Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SCHIZOAFFECTIVE DISORDERS

Facility

$3,746.52

Service Code	APR-DRG 7611
Min. Negotiated Rate	$3,568.11
Max. Negotiated Rate	$3,746.52
Rate for Payer: BCBS Complete	$3,746.52
Rate for Payer: Mclaren Medicaid	$3,568.11
Rate for Payer: Meridian Medicaid	$3,746.52
Rate for Payer: Priority Health Choice Medicaid	$3,568.11
Rate for Payer: UHC Medicaid	$3,568.11
Rate for Payer: UHCCP Medicaid	$3,568.11

SCHIZOAFFECTIVE DISORDERS

Facility

$12,708.34

Service Code	APR-DRG 7614
Min. Negotiated Rate	$12,103.18
Max. Negotiated Rate	$12,708.34
Rate for Payer: BCBS Complete	$12,708.34
Rate for Payer: Mclaren Medicaid	$12,103.18
Rate for Payer: Meridian Medicaid	$12,708.34
Rate for Payer: Priority Health Choice Medicaid	$12,103.18
Rate for Payer: UHC Medicaid	$12,103.18
Rate for Payer: UHCCP Medicaid	$12,103.18

SCHIZOAFFECTIVE DISORDERS

Facility

$4,074.44

Service Code	APR-DRG 7612
Min. Negotiated Rate	$3,880.42
Max. Negotiated Rate	$4,074.44
Rate for Payer: BCBS Complete	$4,074.44
Rate for Payer: Mclaren Medicaid	$3,880.42
Rate for Payer: Meridian Medicaid	$4,074.44
Rate for Payer: Priority Health Choice Medicaid	$3,880.42
Rate for Payer: UHC Medicaid	$3,880.42
Rate for Payer: UHCCP Medicaid	$3,880.42

SCHIZOAFFECTIVE DISORDERS

Facility

$7,409.33

Service Code	APR-DRG 7613
Min. Negotiated Rate	$7,056.50
Max. Negotiated Rate	$7,409.33
Rate for Payer: BCBS Complete	$7,409.33
Rate for Payer: Mclaren Medicaid	$7,056.50
Rate for Payer: Meridian Medicaid	$7,409.33
Rate for Payer: Priority Health Choice Medicaid	$7,056.50
Rate for Payer: UHC Medicaid	$7,056.50
Rate for Payer: UHCCP Medicaid	$7,056.50

SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS

Facility

$6,603.27

Service Code	APR-DRG 7503
Min. Negotiated Rate	$6,288.83
Max. Negotiated Rate	$6,603.27
Rate for Payer: BCBS Complete	$6,603.27
Rate for Payer: Mclaren Medicaid	$6,288.83
Rate for Payer: Meridian Medicaid	$6,603.27
Rate for Payer: Priority Health Choice Medicaid	$6,288.83
Rate for Payer: UHC Medicaid	$6,288.83
Rate for Payer: UHCCP Medicaid	$6,288.83

SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS

Facility

$4,114.00

Service Code	APR-DRG 7501
Min. Negotiated Rate	$3,918.10
Max. Negotiated Rate	$4,114.00
Rate for Payer: BCBS Complete	$4,114.00
Rate for Payer: Mclaren Medicaid	$3,918.10
Rate for Payer: Meridian Medicaid	$4,114.00
Rate for Payer: Priority Health Choice Medicaid	$3,918.10
Rate for Payer: UHC Medicaid	$3,918.10
Rate for Payer: UHCCP Medicaid	$3,918.10

SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS

Facility

$5,219.32

Service Code	APR-DRG 7502
Min. Negotiated Rate	$4,970.78
Max. Negotiated Rate	$5,219.32
Rate for Payer: BCBS Complete	$5,219.32
Rate for Payer: Mclaren Medicaid	$4,970.78
Rate for Payer: Meridian Medicaid	$5,219.32
Rate for Payer: Priority Health Choice Medicaid	$4,970.78
Rate for Payer: UHC Medicaid	$4,970.78
Rate for Payer: UHCCP Medicaid	$4,970.78

SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS

Facility

$13,168.13

Service Code	APR-DRG 7504
Min. Negotiated Rate	$12,541.07
Max. Negotiated Rate	$13,168.13
Rate for Payer: BCBS Complete	$13,168.13
Rate for Payer: Mclaren Medicaid	$12,541.07
Rate for Payer: Meridian Medicaid	$13,168.13
Rate for Payer: Priority Health Choice Medicaid	$12,541.07
Rate for Payer: UHC Medicaid	$12,541.07
Rate for Payer: UHCCP Medicaid	$12,541.07

