Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE CERVIX

Facility

$2,153.41

Service Code	CPT 57460
Hospital Revenue Code	360
Min. Negotiated Rate	$331.36
Max. Negotiated Rate	$2,153.41
Rate for Payer: BCBS Complete	$2,153.41
Rate for Payer: BCCCP Commercial	$331.36
Rate for Payer: Mclaren Medicaid	$2,050.87
Rate for Payer: Meridian Medicaid	$2,153.41
Rate for Payer: Priority Health Choice Medicaid	$2,050.87

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX

Facility

$2,153.41

Service Code	CPT 57461
Hospital Revenue Code	360
Min. Negotiated Rate	$370.46
Max. Negotiated Rate	$2,153.41
Rate for Payer: BCBS Complete	$2,153.41
Rate for Payer: BCCCP Commercial	$370.46
Rate for Payer: Mclaren Medicaid	$2,050.87
Rate for Payer: Meridian Medicaid	$2,153.41
Rate for Payer: Priority Health Choice Medicaid	$2,050.87

COLPOSCOPY OF THE VULVA; WITH BIOPSY(S)

Facility

$220.97

Service Code	CPT 56821
Hospital Revenue Code	360
Min. Negotiated Rate	$210.45
Max. Negotiated Rate	$220.97
Rate for Payer: BCBS Complete	$220.97
Rate for Payer: Mclaren Medicaid	$210.45
Rate for Payer: Meridian Medicaid	$220.97
Rate for Payer: Priority Health Choice Medicaid	$210.45

COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID

Facility

$192.99

Service Code	NDC 574030216
Hospital Charge Code	119062
Hospital Revenue Code	637
Min. Negotiated Rate	$117.70
Max. Negotiated Rate	$173.69
Rate for Payer: Aetna Commercial	$164.04
Rate for Payer: BCBS Trust/PPO	$149.14
Rate for Payer: BCN Commercial	$149.14
Rate for Payer: Cash Price	$154.39
Rate for Payer: Cofinity Commercial	$165.97
Rate for Payer: Encore Health Key Benefits Commercial	$154.39
Rate for Payer: Healthscope Commercial	$173.69
Rate for Payer: Lakeland Regional Health Systems Commercial	$144.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$164.04
Rate for Payer: PHP Commercial	$164.04
Rate for Payer: Priority Health Cigna Priority Health	$135.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$167.90
Rate for Payer: Priority Health Narrow/Tiered Network	$117.70
Rate for Payer: UHC All Payor (Choice/PPO)	$169.83
Rate for Payer: UHC Core	$161.15
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$144.74

CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION

Facility

$2,153.41

Service Code	CPT 57522
Hospital Revenue Code	360
Min. Negotiated Rate	$322.14
Max. Negotiated Rate	$2,153.41
Rate for Payer: BCBS Complete	$2,153.41
Rate for Payer: BCCCP Commercial	$322.14
Rate for Payer: Mclaren Medicaid	$2,050.87
Rate for Payer: Meridian Medicaid	$2,153.41
Rate for Payer: Priority Health Choice Medicaid	$2,050.87

CONJUGATED ESTROGENS 0.3 MG TABLET

Facility

$2,376.14

Service Code	NDC 0046-1100-81
Hospital Charge Code	9973
Hospital Revenue Code	637
Min. Negotiated Rate	$1,449.21
Max. Negotiated Rate	$2,138.53
Rate for Payer: Aetna Commercial	$2,019.72
Rate for Payer: BCBS Trust/PPO	$1,836.28
Rate for Payer: BCN Commercial	$1,836.28
Rate for Payer: Cash Price	$1,900.91
Rate for Payer: Cofinity Commercial	$2,043.48
Rate for Payer: Encore Health Key Benefits Commercial	$1,900.91
Rate for Payer: Healthscope Commercial	$2,138.53
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,782.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,019.72
Rate for Payer: PHP Commercial	$2,019.72
Rate for Payer: Priority Health Cigna Priority Health	$1,663.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,067.24
Rate for Payer: Priority Health Narrow/Tiered Network	$1,449.21
Rate for Payer: UHC All Payor (Choice/PPO)	$2,091.00
Rate for Payer: UHC Core	$1,984.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,782.10

CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM

Facility

$1,464.96

Service Code	NDC 0046-0872-21
Hospital Charge Code	9977
Hospital Revenue Code	250
Min. Negotiated Rate	$893.48
Max. Negotiated Rate	$1,318.46
Rate for Payer: Aetna Commercial	$1,245.22
Rate for Payer: BCBS Trust/PPO	$1,132.12
Rate for Payer: BCN Commercial	$1,132.12
Rate for Payer: Cash Price	$1,171.97
Rate for Payer: Cofinity Commercial	$1,259.87
Rate for Payer: Encore Health Key Benefits Commercial	$1,171.97
Rate for Payer: Healthscope Commercial	$1,318.46
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,098.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,245.22
Rate for Payer: PHP Commercial	$1,245.22
Rate for Payer: Priority Health Cigna Priority Health	$1,025.47
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,274.52
Rate for Payer: Priority Health Narrow/Tiered Network	$893.48
Rate for Payer: UHC All Payor (Choice/PPO)	$1,289.16
Rate for Payer: UHC Core	$1,223.24
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,098.72

CONJUGATED ESTROGENS 0.625 MG TABLET

Facility

$2,376.14

Service Code	NDC 0046-1102-81
Hospital Charge Code	9974
Hospital Revenue Code	637
Min. Negotiated Rate	$1,449.21
Max. Negotiated Rate	$2,138.53
Rate for Payer: Aetna Commercial	$2,019.72
Rate for Payer: BCBS Trust/PPO	$1,836.28
Rate for Payer: BCN Commercial	$1,836.28
Rate for Payer: Cash Price	$1,900.91
Rate for Payer: Cofinity Commercial	$2,043.48
Rate for Payer: Encore Health Key Benefits Commercial	$1,900.91
Rate for Payer: Healthscope Commercial	$2,138.53
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,782.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,019.72
Rate for Payer: PHP Commercial	$2,019.72
Rate for Payer: Priority Health Cigna Priority Health	$1,663.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,067.24
Rate for Payer: Priority Health Narrow/Tiered Network	$1,449.21
Rate for Payer: UHC All Payor (Choice/PPO)	$2,091.00
Rate for Payer: UHC Core	$1,984.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,782.10

CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD

Facility

$4,927.66

Service Code	CPT 28299
Hospital Revenue Code	360
Min. Negotiated Rate	$4,693.01
Max. Negotiated Rate	$4,927.66
Rate for Payer: BCBS Complete	$4,927.66
Rate for Payer: Mclaren Medicaid	$4,693.01
Rate for Payer: Meridian Medicaid	$4,927.66
Rate for Payer: Priority Health Choice Medicaid	$4,693.01

CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL METATARSAL OSTEOTOMY, ANY METHOD

Facility

$2,229.50

Service Code	CPT 28295
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD

Facility

$2,229.50

Service Code	CPT 28292
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)

Facility

$2,229.50

Service Code	CPT 28285
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION

Facility

$131.82

Service Code	HCPCS J0834
Hospital Charge Code	9686
Hospital Revenue Code	636
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$118.64
Rate for Payer: Aetna Commercial	$112.05
Rate for Payer: BCBS Trust/PPO	$101.87
Rate for Payer: BCN Commercial	$101.87
Rate for Payer: Cash Price	$105.46
Rate for Payer: Cofinity Commercial	$113.37
Rate for Payer: Encore Health Key Benefits Commercial	$105.46
Rate for Payer: Healthscope Commercial	$118.64
Rate for Payer: Lakeland Regional Health Systems Commercial	$98.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.05
Rate for Payer: PHP Commercial	$112.05
Rate for Payer: Priority Health Cigna Priority Health	$92.27
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$114.68
Rate for Payer: Priority Health Narrow/Tiered Network	$80.40
Rate for Payer: UHC All Payor (Choice/PPO)	$116.00
Rate for Payer: UHC Core	$110.07
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$98.86

