Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$20.79

Service Code	NDC 51672131200
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$15.59
Max. Negotiated Rate	$20.79
Rate for Payer: Aetna Commercial	$18.71
Rate for Payer: ASR ASR	$20.17
Rate for Payer: BCBS Trust/PPO	$17.07
Rate for Payer: BCN Commercial	$17.07
Rate for Payer: Cash Price	$16.63
Rate for Payer: Cofinity Commercial	$19.54
Rate for Payer: Encore Health Key Benefits Commercial	$16.63
Rate for Payer: Healthscope Commercial	$20.17
Rate for Payer: Healthscope Whirlpool	$20.79
Rate for Payer: Mclaren Commercial	$18.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.67
Rate for Payer: Nomi Health Commercial	$17.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.30

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.26

Service Code	NDC 45802011222
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$29.26
Rate for Payer: Aetna Commercial	$26.33
Rate for Payer: ASR ASR	$28.38
Rate for Payer: BCBS Trust/PPO	$24.03
Rate for Payer: BCN Commercial	$24.03
Rate for Payer: Cash Price	$23.41
Rate for Payer: Cofinity Commercial	$27.50
Rate for Payer: Encore Health Key Benefits Commercial	$23.41
Rate for Payer: Healthscope Commercial	$28.38
Rate for Payer: Healthscope Whirlpool	$29.26
Rate for Payer: Mclaren Commercial	$26.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.87
Rate for Payer: Nomi Health Commercial	$23.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.75

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.26

Service Code	NDC 45802011222
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$29.26
Rate for Payer: Aetna Commercial	$26.33
Rate for Payer: Aetna Medicare	$10.83
Rate for Payer: ASR ASR	$28.38
Rate for Payer: BCBS Complete	$11.70
Rate for Payer: BCBS Trust/PPO	$24.12
Rate for Payer: BCN Commercial	$24.12
Rate for Payer: Cash Price	$23.41
Rate for Payer: Cofinity Commercial	$27.50
Rate for Payer: Encore Health Key Benefits Commercial	$23.41
Rate for Payer: Healthscope Commercial	$28.38
Rate for Payer: Healthscope Whirlpool	$29.26
Rate for Payer: Mclaren Commercial	$26.33
Rate for Payer: MI Amish Medical Board Commercial	$23.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.87
Rate for Payer: Nomi Health Commercial	$23.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$25.64
Rate for Payer: Priority Health Narrow Network	$20.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.75

MUPIROCIN 2 % TOPICAL OINTMENT

Facility

$29.95

Service Code	NDC 68462018022
Hospital Charge Code	10674
Hospital Revenue Code	637
Min. Negotiated Rate	$22.46
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	$24.60
Rate for Payer: BCN Commercial	$24.60
Rate for Payer: Cash Price	$23.96
Rate for Payer: Cofinity Commercial	$28.16
Rate for Payer: Encore Health Key Benefits Commercial	$23.96
Rate for Payer: Healthscope Commercial	$29.05
Rate for Payer: Healthscope Whirlpool	$29.95
Rate for Payer: Mclaren Commercial	$26.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.46
Rate for Payer: Nomi Health Commercial	$24.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$26.36

MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$11,830.86

Service Code	APR-DRG 9121
Min. Negotiated Rate	$10,696.52
Max. Negotiated Rate	$11,830.86
Rate for Payer: BCBS Complete	$11,830.86
Rate for Payer: Mclaren Medicaid	$11,267.49
Rate for Payer: Meridian Medicaid	$11,830.86
Rate for Payer: PHP Medicaid	$10,696.52
Rate for Payer: Priority Health Choice Medicaid	$11,267.49
Rate for Payer: UHC Medicaid	$11,267.49
Rate for Payer: UHCCP Medicaid	$11,267.49

MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$15,727.80

Service Code	APR-DRG 9122
Min. Negotiated Rate	$14,219.81
Max. Negotiated Rate	$15,727.80
Rate for Payer: BCBS Complete	$15,727.80
Rate for Payer: Mclaren Medicaid	$14,978.86
Rate for Payer: Meridian Medicaid	$15,727.80
Rate for Payer: PHP Medicaid	$14,219.81
Rate for Payer: Priority Health Choice Medicaid	$14,978.86
Rate for Payer: UHC Medicaid	$14,978.86
Rate for Payer: UHCCP Medicaid	$14,978.86

MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$32,984.19

Service Code	APR-DRG 9124
Min. Negotiated Rate	$29,821.65
Max. Negotiated Rate	$32,984.19
Rate for Payer: BCBS Complete	$32,984.19
Rate for Payer: Mclaren Medicaid	$31,413.51
Rate for Payer: Meridian Medicaid	$32,984.19
Rate for Payer: PHP Medicaid	$29,821.65
Rate for Payer: Priority Health Choice Medicaid	$31,413.51
Rate for Payer: UHC Medicaid	$31,413.51
Rate for Payer: UHCCP Medicaid	$31,413.51

MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$21,141.88

Service Code	APR-DRG 9123
Min. Negotiated Rate	$19,114.79
Max. Negotiated Rate	$21,141.88
Rate for Payer: BCBS Complete	$21,141.88
Rate for Payer: Mclaren Medicaid	$20,135.12
Rate for Payer: Meridian Medicaid	$21,141.88
Rate for Payer: PHP Medicaid	$19,114.79
Rate for Payer: Priority Health Choice Medicaid	$20,135.12
Rate for Payer: UHC Medicaid	$20,135.12
Rate for Payer: UHCCP Medicaid	$20,135.12

MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG

Facility

$6,884.90

Service Code	APR-DRG 3432
Min. Negotiated Rate	$6,224.77
Max. Negotiated Rate	$6,884.90
Rate for Payer: BCBS Complete	$6,884.90
Rate for Payer: Mclaren Medicaid	$6,557.05
Rate for Payer: Meridian Medicaid	$6,884.90
Rate for Payer: PHP Medicaid	$6,224.77
Rate for Payer: Priority Health Choice Medicaid	$6,557.05
Rate for Payer: UHC Medicaid	$6,557.05
Rate for Payer: UHCCP Medicaid	$6,557.05

MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG

Facility

$10,215.09

Service Code	APR-DRG 3433
Min. Negotiated Rate	$9,235.66
Max. Negotiated Rate	$10,215.09
Rate for Payer: BCBS Complete	$10,215.09
Rate for Payer: Mclaren Medicaid	$9,728.66
Rate for Payer: Meridian Medicaid	$10,215.09
Rate for Payer: PHP Medicaid	$9,235.66
Rate for Payer: Priority Health Choice Medicaid	$9,728.66
Rate for Payer: UHC Medicaid	$9,728.66
Rate for Payer: UHCCP Medicaid	$9,728.66

MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG

Facility

$5,631.51

Service Code	APR-DRG 3431
Min. Negotiated Rate	$5,091.56
Max. Negotiated Rate	$5,631.51
Rate for Payer: BCBS Complete	$5,631.51
Rate for Payer: Mclaren Medicaid	$5,363.35
Rate for Payer: Meridian Medicaid	$5,631.51
Rate for Payer: PHP Medicaid	$5,091.56
Rate for Payer: Priority Health Choice Medicaid	$5,363.35
Rate for Payer: UHC Medicaid	$5,363.35
Rate for Payer: UHCCP Medicaid	$5,363.35

MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG

Facility

$16,526.15

Service Code	APR-DRG 3434
Min. Negotiated Rate	$14,941.62
Max. Negotiated Rate	$16,526.15
Rate for Payer: BCBS Complete	$16,526.15
Rate for Payer: Mclaren Medicaid	$15,739.19
Rate for Payer: Meridian Medicaid	$16,526.15
Rate for Payer: PHP Medicaid	$14,941.62
Rate for Payer: Priority Health Choice Medicaid	$15,739.19
Rate for Payer: UHC Medicaid	$15,739.19
Rate for Payer: UHCCP Medicaid	$15,739.19

