Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$28.17

Service Code	NDC 0409-1761-02
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna New Business (MI Preferred)	$18.31
Rate for Payer: Cash Price	$22.54
Rate for Payer: Cofinity Commercial	$19.72
Rate for Payer: Cofinity Commercial	$24.23
Rate for Payer: Healthscope Commercial	$25.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.94
Rate for Payer: PHP Commercial	$23.94
Rate for Payer: Priority Health Cigna Priority Health	$19.72
Rate for Payer: Priority Health SBD	$17.75

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION

Facility

$28.71

Service Code	HCPCS J0665
Hospital Charge Code	1224
Hospital Revenue Code	636
Min. Negotiated Rate	$18.09
Max. Negotiated Rate	$25.84
Rate for Payer: Aetna Commercial	$24.40
Rate for Payer: Aetna Commercial	$20.95
Rate for Payer: Aetna Commercial	$20.66
Rate for Payer: Aetna New Business (MI Preferred)	$16.02
Rate for Payer: Aetna New Business (MI Preferred)	$15.80
Rate for Payer: Aetna New Business (MI Preferred)	$18.66
Rate for Payer: Cash Price	$19.44
Rate for Payer: Cash Price	$19.72
Rate for Payer: Cash Price	$22.97
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Cofinity Commercial	$20.10
Rate for Payer: Cofinity Commercial	$17.26
Rate for Payer: Cofinity Commercial	$21.20
Rate for Payer: Cofinity Commercial	$24.69
Rate for Payer: Cofinity Commercial	$20.90
Rate for Payer: Healthscope Commercial	$22.18
Rate for Payer: Healthscope Commercial	$21.87
Rate for Payer: Healthscope Commercial	$25.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.66
Rate for Payer: PHP Commercial	$24.40
Rate for Payer: PHP Commercial	$20.95
Rate for Payer: PHP Commercial	$20.66
Rate for Payer: Priority Health Cigna Priority Health	$17.26
Rate for Payer: Priority Health Cigna Priority Health	$17.01
Rate for Payer: Priority Health Cigna Priority Health	$20.10
Rate for Payer: Priority Health SBD	$18.09
Rate for Payer: Priority Health SBD	$15.31
Rate for Payer: Priority Health SBD	$15.53

BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$1,659.80

Service Code	NDC 59011-751-04
Hospital Charge Code	107661
Hospital Revenue Code	637
Min. Negotiated Rate	$1,045.67
Max. Negotiated Rate	$1,493.82
Rate for Payer: Aetna Commercial	$1,410.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,078.87
Rate for Payer: Cash Price	$1,327.84
Rate for Payer: Cofinity Commercial	$1,161.86
Rate for Payer: Cofinity Commercial	$1,427.43
Rate for Payer: Healthscope Commercial	$1,493.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,410.83
Rate for Payer: PHP Commercial	$1,410.83
Rate for Payer: Priority Health Cigna Priority Health	$1,161.86
Rate for Payer: Priority Health SBD	$1,045.67

BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET

Facility

$626.15

Service Code	NDC 0904-7009-06
Hospital Charge Code	34713
Hospital Revenue Code	637
Min. Negotiated Rate	$394.47
Max. Negotiated Rate	$563.54
Rate for Payer: Aetna Commercial	$532.23
Rate for Payer: Aetna New Business (MI Preferred)	$407.00
Rate for Payer: Cash Price	$500.92
Rate for Payer: Cofinity Commercial	$438.30
Rate for Payer: Cofinity Commercial	$538.49
Rate for Payer: Healthscope Commercial	$563.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$532.23
Rate for Payer: PHP Commercial	$532.23
Rate for Payer: Priority Health Cigna Priority Health	$438.30
Rate for Payer: Priority Health SBD	$394.47

BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$451.91

Service Code	NDC 0093-3656-40
Hospital Charge Code	107660
Hospital Revenue Code	637
Min. Negotiated Rate	$284.70
Max. Negotiated Rate	$406.72
Rate for Payer: Aetna Commercial	$384.12
Rate for Payer: Aetna New Business (MI Preferred)	$293.74
Rate for Payer: Cash Price	$361.53
Rate for Payer: Cofinity Commercial	$316.34
Rate for Payer: Cofinity Commercial	$388.64
Rate for Payer: Healthscope Commercial	$406.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$384.12
Rate for Payer: PHP Commercial	$384.12
Rate for Payer: Priority Health Cigna Priority Health	$316.34
Rate for Payer: Priority Health SBD	$284.70

BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$986.88

Service Code	NDC 59011-750-04
Hospital Charge Code	107660
Hospital Revenue Code	637
Min. Negotiated Rate	$621.73
Max. Negotiated Rate	$888.19
Rate for Payer: Aetna Commercial	$838.85
Rate for Payer: Aetna New Business (MI Preferred)	$641.47
Rate for Payer: Cash Price	$789.50
Rate for Payer: Cofinity Commercial	$690.82
Rate for Payer: Cofinity Commercial	$848.72
Rate for Payer: Healthscope Commercial	$888.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$838.85
Rate for Payer: PHP Commercial	$838.85
Rate for Payer: Priority Health Cigna Priority Health	$690.82
Rate for Payer: Priority Health SBD	$621.73

BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$582.82

Service Code	NDC 0093-3239-40
Hospital Charge Code	172295
Hospital Revenue Code	637
Min. Negotiated Rate	$367.18
Max. Negotiated Rate	$524.54
Rate for Payer: Aetna Commercial	$495.40
Rate for Payer: Aetna New Business (MI Preferred)	$378.83
Rate for Payer: Cash Price	$466.26
Rate for Payer: Cofinity Commercial	$407.97
Rate for Payer: Cofinity Commercial	$501.23
Rate for Payer: Healthscope Commercial	$524.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$495.40
Rate for Payer: PHP Commercial	$495.40
Rate for Payer: Priority Health Cigna Priority Health	$407.97
Rate for Payer: Priority Health SBD	$367.18

BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$145.71

Service Code	NDC 0093-3239-21
Hospital Charge Code	172295
Hospital Revenue Code	637
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$131.14
Rate for Payer: Aetna Commercial	$123.85
Rate for Payer: Aetna New Business (MI Preferred)	$94.71
Rate for Payer: Cash Price	$116.57
Rate for Payer: Cofinity Commercial	$102.00
Rate for Payer: Cofinity Commercial	$125.31
Rate for Payer: Healthscope Commercial	$131.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$123.85
Rate for Payer: PHP Commercial	$123.85
Rate for Payer: Priority Health Cigna Priority Health	$102.00
Rate for Payer: Priority Health SBD	$91.80

BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET

Facility

$482.04

Service Code	NDC 0904-7010-06
Hospital Charge Code	34714
Hospital Revenue Code	637
Min. Negotiated Rate	$303.69
Max. Negotiated Rate	$433.84
Rate for Payer: Aetna Commercial	$409.73
Rate for Payer: Aetna New Business (MI Preferred)	$313.33
Rate for Payer: Cash Price	$385.63
Rate for Payer: Cofinity Commercial	$337.43
Rate for Payer: Cofinity Commercial	$414.55
Rate for Payer: Healthscope Commercial	$433.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$409.73
Rate for Payer: PHP Commercial	$409.73
Rate for Payer: Priority Health Cigna Priority Health	$337.43
Rate for Payer: Priority Health SBD	$303.69

BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION

Facility

$53.51

Service Code	HCPCS J0592
Hospital Charge Code	115937
Hospital Revenue Code	636
Min. Negotiated Rate	$33.71
Max. Negotiated Rate	$48.16
Rate for Payer: Aetna Commercial	$45.48
Rate for Payer: Aetna Commercial	$53.37
Rate for Payer: Aetna New Business (MI Preferred)	$40.81
Rate for Payer: Aetna New Business (MI Preferred)	$34.78
Rate for Payer: Cash Price	$42.81
Rate for Payer: Cash Price	$50.23
Rate for Payer: Cofinity Commercial	$46.02
Rate for Payer: Cofinity Commercial	$37.46
Rate for Payer: Cofinity Commercial	$43.95
Rate for Payer: Cofinity Commercial	$54.00
Rate for Payer: Healthscope Commercial	$48.16
Rate for Payer: Healthscope Commercial	$56.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.48
Rate for Payer: PHP Commercial	$53.37
Rate for Payer: PHP Commercial	$45.48
Rate for Payer: Priority Health Cigna Priority Health	$37.46
Rate for Payer: Priority Health Cigna Priority Health	$43.95
Rate for Payer: Priority Health SBD	$33.71
Rate for Payer: Priority Health SBD	$39.56

BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET

Facility

$192.15

Service Code	NDC 0054-0176-13
Hospital Charge Code	34711
Hospital Revenue Code	637
Min. Negotiated Rate	$121.05
Max. Negotiated Rate	$172.94
Rate for Payer: Aetna Commercial	$163.33
Rate for Payer: Aetna New Business (MI Preferred)	$124.90
Rate for Payer: Cash Price	$153.72
Rate for Payer: Cofinity Commercial	$134.50
Rate for Payer: Cofinity Commercial	$165.25
Rate for Payer: Healthscope Commercial	$172.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$163.33
Rate for Payer: PHP Commercial	$163.33
Rate for Payer: Priority Health Cigna Priority Health	$134.50
Rate for Payer: Priority Health SBD	$121.05

BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET

Facility

$140.91

Service Code	NDC 50383-924-93
Hospital Charge Code	34711
Hospital Revenue Code	637
Min. Negotiated Rate	$88.77
Max. Negotiated Rate	$126.82
Rate for Payer: Aetna Commercial	$119.77
Rate for Payer: Aetna New Business (MI Preferred)	$91.59
Rate for Payer: Cash Price	$112.73
Rate for Payer: Cofinity Commercial	$121.18
Rate for Payer: Cofinity Commercial	$98.64
Rate for Payer: Healthscope Commercial	$126.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.77
Rate for Payer: PHP Commercial	$119.77
Rate for Payer: Priority Health Cigna Priority Health	$98.64
Rate for Payer: Priority Health SBD	$88.77

BUPRENORPHINE HCL 75 MCG BUCCAL FILM

Facility

$21.90

Service Code	NDC 59385-021-01
Hospital Charge Code	176431
Hospital Revenue Code	637
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$19.71
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna New Business (MI Preferred)	$14.24
Rate for Payer: Cash Price	$17.52
Rate for Payer: Cofinity Commercial	$15.33
Rate for Payer: Cofinity Commercial	$18.83
Rate for Payer: Healthscope Commercial	$19.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.62
Rate for Payer: PHP Commercial	$18.62
Rate for Payer: Priority Health Cigna Priority Health	$15.33
Rate for Payer: Priority Health SBD	$13.80

BUPRENORPHINE HCL 75 MCG BUCCAL FILM

Facility

$1,313.73

Service Code	NDC 59385-021-60
Hospital Charge Code	176431
Hospital Revenue Code	637
Min. Negotiated Rate	$827.65
Max. Negotiated Rate	$1,182.36
Rate for Payer: Aetna Commercial	$1,116.67
Rate for Payer: Aetna New Business (MI Preferred)	$853.92
Rate for Payer: Cash Price	$1,050.98
Rate for Payer: Cofinity Commercial	$1,129.81
Rate for Payer: Cofinity Commercial	$919.61
Rate for Payer: Healthscope Commercial	$1,182.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,116.67
Rate for Payer: PHP Commercial	$1,116.67
Rate for Payer: Priority Health Cigna Priority Health	$919.61
Rate for Payer: Priority Health SBD	$827.65

BUPROPION HCL 100 MG TABLET

Facility

$244.40

Service Code	NDC 60505-0157-1
Hospital Charge Code	9321
Hospital Revenue Code	637
Min. Negotiated Rate	$153.97
Max. Negotiated Rate	$219.96
Rate for Payer: Aetna Commercial	$207.74
Rate for Payer: Aetna New Business (MI Preferred)	$158.86
Rate for Payer: Cash Price	$195.52
Rate for Payer: Cofinity Commercial	$171.08
Rate for Payer: Cofinity Commercial	$210.18
Rate for Payer: Healthscope Commercial	$219.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.74
Rate for Payer: PHP Commercial	$207.74
Rate for Payer: Priority Health Cigna Priority Health	$171.08
Rate for Payer: Priority Health SBD	$153.97

BUPROPION HCL 100 MG TABLET

Facility

$510.72

Service Code	NDC 0904-6636-61
Hospital Charge Code	9321
Hospital Revenue Code	637
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$459.65
Rate for Payer: Aetna Commercial	$434.11
Rate for Payer: Aetna New Business (MI Preferred)	$331.97
Rate for Payer: Cash Price	$408.58
Rate for Payer: Cofinity Commercial	$357.50
Rate for Payer: Cofinity Commercial	$439.22
Rate for Payer: Healthscope Commercial	$459.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$434.11
Rate for Payer: PHP Commercial	$434.11
Rate for Payer: Priority Health Cigna Priority Health	$357.50
Rate for Payer: Priority Health SBD	$321.75

BUPROPION HCL 75 MG TABLET

Facility

$4.53

Service Code	NDC 51079-943-01
Hospital Charge Code	9322
Hospital Revenue Code	637
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$4.08
Rate for Payer: Aetna Commercial	$3.85
Rate for Payer: Aetna New Business (MI Preferred)	$2.94
Rate for Payer: Cash Price	$3.62
Rate for Payer: Cofinity Commercial	$3.17
Rate for Payer: Cofinity Commercial	$3.90
Rate for Payer: Healthscope Commercial	$4.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.85
Rate for Payer: PHP Commercial	$3.85
Rate for Payer: Priority Health Cigna Priority Health	$3.17
Rate for Payer: Priority Health SBD	$2.85

BUPROPION HCL 75 MG TABLET

Facility

$452.16

Service Code	NDC 51079-943-20
Hospital Charge Code	9322
Hospital Revenue Code	637
Min. Negotiated Rate	$284.86
Max. Negotiated Rate	$406.94
Rate for Payer: Aetna Commercial	$384.34
Rate for Payer: Aetna New Business (MI Preferred)	$293.90
Rate for Payer: Cash Price	$361.73
Rate for Payer: Cofinity Commercial	$316.51
Rate for Payer: Cofinity Commercial	$388.86
Rate for Payer: Healthscope Commercial	$406.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$384.34
Rate for Payer: PHP Commercial	$384.34
Rate for Payer: Priority Health Cigna Priority Health	$316.51
Rate for Payer: Priority Health SBD	$284.86

