Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLURBIPROFEN 0.03 % EYE DROPS

Facility

$117.11

Service Code	NDC 69292-722-25
Hospital Charge Code	10080
Hospital Revenue Code	637
Min. Negotiated Rate	$73.78
Max. Negotiated Rate	$105.40
Rate for Payer: Aetna Commercial	$99.54
Rate for Payer: Aetna New Business (MI Preferred)	$76.12
Rate for Payer: Cash Price	$93.69
Rate for Payer: Cofinity Commercial	$100.71
Rate for Payer: Cofinity Commercial	$81.98
Rate for Payer: Healthscope Commercial	$105.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.54
Rate for Payer: PHP Commercial	$99.54
Rate for Payer: Priority Health Cigna Priority Health	$81.98
Rate for Payer: Priority Health SBD	$73.78

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$781.06

Service Code	NDC 66993-079-96
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$492.07
Max. Negotiated Rate	$702.95
Rate for Payer: Aetna Commercial	$663.90
Rate for Payer: Aetna New Business (MI Preferred)	$507.69
Rate for Payer: Cash Price	$624.85
Rate for Payer: Cofinity Commercial	$546.74
Rate for Payer: Cofinity Commercial	$671.71
Rate for Payer: Healthscope Commercial	$702.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$663.90
Rate for Payer: PHP Commercial	$663.90
Rate for Payer: Priority Health Cigna Priority Health	$546.74
Rate for Payer: Priority Health SBD	$492.07

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$1,045.44

Service Code	NDC 0173-0719-20
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$658.63
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$888.62
Rate for Payer: Aetna New Business (MI Preferred)	$679.54
Rate for Payer: Cash Price	$836.35
Rate for Payer: Cofinity Commercial	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Healthscope Commercial	$940.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$888.62
Rate for Payer: PHP Commercial	$888.62
Rate for Payer: Priority Health Cigna Priority Health	$731.81
Rate for Payer: Priority Health SBD	$658.63

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$934.62

Service Code	NDC 66993-080-96
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$588.81
Max. Negotiated Rate	$841.16
Rate for Payer: Aetna Commercial	$794.43
Rate for Payer: Aetna New Business (MI Preferred)	$607.50
Rate for Payer: Cash Price	$747.70
Rate for Payer: Cofinity Commercial	$654.23
Rate for Payer: Cofinity Commercial	$803.77
Rate for Payer: Healthscope Commercial	$841.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$794.43
Rate for Payer: PHP Commercial	$794.43
Rate for Payer: Priority Health Cigna Priority Health	$654.23
Rate for Payer: Priority Health SBD	$588.81

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$1,243.20

Service Code	NDC 0173-0720-20
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$783.22
Max. Negotiated Rate	$1,118.88
Rate for Payer: Aetna Commercial	$1,056.72
Rate for Payer: Aetna New Business (MI Preferred)	$808.08
Rate for Payer: Cash Price	$994.56
Rate for Payer: Cofinity Commercial	$1,069.15
Rate for Payer: Cofinity Commercial	$870.24
Rate for Payer: Healthscope Commercial	$1,118.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,056.72
Rate for Payer: PHP Commercial	$1,056.72
Rate for Payer: Priority Health Cigna Priority Health	$870.24
Rate for Payer: Priority Health SBD	$783.22

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$1,045.44

Service Code	NDC 0173-0719-20
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$658.63
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$888.62
Rate for Payer: Aetna New Business (MI Preferred)	$679.54
Rate for Payer: Cash Price	$836.35
Rate for Payer: Cofinity Commercial	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Healthscope Commercial	$940.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$888.62
Rate for Payer: PHP Commercial	$888.62
Rate for Payer: Priority Health Cigna Priority Health	$731.81
Rate for Payer: Priority Health SBD	$658.63

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$781.06

Service Code	NDC 66993-079-96
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$492.07
Max. Negotiated Rate	$702.95
Rate for Payer: Aetna Commercial	$663.90
Rate for Payer: Aetna New Business (MI Preferred)	$507.69
Rate for Payer: Cash Price	$624.85
Rate for Payer: Cofinity Commercial	$546.74
Rate for Payer: Cofinity Commercial	$671.71
Rate for Payer: Healthscope Commercial	$702.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$663.90
Rate for Payer: PHP Commercial	$663.90
Rate for Payer: Priority Health Cigna Priority Health	$546.74
Rate for Payer: Priority Health SBD	$492.07

FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$934.62

Service Code	NDC 66993-080-96
Hospital Charge Code	40699
Hospital Revenue Code	637
Min. Negotiated Rate	$588.81
Max. Negotiated Rate	$841.16
Rate for Payer: Aetna Commercial	$794.43
Rate for Payer: Aetna New Business (MI Preferred)	$607.50
Rate for Payer: Cash Price	$747.70
Rate for Payer: Cofinity Commercial	$654.23
Rate for Payer: Cofinity Commercial	$803.77
Rate for Payer: Healthscope Commercial	$841.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$794.43
Rate for Payer: PHP Commercial	$794.43
Rate for Payer: Priority Health Cigna Priority Health	$654.23
Rate for Payer: Priority Health SBD	$588.81

FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$1,243.20

Service Code	NDC 0173-0720-20
Hospital Charge Code	40699
Hospital Revenue Code	637
Min. Negotiated Rate	$783.22
Max. Negotiated Rate	$1,118.88
Rate for Payer: Aetna Commercial	$1,056.72
Rate for Payer: Aetna New Business (MI Preferred)	$808.08
Rate for Payer: Cash Price	$994.56
Rate for Payer: Cofinity Commercial	$1,069.15
Rate for Payer: Cofinity Commercial	$870.24
Rate for Payer: Healthscope Commercial	$1,118.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,056.72
Rate for Payer: PHP Commercial	$1,056.72
Rate for Payer: Priority Health Cigna Priority Health	$870.24
Rate for Payer: Priority Health SBD	$783.22

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION

Facility

$19.80

Service Code	NDC 60505-0829-1
Hospital Charge Code	70536
Hospital Revenue Code	637
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$17.82
Rate for Payer: Aetna Commercial	$16.83
Rate for Payer: Aetna New Business (MI Preferred)	$12.87
Rate for Payer: Cash Price	$15.84
Rate for Payer: Cofinity Commercial	$13.86
Rate for Payer: Cofinity Commercial	$17.03
Rate for Payer: Healthscope Commercial	$17.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.83
Rate for Payer: PHP Commercial	$16.83
Rate for Payer: Priority Health Cigna Priority Health	$13.86
Rate for Payer: Priority Health SBD	$12.47

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION

Facility

$36.57

Service Code	NDC 0054-3270-99
Hospital Charge Code	70536
Hospital Revenue Code	637
Min. Negotiated Rate	$23.04
Max. Negotiated Rate	$32.91
Rate for Payer: Aetna Commercial	$31.08
Rate for Payer: Aetna New Business (MI Preferred)	$23.77
Rate for Payer: Cash Price	$29.26
Rate for Payer: Cofinity Commercial	$25.60
Rate for Payer: Cofinity Commercial	$31.45
Rate for Payer: Healthscope Commercial	$32.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.08
Rate for Payer: PHP Commercial	$31.08
Rate for Payer: Priority Health Cigna Priority Health	$25.60
Rate for Payer: Priority Health SBD	$23.04

FLU VACCINE QS2023-24(65YR UP)(PF)240 MCG/0.7 ML INTRAMUSCULAR SYRINGE

Facility

$222.09

Service Code	HCPCS 90662
Hospital Charge Code	204599
Hospital Revenue Code	636
Min. Negotiated Rate	$139.92
Max. Negotiated Rate	$199.88
Rate for Payer: Aetna Commercial	$188.78
Rate for Payer: Aetna New Business (MI Preferred)	$144.36
Rate for Payer: Cash Price	$177.67
Rate for Payer: Cofinity Commercial	$155.46
Rate for Payer: Cofinity Commercial	$191.00
Rate for Payer: Healthscope Commercial	$199.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$188.78
Rate for Payer: PHP Commercial	$188.78
Rate for Payer: Priority Health Cigna Priority Health	$155.46
Rate for Payer: Priority Health SBD	$139.92

FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE

Facility

$83.74

Service Code	HCPCS 90686
Hospital Charge Code	204598
Hospital Revenue Code	636
Min. Negotiated Rate	$52.76
Max. Negotiated Rate	$75.37
Rate for Payer: Aetna Commercial	$71.18
Rate for Payer: Aetna New Business (MI Preferred)	$54.43
Rate for Payer: Cash Price	$66.99
Rate for Payer: Cofinity Commercial	$58.62
Rate for Payer: Cofinity Commercial	$72.02
Rate for Payer: Healthscope Commercial	$75.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.18
Rate for Payer: PHP Commercial	$71.18
Rate for Payer: Priority Health Cigna Priority Health	$58.62
Rate for Payer: Priority Health SBD	$52.76

FLUVOXAMINE 100 MG TABLET

Facility

$4.15

Service Code	NDC 51079-993-01
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.74
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna New Business (MI Preferred)	$2.70
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Healthscope Commercial	$3.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.53
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health Cigna Priority Health	$2.90
Rate for Payer: Priority Health SBD	$2.61

FLUVOXAMINE 100 MG TABLET

Facility

$414.20

Service Code	NDC 51079-993-20
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$260.95
Max. Negotiated Rate	$372.78
Rate for Payer: Aetna Commercial	$352.07
Rate for Payer: Aetna New Business (MI Preferred)	$269.23
Rate for Payer: Cash Price	$331.36
Rate for Payer: Cofinity Commercial	$289.94
Rate for Payer: Cofinity Commercial	$356.21
Rate for Payer: Healthscope Commercial	$372.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$352.07
Rate for Payer: PHP Commercial	$352.07
Rate for Payer: Priority Health Cigna Priority Health	$289.94
Rate for Payer: Priority Health SBD	$260.95

