Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$15,243.65

Service Code	MS-DRG 059
Min. Negotiated Rate	$11,145.63
Max. Negotiated Rate	$15,243.65
Rate for Payer: Aetna Medicare	$11,732.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,665.30
Rate for Payer: Amish Plain Church Group Commercial	$14,665.30
Rate for Payer: BCBS MAPPO	$11,732.24
Rate for Payer: BCN Medicare Advantage	$11,732.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,732.24
Rate for Payer: Humana Choice PPO Medicare	$11,732.24
Rate for Payer: Mclaren Medicare	$11,732.24
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,318.85
Rate for Payer: MI Amish Medical Board Commercial	$13,492.08
Rate for Payer: PACE Medicare	$11,145.63
Rate for Payer: PACE SWMI	$11,732.24
Rate for Payer: PHP Commercial	$12,905.46
Rate for Payer: PHP Medicare Advantage	$11,732.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,243.65
Rate for Payer: Priority Health Medicare	$11,732.24
Rate for Payer: Priority Health Narrow Network	$12,194.92
Rate for Payer: Railroad Medicare Medicare	$11,732.24
Rate for Payer: UHC Medicare Advantage	$12,084.21
Rate for Payer: VA VA	$11,732.24

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility

$22,186.24

Service Code	MS-DRG 058
Min. Negotiated Rate	$15,494.51
Max. Negotiated Rate	$22,186.24
Rate for Payer: Aetna Medicare	$16,310.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$20,387.51
Rate for Payer: Amish Plain Church Group Commercial	$20,387.51
Rate for Payer: BCBS MAPPO	$16,310.01
Rate for Payer: BCN Medicare Advantage	$16,310.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$16,310.01
Rate for Payer: Humana Choice PPO Medicare	$16,310.01
Rate for Payer: Mclaren Medicare	$16,310.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$17,125.51
Rate for Payer: MI Amish Medical Board Commercial	$18,756.51
Rate for Payer: PACE Medicare	$15,494.51
Rate for Payer: PACE SWMI	$16,310.01
Rate for Payer: PHP Commercial	$17,941.01
Rate for Payer: PHP Medicare Advantage	$16,310.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22,186.24
Rate for Payer: Priority Health Medicare	$16,310.01
Rate for Payer: Priority Health Narrow Network	$17,748.99
Rate for Payer: Railroad Medicare Medicare	$16,310.01
Rate for Payer: UHC Medicare Advantage	$16,799.31
Rate for Payer: VA VA	$16,310.01

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$11,598.36

Service Code	MS-DRG 060
Min. Negotiated Rate	$8,814.76
Max. Negotiated Rate	$11,598.36
Rate for Payer: Aetna Medicare	$9,278.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,598.36
Rate for Payer: Amish Plain Church Group Commercial	$11,598.36
Rate for Payer: BCBS MAPPO	$9,278.69
Rate for Payer: BCN Medicare Advantage	$9,278.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,278.69
Rate for Payer: Humana Choice PPO Medicare	$9,278.69
Rate for Payer: Mclaren Medicare	$9,278.69
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,742.62
Rate for Payer: MI Amish Medical Board Commercial	$10,670.49
Rate for Payer: PACE Medicare	$8,814.76
Rate for Payer: PACE SWMI	$9,278.69
Rate for Payer: PHP Commercial	$10,206.56
Rate for Payer: PHP Medicare Advantage	$9,278.69
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,522.62
Rate for Payer: Priority Health Medicare	$9,278.69
Rate for Payer: Priority Health Narrow Network	$9,218.10
Rate for Payer: Railroad Medicare Medicare	$9,278.69
Rate for Payer: UHC Medicare Advantage	$9,557.05
Rate for Payer: VA VA	$9,278.69

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$180.00

Service Code	NDC 904549261
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$162.00
Rate for Payer: ASR ASR	$174.60
Rate for Payer: BCBS Trust/PPO	$139.55
Rate for Payer: BCN Commercial	$139.55
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$169.20
Rate for Payer: Encore Health Key Benefits Commercial	$144.00
Rate for Payer: Healthscope Commercial	$180.00
Rate for Payer: Healthscope Whirlpool	$174.60
Rate for Payer: Mclaren Commercial	$162.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.00
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$158.40