MYCOPHENOLATE MOFETIL 250 MG CAPSULE

Facility

$2,044.50

Service Code	HCPCS J7517
Hospital Charge Code	15113
Hospital Revenue Code	250
Min. Negotiated Rate	$1,533.38
Max. Negotiated Rate	$2,044.50
Rate for Payer: Aetna Commercial	$1,840.05
Rate for Payer: Aetna Commercial	$389.16
Rate for Payer: ASR ASR	$419.43
Rate for Payer: ASR ASR	$1,983.16
Rate for Payer: BCBS Trust/PPO	$355.09
Rate for Payer: BCBS Trust/PPO	$1,678.94
Rate for Payer: BCN Commercial	$355.09
Rate for Payer: BCN Commercial	$1,678.94
Rate for Payer: Cash Price	$345.92
Rate for Payer: Cash Price	$1,635.60
Rate for Payer: Cofinity Commercial	$1,921.83
Rate for Payer: Cofinity Commercial	$406.46
Rate for Payer: Encore Health Key Benefits Commercial	$345.92
Rate for Payer: Encore Health Key Benefits Commercial	$1,635.60
Rate for Payer: Healthscope Commercial	$1,983.16
Rate for Payer: Healthscope Commercial	$419.43
Rate for Payer: Healthscope Whirlpool	$432.40
Rate for Payer: Healthscope Whirlpool	$2,044.50
Rate for Payer: Mclaren Commercial	$389.16
Rate for Payer: Mclaren Commercial	$1,840.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,737.83
Rate for Payer: Nomi Health Commercial	$354.57
Rate for Payer: Nomi Health Commercial	$1,676.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,533.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$324.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,799.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$380.51

MYCOPHENOLATE MOFETIL 250 MG CAPSULE

Facility

$432.40

Service Code	HCPCS J7517
Hospital Charge Code	15113
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$432.40
Rate for Payer: Aetna Commercial	$389.16
Rate for Payer: Aetna Commercial	$1,840.05
Rate for Payer: Aetna Medicare	$756.47
Rate for Payer: Aetna Medicare	$159.99
Rate for Payer: ASR ASR	$419.43
Rate for Payer: ASR ASR	$1,983.16
Rate for Payer: BCBS Complete	$817.80
Rate for Payer: BCBS Complete	$172.96
Rate for Payer: BCBS Trust/PPO	$356.51
Rate for Payer: BCBS Trust/PPO	$1,685.69
Rate for Payer: BCN Commercial	$1,685.69
Rate for Payer: BCN Commercial	$356.51
Rate for Payer: Cash Price	$345.92
Rate for Payer: Cash Price	$1,635.60
Rate for Payer: Cash Price	$345.92
Rate for Payer: Cash Price	$1,635.60
Rate for Payer: Cofinity Commercial	$1,921.83
Rate for Payer: Cofinity Commercial	$406.46
Rate for Payer: Encore Health Key Benefits Commercial	$345.92
Rate for Payer: Encore Health Key Benefits Commercial	$1,635.60
Rate for Payer: Healthscope Commercial	$419.43
Rate for Payer: Healthscope Commercial	$1,983.16
Rate for Payer: Healthscope Whirlpool	$432.40
Rate for Payer: Healthscope Whirlpool	$2,044.50
Rate for Payer: Mclaren Commercial	$389.16
Rate for Payer: Mclaren Commercial	$1,840.05
Rate for Payer: MI Amish Medical Board Commercial	$345.92
Rate for Payer: MI Amish Medical Board Commercial	$1,635.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,737.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.54
Rate for Payer: Nomi Health Commercial	$1,676.49
Rate for Payer: Nomi Health Commercial	$354.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,533.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$324.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$0.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$0.15
Rate for Payer: Priority Health Narrow Network	$0.12
Rate for Payer: Priority Health Narrow Network	$0.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,799.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$380.51