CPT 0255T

Professional

Both

$446.00

Service Code	HCPCS 0255T
Min. Negotiated Rate	$178.40
Max. Negotiated Rate	$312.20
Rate for Payer: BCBS Complete	$178.40
Rate for Payer: Cash Price	$356.80
Rate for Payer: Priority Health Cigna Priority Health	$312.20

CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION

Facility

$17.54

Service Code	HCPCS J3420
Hospital Charge Code	2007
Hospital Revenue Code	636
Min. Negotiated Rate	$10.70
Max. Negotiated Rate	$15.79
Rate for Payer: Aetna Commercial	$14.91
Rate for Payer: BCBS Trust/PPO	$13.55
Rate for Payer: BCN Commercial	$13.55
Rate for Payer: Cash Price	$14.03
Rate for Payer: Cofinity Commercial	$15.08
Rate for Payer: Encore Health Key Benefits Commercial	$14.03
Rate for Payer: Healthscope Commercial	$15.79
Rate for Payer: Lakeland Regional Health Systems Commercial	$13.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.91
Rate for Payer: PHP Commercial	$14.91
Rate for Payer: Priority Health Cigna Priority Health	$12.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.26
Rate for Payer: Priority Health Narrow/Tiered Network	$10.70
Rate for Payer: UHC All Payor (Choice/PPO)	$15.44
Rate for Payer: UHC Core	$14.65
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$13.16

CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET

Facility

$312.55

Service Code	NDC 7733393810
Hospital Charge Code	2009
Hospital Revenue Code	637
Min. Negotiated Rate	$190.62
Max. Negotiated Rate	$281.30
Rate for Payer: Aetna Commercial	$265.67
Rate for Payer: BCBS Trust/PPO	$241.54
Rate for Payer: BCN Commercial	$241.54
Rate for Payer: Cash Price	$250.04
Rate for Payer: Cofinity Commercial	$268.79
Rate for Payer: Encore Health Key Benefits Commercial	$250.04
Rate for Payer: Healthscope Commercial	$281.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$234.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$265.67
Rate for Payer: PHP Commercial	$265.67
Rate for Payer: Priority Health Cigna Priority Health	$218.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$271.92
Rate for Payer: Priority Health Narrow/Tiered Network	$190.62
Rate for Payer: UHC All Payor (Choice/PPO)	$275.04
Rate for Payer: UHC Core	$260.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$234.41

CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET

Facility

$3.13

Service Code	NDC 7733393825
Hospital Charge Code	2009
Hospital Revenue Code	637
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$2.82
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: BCBS Trust/PPO	$2.42
Rate for Payer: BCN Commercial	$2.42
Rate for Payer: Cash Price	$2.50
Rate for Payer: Cofinity Commercial	$2.69
Rate for Payer: Encore Health Key Benefits Commercial	$2.50
Rate for Payer: Healthscope Commercial	$2.82
Rate for Payer: Lakeland Regional Health Systems Commercial	$2.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.66
Rate for Payer: PHP Commercial	$2.66
Rate for Payer: Priority Health Cigna Priority Health	$2.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.72
Rate for Payer: Priority Health Narrow/Tiered Network	$1.91
Rate for Payer: UHC All Payor (Choice/PPO)	$2.75
Rate for Payer: UHC Core	$2.61
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.35