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$632.41

Service Code	NDC 00378647097
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$248.54
Max. Negotiated Rate	$569.17
Rate for Payer: Aetna Commercial	$537.55
Rate for Payer: Aetna Medicare	$316.20
Rate for Payer: Aetna New Business (MI Preferred)	$411.07
Rate for Payer: BCBS Complete	$252.96
Rate for Payer: Cash Price	$505.93
Rate for Payer: Cofinity Advantage	$442.69
Rate for Payer: Cofinity Commercial	$543.87
Rate for Payer: Encore Health Key Benefits Commercial	$505.93
Rate for Payer: Healthscope Commercial	$569.17
Rate for Payer: MI Amish Medical Board Commercial	$505.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$537.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$474.31
Rate for Payer: PHP Commercial	$537.55
Rate for Payer: Priority Health SBD	$398.42
Rate for Payer: UHC All Payor (Choice/PPO)	$411.07
Rate for Payer: UHC Core	$329.49
Rate for Payer: UHC Exchange	$248.54

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$326.90

Service Code	NDC 45802058046
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$128.47
Max. Negotiated Rate	$294.21
Rate for Payer: Aetna Commercial	$277.87
Rate for Payer: Aetna Medicare	$163.45
Rate for Payer: Aetna New Business (MI Preferred)	$212.49
Rate for Payer: BCBS Complete	$130.76
Rate for Payer: Cash Price	$261.52
Rate for Payer: Cofinity Advantage	$228.83
Rate for Payer: Cofinity Commercial	$281.13
Rate for Payer: Encore Health Key Benefits Commercial	$261.52
Rate for Payer: Healthscope Commercial	$294.21
Rate for Payer: MI Amish Medical Board Commercial	$261.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.18
Rate for Payer: PHP Commercial	$277.87
Rate for Payer: Priority Health SBD	$205.95
Rate for Payer: UHC All Payor (Choice/PPO)	$212.49
Rate for Payer: UHC Core	$170.31
Rate for Payer: UHC Exchange	$128.47

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$63.25

Service Code	NDC 00378647016
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$39.85
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$53.76
Rate for Payer: Aetna New Business (MI Preferred)	$41.11
Rate for Payer: Cash Price	$50.60
Rate for Payer: Cofinity Advantage	$44.27
Rate for Payer: Cofinity Commercial	$54.40
Rate for Payer: Encore Health Key Benefits Commercial	$50.60
Rate for Payer: Healthscope Commercial	$56.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.44
Rate for Payer: PHP Commercial	$53.76
Rate for Payer: Priority Health SBD	$39.85

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$32.69

Service Code	NDC 45802058001
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$29.42
Rate for Payer: Aetna Commercial	$27.79
Rate for Payer: Aetna New Business (MI Preferred)	$21.25
Rate for Payer: Cash Price	$26.15
Rate for Payer: Cofinity Advantage	$22.88
Rate for Payer: Cofinity Commercial	$28.11
Rate for Payer: Encore Health Key Benefits Commercial	$26.15
Rate for Payer: Healthscope Commercial	$29.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.52
Rate for Payer: PHP Commercial	$27.79
Rate for Payer: Priority Health SBD	$20.59

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$632.41

Service Code	NDC 00378647097
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$398.42
Max. Negotiated Rate	$569.17
Rate for Payer: Aetna Commercial	$537.55
Rate for Payer: Aetna New Business (MI Preferred)	$411.07
Rate for Payer: Cash Price	$505.93
Rate for Payer: Cofinity Advantage	$442.69
Rate for Payer: Cofinity Commercial	$543.87
Rate for Payer: Encore Health Key Benefits Commercial	$505.93
Rate for Payer: Healthscope Commercial	$569.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$537.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$474.31
Rate for Payer: PHP Commercial	$537.55
Rate for Payer: Priority Health SBD	$398.42

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$24.68

Service Code	NDC 50742050501
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$15.55
Max. Negotiated Rate	$22.21
Rate for Payer: Aetna Commercial	$20.98
Rate for Payer: Aetna New Business (MI Preferred)	$16.04
Rate for Payer: Cash Price	$19.74
Rate for Payer: Cofinity Advantage	$17.28
Rate for Payer: Cofinity Commercial	$21.22
Rate for Payer: Encore Health Key Benefits Commercial	$19.74
Rate for Payer: Healthscope Commercial	$22.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.51
Rate for Payer: PHP Commercial	$20.98
Rate for Payer: Priority Health SBD	$15.55

