Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LEVOTHYROXINE 112 MCG TABLET

Facility

$2.82

Service Code	NDC 42292-039-01
Hospital Charge Code	10404
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Healthscope Commercial	$2.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.40
Rate for Payer: PHP Commercial	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.97
Rate for Payer: Priority Health SBD	$1.78

LEVOTHYROXINE 112 MCG TABLET

Facility

$492.96

Service Code	NDC 60793-855-01
Hospital Charge Code	10404
Hospital Revenue Code	637
Min. Negotiated Rate	$310.56
Max. Negotiated Rate	$443.66
Rate for Payer: Aetna Commercial	$419.02
Rate for Payer: Aetna New Business (MI Preferred)	$320.42
Rate for Payer: Cash Price	$394.37
Rate for Payer: Cofinity Commercial	$345.07
Rate for Payer: Cofinity Commercial	$423.95
Rate for Payer: Healthscope Commercial	$443.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$419.02
Rate for Payer: PHP Commercial	$419.02
Rate for Payer: Priority Health Cigna Priority Health	$345.07
Rate for Payer: Priority Health SBD	$310.56

LEVOTHYROXINE 112 MCG TABLET

Facility

$217.73

Service Code	NDC 0378-1811-77
Hospital Charge Code	10404
Hospital Revenue Code	637
Min. Negotiated Rate	$137.17
Max. Negotiated Rate	$195.96
Rate for Payer: Aetna Commercial	$185.07
Rate for Payer: Aetna New Business (MI Preferred)	$141.52
Rate for Payer: Cash Price	$174.18
Rate for Payer: Cofinity Commercial	$152.41
Rate for Payer: Cofinity Commercial	$187.25
Rate for Payer: Healthscope Commercial	$195.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$185.07
Rate for Payer: PHP Commercial	$185.07
Rate for Payer: Priority Health Cigna Priority Health	$152.41
Rate for Payer: Priority Health SBD	$137.17

LEVOTHYROXINE 125 MCG TABLET

Facility

$315.84

Service Code	NDC 51079-443-20
Hospital Charge Code	4424
Hospital Revenue Code	637
Min. Negotiated Rate	$198.98
Max. Negotiated Rate	$284.26
Rate for Payer: Aetna Commercial	$268.46
Rate for Payer: Aetna New Business (MI Preferred)	$205.30
Rate for Payer: Cash Price	$252.67
Rate for Payer: Cofinity Commercial	$221.09
Rate for Payer: Cofinity Commercial	$271.62
Rate for Payer: Healthscope Commercial	$284.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$268.46
Rate for Payer: PHP Commercial	$268.46
Rate for Payer: Priority Health Cigna Priority Health	$221.09
Rate for Payer: Priority Health SBD	$198.98

LEVOTHYROXINE 125 MCG TABLET

Facility

$220.32

Service Code	NDC 0378-1813-77
Hospital Charge Code	4424
Hospital Revenue Code	637
Min. Negotiated Rate	$138.80
Max. Negotiated Rate	$198.29
Rate for Payer: Aetna Commercial	$187.27
Rate for Payer: Aetna New Business (MI Preferred)	$143.21
Rate for Payer: Cash Price	$176.26
Rate for Payer: Cofinity Commercial	$154.22
Rate for Payer: Cofinity Commercial	$189.48
Rate for Payer: Healthscope Commercial	$198.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.27
Rate for Payer: PHP Commercial	$187.27
Rate for Payer: Priority Health Cigna Priority Health	$154.22
Rate for Payer: Priority Health SBD	$138.80

LEVOTHYROXINE 125 MCG TABLET

Facility

$2,452.80

Service Code	NDC 0378-1813-10
Hospital Charge Code	4424
Hospital Revenue Code	637
Min. Negotiated Rate	$1,545.26
Max. Negotiated Rate	$2,207.52
Rate for Payer: Aetna Commercial	$2,084.88
Rate for Payer: Aetna New Business (MI Preferred)	$1,594.32
Rate for Payer: Cash Price	$1,962.24
Rate for Payer: Cofinity Commercial	$1,716.96
Rate for Payer: Cofinity Commercial	$2,109.41
Rate for Payer: Healthscope Commercial	$2,207.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,084.88
Rate for Payer: PHP Commercial	$2,084.88
Rate for Payer: Priority Health Cigna Priority Health	$1,716.96
Rate for Payer: Priority Health SBD	$1,545.26