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$275.60

Service Code	NDC 4098522368
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$192.92
Max. Negotiated Rate	$275.60
Rate for Payer: Aetna Commercial	$248.04
Rate for Payer: ASR ASR	$267.33
Rate for Payer: BCBS Trust/PPO	$213.67
Rate for Payer: BCN Commercial	$213.67
Rate for Payer: Cash Price	$220.48
Rate for Payer: Cofinity Commercial	$259.06
Rate for Payer: Encore Health Key Benefits Commercial	$220.48
Rate for Payer: Healthscope Commercial	$275.60
Rate for Payer: Healthscope Whirlpool	$267.33
Rate for Payer: Mclaren Commercial	$248.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$234.26
Rate for Payer: Priority Health Cigna Priority Health	$192.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$242.53

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.95

Service Code	NDC 45802-112-22
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$29.95
Rate for Payer: Aetna Commercial	$26.96
Rate for Payer: ASR ASR	$29.05
Rate for Payer: BCBS Trust/PPO	$23.22
Rate for Payer: BCN Commercial	$23.22
Rate for Payer: Cash Price	$23.96
Rate for Payer: Cofinity Commercial	$28.15
Rate for Payer: Encore Health Key Benefits Commercial	$23.96
Rate for Payer: Healthscope Commercial	$29.95
Rate for Payer: Healthscope Whirlpool	$29.05
Rate for Payer: Mclaren Commercial	$26.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.46
Rate for Payer: Priority Health Cigna Priority Health	$20.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$26.36

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$20.20

Service Code	NDC 51672-1312-0
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$20.20
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: ASR ASR	$19.59
Rate for Payer: BCBS Trust/PPO	$15.66
Rate for Payer: BCN Commercial	$15.66
Rate for Payer: Cash Price	$16.16
Rate for Payer: Cofinity Commercial	$18.99
Rate for Payer: Encore Health Key Benefits Commercial	$16.16
Rate for Payer: Healthscope Commercial	$20.20
Rate for Payer: Healthscope Whirlpool	$19.59
Rate for Payer: Mclaren Commercial	$18.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.17
Rate for Payer: Priority Health Cigna Priority Health	$14.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$17.78

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.95

Service Code	NDC 68462-180-22
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$20.96
Max. Negotiated Rate	$29.95
Rate for Payer: Aetna Commercial	$26.96
Rate for Payer: ASR ASR	$29.05
Rate for Payer: BCBS Trust/PPO	$23.22
Rate for Payer: BCN Commercial	$23.22
Rate for Payer: Cash Price	$23.96
Rate for Payer: Cofinity Commercial	$28.15
Rate for Payer: Encore Health Key Benefits Commercial	$23.96
Rate for Payer: Healthscope Commercial	$29.95
Rate for Payer: Healthscope Whirlpool	$29.05
Rate for Payer: Mclaren Commercial	$26.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.46
Rate for Payer: Priority Health Cigna Priority Health	$20.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$26.36

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$29,752.85

Service Code	MS-DRG 827
Min. Negotiated Rate	$20,234.32
Max. Negotiated Rate	$29,752.85
Rate for Payer: Aetna Medicare	$21,299.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$26,624.10
Rate for Payer: Amish Plain Church Group Commercial	$26,624.10
Rate for Payer: BCBS MAPPO	$21,299.28
Rate for Payer: BCN Medicare Advantage	$21,299.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$21,299.28
Rate for Payer: Humana Choice PPO Medicare	$21,299.28
Rate for Payer: Mclaren Medicare	$21,299.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22,364.24
Rate for Payer: MI Amish Medical Board Commercial	$24,494.17
Rate for Payer: PACE Medicare	$20,234.32
Rate for Payer: PACE SWMI	$21,299.28
Rate for Payer: PHP Commercial	$23,429.21
Rate for Payer: PHP Medicare Advantage	$21,299.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29,752.85
Rate for Payer: Priority Health Medicare	$21,299.28
Rate for Payer: Priority Health Narrow Network	$23,802.28
Rate for Payer: Railroad Medicare Medicare	$21,299.28
Rate for Payer: UHC Medicare Advantage	$21,938.26
Rate for Payer: VA VA	$21,299.28

