Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$37.60

Service Code	NDC 80681016900
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$37.60
Rate for Payer: Aetna Commercial	$33.84
Rate for Payer: ASR ASR	$36.47
Rate for Payer: ASR Commercial	$36.47
Rate for Payer: BCBS Trust/PPO	$30.64
Rate for Payer: BCN Commercial	$29.15
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cofinity Commercial	$35.34
Rate for Payer: Encore Health Key Benefits Commercial	$30.08
Rate for Payer: Healthscope Commercial	$37.60
Rate for Payer: Healthscope Whirlpool	$36.47
Rate for Payer: Mclaren Commercial	$33.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.96
Rate for Payer: Nomi Health Commercial	$30.83
Rate for Payer: Priority Health Cigna Priority Health	$24.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$33.09

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$37.60

Service Code	NDC 80681016900
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$37.60
Rate for Payer: Aetna Commercial	$33.84
Rate for Payer: Aetna Medicare	$18.80
Rate for Payer: ASR ASR	$36.47
Rate for Payer: ASR Commercial	$36.47
Rate for Payer: BCBS Complete	$15.04
Rate for Payer: BCBS Trust/PPO	$30.79
Rate for Payer: BCN Commercial	$29.15
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cofinity Commercial	$35.34
Rate for Payer: Encore Health Key Benefits Commercial	$30.08
Rate for Payer: Healthscope Commercial	$37.60
Rate for Payer: Healthscope Whirlpool	$36.47
Rate for Payer: Mclaren Commercial	$33.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.96
Rate for Payer: Nomi Health Commercial	$30.83
Rate for Payer: Priority Health Cigna Priority Health	$24.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$32.95
Rate for Payer: Priority Health Narrow Network	$26.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$33.09

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$224.20

Service Code	NDC 48433010401
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$89.68
Max. Negotiated Rate	$224.20
Rate for Payer: Aetna Commercial	$201.78
Rate for Payer: Aetna Medicare	$112.10
Rate for Payer: ASR ASR	$217.47
Rate for Payer: ASR Commercial	$217.47
Rate for Payer: BCBS Complete	$89.68
Rate for Payer: BCBS Trust/PPO	$183.60
Rate for Payer: BCN Commercial	$173.82
Rate for Payer: Cash Price	$179.36
Rate for Payer: Cofinity Commercial	$210.75
Rate for Payer: Encore Health Key Benefits Commercial	$179.36
Rate for Payer: Healthscope Commercial	$224.20
Rate for Payer: Healthscope Whirlpool	$217.47
Rate for Payer: Mclaren Commercial	$201.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.57
Rate for Payer: Nomi Health Commercial	$183.84
Rate for Payer: Priority Health Cigna Priority Health	$145.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$196.44
Rate for Payer: Priority Health Narrow Network	$157.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$197.30

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$133.95

Service Code	NDC 31604001870
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$53.58
Max. Negotiated Rate	$133.95
Rate for Payer: Aetna Commercial	$120.56
Rate for Payer: Aetna Medicare	$66.98
Rate for Payer: ASR ASR	$129.93
Rate for Payer: ASR Commercial	$129.93
Rate for Payer: BCBS Complete	$53.58
Rate for Payer: BCBS Trust/PPO	$109.69
Rate for Payer: BCN Commercial	$103.85
Rate for Payer: Cash Price	$107.16
Rate for Payer: Cofinity Commercial	$125.91
Rate for Payer: Encore Health Key Benefits Commercial	$107.16
Rate for Payer: Healthscope Commercial	$133.95
Rate for Payer: Healthscope Whirlpool	$129.93
Rate for Payer: Mclaren Commercial	$120.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$113.86
Rate for Payer: Nomi Health Commercial	$109.84
Rate for Payer: Priority Health Cigna Priority Health	$87.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.37
Rate for Payer: Priority Health Narrow Network	$93.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$117.88

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$224.20

Service Code	NDC 48433010401
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$145.73
Max. Negotiated Rate	$224.20
Rate for Payer: Aetna Commercial	$201.78
Rate for Payer: ASR ASR	$217.47
Rate for Payer: ASR Commercial	$217.47
Rate for Payer: BCBS Trust/PPO	$182.70
Rate for Payer: BCN Commercial	$173.82
Rate for Payer: Cash Price	$179.36
Rate for Payer: Cofinity Commercial	$210.75
Rate for Payer: Encore Health Key Benefits Commercial	$179.36
Rate for Payer: Healthscope Commercial	$224.20
Rate for Payer: Healthscope Whirlpool	$217.47
Rate for Payer: Mclaren Commercial	$201.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.57
Rate for Payer: Nomi Health Commercial	$183.84
Rate for Payer: Priority Health Cigna Priority Health	$145.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$197.30