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

Facility

$31,753.11

Service Code	MSDRG 827
Min. Negotiated Rate	$17,478.08
Max. Negotiated Rate	$31,753.11
Rate for Payer: Aetna Medicare	$18,397.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,997.47
Rate for Payer: Amish Plain Church Group Commercial	$22,997.47
Rate for Payer: BCBS MAPPO	$18,397.98
Rate for Payer: BCN Medicare Advantage	$18,397.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,397.98
Rate for Payer: Humana Choice PPO Medicare	$18,397.98
Rate for Payer: Mclaren Medicare	$18,397.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,317.88
Rate for Payer: MI Amish Medical Board Commercial	$21,157.68
Rate for Payer: Molina Medicare/Medicaid	$20,237.78
Rate for Payer: PACE Medicare	$17,478.08
Rate for Payer: PACE SWMI	$18,397.98
Rate for Payer: PHP Commercial	$20,237.78
Rate for Payer: PHP Medicare Advantage	$18,397.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$31,753.11
Rate for Payer: Priority Health Medicare	$18,397.98
Rate for Payer: Priority Health Narrow Network	$25,402.49
Rate for Payer: Railroad Medicare Medicare	$18,397.98
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,397.98
Rate for Payer: UHC Exchange	$28,516.87
Rate for Payer: UHCCP DNSP	$18,397.98
Rate for Payer: VA VA	$18,397.98

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

Facility

$64,267.36

Service Code	MSDRG 826
Min. Negotiated Rate	$33,668.42
Max. Negotiated Rate	$64,267.36
Rate for Payer: Aetna Medicare	$35,440.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$44,300.55
Rate for Payer: Amish Plain Church Group Commercial	$44,300.55
Rate for Payer: BCBS MAPPO	$35,440.44
Rate for Payer: BCN Medicare Advantage	$35,440.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$35,440.44
Rate for Payer: Humana Choice PPO Medicare	$35,440.44
Rate for Payer: Mclaren Medicare	$35,440.44
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$37,212.46
Rate for Payer: MI Amish Medical Board Commercial	$40,756.51
Rate for Payer: Molina Medicare/Medicaid	$38,984.48
Rate for Payer: PACE Medicare	$33,668.42
Rate for Payer: PACE SWMI	$35,440.44
Rate for Payer: PHP Commercial	$38,984.48
Rate for Payer: PHP Medicare Advantage	$35,440.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$64,267.36
Rate for Payer: Priority Health Medicare	$35,440.44
Rate for Payer: Priority Health Narrow Network	$51,413.89
Rate for Payer: Railroad Medicare Medicare	$35,440.44
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$35,440.44
Rate for Payer: UHC Exchange	$54,932.68
Rate for Payer: UHCCP DNSP	$35,440.44
Rate for Payer: VA VA	$35,440.44

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

Facility

$23,408.17

Service Code	MSDRG 828
Min. Negotiated Rate	$13,322.74
Max. Negotiated Rate	$23,408.17
Rate for Payer: Aetna Medicare	$14,023.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,529.92
Rate for Payer: Amish Plain Church Group Commercial	$17,529.92
Rate for Payer: BCBS MAPPO	$14,023.94
Rate for Payer: BCN Medicare Advantage	$14,023.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,023.94
Rate for Payer: Humana Choice PPO Medicare	$14,023.94
Rate for Payer: Mclaren Medicare	$14,023.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,725.14
Rate for Payer: MI Amish Medical Board Commercial	$16,127.53
Rate for Payer: Molina Medicare/Medicaid	$15,426.33
Rate for Payer: PACE Medicare	$13,322.74
Rate for Payer: PACE SWMI	$14,023.94
Rate for Payer: PHP Commercial	$15,426.33
Rate for Payer: PHP Medicare Advantage	$14,023.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$23,408.17
Rate for Payer: Priority Health Medicare	$14,023.94
Rate for Payer: Priority Health Narrow Network	$18,726.53
Rate for Payer: Railroad Medicare Medicare	$14,023.94
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,023.94
Rate for Payer: UHC Exchange	$21,737.11
Rate for Payer: UHCCP DNSP	$14,023.94
Rate for Payer: VA VA	$14,023.94