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$56,352.19

Service Code	MS-DRG 826
Min. Negotiated Rate	$38,817.84
Max. Negotiated Rate	$56,352.19
Rate for Payer: Aetna Medicare	$40,860.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$51,076.10
Rate for Payer: Amish Plain Church Group Commercial	$51,076.10
Rate for Payer: BCBS MAPPO	$40,860.88
Rate for Payer: BCN Medicare Advantage	$40,860.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$40,860.88
Rate for Payer: Humana Choice PPO Medicare	$40,860.88
Rate for Payer: Mclaren Medicare	$40,860.88
Rate for Payer: Meridian Wellcare - Medicare Advantage	$42,903.92
Rate for Payer: MI Amish Medical Board Commercial	$46,990.01
Rate for Payer: PACE Medicare	$38,817.84
Rate for Payer: PACE SWMI	$40,860.88
Rate for Payer: PHP Commercial	$44,946.97
Rate for Payer: PHP Medicare Advantage	$40,860.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56,352.19
Rate for Payer: Priority Health Medicare	$40,860.88
Rate for Payer: Priority Health Narrow Network	$45,081.75
Rate for Payer: Railroad Medicare Medicare	$40,860.88
Rate for Payer: UHC Medicare Advantage	$42,086.71
Rate for Payer: VA VA	$40,860.88

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$21,062.74

Service Code	MS-DRG 828
Min. Negotiated Rate	$14,790.75
Max. Negotiated Rate	$21,062.74
Rate for Payer: Aetna Medicare	$15,569.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,461.51
Rate for Payer: Amish Plain Church Group Commercial	$19,461.51
Rate for Payer: BCBS MAPPO	$15,569.21
Rate for Payer: BCN Medicare Advantage	$15,569.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,569.21
Rate for Payer: Humana Choice PPO Medicare	$15,569.21
Rate for Payer: Mclaren Medicare	$15,569.21
Rate for Payer: Meridian Wellcare - Medicare Advantage	$16,347.67
Rate for Payer: MI Amish Medical Board Commercial	$17,904.59
Rate for Payer: PACE Medicare	$14,790.75
Rate for Payer: PACE SWMI	$15,569.21
Rate for Payer: PHP Commercial	$17,126.13
Rate for Payer: PHP Medicare Advantage	$15,569.21
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21,062.74
Rate for Payer: Priority Health Medicare	$15,569.21
Rate for Payer: Priority Health Narrow Network	$16,850.19
Rate for Payer: Railroad Medicare Medicare	$15,569.21
Rate for Payer: UHC Medicare Advantage	$16,036.29
Rate for Payer: VA VA	$15,569.21

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$40,494.79

Service Code	MS-DRG 829
Min. Negotiated Rate	$26,963.14
Max. Negotiated Rate	$40,494.79
Rate for Payer: Aetna Medicare	$28,382.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$35,477.81
Rate for Payer: Amish Plain Church Group Commercial	$35,477.81
Rate for Payer: BCBS MAPPO	$28,382.25
Rate for Payer: BCN Medicare Advantage	$28,382.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$28,382.25
Rate for Payer: Humana Choice PPO Medicare	$28,382.25
Rate for Payer: Mclaren Medicare	$28,382.25
Rate for Payer: Meridian Wellcare - Medicare Advantage	$29,801.36
Rate for Payer: MI Amish Medical Board Commercial	$32,639.59
Rate for Payer: PACE Medicare	$26,963.14
Rate for Payer: PACE SWMI	$28,382.25
Rate for Payer: PHP Commercial	$31,220.48
Rate for Payer: PHP Medicare Advantage	$28,382.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40,494.79
Rate for Payer: Priority Health Medicare	$28,382.25
Rate for Payer: Priority Health Narrow Network	$32,395.83
Rate for Payer: Railroad Medicare Medicare	$28,382.25
Rate for Payer: UHC Medicare Advantage	$29,233.72
Rate for Payer: VA VA	$28,382.25