FLUVOXAMINE 100 MG TABLET

Facility

$209.00

Service Code	NDC 62559-160-01
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$131.67
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna New Business (MI Preferred)	$135.85
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cofinity Commercial	$146.30
Rate for Payer: Cofinity Commercial	$179.74
Rate for Payer: Healthscope Commercial	$188.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$177.65
Rate for Payer: PHP Commercial	$177.65
Rate for Payer: Priority Health Cigna Priority Health	$146.30
Rate for Payer: Priority Health SBD	$131.67

FLUVOXAMINE 50 MG TABLET

Facility

$374.30

Service Code	NDC 51079-992-20
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$235.81
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.16
Rate for Payer: Aetna New Business (MI Preferred)	$243.30
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Commercial	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$318.16
Rate for Payer: PHP Commercial	$318.16
Rate for Payer: Priority Health Cigna Priority Health	$262.01
Rate for Payer: Priority Health SBD	$235.81

FLUVOXAMINE 50 MG TABLET

Facility

$3.75

Service Code	NDC 51079-992-01
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.62
Rate for Payer: Priority Health SBD	$2.36

FOLIC ACID 1 MG TABLET

Facility

$224.00

Service Code	NDC 11534-165-01
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$141.12
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$190.40
Rate for Payer: Aetna New Business (MI Preferred)	$145.60
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cofinity Commercial	$156.80
Rate for Payer: Cofinity Commercial	$192.64
Rate for Payer: Healthscope Commercial	$201.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$190.40
Rate for Payer: PHP Commercial	$190.40
Rate for Payer: Priority Health Cigna Priority Health	$156.80
Rate for Payer: Priority Health SBD	$141.12

FOLIC ACID 1 MG TABLET

Facility

$149.60

Service Code	NDC 62584-897-01
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$94.25
Max. Negotiated Rate	$134.64
Rate for Payer: Aetna Commercial	$127.16
Rate for Payer: Aetna New Business (MI Preferred)	$97.24
Rate for Payer: Cash Price	$119.68
Rate for Payer: Cofinity Commercial	$104.72
Rate for Payer: Cofinity Commercial	$128.66
Rate for Payer: Healthscope Commercial	$134.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.16
Rate for Payer: PHP Commercial	$127.16
Rate for Payer: Priority Health Cigna Priority Health	$104.72
Rate for Payer: Priority Health SBD	$94.25

FOLIC ACID 1 MG TABLET

Facility

$135.30

Service Code	NDC 0904-7224-61
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$85.24
Max. Negotiated Rate	$121.77
Rate for Payer: Aetna Commercial	$115.00
Rate for Payer: Aetna New Business (MI Preferred)	$87.94
Rate for Payer: Cash Price	$108.24
Rate for Payer: Cofinity Commercial	$116.36
Rate for Payer: Cofinity Commercial	$94.71
Rate for Payer: Healthscope Commercial	$121.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$115.00
Rate for Payer: PHP Commercial	$115.00
Rate for Payer: Priority Health Cigna Priority Health	$94.71
Rate for Payer: Priority Health SBD	$85.24

FOLIC ACID 1 MG TABLET

Facility

$284.00

Service Code	NDC 63739-537-10
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$178.92
Max. Negotiated Rate	$255.60
Rate for Payer: Aetna Commercial	$241.40
Rate for Payer: Aetna New Business (MI Preferred)	$184.60
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cofinity Commercial	$198.80
Rate for Payer: Cofinity Commercial	$244.24
Rate for Payer: Healthscope Commercial	$255.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$241.40
Rate for Payer: PHP Commercial	$241.40
Rate for Payer: Priority Health Cigna Priority Health	$198.80
Rate for Payer: Priority Health SBD	$178.92

FOLIC ACID 1 MG TABLET

Facility

$160.00

Service Code	NDC 69315-127-01
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Commercial	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$136.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health SBD	$100.80

FOLIC ACID 1 MG TABLET

Facility

$1.50

Service Code	NDC 62584-897-11
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna Commercial	$1.28
Rate for Payer: Aetna New Business (MI Preferred)	$0.98
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cofinity Commercial	$1.05
Rate for Payer: Cofinity Commercial	$1.29
Rate for Payer: Healthscope Commercial	$1.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.28
Rate for Payer: PHP Commercial	$1.28
Rate for Payer: Priority Health Cigna Priority Health	$1.05
Rate for Payer: Priority Health SBD	$0.95

FOLIC ACID 1 MG TABLET

Facility

$1.56

Service Code	NDC 60687-681-11
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna Commercial	$1.33
Rate for Payer: Aetna New Business (MI Preferred)	$1.01
Rate for Payer: Cash Price	$1.25
Rate for Payer: Cofinity Commercial	$1.34
Rate for Payer: Cofinity Commercial	$1.09
Rate for Payer: Healthscope Commercial	$1.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.33
Rate for Payer: PHP Commercial	$1.33
Rate for Payer: Priority Health Cigna Priority Health	$1.09
Rate for Payer: Priority Health SBD	$0.98

Know your out-of-pocket cost for care.

All Charges