COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL REHAB UNIT

Legal name: WILLIAM BEAUMONT HOSPITAL

ROYAL OAK, MI 480736712 (248) 898-5000 273Y00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
LEUCOVORIN CALCIUM 100 MG IJ SOLR [4392]	00574	N/A	N/A
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]	10006	N/A	N/A
KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN [22472]	10019	N/A	N/A
ADALIMUMAB 40 MG/0.4ML SUBCUT PSKT [150535]	10702	N/A	N/A
ZINC OXIDE 20 % EXT OINT [8874]	11701	N/A	N/A
CARBAMIDE PEROXIDE 6.5 % OTIC SOLN [1359]	12547	N/A	N/A
MAGNESIUM SULFATE 4 GM/50ML IV SOLN [125078]	13107	N/A	N/A
METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN [5002]	13668	N/A	N/A
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT [104596]	13925	N/A	N/A
MECLIZINE HCL 25 MG PO TABS [12025]	14428	N/A	N/A
SODIUM CHLORIDE 0.9 % IV SOLN [27838]	16571	N/A	N/A
BEVACIZUMAB 100 MG/4ML IV SOLN [102676]	16729	N/A	N/A
FLUCONAZOLE 150 MG PO TABS [13577]	16784	N/A	N/A
HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN [10176]	16864	N/A	N/A
ACYCLOVIR 400 MG PO TABS [8971]	17271	N/A	N/A
LIDOCAINE 4 % EXT CREA [23461]	17478	N/A	N/A
LINEZOLID 100 MG/5ML PO SUSR [28225]	19903	N/A	N/A
MEXILETINE HCL 150 MG PO CAPS [10595]	20555	N/A	N/A

Prices shown are published rates from hospital chargemaster files and insurer rate data. Your actual cost depends on your insurance plan, deductible status, and services rendered.