Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION

Facility

$130.83

Service Code	HCPCS J1205
Hospital Charge Code	9526
Hospital Revenue Code	636
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$117.75
Rate for Payer: Aetna Commercial	$111.21
Rate for Payer: Aetna Commercial	$149.52
Rate for Payer: Aetna New Business (MI Preferred)	$85.04
Rate for Payer: Aetna New Business (MI Preferred)	$114.34
Rate for Payer: Cash Price	$104.66
Rate for Payer: Cash Price	$140.73
Rate for Payer: Cofinity Commercial	$123.14
Rate for Payer: Cofinity Commercial	$112.51
Rate for Payer: Cofinity Commercial	$91.58
Rate for Payer: Cofinity Commercial	$151.28
Rate for Payer: Healthscope Commercial	$158.32
Rate for Payer: Healthscope Commercial	$117.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$149.52
Rate for Payer: PHP Commercial	$111.21
Rate for Payer: PHP Commercial	$149.52
Rate for Payer: Priority Health Cigna Priority Health	$123.14
Rate for Payer: Priority Health Cigna Priority Health	$91.58
Rate for Payer: Priority Health SBD	$82.42
Rate for Payer: Priority Health SBD	$110.82

CHLORPROMAZINE 10 MG TABLET

Facility

$315.60

Service Code	NDC 50268-162-15
Hospital Charge Code	1653
Hospital Revenue Code	637
Min. Negotiated Rate	$198.83
Max. Negotiated Rate	$284.04
Rate for Payer: Aetna Commercial	$268.26
Rate for Payer: Aetna New Business (MI Preferred)	$205.14
Rate for Payer: Cash Price	$252.48
Rate for Payer: Cofinity Commercial	$220.92
Rate for Payer: Cofinity Commercial	$271.42
Rate for Payer: Healthscope Commercial	$284.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$268.26
Rate for Payer: PHP Commercial	$268.26
Rate for Payer: Priority Health Cigna Priority Health	$220.92
Rate for Payer: Priority Health SBD	$198.83

CHLORPROMAZINE 10 MG TABLET

Facility

$927.96

Service Code	NDC 0781-5913-01
Hospital Charge Code	1653
Hospital Revenue Code	637
Min. Negotiated Rate	$584.61
Max. Negotiated Rate	$835.16
Rate for Payer: Aetna Commercial	$788.77
Rate for Payer: Aetna New Business (MI Preferred)	$603.17
Rate for Payer: Cash Price	$742.37
Rate for Payer: Cofinity Commercial	$649.57
Rate for Payer: Cofinity Commercial	$798.05
Rate for Payer: Healthscope Commercial	$835.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$788.77
Rate for Payer: PHP Commercial	$788.77
Rate for Payer: Priority Health Cigna Priority Health	$649.57
Rate for Payer: Priority Health SBD	$584.61

CHLORPROMAZINE 10 MG TABLET

Facility

$912.79

Service Code	NDC 0832-0300-00
Hospital Charge Code	1653
Hospital Revenue Code	637
Min. Negotiated Rate	$575.06
Max. Negotiated Rate	$821.51
Rate for Payer: Aetna Commercial	$775.87
Rate for Payer: Aetna New Business (MI Preferred)	$593.31
Rate for Payer: Cash Price	$730.23
Rate for Payer: Cofinity Commercial	$638.95
Rate for Payer: Cofinity Commercial	$785.00
Rate for Payer: Healthscope Commercial	$821.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$775.87
Rate for Payer: PHP Commercial	$775.87
Rate for Payer: Priority Health Cigna Priority Health	$638.95
Rate for Payer: Priority Health SBD	$575.06

CHLORPROMAZINE 10 MG TABLET

Facility

$6.32

Service Code	NDC 50268-162-11
Hospital Charge Code	1653
Hospital Revenue Code	637
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$5.69
Rate for Payer: Aetna Commercial	$5.37
Rate for Payer: Aetna New Business (MI Preferred)	$4.11
Rate for Payer: Cash Price	$5.06
Rate for Payer: Cofinity Commercial	$4.42
Rate for Payer: Cofinity Commercial	$5.44
Rate for Payer: Healthscope Commercial	$5.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.37
Rate for Payer: PHP Commercial	$5.37
Rate for Payer: Priority Health Cigna Priority Health	$4.42
Rate for Payer: Priority Health SBD	$3.98