LEVOTHYROXINE 125 MCG TABLET

Facility

$460.75

Service Code	NDC 0904-6955-61
Hospital Charge Code	4424
Hospital Revenue Code	637
Min. Negotiated Rate	$290.27
Max. Negotiated Rate	$414.68
Rate for Payer: Aetna Commercial	$391.64
Rate for Payer: Aetna New Business (MI Preferred)	$299.49
Rate for Payer: Cash Price	$368.60
Rate for Payer: Cofinity Commercial	$322.52
Rate for Payer: Cofinity Commercial	$396.24
Rate for Payer: Healthscope Commercial	$414.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$391.64
Rate for Payer: PHP Commercial	$391.64
Rate for Payer: Priority Health Cigna Priority Health	$322.52
Rate for Payer: Priority Health SBD	$290.27

LEVOTHYROXINE 125 MCG TABLET

Facility

$703.68

Service Code	NDC 0074-7068-11
Hospital Charge Code	4424
Hospital Revenue Code	637
Min. Negotiated Rate	$443.32
Max. Negotiated Rate	$633.31
Rate for Payer: Aetna Commercial	$598.13
Rate for Payer: Aetna New Business (MI Preferred)	$457.39
Rate for Payer: Cash Price	$562.94
Rate for Payer: Cofinity Commercial	$492.58
Rate for Payer: Cofinity Commercial	$605.16
Rate for Payer: Healthscope Commercial	$633.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$598.13
Rate for Payer: PHP Commercial	$598.13
Rate for Payer: Priority Health Cigna Priority Health	$492.58
Rate for Payer: Priority Health SBD	$443.32

LEVOTHYROXINE 125 MCG TABLET

Facility

$3.16

Service Code	NDC 51079-443-01
Hospital Charge Code	4424
Hospital Revenue Code	637
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.05
Rate for Payer: Cash Price	$2.53
Rate for Payer: Cofinity Commercial	$2.21
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Healthscope Commercial	$2.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.69
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health Cigna Priority Health	$2.21
Rate for Payer: Priority Health SBD	$1.99

LEVOTHYROXINE 150 MCG TABLET

Facility

$3.26

Service Code	NDC 51079-445-01
Hospital Charge Code	4425
Hospital Revenue Code	637
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna New Business (MI Preferred)	$2.12
Rate for Payer: Cash Price	$2.61
Rate for Payer: Cofinity Commercial	$2.28
Rate for Payer: Cofinity Commercial	$2.80
Rate for Payer: Healthscope Commercial	$2.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.77
Rate for Payer: PHP Commercial	$2.77
Rate for Payer: Priority Health Cigna Priority Health	$2.28
Rate for Payer: Priority Health SBD	$2.05

LEVOTHYROXINE 150 MCG TABLET

Facility

$226.80

Service Code	NDC 0378-1815-77
Hospital Charge Code	4425
Hospital Revenue Code	637
Min. Negotiated Rate	$142.88
Max. Negotiated Rate	$204.12
Rate for Payer: Aetna Commercial	$192.78
Rate for Payer: Aetna New Business (MI Preferred)	$147.42
Rate for Payer: Cash Price	$181.44
Rate for Payer: Cofinity Commercial	$158.76
Rate for Payer: Cofinity Commercial	$195.05
Rate for Payer: Healthscope Commercial	$204.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$192.78
Rate for Payer: PHP Commercial	$192.78
Rate for Payer: Priority Health Cigna Priority Health	$158.76
Rate for Payer: Priority Health SBD	$142.88

LEVOTHYROXINE 150 MCG TABLET

Facility

$325.92

Service Code	NDC 51079-445-20
Hospital Charge Code	4425
Hospital Revenue Code	637
Min. Negotiated Rate	$205.33
Max. Negotiated Rate	$293.33
Rate for Payer: Aetna Commercial	$277.03
Rate for Payer: Aetna New Business (MI Preferred)	$211.85
Rate for Payer: Cash Price	$260.74
Rate for Payer: Cofinity Commercial	$228.14
Rate for Payer: Cofinity Commercial	$280.29
Rate for Payer: Healthscope Commercial	$293.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$277.03
Rate for Payer: PHP Commercial	$277.03
Rate for Payer: Priority Health Cigna Priority Health	$228.14
Rate for Payer: Priority Health SBD	$205.33