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET

Facility

$133.95

Service Code	NDC 31604001870
Hospital Charge Code	82639
Hospital Revenue Code	637
Min. Negotiated Rate	$87.07
Max. Negotiated Rate	$133.95
Rate for Payer: Aetna Commercial	$120.56
Rate for Payer: ASR ASR	$129.93
Rate for Payer: ASR Commercial	$129.93
Rate for Payer: BCBS Trust/PPO	$109.16
Rate for Payer: BCN Commercial	$103.85
Rate for Payer: Cash Price	$107.16
Rate for Payer: Cofinity Commercial	$125.91
Rate for Payer: Encore Health Key Benefits Commercial	$107.16
Rate for Payer: Healthscope Commercial	$133.95
Rate for Payer: Healthscope Whirlpool	$129.93
Rate for Payer: Mclaren Commercial	$120.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$113.86
Rate for Payer: Nomi Health Commercial	$109.84
Rate for Payer: Priority Health Cigna Priority Health	$87.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$117.88

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$4.29

Service Code	NDC 49884046564
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.86
Rate for Payer: ASR ASR	$4.16
Rate for Payer: ASR Commercial	$4.16
Rate for Payer: BCBS Trust/PPO	$3.50
Rate for Payer: BCN Commercial	$3.33
Rate for Payer: Cash Price	$3.43
Rate for Payer: Cofinity Commercial	$4.03
Rate for Payer: Encore Health Key Benefits Commercial	$3.43
Rate for Payer: Healthscope Commercial	$4.29
Rate for Payer: Healthscope Whirlpool	$4.16
Rate for Payer: Mclaren Commercial	$3.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.65
Rate for Payer: Nomi Health Commercial	$3.52
Rate for Payer: Priority Health Cigna Priority Health	$2.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.78

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$257.47

Service Code	NDC 49884046565
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$102.99
Max. Negotiated Rate	$257.47
Rate for Payer: Aetna Commercial	$231.72
Rate for Payer: Aetna Medicare	$128.74
Rate for Payer: ASR ASR	$249.75
Rate for Payer: ASR Commercial	$249.75
Rate for Payer: BCBS Complete	$102.99
Rate for Payer: BCBS Trust/PPO	$210.84
Rate for Payer: BCN Commercial	$199.62
Rate for Payer: Cash Price	$205.98
Rate for Payer: Cofinity Commercial	$242.02
Rate for Payer: Encore Health Key Benefits Commercial	$205.98
Rate for Payer: Healthscope Commercial	$257.47
Rate for Payer: Healthscope Whirlpool	$249.75
Rate for Payer: Mclaren Commercial	$231.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$218.85
Rate for Payer: Nomi Health Commercial	$211.13
Rate for Payer: Priority Health Cigna Priority Health	$167.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$225.60
Rate for Payer: Priority Health Narrow Network	$180.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$226.57

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$4.29

Service Code	NDC 49884046564
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.86
Rate for Payer: Aetna Medicare	$2.14
Rate for Payer: ASR ASR	$4.16
Rate for Payer: ASR Commercial	$4.16
Rate for Payer: BCBS Complete	$1.72
Rate for Payer: BCBS Trust/PPO	$3.51
Rate for Payer: BCN Commercial	$3.33
Rate for Payer: Cash Price	$3.43
Rate for Payer: Cofinity Commercial	$4.03
Rate for Payer: Encore Health Key Benefits Commercial	$3.43
Rate for Payer: Healthscope Commercial	$4.29
Rate for Payer: Healthscope Whirlpool	$4.16
Rate for Payer: Mclaren Commercial	$3.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.65
Rate for Payer: Nomi Health Commercial	$3.52
Rate for Payer: Priority Health Cigna Priority Health	$2.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.76
Rate for Payer: Priority Health Narrow Network	$3.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.78

