Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDROMORPHONE 2 MG TABLET

Facility

$269.50

Service Code	NDC 42858-301-25
Hospital Charge Code	3760
Hospital Revenue Code	637
Min. Negotiated Rate	$169.78
Max. Negotiated Rate	$242.55
Rate for Payer: Aetna Commercial	$229.08
Rate for Payer: Aetna New Business (MI Preferred)	$175.18
Rate for Payer: Cash Price	$215.60
Rate for Payer: Cofinity Commercial	$188.65
Rate for Payer: Cofinity Commercial	$231.77
Rate for Payer: Healthscope Commercial	$242.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.08
Rate for Payer: PHP Commercial	$229.08
Rate for Payer: Priority Health Cigna Priority Health	$188.65
Rate for Payer: Priority Health SBD	$169.78

HYDROMORPHONE 2 MG TABLET

Facility

$269.50

Service Code	NDC 42858-301-25
Hospital Charge Code	3760
Hospital Revenue Code	637
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$242.55
Rate for Payer: Aetna Commercial	$229.08
Rate for Payer: Aetna New Business (MI Preferred)	$175.18
Rate for Payer: BCBS Complete	$107.80
Rate for Payer: Cash Price	$215.60
Rate for Payer: Cofinity Commercial	$188.65
Rate for Payer: Cofinity Commercial	$231.77
Rate for Payer: Healthscope Commercial	$242.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.08
Rate for Payer: PHP Commercial	$229.08
Rate for Payer: Priority Health Cigna Priority Health	$188.65
Rate for Payer: Priority Health SBD	$169.78

HYDROMORPHONE 4 MG TABLET

Facility

$262.20

Service Code	NDC 0054-0264-24
Hospital Charge Code	3761
Hospital Revenue Code	637
Min. Negotiated Rate	$165.19
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Commercial	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$222.87
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health Cigna Priority Health	$183.54
Rate for Payer: Priority Health SBD	$165.19

HYDROMORPHONE 4 MG TABLET

Facility

$453.55

Service Code	NDC 42858-302-25
Hospital Charge Code	3761
Hospital Revenue Code	637
Min. Negotiated Rate	$285.74
Max. Negotiated Rate	$408.20
Rate for Payer: Aetna Commercial	$385.52
Rate for Payer: Aetna New Business (MI Preferred)	$294.81
Rate for Payer: Cash Price	$362.84
Rate for Payer: Cofinity Commercial	$317.48
Rate for Payer: Cofinity Commercial	$390.05
Rate for Payer: Healthscope Commercial	$408.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$385.52
Rate for Payer: PHP Commercial	$385.52
Rate for Payer: Priority Health Cigna Priority Health	$317.48
Rate for Payer: Priority Health SBD	$285.74

HYDROMORPHONE 50 MG/50 ML PCA IV SOLUTION

Facility

$111.25

Service Code	HCPCS J1170
Hospital Charge Code	150928
Hospital Revenue Code	636
Min. Negotiated Rate	$70.09
Max. Negotiated Rate	$100.12
Rate for Payer: Aetna Commercial	$94.56
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna New Business (MI Preferred)	$25.48
Rate for Payer: Aetna New Business (MI Preferred)	$72.31
Rate for Payer: Cash Price	$89.00
Rate for Payer: Cash Price	$31.36
Rate for Payer: Cofinity Commercial	$77.88
Rate for Payer: Cofinity Commercial	$95.68
Rate for Payer: Cofinity Commercial	$27.44
Rate for Payer: Cofinity Commercial	$33.71
Rate for Payer: Healthscope Commercial	$100.12
Rate for Payer: Healthscope Commercial	$35.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.56
Rate for Payer: PHP Commercial	$33.32
Rate for Payer: PHP Commercial	$94.56
Rate for Payer: Priority Health Cigna Priority Health	$77.88
Rate for Payer: Priority Health Cigna Priority Health	$27.44
Rate for Payer: Priority Health SBD	$70.09
Rate for Payer: Priority Health SBD	$24.70

HYDROMORPHONE AVERAGE 50 MG/50 ML PCA IV SOLUTION

Facility

$111.25

Service Code	HCPCS J1170
Hospital Charge Code	190317
Hospital Revenue Code	636
Min. Negotiated Rate	$70.09
Max. Negotiated Rate	$100.12
Rate for Payer: Aetna Commercial	$94.56
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna New Business (MI Preferred)	$25.48
Rate for Payer: Aetna New Business (MI Preferred)	$72.31
Rate for Payer: Cash Price	$89.00
Rate for Payer: Cash Price	$31.36
Rate for Payer: Cofinity Commercial	$33.71
Rate for Payer: Cofinity Commercial	$95.68
Rate for Payer: Cofinity Commercial	$77.88
Rate for Payer: Cofinity Commercial	$27.44
Rate for Payer: Healthscope Commercial	$35.28
Rate for Payer: Healthscope Commercial	$100.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.32
Rate for Payer: PHP Commercial	$33.32
Rate for Payer: PHP Commercial	$94.56
Rate for Payer: Priority Health Cigna Priority Health	$27.44
Rate for Payer: Priority Health Cigna Priority Health	$77.88
Rate for Payer: Priority Health SBD	$24.70
Rate for Payer: Priority Health SBD	$70.09