LEVOTHYROXINE 175 MCG TABLET

Facility

$301.92

Service Code	NDC 0527-1350-01
Hospital Charge Code	10406
Hospital Revenue Code	637
Min. Negotiated Rate	$190.21
Max. Negotiated Rate	$271.73
Rate for Payer: Aetna Commercial	$256.63
Rate for Payer: Aetna New Business (MI Preferred)	$196.25
Rate for Payer: Cash Price	$241.54
Rate for Payer: Cofinity Commercial	$211.34
Rate for Payer: Cofinity Commercial	$259.65
Rate for Payer: Healthscope Commercial	$271.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$256.63
Rate for Payer: PHP Commercial	$256.63
Rate for Payer: Priority Health Cigna Priority Health	$211.34
Rate for Payer: Priority Health SBD	$190.21

LEVOTHYROXINE 175 MCG TABLET

Facility

$364.80

Service Code	NDC 42292-040-20
Hospital Charge Code	10406
Hospital Revenue Code	637
Min. Negotiated Rate	$229.82
Max. Negotiated Rate	$328.32
Rate for Payer: Aetna Commercial	$310.08
Rate for Payer: Aetna New Business (MI Preferred)	$237.12
Rate for Payer: Cash Price	$291.84
Rate for Payer: Cofinity Commercial	$255.36
Rate for Payer: Cofinity Commercial	$313.73
Rate for Payer: Healthscope Commercial	$328.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$310.08
Rate for Payer: PHP Commercial	$310.08
Rate for Payer: Priority Health Cigna Priority Health	$255.36
Rate for Payer: Priority Health SBD	$229.82

LEVOTHYROXINE 175 MCG TABLET

Facility

$3.65

Service Code	NDC 42292-040-01
Hospital Charge Code	10406
Hospital Revenue Code	637
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$3.28
Rate for Payer: Aetna Commercial	$3.10
Rate for Payer: Aetna New Business (MI Preferred)	$2.37
Rate for Payer: Cash Price	$2.92
Rate for Payer: Cofinity Commercial	$2.56
Rate for Payer: Cofinity Commercial	$3.14
Rate for Payer: Healthscope Commercial	$3.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.10
Rate for Payer: PHP Commercial	$3.10
Rate for Payer: Priority Health Cigna Priority Health	$2.56
Rate for Payer: Priority Health SBD	$2.30

LEVOTHYROXINE 25 MCG TABLET

Facility

$411.35

Service Code	NDC 51079-444-20
Hospital Charge Code	4420
Hospital Revenue Code	637
Min. Negotiated Rate	$259.15
Max. Negotiated Rate	$370.22
Rate for Payer: Aetna Commercial	$349.65
Rate for Payer: Aetna New Business (MI Preferred)	$267.38
Rate for Payer: Cash Price	$329.08
Rate for Payer: Cofinity Commercial	$287.94
Rate for Payer: Cofinity Commercial	$353.76
Rate for Payer: Healthscope Commercial	$370.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$349.65
Rate for Payer: PHP Commercial	$349.65
Rate for Payer: Priority Health Cigna Priority Health	$287.94
Rate for Payer: Priority Health SBD	$259.15

LEVOTHYROXINE 25 MCG TABLET

Facility

$289.85

Service Code	NDC 0378-1800-77
Hospital Charge Code	4420
Hospital Revenue Code	637
Min. Negotiated Rate	$182.61
Max. Negotiated Rate	$260.86
Rate for Payer: Aetna Commercial	$246.37
Rate for Payer: Aetna New Business (MI Preferred)	$188.40
Rate for Payer: Cash Price	$231.88
Rate for Payer: Cofinity Commercial	$202.90
Rate for Payer: Cofinity Commercial	$249.27
Rate for Payer: Healthscope Commercial	$260.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.37
Rate for Payer: PHP Commercial	$246.37
Rate for Payer: Priority Health Cigna Priority Health	$202.90
Rate for Payer: Priority Health SBD	$182.61

LEVOTHYROXINE 25 MCG TABLET

Facility

$3.05

Service Code	NDC 60687-453-11
Hospital Charge Code	4420
Hospital Revenue Code	637
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$2.74
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna New Business (MI Preferred)	$1.98
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cofinity Commercial	$2.14
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Healthscope Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.59
Rate for Payer: PHP Commercial	$2.59
Rate for Payer: Priority Health Cigna Priority Health	$2.14
Rate for Payer: Priority Health SBD	$1.92