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET

Facility

$257.47

Service Code	NDC 49884046565
Hospital Charge Code	9588
Hospital Revenue Code	637
Min. Negotiated Rate	$167.36
Max. Negotiated Rate	$257.47
Rate for Payer: Aetna Commercial	$231.72
Rate for Payer: ASR ASR	$249.75
Rate for Payer: ASR Commercial	$249.75
Rate for Payer: BCBS Trust/PPO	$209.81
Rate for Payer: BCN Commercial	$199.62
Rate for Payer: Cash Price	$205.98
Rate for Payer: Cofinity Commercial	$242.02
Rate for Payer: Encore Health Key Benefits Commercial	$205.98
Rate for Payer: Healthscope Commercial	$257.47
Rate for Payer: Healthscope Whirlpool	$249.75
Rate for Payer: Mclaren Commercial	$231.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$218.85
Rate for Payer: Nomi Health Commercial	$211.13
Rate for Payer: Priority Health Cigna Priority Health	$167.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$226.57

CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING

Facility

$345.53

Service Code	NDC 08065183150
Hospital Charge Code	28917
Hospital Revenue Code	250
Min. Negotiated Rate	$138.21
Max. Negotiated Rate	$345.53
Rate for Payer: Aetna Commercial	$310.98
Rate for Payer: Aetna Medicare	$172.76
Rate for Payer: ASR ASR	$335.16
Rate for Payer: ASR Commercial	$335.16
Rate for Payer: BCBS Complete	$138.21
Rate for Payer: BCBS Trust/PPO	$282.95
Rate for Payer: BCN Commercial	$267.89
Rate for Payer: Cash Price	$276.43
Rate for Payer: Cofinity Commercial	$324.80
Rate for Payer: Encore Health Key Benefits Commercial	$276.42
Rate for Payer: Healthscope Commercial	$345.53
Rate for Payer: Healthscope Whirlpool	$335.16
Rate for Payer: Mclaren Commercial	$310.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.70
Rate for Payer: Nomi Health Commercial	$283.33
Rate for Payer: Priority Health Cigna Priority Health	$224.59
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$302.75
Rate for Payer: Priority Health Narrow Network	$242.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$304.07

CHONDROITIN-SOD HYALURON 3 %-4 %(0.5 ML)1 %(0.55 ML)INTRAOCULAR SYRING

Facility

$345.53

Service Code	NDC 08065183150
Hospital Charge Code	28917
Hospital Revenue Code	250
Min. Negotiated Rate	$224.59
Max. Negotiated Rate	$345.53
Rate for Payer: Aetna Commercial	$310.98
Rate for Payer: ASR ASR	$335.16
Rate for Payer: ASR Commercial	$335.16
Rate for Payer: BCBS Trust/PPO	$281.57
Rate for Payer: BCN Commercial	$267.89
Rate for Payer: Cash Price	$276.43
Rate for Payer: Cofinity Commercial	$324.80
Rate for Payer: Encore Health Key Benefits Commercial	$276.42
Rate for Payer: Healthscope Commercial	$345.53
Rate for Payer: Healthscope Whirlpool	$335.16
Rate for Payer: Mclaren Commercial	$310.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$293.70
Rate for Payer: Nomi Health Commercial	$283.33
Rate for Payer: Priority Health Cigna Priority Health	$224.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$304.07

CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE

Facility

$218.01

Service Code	HCPCS J7327
Hospital Charge Code	28923
Hospital Revenue Code	250
Min. Negotiated Rate	$141.71
Max. Negotiated Rate	$875.21
Rate for Payer: Aetna Commercial	$196.21
Rate for Payer: Aetna Medicare	$564.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$705.81
Rate for Payer: Amish Plain Church Group Commercial	$705.81
Rate for Payer: ASR ASR	$211.47
Rate for Payer: ASR Commercial	$211.47
Rate for Payer: BCBS Complete	$317.79
Rate for Payer: BCBS MAPPO	$564.65
Rate for Payer: BCBS Trust/PPO	$178.53
Rate for Payer: BCN Commercial	$169.02
Rate for Payer: BCN Medicare Advantage	$564.65
Rate for Payer: Cash Price	$174.40
Rate for Payer: Cash Price	$174.40
Rate for Payer: Cofinity Commercial	$204.93
Rate for Payer: Encore Health Key Benefits Commercial	$174.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$564.65
Rate for Payer: Healthscope Commercial	$218.01
Rate for Payer: Healthscope Whirlpool	$211.47
Rate for Payer: Humana Choice PPO Medicare	$564.65
Rate for Payer: Mclaren Commercial	$196.21
Rate for Payer: Mclaren Medicaid	$302.65
Rate for Payer: Mclaren Medicare	$564.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$592.88
Rate for Payer: Meridian Medicaid	$317.79
Rate for Payer: MI Amish Medical Board Commercial	$649.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.31
Rate for Payer: Nomi Health Commercial	$178.77
Rate for Payer: PACE Medicare	$536.42
Rate for Payer: PACE SWMI	$564.65
Rate for Payer: PHP Commercial	$621.12
Rate for Payer: PHP Medicaid	$302.65
Rate for Payer: PHP Medicare Advantage	$564.65
Rate for Payer: Priority Health Choice Medicaid	$302.65
Rate for Payer: Priority Health Cigna Priority Health	$141.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$688.68
Rate for Payer: Priority Health Medicare	$564.65
Rate for Payer: Priority Health Narrow Network	$550.94
Rate for Payer: Railroad Medicare Medicare	$564.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$191.85
Rate for Payer: UHC Dual Complete DSNP	$564.65
Rate for Payer: UHC Exchange	$875.21
Rate for Payer: UHC Medicare Advantage	$564.65
Rate for Payer: UHCCP DNSP	$564.65
Rate for Payer: UHCCP Medicaid	$302.65
Rate for Payer: VA VA	$564.65

CHONDROITIN-SOD HYALURON 4 %-3 % (40 MG-30 MG/ML) INTRAOCULAR SYRINGE

Facility

$218.01

Service Code	HCPCS J7327
Hospital Charge Code	28923
Hospital Revenue Code	250
Min. Negotiated Rate	$141.71
Max. Negotiated Rate	$218.01
Rate for Payer: Aetna Commercial	$196.21
Rate for Payer: ASR ASR	$211.47
Rate for Payer: ASR Commercial	$211.47
Rate for Payer: BCBS Trust/PPO	$177.66
Rate for Payer: BCN Commercial	$169.02
Rate for Payer: Cash Price	$174.40
Rate for Payer: Cofinity Commercial	$204.93
Rate for Payer: Encore Health Key Benefits Commercial	$174.41
Rate for Payer: Healthscope Commercial	$218.01
Rate for Payer: Healthscope Whirlpool	$211.47
Rate for Payer: Mclaren Commercial	$196.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.31
Rate for Payer: Nomi Health Commercial	$178.77
Rate for Payer: Priority Health Cigna Priority Health	$141.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$191.85

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$399.94

Service Code	NDC 43598032675
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$159.98
Max. Negotiated Rate	$399.94
Rate for Payer: Aetna Commercial	$359.95
Rate for Payer: Aetna Medicare	$199.97
Rate for Payer: ASR ASR	$387.94
Rate for Payer: ASR Commercial	$387.94
Rate for Payer: BCBS Complete	$159.98
Rate for Payer: BCBS Trust/PPO	$327.51
Rate for Payer: BCN Commercial	$310.07
Rate for Payer: Cash Price	$319.96
Rate for Payer: Cofinity Commercial	$375.94
Rate for Payer: Encore Health Key Benefits Commercial	$319.95
Rate for Payer: Healthscope Commercial	$399.94
Rate for Payer: Healthscope Whirlpool	$387.94
Rate for Payer: Mclaren Commercial	$359.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.95
Rate for Payer: Nomi Health Commercial	$327.95
Rate for Payer: Priority Health Cigna Priority Health	$259.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$350.43
Rate for Payer: Priority Health Narrow Network	$280.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$351.95

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$729.72

Service Code	NDC 00781618667
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$291.89
Max. Negotiated Rate	$729.72
Rate for Payer: Aetna Commercial	$656.75
Rate for Payer: Aetna Medicare	$364.86
Rate for Payer: ASR ASR	$707.83
Rate for Payer: ASR Commercial	$707.83
Rate for Payer: BCBS Complete	$291.89
Rate for Payer: BCBS Trust/PPO	$597.57
Rate for Payer: BCN Commercial	$565.75
Rate for Payer: Cash Price	$583.78
Rate for Payer: Cofinity Commercial	$685.94
Rate for Payer: Encore Health Key Benefits Commercial	$583.78
Rate for Payer: Healthscope Commercial	$729.72
Rate for Payer: Healthscope Whirlpool	$707.83
Rate for Payer: Mclaren Commercial	$656.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$620.26
Rate for Payer: Nomi Health Commercial	$598.37
Rate for Payer: Priority Health Cigna Priority Health	$474.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$639.38
Rate for Payer: Priority Health Narrow Network	$511.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$642.15