HYDROMORPHONE AVERAGE 50 MG/50 ML PCA IV SOLUTION (BBC)

Facility

$39.20

Service Code	HCPCS J1170
Hospital Charge Code	301225
Hospital Revenue Code	636
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$35.28
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna Commercial	$94.56
Rate for Payer: Aetna New Business (MI Preferred)	$72.31
Rate for Payer: Aetna New Business (MI Preferred)	$25.48
Rate for Payer: Cash Price	$89.00
Rate for Payer: Cash Price	$31.36
Rate for Payer: Cofinity Commercial	$27.44
Rate for Payer: Cofinity Commercial	$77.88
Rate for Payer: Cofinity Commercial	$95.68
Rate for Payer: Cofinity Commercial	$33.71
Rate for Payer: Healthscope Commercial	$100.12
Rate for Payer: Healthscope Commercial	$35.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.32
Rate for Payer: PHP Commercial	$33.32
Rate for Payer: PHP Commercial	$94.56
Rate for Payer: Priority Health Cigna Priority Health	$77.88
Rate for Payer: Priority Health Cigna Priority Health	$27.44
Rate for Payer: Priority Health SBD	$70.09
Rate for Payer: Priority Health SBD	$24.70

HYDROMORPHONE INFUSION (IV PREMIX)

Facility

$39.20

Service Code	NDC 9900-0018-38
Hospital Charge Code	151075
Hospital Revenue Code	250
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$35.28
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna New Business (MI Preferred)	$25.48
Rate for Payer: Cash Price	$31.36
Rate for Payer: Cofinity Commercial	$27.44
Rate for Payer: Cofinity Commercial	$33.71
Rate for Payer: Healthscope Commercial	$35.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.32
Rate for Payer: PHP Commercial	$33.32
Rate for Payer: Priority Health Cigna Priority Health	$27.44
Rate for Payer: Priority Health SBD	$24.70

HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION

Facility

$233.28

Service Code	HCPCS J1170
Hospital Charge Code	10224
Hospital Revenue Code	636
Min. Negotiated Rate	$146.97
Max. Negotiated Rate	$209.95
Rate for Payer: Aetna Commercial	$198.29
Rate for Payer: Aetna Commercial	$34.42
Rate for Payer: Aetna New Business (MI Preferred)	$26.32
Rate for Payer: Aetna New Business (MI Preferred)	$151.63
Rate for Payer: Cash Price	$186.62
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cofinity Commercial	$200.62
Rate for Payer: Cofinity Commercial	$163.30
Rate for Payer: Cofinity Commercial	$28.35
Rate for Payer: Cofinity Commercial	$34.83
Rate for Payer: Healthscope Commercial	$36.45
Rate for Payer: Healthscope Commercial	$209.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$198.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.42
Rate for Payer: PHP Commercial	$34.42
Rate for Payer: PHP Commercial	$198.29
Rate for Payer: Priority Health Cigna Priority Health	$163.30
Rate for Payer: Priority Health Cigna Priority Health	$28.35
Rate for Payer: Priority Health SBD	$146.97
Rate for Payer: Priority Health SBD	$25.52

HYDROMORPHONE (PF) 2 MG/ML SYRINGE (CODE)

Facility

$27.21

Service Code	HCPCS J1170
Hospital Charge Code	163725
Hospital Revenue Code	636
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$24.49
Rate for Payer: Aetna Commercial	$23.13
Rate for Payer: Aetna New Business (MI Preferred)	$17.69
Rate for Payer: Cash Price	$21.77
Rate for Payer: Cofinity Commercial	$23.40
Rate for Payer: Cofinity Commercial	$19.05
Rate for Payer: Healthscope Commercial	$24.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.13
Rate for Payer: PHP Commercial	$23.13
Rate for Payer: Priority Health Cigna Priority Health	$19.05
Rate for Payer: Priority Health SBD	$17.14