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$351.09

Service Code	NDC 0115-6811-10
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$221.19
Max. Negotiated Rate	$315.98
Rate for Payer: Aetna Commercial	$298.43
Rate for Payer: Aetna New Business (MI Preferred)	$228.21
Rate for Payer: Cash Price	$280.87
Rate for Payer: Cofinity Commercial	$245.76
Rate for Payer: Cofinity Commercial	$301.94
Rate for Payer: Healthscope Commercial	$315.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$298.43
Rate for Payer: PHP Commercial	$298.43
Rate for Payer: Priority Health Cigna Priority Health	$245.76
Rate for Payer: Priority Health SBD	$221.19

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$669.60

Service Code	NDC 60687-312-01
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$421.85
Max. Negotiated Rate	$602.64
Rate for Payer: Aetna Commercial	$569.16
Rate for Payer: Aetna New Business (MI Preferred)	$435.24
Rate for Payer: Cash Price	$535.68
Rate for Payer: Cofinity Commercial	$468.72
Rate for Payer: Cofinity Commercial	$575.86
Rate for Payer: Healthscope Commercial	$602.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$569.16
Rate for Payer: PHP Commercial	$569.16
Rate for Payer: Priority Health Cigna Priority Health	$468.72
Rate for Payer: Priority Health SBD	$421.85

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$64.70

Service Code	NDC 60429-933-30
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$40.76
Max. Negotiated Rate	$58.23
Rate for Payer: Aetna Commercial	$55.00
Rate for Payer: Aetna New Business (MI Preferred)	$42.06
Rate for Payer: Cash Price	$51.76
Rate for Payer: Cofinity Commercial	$45.29
Rate for Payer: Cofinity Commercial	$55.64
Rate for Payer: Healthscope Commercial	$58.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$55.00
Rate for Payer: PHP Commercial	$55.00
Rate for Payer: Priority Health Cigna Priority Health	$45.29
Rate for Payer: Priority Health SBD	$40.76

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$6.70

Service Code	NDC 60687-312-11
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna New Business (MI Preferred)	$4.36
Rate for Payer: Cash Price	$5.36
Rate for Payer: Cofinity Commercial	$4.69
Rate for Payer: Cofinity Commercial	$5.76
Rate for Payer: Healthscope Commercial	$6.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.70
Rate for Payer: PHP Commercial	$5.70
Rate for Payer: Priority Health Cigna Priority Health	$4.69
Rate for Payer: Priority Health SBD	$4.22

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$158.55

Service Code	NDC 0904-6573-04
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$99.89
Max. Negotiated Rate	$142.70
Rate for Payer: Aetna Commercial	$134.77
Rate for Payer: Aetna New Business (MI Preferred)	$103.06
Rate for Payer: Cash Price	$126.84
Rate for Payer: Cofinity Commercial	$110.98
Rate for Payer: Cofinity Commercial	$136.35
Rate for Payer: Healthscope Commercial	$142.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$134.77
Rate for Payer: PHP Commercial	$134.77
Rate for Payer: Priority Health Cigna Priority Health	$110.98
Rate for Payer: Priority Health SBD	$99.89

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$131.84

Service Code	NDC 68180-320-06
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$83.06
Max. Negotiated Rate	$118.66
Rate for Payer: Aetna Commercial	$112.06
Rate for Payer: Aetna New Business (MI Preferred)	$85.70
Rate for Payer: Cash Price	$105.47
Rate for Payer: Cofinity Commercial	$113.38
Rate for Payer: Cofinity Commercial	$92.29
Rate for Payer: Healthscope Commercial	$118.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.06
Rate for Payer: PHP Commercial	$112.06
Rate for Payer: Priority Health Cigna Priority Health	$92.29
Rate for Payer: Priority Health SBD	$83.06

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$252.96

Service Code	NDC 50268-141-15
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$159.36
Max. Negotiated Rate	$227.66
Rate for Payer: Aetna Commercial	$215.02
Rate for Payer: Aetna New Business (MI Preferred)	$164.42
Rate for Payer: Cash Price	$202.37
Rate for Payer: Cofinity Commercial	$177.07
Rate for Payer: Cofinity Commercial	$217.55
Rate for Payer: Healthscope Commercial	$227.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.02
Rate for Payer: PHP Commercial	$215.02
Rate for Payer: Priority Health Cigna Priority Health	$177.07
Rate for Payer: Priority Health SBD	$159.36

Know your out-of-pocket cost for care.

All Charges