CHLORPROMAZINE 10 MG TABLET

Facility

$12.19

Service Code	NDC 51079-518-01
Hospital Charge Code	1653
Hospital Revenue Code	637
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$10.97
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna New Business (MI Preferred)	$7.92
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cofinity Commercial	$10.48
Rate for Payer: Cofinity Commercial	$8.53
Rate for Payer: Healthscope Commercial	$10.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.36
Rate for Payer: PHP Commercial	$10.36
Rate for Payer: Priority Health Cigna Priority Health	$8.53
Rate for Payer: Priority Health SBD	$7.68

CHLORPROMAZINE 10 MG TABLET

Facility

$1,218.78

Service Code	NDC 51079-518-20
Hospital Charge Code	1653
Hospital Revenue Code	637
Min. Negotiated Rate	$767.83
Max. Negotiated Rate	$1,096.90
Rate for Payer: Aetna Commercial	$1,035.96
Rate for Payer: Aetna New Business (MI Preferred)	$792.21
Rate for Payer: Cash Price	$975.02
Rate for Payer: Cofinity Commercial	$1,048.15
Rate for Payer: Cofinity Commercial	$853.15
Rate for Payer: Healthscope Commercial	$1,096.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,035.96
Rate for Payer: PHP Commercial	$1,035.96
Rate for Payer: Priority Health Cigna Priority Health	$853.15
Rate for Payer: Priority Health SBD	$767.83

CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION

Facility

$104.80

Service Code	HCPCS J3230
Hospital Charge Code	1649
Hospital Revenue Code	636
Min. Negotiated Rate	$66.02
Max. Negotiated Rate	$94.32
Rate for Payer: Aetna Commercial	$89.08
Rate for Payer: Aetna Commercial	$79.93
Rate for Payer: Aetna New Business (MI Preferred)	$61.13
Rate for Payer: Aetna New Business (MI Preferred)	$68.12
Rate for Payer: Cash Price	$83.84
Rate for Payer: Cash Price	$75.23
Rate for Payer: Cofinity Commercial	$80.87
Rate for Payer: Cofinity Commercial	$90.13
Rate for Payer: Cofinity Commercial	$73.36
Rate for Payer: Cofinity Commercial	$65.83
Rate for Payer: Healthscope Commercial	$84.64
Rate for Payer: Healthscope Commercial	$94.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$89.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$79.93
Rate for Payer: PHP Commercial	$79.93
Rate for Payer: PHP Commercial	$89.08
Rate for Payer: Priority Health Cigna Priority Health	$65.83
Rate for Payer: Priority Health Cigna Priority Health	$73.36
Rate for Payer: Priority Health SBD	$59.25
Rate for Payer: Priority Health SBD	$66.02

CHLORPROMAZINE 25 MG TABLET

Facility

$1,307.95

Service Code	NDC 0832-0301-00
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$824.01
Max. Negotiated Rate	$1,177.16
Rate for Payer: Aetna Commercial	$1,111.76
Rate for Payer: Aetna New Business (MI Preferred)	$850.17
Rate for Payer: Cash Price	$1,046.36
Rate for Payer: Cofinity Commercial	$1,124.84
Rate for Payer: Cofinity Commercial	$915.56
Rate for Payer: Healthscope Commercial	$1,177.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,111.76
Rate for Payer: PHP Commercial	$1,111.76
Rate for Payer: Priority Health Cigna Priority Health	$915.56
Rate for Payer: Priority Health SBD	$824.01

CHLORPROMAZINE 25 MG TABLET

Facility

$1,523.29

Service Code	NDC 51079-519-20
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$959.67
Max. Negotiated Rate	$1,370.96
Rate for Payer: Aetna Commercial	$1,294.80
Rate for Payer: Aetna New Business (MI Preferred)	$990.14
Rate for Payer: Cash Price	$1,218.63
Rate for Payer: Cofinity Commercial	$1,066.30
Rate for Payer: Cofinity Commercial	$1,310.03
Rate for Payer: Healthscope Commercial	$1,370.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,294.80
Rate for Payer: PHP Commercial	$1,294.80
Rate for Payer: Priority Health Cigna Priority Health	$1,066.30
Rate for Payer: Priority Health SBD	$959.67