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$24.68

Service Code	NDC 50742050501
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$22.21
Rate for Payer: Aetna Commercial	$20.98
Rate for Payer: Aetna Medicare	$12.34
Rate for Payer: Aetna New Business (MI Preferred)	$16.04
Rate for Payer: BCBS Complete	$9.87
Rate for Payer: Cash Price	$19.74
Rate for Payer: Cofinity Advantage	$17.28
Rate for Payer: Cofinity Commercial	$21.22
Rate for Payer: Encore Health Key Benefits Commercial	$19.74
Rate for Payer: Healthscope Commercial	$22.21
Rate for Payer: MI Amish Medical Board Commercial	$19.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.51
Rate for Payer: PHP Commercial	$20.98
Rate for Payer: Priority Health SBD	$15.55
Rate for Payer: UHC All Payor (Choice/PPO)	$16.04
Rate for Payer: UHC Core	$12.86
Rate for Payer: UHC Exchange	$9.70

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$590.70

Service Code	NDC 50742050524
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$232.15
Max. Negotiated Rate	$531.63
Rate for Payer: Aetna Commercial	$502.10
Rate for Payer: Aetna Medicare	$295.35
Rate for Payer: Aetna New Business (MI Preferred)	$383.95
Rate for Payer: BCBS Complete	$236.28
Rate for Payer: Cash Price	$472.56
Rate for Payer: Cofinity Advantage	$413.49
Rate for Payer: Cofinity Commercial	$508.00
Rate for Payer: Encore Health Key Benefits Commercial	$472.56
Rate for Payer: Healthscope Commercial	$531.63
Rate for Payer: MI Amish Medical Board Commercial	$472.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$502.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$443.02
Rate for Payer: PHP Commercial	$502.10
Rate for Payer: Priority Health SBD	$372.14
Rate for Payer: UHC All Payor (Choice/PPO)	$383.95
Rate for Payer: UHC Core	$307.75
Rate for Payer: UHC Exchange	$232.15

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$326.90

Service Code	NDC 45802058046
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$205.95
Max. Negotiated Rate	$294.21
Rate for Payer: Aetna Commercial	$277.87
Rate for Payer: Aetna New Business (MI Preferred)	$212.49
Rate for Payer: Cash Price	$261.52
Rate for Payer: Cofinity Advantage	$228.83
Rate for Payer: Cofinity Commercial	$281.13
Rate for Payer: Encore Health Key Benefits Commercial	$261.52
Rate for Payer: Healthscope Commercial	$294.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.18
Rate for Payer: PHP Commercial	$277.87
Rate for Payer: Priority Health SBD	$205.95

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$1,051.31

Service Code	NDC 10019055304
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$413.16
Max. Negotiated Rate	$946.18
Rate for Payer: Aetna Commercial	$893.61
Rate for Payer: Aetna Medicare	$525.65
Rate for Payer: Aetna New Business (MI Preferred)	$683.35
Rate for Payer: BCBS Complete	$420.52
Rate for Payer: Cash Price	$841.05
Rate for Payer: Cofinity Advantage	$735.92
Rate for Payer: Cofinity Commercial	$904.13
Rate for Payer: Encore Health Key Benefits Commercial	$841.05
Rate for Payer: Healthscope Commercial	$946.18
Rate for Payer: MI Amish Medical Board Commercial	$841.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$893.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$788.48
Rate for Payer: PHP Commercial	$893.61
Rate for Payer: Priority Health SBD	$662.33
Rate for Payer: UHC All Payor (Choice/PPO)	$683.35
Rate for Payer: UHC Core	$547.73
Rate for Payer: UHC Exchange	$413.16

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$43.81

Service Code	NDC 10019055390
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$39.43
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare	$21.91
Rate for Payer: Aetna New Business (MI Preferred)	$28.48
Rate for Payer: BCBS Complete	$17.52
Rate for Payer: Cash Price	$35.05
Rate for Payer: Cofinity Advantage	$30.67
Rate for Payer: Cofinity Commercial	$37.68
Rate for Payer: Encore Health Key Benefits Commercial	$35.05
Rate for Payer: Healthscope Commercial	$39.43
Rate for Payer: MI Amish Medical Board Commercial	$35.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.86
Rate for Payer: PHP Commercial	$37.24
Rate for Payer: Priority Health SBD	$27.60
Rate for Payer: UHC All Payor (Choice/PPO)	$28.48
Rate for Payer: UHC Core	$22.83
Rate for Payer: UHC Exchange	$17.22