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$20,302.61

Service Code	MS-DRG 830
Min. Negotiated Rate	$14,314.61
Max. Negotiated Rate	$20,302.61
Rate for Payer: Aetna Medicare	$15,068.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,835.01
Rate for Payer: Amish Plain Church Group Commercial	$18,835.01
Rate for Payer: BCBS MAPPO	$15,068.01
Rate for Payer: BCN Medicare Advantage	$15,068.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,068.01
Rate for Payer: Humana Choice PPO Medicare	$15,068.01
Rate for Payer: Mclaren Medicare	$15,068.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,821.41
Rate for Payer: MI Amish Medical Board Commercial	$17,328.21
Rate for Payer: PACE Medicare	$14,314.61
Rate for Payer: PACE SWMI	$15,068.01
Rate for Payer: PHP Commercial	$16,574.81
Rate for Payer: PHP Medicare Advantage	$15,068.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,302.61
Rate for Payer: Priority Health Medicare	$15,068.01
Rate for Payer: Priority Health Narrow Network	$16,242.09
Rate for Payer: Railroad Medicare Medicare	$15,068.01
Rate for Payer: UHC Medicare Advantage	$15,520.05
Rate for Payer: VA VA	$15,068.01

NADOLOL 20 MG TABLET

Facility

$1,150.33

Service Code	NDC 51079-812-20
Hospital Charge Code	5330
Hospital Revenue Code	637
Min. Negotiated Rate	$805.23
Max. Negotiated Rate	$1,150.33
Rate for Payer: Aetna Commercial	$1,035.30
Rate for Payer: ASR ASR	$1,115.82
Rate for Payer: BCBS Trust/PPO	$891.85
Rate for Payer: BCN Commercial	$891.85
Rate for Payer: Cash Price	$920.26
Rate for Payer: Cofinity Commercial	$1,081.31
Rate for Payer: Encore Health Key Benefits Commercial	$920.26
Rate for Payer: Healthscope Commercial	$1,150.33
Rate for Payer: Healthscope Whirlpool	$1,115.82
Rate for Payer: Mclaren Commercial	$1,035.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$977.78
Rate for Payer: Priority Health Cigna Priority Health	$805.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,012.29

NADOLOL 40 MG TABLET

Facility

$369.19

Service Code	NDC 60687-313-25
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$258.43
Max. Negotiated Rate	$369.19
Rate for Payer: Aetna Commercial	$332.27
Rate for Payer: ASR ASR	$358.11
Rate for Payer: BCBS Trust/PPO	$286.23
Rate for Payer: BCN Commercial	$286.23
Rate for Payer: Cash Price	$295.35
Rate for Payer: Cofinity Commercial	$347.04
Rate for Payer: Encore Health Key Benefits Commercial	$295.35
Rate for Payer: Healthscope Commercial	$369.19
Rate for Payer: Healthscope Whirlpool	$358.11
Rate for Payer: Mclaren Commercial	$332.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$313.81
Rate for Payer: Priority Health Cigna Priority Health	$258.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$324.89

NADOLOL 40 MG TABLET

Facility

$284.27

Service Code	NDC 0904-7071-07
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$198.99
Max. Negotiated Rate	$284.27
Rate for Payer: Aetna Commercial	$255.84
Rate for Payer: ASR ASR	$275.74
Rate for Payer: BCBS Trust/PPO	$220.39
Rate for Payer: BCN Commercial	$220.39
Rate for Payer: Cash Price	$227.42
Rate for Payer: Cofinity Commercial	$267.21
Rate for Payer: Encore Health Key Benefits Commercial	$227.42
Rate for Payer: Healthscope Commercial	$284.27
Rate for Payer: Healthscope Whirlpool	$275.74
Rate for Payer: Mclaren Commercial	$255.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$241.63
Rate for Payer: Priority Health Cigna Priority Health	$198.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$250.16

NADOLOL 40 MG TABLET

Facility

$12.31

Service Code	NDC 60687-313-95
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$12.31
Rate for Payer: Aetna Commercial	$11.08
Rate for Payer: ASR ASR	$11.94
Rate for Payer: BCBS Trust/PPO	$9.54
Rate for Payer: BCN Commercial	$9.54
Rate for Payer: Cash Price	$9.85
Rate for Payer: Cofinity Commercial	$11.57
Rate for Payer: Encore Health Key Benefits Commercial	$9.85
Rate for Payer: Healthscope Commercial	$12.31
Rate for Payer: Healthscope Whirlpool	$11.94
Rate for Payer: Mclaren Commercial	$11.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.46
Rate for Payer: Priority Health Cigna Priority Health	$8.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.83