HYDROMORPHONE VARIABLE DOSE

Facility

$14.07

Service Code	HCPCS J1170
Hospital Charge Code	150712
Hospital Revenue Code	636
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$12.66
Rate for Payer: Aetna Commercial	$11.96
Rate for Payer: Aetna New Business (MI Preferred)	$9.15
Rate for Payer: Cash Price	$11.26
Rate for Payer: Cofinity Commercial	$12.10
Rate for Payer: Cofinity Commercial	$9.85
Rate for Payer: Healthscope Commercial	$12.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.96
Rate for Payer: PHP Commercial	$11.96
Rate for Payer: Priority Health Cigna Priority Health	$9.85
Rate for Payer: Priority Health SBD	$8.86

HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION

Facility

$2,650.82

Service Code	NDC 11704-370-01
Hospital Charge Code	155400
Hospital Revenue Code	250
Min. Negotiated Rate	$1,670.02
Max. Negotiated Rate	$2,385.74
Rate for Payer: Aetna Commercial	$2,253.20
Rate for Payer: Aetna New Business (MI Preferred)	$1,723.03
Rate for Payer: Cash Price	$2,120.66
Rate for Payer: Cofinity Commercial	$2,279.71
Rate for Payer: Cofinity Commercial	$1,855.57
Rate for Payer: Healthscope Commercial	$2,385.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,253.20
Rate for Payer: PHP Commercial	$2,253.20
Rate for Payer: Priority Health Cigna Priority Health	$1,855.57
Rate for Payer: Priority Health SBD	$1,670.02

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$593.76

Service Code	NDC 68084-269-11
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$374.07
Max. Negotiated Rate	$534.38
Rate for Payer: Aetna Commercial	$504.70
Rate for Payer: Aetna New Business (MI Preferred)	$385.94
Rate for Payer: Cash Price	$475.01
Rate for Payer: Cofinity Commercial	$415.63
Rate for Payer: Cofinity Commercial	$510.63
Rate for Payer: Healthscope Commercial	$534.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$504.70
Rate for Payer: PHP Commercial	$504.70
Rate for Payer: Priority Health Cigna Priority Health	$415.63
Rate for Payer: Priority Health SBD	$374.07

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$593.76

Service Code	NDC 68084-269-01
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$374.07
Max. Negotiated Rate	$534.38
Rate for Payer: Aetna Commercial	$504.70
Rate for Payer: Aetna New Business (MI Preferred)	$385.94
Rate for Payer: Cash Price	$475.01
Rate for Payer: Cofinity Commercial	$415.63
Rate for Payer: Cofinity Commercial	$510.63
Rate for Payer: Healthscope Commercial	$534.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$504.70
Rate for Payer: PHP Commercial	$504.70
Rate for Payer: Priority Health Cigna Priority Health	$415.63
Rate for Payer: Priority Health SBD	$374.07

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$306.72

Service Code	NDC 68382-096-01
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$193.23
Max. Negotiated Rate	$276.05
Rate for Payer: Aetna Commercial	$260.71
Rate for Payer: Aetna New Business (MI Preferred)	$199.37
Rate for Payer: Cash Price	$245.38
Rate for Payer: Cofinity Commercial	$214.70
Rate for Payer: Cofinity Commercial	$263.78
Rate for Payer: Healthscope Commercial	$276.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$260.71
Rate for Payer: PHP Commercial	$260.71
Rate for Payer: Priority Health Cigna Priority Health	$214.70
Rate for Payer: Priority Health SBD	$193.23

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$244.80

Service Code	NDC 63304-296-01
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$154.22
Max. Negotiated Rate	$220.32
Rate for Payer: Aetna Commercial	$208.08
Rate for Payer: Aetna New Business (MI Preferred)	$159.12
Rate for Payer: Cash Price	$195.84
Rate for Payer: Cofinity Commercial	$171.36
Rate for Payer: Cofinity Commercial	$210.53
Rate for Payer: Healthscope Commercial	$220.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.08
Rate for Payer: PHP Commercial	$208.08
Rate for Payer: Priority Health Cigna Priority Health	$171.36
Rate for Payer: Priority Health SBD	$154.22

HYDROXYUREA 500 MG CAPSULE

Facility

$358.08

Service Code	NDC 68084-284-01
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$225.59
Max. Negotiated Rate	$322.27
Rate for Payer: Aetna Commercial	$304.37
Rate for Payer: Aetna New Business (MI Preferred)	$232.75
Rate for Payer: Cash Price	$286.46
Rate for Payer: Cofinity Commercial	$250.66
Rate for Payer: Cofinity Commercial	$307.95
Rate for Payer: Healthscope Commercial	$322.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$304.37
Rate for Payer: PHP Commercial	$304.37
Rate for Payer: Priority Health Cigna Priority Health	$250.66
Rate for Payer: Priority Health SBD	$225.59