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$590.70

Service Code	NDC 50742050524
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$372.14
Max. Negotiated Rate	$531.63
Rate for Payer: Aetna Commercial	$502.10
Rate for Payer: Aetna New Business (MI Preferred)	$383.95
Rate for Payer: Cash Price	$472.56
Rate for Payer: Cofinity Advantage	$413.49
Rate for Payer: Cofinity Commercial	$508.00
Rate for Payer: Encore Health Key Benefits Commercial	$472.56
Rate for Payer: Healthscope Commercial	$531.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$502.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$443.02
Rate for Payer: PHP Commercial	$502.10
Rate for Payer: Priority Health SBD	$372.14

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$438.05

Service Code	NDC 10019055303
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$275.97
Max. Negotiated Rate	$394.25
Rate for Payer: Aetna Commercial	$372.34
Rate for Payer: Aetna New Business (MI Preferred)	$284.73
Rate for Payer: Cash Price	$350.44
Rate for Payer: Cofinity Advantage	$306.63
Rate for Payer: Cofinity Commercial	$376.72
Rate for Payer: Encore Health Key Benefits Commercial	$350.44
Rate for Payer: Healthscope Commercial	$394.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$372.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$328.54
Rate for Payer: PHP Commercial	$372.34
Rate for Payer: Priority Health SBD	$275.97

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$245.68

Service Code	NDC 50742050510
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$96.55
Max. Negotiated Rate	$221.11
Rate for Payer: Aetna Commercial	$208.83
Rate for Payer: Aetna Medicare	$122.84
Rate for Payer: Aetna New Business (MI Preferred)	$159.69
Rate for Payer: BCBS Complete	$98.27
Rate for Payer: Cash Price	$196.54
Rate for Payer: Cofinity Advantage	$171.98
Rate for Payer: Cofinity Commercial	$211.28
Rate for Payer: Encore Health Key Benefits Commercial	$196.54
Rate for Payer: Healthscope Commercial	$221.11
Rate for Payer: MI Amish Medical Board Commercial	$196.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.26
Rate for Payer: PHP Commercial	$208.83
Rate for Payer: Priority Health SBD	$154.78
Rate for Payer: UHC All Payor (Choice/PPO)	$159.69
Rate for Payer: UHC Core	$128.00
Rate for Payer: UHC Exchange	$96.55

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$32.69

Service Code	NDC 45802058001
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$29.42
Rate for Payer: Aetna Commercial	$27.79
Rate for Payer: Aetna Medicare	$16.34
Rate for Payer: Aetna New Business (MI Preferred)	$21.25
Rate for Payer: BCBS Complete	$13.08
Rate for Payer: Cash Price	$26.15
Rate for Payer: Cofinity Advantage	$22.88
Rate for Payer: Cofinity Commercial	$28.11
Rate for Payer: Encore Health Key Benefits Commercial	$26.15
Rate for Payer: Healthscope Commercial	$29.42
Rate for Payer: MI Amish Medical Board Commercial	$26.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.52
Rate for Payer: PHP Commercial	$27.79
Rate for Payer: Priority Health SBD	$20.59
Rate for Payer: UHC All Payor (Choice/PPO)	$21.25
Rate for Payer: UHC Core	$17.03
Rate for Payer: UHC Exchange	$12.85

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$245.68

Service Code	NDC 50742050510
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$154.78
Max. Negotiated Rate	$221.11
Rate for Payer: Aetna Commercial	$208.83
Rate for Payer: Aetna New Business (MI Preferred)	$159.69
Rate for Payer: Cash Price	$196.54
Rate for Payer: Cofinity Advantage	$171.98
Rate for Payer: Cofinity Commercial	$211.28
Rate for Payer: Encore Health Key Benefits Commercial	$196.54
Rate for Payer: Healthscope Commercial	$221.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.26
Rate for Payer: PHP Commercial	$208.83
Rate for Payer: Priority Health SBD	$154.78

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$43.81

Service Code	NDC 10019055390
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$39.43
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna New Business (MI Preferred)	$28.48
Rate for Payer: Cash Price	$35.05
Rate for Payer: Cofinity Advantage	$30.67
Rate for Payer: Cofinity Commercial	$37.68
Rate for Payer: Encore Health Key Benefits Commercial	$35.05
Rate for Payer: Healthscope Commercial	$39.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.86
Rate for Payer: PHP Commercial	$37.24
Rate for Payer: Priority Health SBD	$27.60

Know your out-of-pocket cost for care.

All Charges