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$399.94

Service Code	NDC 43598032675
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$259.96
Max. Negotiated Rate	$399.94
Rate for Payer: Aetna Commercial	$359.95
Rate for Payer: ASR ASR	$387.94
Rate for Payer: ASR Commercial	$387.94
Rate for Payer: BCBS Trust/PPO	$325.91
Rate for Payer: BCN Commercial	$310.07
Rate for Payer: Cash Price	$319.96
Rate for Payer: Cofinity Commercial	$375.94
Rate for Payer: Encore Health Key Benefits Commercial	$319.95
Rate for Payer: Healthscope Commercial	$399.94
Rate for Payer: Healthscope Whirlpool	$387.94
Rate for Payer: Mclaren Commercial	$359.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.95
Rate for Payer: Nomi Health Commercial	$327.95
Rate for Payer: Priority Health Cigna Priority Health	$259.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$351.95

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$302.71

Service Code	NDC 72485062513
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$196.76
Max. Negotiated Rate	$302.71
Rate for Payer: Aetna Commercial	$272.44
Rate for Payer: ASR ASR	$293.63
Rate for Payer: ASR Commercial	$293.63
Rate for Payer: BCBS Trust/PPO	$246.68
Rate for Payer: BCN Commercial	$234.69
Rate for Payer: Cash Price	$242.17
Rate for Payer: Cofinity Commercial	$284.55
Rate for Payer: Encore Health Key Benefits Commercial	$242.17
Rate for Payer: Healthscope Commercial	$302.71
Rate for Payer: Healthscope Whirlpool	$293.63
Rate for Payer: Mclaren Commercial	$272.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.30
Rate for Payer: Nomi Health Commercial	$248.22
Rate for Payer: Priority Health Cigna Priority Health	$196.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$266.38

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$302.71

Service Code	NDC 72485062513
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$121.08
Max. Negotiated Rate	$302.71
Rate for Payer: Aetna Commercial	$272.44
Rate for Payer: Aetna Medicare	$151.36
Rate for Payer: ASR ASR	$293.63
Rate for Payer: ASR Commercial	$293.63
Rate for Payer: BCBS Complete	$121.08
Rate for Payer: BCBS Trust/PPO	$247.89
Rate for Payer: BCN Commercial	$234.69
Rate for Payer: Cash Price	$242.17
Rate for Payer: Cofinity Commercial	$284.55
Rate for Payer: Encore Health Key Benefits Commercial	$242.17
Rate for Payer: Healthscope Commercial	$302.71
Rate for Payer: Healthscope Whirlpool	$293.63
Rate for Payer: Mclaren Commercial	$272.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.30
Rate for Payer: Nomi Health Commercial	$248.22
Rate for Payer: Priority Health Cigna Priority Health	$196.76
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$265.23
Rate for Payer: Priority Health Narrow Network	$212.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$266.38

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION

Facility

$729.72

Service Code	NDC 00781618667
Hospital Charge Code	36576
Hospital Revenue Code	637
Min. Negotiated Rate	$474.32
Max. Negotiated Rate	$729.72
Rate for Payer: Aetna Commercial	$656.75
Rate for Payer: ASR ASR	$707.83
Rate for Payer: ASR Commercial	$707.83
Rate for Payer: BCBS Trust/PPO	$594.65
Rate for Payer: BCN Commercial	$565.75
Rate for Payer: Cash Price	$583.78
Rate for Payer: Cofinity Commercial	$685.94
Rate for Payer: Encore Health Key Benefits Commercial	$583.78
Rate for Payer: Healthscope Commercial	$729.72
Rate for Payer: Healthscope Whirlpool	$707.83
Rate for Payer: Mclaren Commercial	$656.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$620.26
Rate for Payer: Nomi Health Commercial	$598.37
Rate for Payer: Priority Health Cigna Priority Health	$474.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$642.15