CHLORPROMAZINE 25 MG TABLET

Facility

$1,293.89

Service Code	NDC 0781-5914-01
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$815.15
Max. Negotiated Rate	$1,164.50
Rate for Payer: Aetna Commercial	$1,099.81
Rate for Payer: Aetna New Business (MI Preferred)	$841.03
Rate for Payer: Cash Price	$1,035.11
Rate for Payer: Cofinity Commercial	$1,112.75
Rate for Payer: Cofinity Commercial	$905.72
Rate for Payer: Healthscope Commercial	$1,164.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,099.81
Rate for Payer: PHP Commercial	$1,099.81
Rate for Payer: Priority Health Cigna Priority Health	$905.72
Rate for Payer: Priority Health SBD	$815.15

CHLORPROMAZINE 25 MG TABLET

Facility

$1,140.71

Service Code	NDC 0904-7130-61
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$718.65
Max. Negotiated Rate	$1,026.64
Rate for Payer: Aetna Commercial	$969.60
Rate for Payer: Aetna New Business (MI Preferred)	$741.46
Rate for Payer: Cash Price	$912.57
Rate for Payer: Cofinity Commercial	$798.50
Rate for Payer: Cofinity Commercial	$981.01
Rate for Payer: Healthscope Commercial	$1,026.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$969.60
Rate for Payer: PHP Commercial	$969.60
Rate for Payer: Priority Health Cigna Priority Health	$798.50
Rate for Payer: Priority Health SBD	$718.65

CHLORPROMAZINE 25 MG TABLET

Facility

$15.24

Service Code	NDC 51079-519-01
Hospital Charge Code	1656
Hospital Revenue Code	637
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$13.72
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna New Business (MI Preferred)	$9.91
Rate for Payer: Cash Price	$12.19
Rate for Payer: Cofinity Commercial	$10.67
Rate for Payer: Cofinity Commercial	$13.11
Rate for Payer: Healthscope Commercial	$13.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.95
Rate for Payer: PHP Commercial	$12.95
Rate for Payer: Priority Health Cigna Priority Health	$10.67
Rate for Payer: Priority Health SBD	$9.60

CHLORTHALIDONE 25 MG TABLET

Facility

$868.80

Service Code	NDC 51079-058-20
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$547.34
Max. Negotiated Rate	$781.92
Rate for Payer: Aetna Commercial	$738.48
Rate for Payer: Aetna New Business (MI Preferred)	$564.72
Rate for Payer: Cash Price	$695.04
Rate for Payer: Cofinity Commercial	$608.16
Rate for Payer: Cofinity Commercial	$747.17
Rate for Payer: Healthscope Commercial	$781.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$738.48
Rate for Payer: PHP Commercial	$738.48
Rate for Payer: Priority Health Cigna Priority Health	$608.16
Rate for Payer: Priority Health SBD	$547.34

CHLORTHALIDONE 25 MG TABLET

Facility

$203.62

Service Code	NDC 0904-6900-04
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$128.28
Max. Negotiated Rate	$183.26
Rate for Payer: Aetna Commercial	$173.08
Rate for Payer: Aetna New Business (MI Preferred)	$132.35
Rate for Payer: Cash Price	$162.90
Rate for Payer: Cofinity Commercial	$142.53
Rate for Payer: Cofinity Commercial	$175.11
Rate for Payer: Healthscope Commercial	$183.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$173.08
Rate for Payer: PHP Commercial	$173.08
Rate for Payer: Priority Health Cigna Priority Health	$142.53
Rate for Payer: Priority Health SBD	$128.28

CHLORTHALIDONE 25 MG TABLET

Facility

$8.69

Service Code	NDC 51079-058-01
Hospital Charge Code	1661
Hospital Revenue Code	637
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$7.82
Rate for Payer: Aetna Commercial	$7.39
Rate for Payer: Aetna New Business (MI Preferred)	$5.65
Rate for Payer: Cash Price	$6.95
Rate for Payer: Cofinity Commercial	$6.08
Rate for Payer: Cofinity Commercial	$7.47
Rate for Payer: Healthscope Commercial	$7.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.39
Rate for Payer: PHP Commercial	$7.39
Rate for Payer: Priority Health Cigna Priority Health	$6.08
Rate for Payer: Priority Health SBD	$5.47