NADOLOL 40 MG TABLET

Facility

$20.78

Service Code	NDC 51079-813-01
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$20.78
Rate for Payer: Aetna Commercial	$18.70
Rate for Payer: ASR ASR	$20.16
Rate for Payer: BCBS Trust/PPO	$16.11
Rate for Payer: BCN Commercial	$16.11
Rate for Payer: Cash Price	$16.62
Rate for Payer: Cofinity Commercial	$19.53
Rate for Payer: Encore Health Key Benefits Commercial	$16.62
Rate for Payer: Healthscope Commercial	$20.78
Rate for Payer: Healthscope Whirlpool	$20.16
Rate for Payer: Mclaren Commercial	$18.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.66
Rate for Payer: Priority Health Cigna Priority Health	$14.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.29

NADOLOL 40 MG TABLET

Facility

$283.00

Service Code	NDC 69238-1124-9
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$198.10
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$254.70
Rate for Payer: ASR ASR	$274.51
Rate for Payer: BCBS Trust/PPO	$219.41
Rate for Payer: BCN Commercial	$219.41
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cofinity Commercial	$266.02
Rate for Payer: Encore Health Key Benefits Commercial	$226.40
Rate for Payer: Healthscope Commercial	$283.00
Rate for Payer: Healthscope Whirlpool	$274.51
Rate for Payer: Mclaren Commercial	$254.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$240.55
Rate for Payer: Priority Health Cigna Priority Health	$198.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$249.04

NAFCILLIN 1 GRAM SOLUTION FOR INJECTION

Facility

$21.52

Service Code	NDC 55150-122-15
Hospital Charge Code	5333
Hospital Revenue Code	250
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$21.52
Rate for Payer: Aetna Commercial	$19.37
Rate for Payer: ASR ASR	$20.87
Rate for Payer: BCBS Trust/PPO	$16.68
Rate for Payer: BCN Commercial	$16.68
Rate for Payer: Cash Price	$17.22
Rate for Payer: Cofinity Commercial	$20.23
Rate for Payer: Encore Health Key Benefits Commercial	$17.22
Rate for Payer: Healthscope Commercial	$21.52
Rate for Payer: Healthscope Whirlpool	$20.87
Rate for Payer: Mclaren Commercial	$19.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.29
Rate for Payer: Priority Health Cigna Priority Health	$15.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.94

NAFCILLIN 1 GRAM SOLUTION FOR INJECTION

Facility

$21.34

Service Code	NDC 25021-139-10
Hospital Charge Code	5333
Hospital Revenue Code	250
Min. Negotiated Rate	$14.94
Max. Negotiated Rate	$21.34
Rate for Payer: Aetna Commercial	$19.21
Rate for Payer: ASR ASR	$20.70
Rate for Payer: BCBS Trust/PPO	$16.54
Rate for Payer: BCN Commercial	$16.54
Rate for Payer: Cash Price	$17.07
Rate for Payer: Cofinity Commercial	$20.06
Rate for Payer: Encore Health Key Benefits Commercial	$17.07
Rate for Payer: Healthscope Commercial	$21.34
Rate for Payer: Healthscope Whirlpool	$20.70
Rate for Payer: Mclaren Commercial	$19.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.14
Rate for Payer: Priority Health Cigna Priority Health	$14.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.78

NAFCILLIN 2 GRAM SOLUTION FOR INJECTION

Facility

$24.09

Service Code	NDC 55150-123-16
Hospital Charge Code	5335
Hospital Revenue Code	250
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$24.09
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: ASR ASR	$23.37
Rate for Payer: BCBS Trust/PPO	$18.68
Rate for Payer: BCN Commercial	$18.68
Rate for Payer: Cash Price	$19.27
Rate for Payer: Cofinity Commercial	$22.64
Rate for Payer: Encore Health Key Benefits Commercial	$19.27
Rate for Payer: Healthscope Commercial	$24.09
Rate for Payer: Healthscope Whirlpool	$23.37
Rate for Payer: Mclaren Commercial	$21.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.48
Rate for Payer: Priority Health Cigna Priority Health	$16.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.20