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$21.51

Service Code	NDC 69315030802
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$21.51
Rate for Payer: Aetna Commercial	$19.36
Rate for Payer: ASR ASR	$20.86
Rate for Payer: ASR Commercial	$20.86
Rate for Payer: BCBS Trust/PPO	$17.53
Rate for Payer: BCN Commercial	$16.68
Rate for Payer: Cash Price	$17.21
Rate for Payer: Cofinity Commercial	$20.22
Rate for Payer: Encore Health Key Benefits Commercial	$17.21
Rate for Payer: Healthscope Commercial	$21.51
Rate for Payer: Healthscope Whirlpool	$20.86
Rate for Payer: Mclaren Commercial	$19.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.28
Rate for Payer: Nomi Health Commercial	$17.64
Rate for Payer: Priority Health Cigna Priority Health	$13.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.93

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$34.20

Service Code	NDC 61314065625
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare	$17.10
Rate for Payer: ASR ASR	$33.17
Rate for Payer: ASR Commercial	$33.17
Rate for Payer: BCBS Complete	$13.68
Rate for Payer: BCBS Trust/PPO	$28.01
Rate for Payer: BCN Commercial	$26.52
Rate for Payer: Cash Price	$27.36
Rate for Payer: Cofinity Commercial	$32.15
Rate for Payer: Encore Health Key Benefits Commercial	$27.36
Rate for Payer: Healthscope Commercial	$34.20
Rate for Payer: Healthscope Whirlpool	$33.17
Rate for Payer: Mclaren Commercial	$30.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.07
Rate for Payer: Nomi Health Commercial	$28.04
Rate for Payer: Priority Health Cigna Priority Health	$22.23
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.97
Rate for Payer: Priority Health Narrow Network	$23.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$30.10

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$34.20

Service Code	NDC 61314065625
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$22.23
Max. Negotiated Rate	$34.20
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: ASR ASR	$33.17
Rate for Payer: ASR Commercial	$33.17
Rate for Payer: BCBS Trust/PPO	$27.87
Rate for Payer: BCN Commercial	$26.52
Rate for Payer: Cash Price	$27.36
Rate for Payer: Cofinity Commercial	$32.15
Rate for Payer: Encore Health Key Benefits Commercial	$27.36
Rate for Payer: Healthscope Commercial	$34.20
Rate for Payer: Healthscope Whirlpool	$33.17
Rate for Payer: Mclaren Commercial	$30.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.07
Rate for Payer: Nomi Health Commercial	$28.04
Rate for Payer: Priority Health Cigna Priority Health	$22.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$30.10

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$24.50

Service Code	NDC 17478071425
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna Medicare	$12.25
Rate for Payer: ASR ASR	$23.76
Rate for Payer: ASR Commercial	$23.76
Rate for Payer: BCBS Complete	$9.80
Rate for Payer: BCBS Trust/PPO	$20.06
Rate for Payer: BCN Commercial	$18.99
Rate for Payer: Cash Price	$19.60
Rate for Payer: Cofinity Commercial	$23.03
Rate for Payer: Encore Health Key Benefits Commercial	$19.60
Rate for Payer: Healthscope Commercial	$24.50
Rate for Payer: Healthscope Whirlpool	$23.76
Rate for Payer: Mclaren Commercial	$22.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.82
Rate for Payer: Nomi Health Commercial	$20.09
Rate for Payer: Priority Health Cigna Priority Health	$15.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21.47
Rate for Payer: Priority Health Narrow Network	$17.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.56

CIPROFLOXACIN 0.3 % EYE DROPS

Facility

$21.51

Service Code	NDC 69315030802
Hospital Charge Code	9610
Hospital Revenue Code	637
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$21.51
Rate for Payer: Aetna Commercial	$19.36
Rate for Payer: Aetna Medicare	$10.76
Rate for Payer: ASR ASR	$20.86
Rate for Payer: ASR Commercial	$20.86
Rate for Payer: BCBS Complete	$8.60
Rate for Payer: BCBS Trust/PPO	$17.61
Rate for Payer: BCN Commercial	$16.68
Rate for Payer: Cash Price	$17.21
Rate for Payer: Cofinity Commercial	$20.22
Rate for Payer: Encore Health Key Benefits Commercial	$17.21
Rate for Payer: Healthscope Commercial	$21.51
Rate for Payer: Healthscope Whirlpool	$20.86
Rate for Payer: Mclaren Commercial	$19.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.28
Rate for Payer: Nomi Health Commercial	$17.64
Rate for Payer: Priority Health Cigna Priority Health	$13.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.85
Rate for Payer: Priority Health Narrow Network	$15.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.93

Know your out-of-pocket cost for care.

All Charges