$474.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$537.70
Rate for Payer: PHP Commercial	$537.70
Rate for Payer: Priority Health Cigna Priority Health	$442.81
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$550.35
Rate for Payer: Priority Health Narrow/Tiered Network	$385.82
Rate for Payer: UHC All Payor (Choice/PPO)	$556.68
Rate for Payer: UHC Core	$528.21
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$474.44

BRIMONIDINE 0.2 % EYE DROPS

Facility

$19.93

Service Code	NDC 70069-233-01
Hospital Charge Code	17881
Hospital Revenue Code	637
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$17.94
Rate for Payer: Aetna Commercial	$16.94
Rate for Payer: BCBS Trust/PPO	$15.40
Rate for Payer: BCN Commercial	$15.40
Rate for Payer: Cash Price	$15.94
Rate for Payer: Cofinity Commercial	$17.14
Rate for Payer: Encore Health Key Benefits Commercial	$15.94
Rate for Payer: Healthscope Commercial	$17.94
Rate for Payer: Lakeland Regional Health Systems Commercial	$14.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.94
Rate for Payer: PHP Commercial	$16.94
Rate for Payer: Priority Health Cigna Priority Health	$13.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.34
Rate for Payer: Priority Health Narrow/Tiered Network	$12.16
Rate for Payer: UHC All Payor (Choice/PPO)	$17.54
Rate for Payer: UHC Core	$16.64
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$14.95

BRIMONIDINE 0.2 % EYE DROPS

Facility

$22.26

Service Code	NDC 61314-143-15
Hospital Charge Code	17881
Hospital Revenue Code	637
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$20.03
Rate for Payer: Aetna Commercial	$18.92
Rate for Payer: BCBS Trust/PPO	$17.20
Rate for Payer: BCN Commercial	$17.20
Rate for Payer: Cash Price	$17.81
Rate for Payer: Cofinity Commercial	$19.14
Rate for Payer: Encore Health Key Benefits Commercial	$17.81
Rate for Payer: Healthscope Commercial	$20.03
Rate for Payer: Lakeland Regional Health Systems Commercial	$16.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.92
Rate for Payer: PHP Commercial	$18.92
Rate for Payer: Priority Health Cigna Priority Health	$15.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.37
Rate for Payer: Priority Health Narrow/Tiered Network	$13.58
Rate for Payer: UHC All Payor (Choice/PPO)	$19.59
Rate for Payer: UHC Core	$18.59
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$16.70

BRIMONIDINE-TIMOLOL 0.2 %-0.5 % EYE DROPS

Facility

$664.13

Service Code	NDC 0023-9211-05
Hospital Charge Code	87834
Hospital Revenue Code	637
Min. Negotiated Rate	$405.05
Max. Negotiated Rate	$597.72
Rate for Payer: Aetna Commercial	$564.51
Rate for Payer: BCBS Trust/PPO	$513.24
Rate for Payer: BCN Commercial	$513.24
Rate for Payer: Cash Price	$531.30
Rate for Payer: Cofinity Commercial	$571.15
Rate for Payer: Encore Health Key Benefits Commercial	$531.30
Rate for Payer: Healthscope Commercial	$597.72
Rate for Payer: Lakeland Regional Health Systems Commercial	$498.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$564.51
Rate for Payer: PHP Commercial	$564.51
Rate for Payer: Priority Health Cigna Priority Health	$464.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$577.79
Rate for Payer: Priority Health Narrow/Tiered Network	$405.05
Rate for Payer: UHC All Payor (Choice/PPO)	$584.43
Rate for Payer: UHC Core	$554.55
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$498.10

BRINZOLAMIDE 1 %-BRIMONIDINE 0.2 % EYE DROPS,SUSPENSION

Facility

$636.25

Service Code	NDC 0065-4147-27
Hospital Charge Code	166167
Hospital Revenue Code	637
Min. Negotiated Rate	$388.05
Max. Negotiated Rate	$572.62
Rate for Payer: Aetna Commercial	$540.81
Rate for Payer: BCBS Trust/PPO	$491.69
Rate for Payer: BCN Commercial	$491.69
Rate for Payer: Cash Price	$509.00
Rate for Payer: Cofinity Commercial	$547.18
Rate for Payer: Encore Health Key Benefits Commercial	$509.00
Rate for Payer: Healthscope Commercial	$572.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$477.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$540.81
Rate for Payer: PHP Commercial	$540.81
Rate for Payer: Priority Health Cigna Priority Health	$445.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$553.54
Rate for Payer: Priority Health Narrow/Tiered Network	$388.05
Rate for Payer: UHC All Payor (Choice/PPO)	$559.90
Rate for Payer: UHC Core	$531.27
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$477.19

BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION

Facility

$1,114.61

Service Code	NDC 0065-0275-10
Hospital Charge Code	22953
Hospital Revenue Code	637
Min. Negotiated Rate	$679.80
Max. Negotiated Rate	$1,003.15
Rate for Payer: Aetna Commercial	$947.42
Rate for Payer: BCBS Trust/PPO	$861.37
Rate for Payer: BCN Commercial	$861.37
Rate for Payer: Cash Price	$891.69
Rate for Payer: Cofinity Commercial	$958.56
Rate for Payer: Encore Health Key Benefits Commercial	$891.69
Rate for Payer: Healthscope Commercial	$1,003.15
Rate for Payer: Lakeland Regional Health Systems Commercial	$835.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$947.42
Rate for Payer: PHP Commercial	$947.42
Rate for Payer: Priority Health Cigna Priority Health	$780.23
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$969.71
Rate for Payer: Priority Health Narrow/Tiered Network	$679.80
Rate for Payer: UHC All Payor (Choice/PPO)	$980.86
Rate for Payer: UHC Core	$930.70
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$835.96

BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION

Facility

$965.27

Service Code	NDC 0591-2127-79
Hospital Charge Code	22953
Hospital Revenue Code	637
Min. Negotiated Rate	$588.72
Max. Negotiated Rate	$868.74
Rate for Payer: Aetna Commercial	$820.48
Rate for Payer: BCBS Trust/PPO	$745.96
Rate for Payer: BCN Commercial	$745.96
Rate for Payer: Cash Price	$772.22
Rate for Payer: Cofinity Commercial	$830.13
Rate for Payer: Encore Health Key Benefits Commercial	$772.22
Rate for Payer: Healthscope Commercial	$868.74
Rate for Payer: Lakeland Regional Health Systems Commercial	$723.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$820.48
Rate for Payer: PHP Commercial	$820.48
Rate for Payer: Priority Health Cigna Priority Health	$675.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$839.78
Rate for Payer: Priority Health Narrow/Tiered Network	$588.72
Rate for Payer: UHC All Payor (Choice/PPO)	$849.44
Rate for Payer: UHC Core	$806.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$723.95

Know your out-of-pocket cost for care.

All Charges