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$1.99

Service Code	NDC 5026886311
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna New Business (MI Preferred)	$1.29
Rate for Payer: Cash Price	$1.59
Rate for Payer: Cofinity Commercial	$1.39
Rate for Payer: Cofinity Commercial	$1.71
Rate for Payer: Healthscope Commercial	$1.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.69
Rate for Payer: PHP Commercial	$1.69
Rate for Payer: Priority Health Cigna Priority Health	$1.39
Rate for Payer: Priority Health SBD	$1.25

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$99.28

Service Code	NDC 5026886315
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$89.35
Rate for Payer: Aetna Commercial	$84.39
Rate for Payer: Aetna New Business (MI Preferred)	$64.53
Rate for Payer: Cash Price	$79.42
Rate for Payer: Cofinity Commercial	$69.50
Rate for Payer: Cofinity Commercial	$85.38
Rate for Payer: Healthscope Commercial	$89.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84.39
Rate for Payer: PHP Commercial	$84.39
Rate for Payer: Priority Health Cigna Priority Health	$69.50
Rate for Payer: Priority Health SBD	$62.55

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$30.55

Service Code	NDC 904582360
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$25.97
Rate for Payer: Aetna New Business (MI Preferred)	$19.86
Rate for Payer: Cash Price	$24.44
Rate for Payer: Cofinity Commercial	$21.38
Rate for Payer: Cofinity Commercial	$26.27
Rate for Payer: Healthscope Commercial	$27.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.97
Rate for Payer: PHP Commercial	$25.97
Rate for Payer: Priority Health Cigna Priority Health	$21.38
Rate for Payer: Priority Health SBD	$19.25

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$331.35

Service Code	NDC 7733394810
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$208.75
Max. Negotiated Rate	$298.22
Rate for Payer: Aetna Commercial	$281.65
Rate for Payer: Aetna New Business (MI Preferred)	$215.38
Rate for Payer: Cash Price	$265.08
Rate for Payer: Cofinity Commercial	$231.94
Rate for Payer: Cofinity Commercial	$284.96
Rate for Payer: Healthscope Commercial	$298.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.65
Rate for Payer: PHP Commercial	$281.65
Rate for Payer: Priority Health Cigna Priority Health	$231.94
Rate for Payer: Priority Health SBD	$208.75

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$44.65

Service Code	NDC 9629512845
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$28.13
Max. Negotiated Rate	$40.18
Rate for Payer: Aetna Commercial	$37.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: Cash Price	$35.72
Rate for Payer: Cofinity Commercial	$31.26
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Healthscope Commercial	$40.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$37.95
Rate for Payer: PHP Commercial	$37.95
Rate for Payer: Priority Health Cigna Priority Health	$31.26
Rate for Payer: Priority Health SBD	$28.13

CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET

Facility

$3.32

Service Code	NDC 7733394825
Hospital Charge Code	109842
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.82
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health Cigna Priority Health	$2.32
Rate for Payer: Priority Health SBD	$2.09

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$2.68

Service Code	NDC 5026886811
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna New Business (MI Preferred)	$1.74
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cofinity Commercial	$1.88
Rate for Payer: Cofinity Commercial	$2.30
Rate for Payer: Healthscope Commercial	$2.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.28
Rate for Payer: PHP Commercial	$2.28
Rate for Payer: Priority Health Cigna Priority Health	$1.88
Rate for Payer: Priority Health SBD	$1.69

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$108.10

Service Code	NDC 510509460
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.88
Rate for Payer: Aetna New Business (MI Preferred)	$70.26
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$91.88
Rate for Payer: PHP Commercial	$91.88
Rate for Payer: Priority Health Cigna Priority Health	$75.67
Rate for Payer: Priority Health SBD	$68.10

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE

Facility

$133.95

Service Code	NDC 5026886815
Hospital Charge Code	15636
Hospital Revenue Code	637
Min. Negotiated Rate	$84.39
Max. Negotiated Rate	$120.56
Rate for Payer: Aetna Commercial	$113.86
Rate for Payer: Aetna New Business (MI Preferred)	$87.07
Rate for Payer: Cash Price	$107.16
Rate for Payer: Cofinity Commercial	$115.20
Rate for Payer: Cofinity Commercial	$93.76
Rate for Payer: Healthscope Commercial	$120.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.86
Rate for Payer: PHP Commercial	$113.86
Rate for Payer: Priority Health Cigna Priority Health	$93.76
Rate for Payer: Priority Health SBD	$84.39

Know your out-of-pocket cost for care.

All Charges