HYDROXYUREA 500 MG CAPSULE

Facility

$3.59

Service Code	NDC 68084-284-11
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$3.23
Rate for Payer: Aetna Commercial	$3.05
Rate for Payer: Aetna New Business (MI Preferred)	$2.33
Rate for Payer: Cash Price	$2.87
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Cofinity Commercial	$3.09
Rate for Payer: Healthscope Commercial	$3.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.05
Rate for Payer: PHP Commercial	$3.05
Rate for Payer: Priority Health Cigna Priority Health	$2.51
Rate for Payer: Priority Health SBD	$2.26

HYDROXYUREA 500 MG CAPSULE

Facility

$250.08

Service Code	NDC 49884-724-01
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$157.55
Max. Negotiated Rate	$225.07
Rate for Payer: Aetna Commercial	$212.57
Rate for Payer: Aetna New Business (MI Preferred)	$162.55
Rate for Payer: Cash Price	$200.06
Rate for Payer: Cofinity Commercial	$175.06
Rate for Payer: Cofinity Commercial	$215.07
Rate for Payer: Healthscope Commercial	$225.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.57
Rate for Payer: PHP Commercial	$212.57
Rate for Payer: Priority Health Cigna Priority Health	$175.06
Rate for Payer: Priority Health SBD	$157.55

HYDROXYZINE HCL 10 MG TABLET

Facility

$345.45

Service Code	NDC 63739-483-10
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$217.63
Max. Negotiated Rate	$310.90
Rate for Payer: Aetna Commercial	$293.63
Rate for Payer: Aetna New Business (MI Preferred)	$224.54
Rate for Payer: Cash Price	$276.36
Rate for Payer: Cofinity Commercial	$241.82
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Healthscope Commercial	$310.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$293.63
Rate for Payer: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$241.82
Rate for Payer: Priority Health SBD	$217.63

HYDROXYZINE HCL 10 MG TABLET

Facility

$178.60

Service Code	NDC 10702-010-01
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$112.52
Max. Negotiated Rate	$160.74
Rate for Payer: Aetna Commercial	$151.81
Rate for Payer: Aetna New Business (MI Preferred)	$116.09
Rate for Payer: Cash Price	$142.88
Rate for Payer: Cofinity Commercial	$125.02
Rate for Payer: Cofinity Commercial	$153.60
Rate for Payer: Healthscope Commercial	$160.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$151.81
Rate for Payer: PHP Commercial	$151.81
Rate for Payer: Priority Health Cigna Priority Health	$125.02
Rate for Payer: Priority Health SBD	$112.52

HYDROXYZINE HCL 10 MG TABLET

Facility

$427.70

Service Code	NDC 68084-253-01
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$384.93
Rate for Payer: Aetna Commercial	$363.54
Rate for Payer: Aetna New Business (MI Preferred)	$278.00
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$299.39
Rate for Payer: Cofinity Commercial	$367.82
Rate for Payer: Healthscope Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$363.54
Rate for Payer: PHP Commercial	$363.54
Rate for Payer: Priority Health Cigna Priority Health	$299.39
Rate for Payer: Priority Health SBD	$269.45

HYDROXYZINE HCL 10 MG TABLET

Facility

$427.70

Service Code	NDC 68084-253-11
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$384.93
Rate for Payer: Aetna Commercial	$363.54
Rate for Payer: Aetna New Business (MI Preferred)	$278.00
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$299.39
Rate for Payer: Cofinity Commercial	$367.82
Rate for Payer: Healthscope Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$363.54
Rate for Payer: PHP Commercial	$363.54
Rate for Payer: Priority Health Cigna Priority Health	$299.39
Rate for Payer: Priority Health SBD	$269.45

HYDROXYZINE HCL 10 MG TABLET

Facility

$3.58

Service Code	NDC 60687-664-11
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$3.22
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna New Business (MI Preferred)	$2.33
Rate for Payer: Cash Price	$2.86
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Healthscope Commercial	$3.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.04
Rate for Payer: PHP Commercial	$3.04
Rate for Payer: Priority Health Cigna Priority Health	$2.51
Rate for Payer: Priority Health SBD	$2.26

HYDROXYZINE HCL 10 MG TABLET

Facility

$357.20

Service Code	NDC 60687-664-01
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$225.04
Max. Negotiated Rate	$321.48
Rate for Payer: Aetna Commercial	$303.62
Rate for Payer: Aetna New Business (MI Preferred)	$232.18
Rate for Payer: Cash Price	$285.76
Rate for Payer: Cofinity Commercial	$250.04
Rate for Payer: Cofinity Commercial	$307.19
Rate for Payer: Healthscope Commercial	$321.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$303.62
Rate for Payer: PHP Commercial	$303.62
Rate for Payer: Priority Health Cigna Priority Health	$250.04
Rate for Payer: Priority Health SBD	$225.04

Know your out-of-pocket cost for care.

All Charges