NAFCILLIN 2 GRAM SOLUTION FOR INJECTION

Facility

$95.29

Service Code	NDC 0781-3125-95
Hospital Charge Code	5335
Hospital Revenue Code	250
Min. Negotiated Rate	$66.70
Max. Negotiated Rate	$95.29
Rate for Payer: Aetna Commercial	$85.76
Rate for Payer: ASR ASR	$92.43
Rate for Payer: BCBS Trust/PPO	$73.88
Rate for Payer: BCN Commercial	$73.88
Rate for Payer: Cash Price	$76.23
Rate for Payer: Cofinity Commercial	$89.57
Rate for Payer: Encore Health Key Benefits Commercial	$76.23
Rate for Payer: Healthscope Commercial	$95.29
Rate for Payer: Healthscope Whirlpool	$92.43
Rate for Payer: Mclaren Commercial	$85.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.00
Rate for Payer: Priority Health Cigna Priority Health	$66.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$83.86

NALOXONE 0.4 MG/ML INJECTION (CODE)

Facility

$63.57

Service Code	HCPCS J2310
Hospital Charge Code	163714
Hospital Revenue Code	636
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$63.57
Rate for Payer: Aetna Commercial	$57.21
Rate for Payer: ASR ASR	$61.66
Rate for Payer: BCBS Trust/PPO	$49.29
Rate for Payer: BCN Commercial	$49.29
Rate for Payer: Cash Price	$50.86
Rate for Payer: Cofinity Commercial	$59.76
Rate for Payer: Encore Health Key Benefits Commercial	$50.86
Rate for Payer: Healthscope Commercial	$63.57
Rate for Payer: Healthscope Whirlpool	$61.66
Rate for Payer: Mclaren Commercial	$57.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.03
Rate for Payer: Priority Health Cigna Priority Health	$44.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.94

NALOXONE 0.4 MG/ML INJECTION SOLUTION

Facility

$63.57

Service Code	HCPCS J2310
Hospital Charge Code	5373
Hospital Revenue Code	636
Min. Negotiated Rate	$44.50
Max. Negotiated Rate	$63.57
Rate for Payer: Aetna Commercial	$57.21
Rate for Payer: Aetna Commercial	$16.98
Rate for Payer: Aetna Commercial	$35.39
Rate for Payer: ASR ASR	$38.14
Rate for Payer: ASR ASR	$18.30
Rate for Payer: ASR ASR	$61.66
Rate for Payer: BCBS Trust/PPO	$14.63
Rate for Payer: BCBS Trust/PPO	$49.29
Rate for Payer: BCBS Trust/PPO	$30.48
Rate for Payer: BCN Commercial	$14.63
Rate for Payer: BCN Commercial	$49.29
Rate for Payer: BCN Commercial	$30.48
Rate for Payer: Cash Price	$31.45
Rate for Payer: Cash Price	$15.09
Rate for Payer: Cash Price	$50.86
Rate for Payer: Cofinity Commercial	$59.76
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Cofinity Commercial	$36.96
Rate for Payer: Encore Health Key Benefits Commercial	$31.46
Rate for Payer: Encore Health Key Benefits Commercial	$15.10
Rate for Payer: Encore Health Key Benefits Commercial	$50.86
Rate for Payer: Healthscope Commercial	$39.32
Rate for Payer: Healthscope Commercial	$18.87
Rate for Payer: Healthscope Commercial	$63.57
Rate for Payer: Healthscope Whirlpool	$18.30
Rate for Payer: Healthscope Whirlpool	$38.14
Rate for Payer: Healthscope Whirlpool	$61.66
Rate for Payer: Mclaren Commercial	$57.21
Rate for Payer: Mclaren Commercial	$35.39
Rate for Payer: Mclaren Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$54.03
Rate for Payer: Priority Health Cigna Priority Health	$13.21
Rate for Payer: Priority Health Cigna Priority Health	$27.52
Rate for Payer: Priority Health Cigna Priority Health	$44.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$34.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.94

Know your out-of-pocket cost for care.

All Charges