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

Facility

$43,414.61

Service Code	MSDRG 829
Min. Negotiated Rate	$23,284.86
Max. Negotiated Rate	$43,414.61
Rate for Payer: Aetna Medicare	$24,510.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$30,637.97
Rate for Payer: Amish Plain Church Group Commercial	$30,637.97
Rate for Payer: BCBS MAPPO	$24,510.38
Rate for Payer: BCN Medicare Advantage	$24,510.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$24,510.38
Rate for Payer: Humana Choice PPO Medicare	$24,510.38
Rate for Payer: Mclaren Medicare	$24,510.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$25,735.90
Rate for Payer: MI Amish Medical Board Commercial	$28,186.94
Rate for Payer: Molina Medicare/Medicaid	$26,961.42
Rate for Payer: PACE Medicare	$23,284.86
Rate for Payer: PACE SWMI	$24,510.38
Rate for Payer: PHP Commercial	$26,961.42
Rate for Payer: PHP Medicare Advantage	$24,510.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$43,414.61
Rate for Payer: Priority Health Medicare	$24,510.38
Rate for Payer: Priority Health Narrow Network	$34,731.69
Rate for Payer: Railroad Medicare Medicare	$24,510.38
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$24,510.38
Rate for Payer: UHC Exchange	$37,991.09
Rate for Payer: UHCCP DNSP	$24,510.38
Rate for Payer: VA VA	$24,510.38

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

Facility

$20,676.89

Service Code	MSDRG 830
Min. Negotiated Rate	$11,962.71
Max. Negotiated Rate	$20,676.89
Rate for Payer: Aetna Medicare	$12,592.33
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,740.41
Rate for Payer: Amish Plain Church Group Commercial	$15,740.41
Rate for Payer: BCBS MAPPO	$12,592.33
Rate for Payer: BCN Medicare Advantage	$12,592.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,592.33
Rate for Payer: Humana Choice PPO Medicare	$12,592.33
Rate for Payer: Mclaren Medicare	$12,592.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,221.95
Rate for Payer: MI Amish Medical Board Commercial	$14,481.18
Rate for Payer: Molina Medicare/Medicaid	$13,851.56
Rate for Payer: PACE Medicare	$11,962.71
Rate for Payer: PACE SWMI	$12,592.33
Rate for Payer: PHP Commercial	$13,851.56
Rate for Payer: PHP Medicare Advantage	$12,592.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$20,676.89
Rate for Payer: Priority Health Medicare	$12,592.33
Rate for Payer: Priority Health Narrow Network	$16,541.52
Rate for Payer: Railroad Medicare Medicare	$12,592.33
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,592.33
Rate for Payer: UHC Exchange	$19,518.11
Rate for Payer: UHCCP DNSP	$12,592.33
Rate for Payer: VA VA	$12,592.33

NADOLOL 40 MG TABLET

Facility

$12.00

Service Code	NDC 60687031395
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: ASR ASR	$11.64
Rate for Payer: BCBS Trust/PPO	$9.85
Rate for Payer: BCN Commercial	$9.85
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$11.28
Rate for Payer: Encore Health Key Benefits Commercial	$9.60
Rate for Payer: Healthscope Commercial	$11.64
Rate for Payer: Healthscope Whirlpool	$12.00
Rate for Payer: Mclaren Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.20
Rate for Payer: Nomi Health Commercial	$9.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.56