CYANOCOBALAMIN (VIT B-12) 250 MCG TABLET

Facility

$3.48

Service Code	NDC 5026885311
Hospital Charge Code	2010
Hospital Revenue Code	637
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$2.96
Rate for Payer: BCBS Trust/PPO	$2.69
Rate for Payer: BCN Commercial	$2.69
Rate for Payer: Cash Price	$2.78
Rate for Payer: Cofinity Commercial	$2.99
Rate for Payer: Encore Health Key Benefits Commercial	$2.78
Rate for Payer: Healthscope Commercial	$3.13
Rate for Payer: Lakeland Regional Health Systems Commercial	$2.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.96
Rate for Payer: PHP Commercial	$2.96
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.03
Rate for Payer: Priority Health Narrow/Tiered Network	$2.12
Rate for Payer: UHC All Payor (Choice/PPO)	$3.06
Rate for Payer: UHC Core	$2.91
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.61

CYANOCOBALAMIN (VIT B-12) 250 MCG TABLET

Facility

$173.90

Service Code	NDC 5026885315
Hospital Charge Code	2010
Hospital Revenue Code	637
Min. Negotiated Rate	$106.06
Max. Negotiated Rate	$156.51
Rate for Payer: Aetna Commercial	$147.82
Rate for Payer: BCBS Trust/PPO	$134.39
Rate for Payer: BCN Commercial	$134.39
Rate for Payer: Cash Price	$139.12
Rate for Payer: Cofinity Commercial	$149.55
Rate for Payer: Encore Health Key Benefits Commercial	$139.12
Rate for Payer: Healthscope Commercial	$156.51
Rate for Payer: Lakeland Regional Health Systems Commercial	$130.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$147.82
Rate for Payer: PHP Commercial	$147.82
Rate for Payer: Priority Health Cigna Priority Health	$121.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$151.29
Rate for Payer: Priority Health Narrow/Tiered Network	$106.06
Rate for Payer: UHC All Payor (Choice/PPO)	$153.03
Rate for Payer: UHC Core	$145.21
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$130.42

CYANOCOBALAMIN (VIT B-12) 250 MCG TABLET

Facility

$39.72

Service Code	NDC 904421813
Hospital Charge Code	2010
Hospital Revenue Code	637
Min. Negotiated Rate	$24.23
Max. Negotiated Rate	$35.75
Rate for Payer: Aetna Commercial	$33.76
Rate for Payer: BCBS Trust/PPO	$30.70
Rate for Payer: BCN Commercial	$30.70
Rate for Payer: Cash Price	$31.78
Rate for Payer: Cofinity Commercial	$34.16
Rate for Payer: Encore Health Key Benefits Commercial	$31.78
Rate for Payer: Healthscope Commercial	$35.75
Rate for Payer: Lakeland Regional Health Systems Commercial	$29.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.76
Rate for Payer: PHP Commercial	$33.76
Rate for Payer: Priority Health Cigna Priority Health	$27.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.56
Rate for Payer: Priority Health Narrow/Tiered Network	$24.23
Rate for Payer: UHC All Payor (Choice/PPO)	$34.95
Rate for Payer: UHC Core	$33.17
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$29.79

CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET

Facility

$1.34

Service Code	NDC 7733393725
Hospital Charge Code	2012
Hospital Revenue Code	637
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.21
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: BCBS Trust/PPO	$1.04
Rate for Payer: BCN Commercial	$1.04
Rate for Payer: Cash Price	$1.07
Rate for Payer: Cofinity Commercial	$1.15
Rate for Payer: Encore Health Key Benefits Commercial	$1.07
Rate for Payer: Healthscope Commercial	$1.21
Rate for Payer: Lakeland Regional Health Systems Commercial	$1.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.14
Rate for Payer: PHP Commercial	$1.14
Rate for Payer: Priority Health Cigna Priority Health	$0.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1.17
Rate for Payer: Priority Health Narrow/Tiered Network	$0.82
Rate for Payer: UHC All Payor (Choice/PPO)	$1.18
Rate for Payer: UHC Core	$1.12
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1.00

CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET

Facility

$133.10

Service Code	NDC 7733393710
Hospital Charge Code	2012
Hospital Revenue Code	637
Min. Negotiated Rate	$81.18
Max. Negotiated Rate	$119.79
Rate for Payer: Aetna Commercial	$113.14
Rate for Payer: BCBS Trust/PPO	$102.86
Rate for Payer: BCN Commercial	$102.86
Rate for Payer: Cash Price	$106.48
Rate for Payer: Cofinity Commercial	$114.47
Rate for Payer: Encore Health Key Benefits Commercial	$106.48
Rate for Payer: Healthscope Commercial	$119.79
Rate for Payer: Lakeland Regional Health Systems Commercial	$99.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.14
Rate for Payer: PHP Commercial	$113.14
Rate for Payer: Priority Health Cigna Priority Health	$93.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$115.80
Rate for Payer: Priority Health Narrow/Tiered Network	$81.18
Rate for Payer: UHC All Payor (Choice/PPO)	$117.13
Rate for Payer: UHC Core	$111.14
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$99.82

CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET

Facility

$200.00

Service Code	NDC 7985420060
Hospital Charge Code	2012
Hospital Revenue Code	637
Min. Negotiated Rate	$121.98
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$170.00
Rate for Payer: BCBS Trust/PPO	$154.56
Rate for Payer: BCN Commercial	$154.56
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cofinity Commercial	$172.00
Rate for Payer: Encore Health Key Benefits Commercial	$160.00
Rate for Payer: Healthscope Commercial	$180.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$150.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$170.00
Rate for Payer: PHP Commercial	$170.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$174.00
Rate for Payer: Priority Health Narrow/Tiered Network	$121.98
Rate for Payer: UHC All Payor (Choice/PPO)	$176.00
Rate for Payer: UHC Core	$167.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$150.00

CYCLOBENZAPRINE 5 MG TABLET

Facility

$115.71

Service Code	NDC 68084-753-25
Hospital Charge Code	35184
Hospital Revenue Code	637
Min. Negotiated Rate	$70.57
Max. Negotiated Rate	$104.14
Rate for Payer: Aetna Commercial	$98.35
Rate for Payer: BCBS Trust/PPO	$89.42
Rate for Payer: BCN Commercial	$89.42
Rate for Payer: Cash Price	$92.57
Rate for Payer: Cofinity Commercial	$99.51
Rate for Payer: Encore Health Key Benefits Commercial	$92.57
Rate for Payer: Healthscope Commercial	$104.14
Rate for Payer: Lakeland Regional Health Systems Commercial	$86.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.35
Rate for Payer: PHP Commercial	$98.35
Rate for Payer: Priority Health Cigna Priority Health	$81.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.67
Rate for Payer: Priority Health Narrow/Tiered Network	$70.57
Rate for Payer: UHC All Payor (Choice/PPO)	$101.82
Rate for Payer: UHC Core	$96.62
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$86.78

CYCLOBENZAPRINE 5 MG TABLET

Facility

$103.40

Service Code	NDC 10702-006-01
Hospital Charge Code	35184
Hospital Revenue Code	637
Min. Negotiated Rate	$63.06
Max. Negotiated Rate	$93.06
Rate for Payer: Aetna Commercial	$87.89
Rate for Payer: BCBS Trust/PPO	$79.91
Rate for Payer: BCN Commercial	$79.91
Rate for Payer: Cash Price	$82.72
Rate for Payer: Cofinity Commercial	$88.92
Rate for Payer: Encore Health Key Benefits Commercial	$82.72
Rate for Payer: Healthscope Commercial	$93.06
Rate for Payer: Lakeland Regional Health Systems Commercial	$77.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$87.89
Rate for Payer: PHP Commercial	$87.89
Rate for Payer: Priority Health Cigna Priority Health	$72.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$89.96
Rate for Payer: Priority Health Narrow/Tiered Network	$63.06
Rate for Payer: UHC All Payor (Choice/PPO)	$90.99
Rate for Payer: UHC Core	$86.34
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$77.55

Know your out-of-pocket cost for care.

All Charges