NADOLOL 40 MG TABLET

Facility

$283.01

Service Code	NDC 69238112409
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$104.71
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$254.70
Rate for Payer: Aetna Medicare	$104.71
Rate for Payer: ASR ASR	$274.51
Rate for Payer: BCBS Complete	$113.20
Rate for Payer: BCBS Trust/PPO	$233.34
Rate for Payer: BCN Commercial	$233.34
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	$274.51
Rate for Payer: Healthscope Whirlpool	$283.00
Rate for Payer: Mclaren Commercial	$254.70
Rate for Payer: MI Amish Medical Board Commercial	$226.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$240.55
Rate for Payer: Nomi Health Commercial	$232.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$212.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$247.97
Rate for Payer: Priority Health Narrow Network	$198.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$249.04

NADOLOL 40 MG TABLET

Facility

$359.97

Service Code	NDC 60687031325
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$133.19
Max. Negotiated Rate	$359.97
Rate for Payer: Aetna Commercial	$323.98
Rate for Payer: Aetna Medicare	$133.19
Rate for Payer: ASR ASR	$349.17
Rate for Payer: BCBS Complete	$143.99
Rate for Payer: BCBS Trust/PPO	$296.80
Rate for Payer: BCN Commercial	$296.80
Rate for Payer: Cash Price	$287.98
Rate for Payer: Cofinity Commercial	$338.37
Rate for Payer: Encore Health Key Benefits Commercial	$287.98
Rate for Payer: Healthscope Commercial	$349.17
Rate for Payer: Healthscope Whirlpool	$359.97
Rate for Payer: Mclaren Commercial	$323.98
Rate for Payer: MI Amish Medical Board Commercial	$287.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$305.98
Rate for Payer: Nomi Health Commercial	$295.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$269.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$315.41
Rate for Payer: Priority Health Narrow Network	$252.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$316.78

NADOLOL 40 MG TABLET

Facility

$284.83

Service Code	NDC 904707107
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$105.39
Max. Negotiated Rate	$284.83
Rate for Payer: Aetna Commercial	$256.34
Rate for Payer: Aetna Medicare	$105.39
Rate for Payer: ASR ASR	$276.28
Rate for Payer: BCBS Complete	$113.93
Rate for Payer: BCBS Trust/PPO	$234.84
Rate for Payer: BCN Commercial	$234.84
Rate for Payer: Cash Price	$227.86
Rate for Payer: Cofinity Commercial	$267.74
Rate for Payer: Encore Health Key Benefits Commercial	$227.86
Rate for Payer: Healthscope Commercial	$276.28
Rate for Payer: Healthscope Whirlpool	$284.83
Rate for Payer: Mclaren Commercial	$256.34
Rate for Payer: MI Amish Medical Board Commercial	$227.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.10
Rate for Payer: Nomi Health Commercial	$233.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$249.56
Rate for Payer: Priority Health Narrow Network	$199.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$250.65

NADOLOL 40 MG TABLET

Facility

$284.83

Service Code	NDC 904707107
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$213.62
Max. Negotiated Rate	$284.83
Rate for Payer: Aetna Commercial	$256.34
Rate for Payer: ASR ASR	$276.28
Rate for Payer: BCBS Trust/PPO	$233.90
Rate for Payer: BCN Commercial	$233.90
Rate for Payer: Cash Price	$227.86
Rate for Payer: Cofinity Commercial	$267.74
Rate for Payer: Encore Health Key Benefits Commercial	$227.86
Rate for Payer: Healthscope Commercial	$276.28
Rate for Payer: Healthscope Whirlpool	$284.83
Rate for Payer: Mclaren Commercial	$256.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.10
Rate for Payer: Nomi Health Commercial	$233.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$250.65

NADOLOL 40 MG TABLET

Facility

$283.01

Service Code	NDC 69238112409
Hospital Charge Code	5331
Hospital Revenue Code	637
Min. Negotiated Rate	$212.25
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	$232.40
Rate for Payer: BCN Commercial	$232.40
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	$274.51
Rate for Payer: Healthscope Whirlpool	$283.00
Rate for Payer: Mclaren Commercial	$254.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$240.55
Rate for Payer: Nomi Health Commercial	$232.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$212.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$249.04

Know your out-of-pocket cost for care.

All Charges