LEVOTHYROXINE 25 MCG TABLET

Facility

$304.95

Service Code	NDC 60687-453-01
Hospital Charge Code	4420
Hospital Revenue Code	637
Min. Negotiated Rate	$192.12
Max. Negotiated Rate	$274.46
Rate for Payer: Aetna Commercial	$259.21
Rate for Payer: Aetna New Business (MI Preferred)	$198.22
Rate for Payer: Cash Price	$243.96
Rate for Payer: Cofinity Commercial	$213.46
Rate for Payer: Cofinity Commercial	$262.26
Rate for Payer: Healthscope Commercial	$274.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$259.21
Rate for Payer: PHP Commercial	$259.21
Rate for Payer: Priority Health Cigna Priority Health	$213.46
Rate for Payer: Priority Health SBD	$192.12

LEVOTHYROXINE 25 MCG TABLET

Facility

$4.12

Service Code	NDC 51079-444-01
Hospital Charge Code	4420
Hospital Revenue Code	637
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$3.71
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna New Business (MI Preferred)	$2.68
Rate for Payer: Cash Price	$3.30
Rate for Payer: Cofinity Commercial	$2.88
Rate for Payer: Cofinity Commercial	$3.54
Rate for Payer: Healthscope Commercial	$3.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.50
Rate for Payer: PHP Commercial	$3.50
Rate for Payer: Priority Health Cigna Priority Health	$2.88
Rate for Payer: Priority Health SBD	$2.60

LEVOTHYROXINE 50 MCG TABLET

Facility

$633.75

Service Code	NDC 0074-4552-90
Hospital Charge Code	4421
Hospital Revenue Code	637
Min. Negotiated Rate	$399.26
Max. Negotiated Rate	$570.38
Rate for Payer: Aetna Commercial	$538.69
Rate for Payer: Aetna New Business (MI Preferred)	$411.94
Rate for Payer: Cash Price	$507.00
Rate for Payer: Cofinity Commercial	$443.62
Rate for Payer: Cofinity Commercial	$545.02
Rate for Payer: Healthscope Commercial	$570.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$538.69
Rate for Payer: PHP Commercial	$538.69
Rate for Payer: Priority Health Cigna Priority Health	$443.62
Rate for Payer: Priority Health SBD	$399.26

LEVOTHYROXINE 50 MCG TABLET

Facility

$328.70

Service Code	NDC 60687-464-01
Hospital Charge Code	4421
Hospital Revenue Code	637
Min. Negotiated Rate	$207.08
Max. Negotiated Rate	$295.83
Rate for Payer: Aetna Commercial	$279.40
Rate for Payer: Aetna New Business (MI Preferred)	$213.66
Rate for Payer: Cash Price	$262.96
Rate for Payer: Cofinity Commercial	$230.09
Rate for Payer: Cofinity Commercial	$282.68
Rate for Payer: Healthscope Commercial	$295.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$279.40
Rate for Payer: PHP Commercial	$279.40
Rate for Payer: Priority Health Cigna Priority Health	$230.09
Rate for Payer: Priority Health SBD	$207.08

LEVOTHYROXINE 50 MCG TABLET

Facility

$328.32

Service Code	NDC 0378-1803-77
Hospital Charge Code	4421
Hospital Revenue Code	637
Min. Negotiated Rate	$206.84
Max. Negotiated Rate	$295.49
Rate for Payer: Aetna Commercial	$279.07
Rate for Payer: Aetna New Business (MI Preferred)	$213.41
Rate for Payer: Cash Price	$262.66
Rate for Payer: Cofinity Commercial	$229.82
Rate for Payer: Cofinity Commercial	$282.36
Rate for Payer: Healthscope Commercial	$295.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$279.07
Rate for Payer: PHP Commercial	$279.07
Rate for Payer: Priority Health Cigna Priority Health	$229.82
Rate for Payer: Priority Health SBD	$206.84

LEVOTHYROXINE 50 MCG TABLET

Facility

$3.29

Service Code	NDC 60687-464-11
Hospital Charge Code	4421
Hospital Revenue Code	637
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.96
Rate for Payer: Aetna Commercial	$2.80
Rate for Payer: Aetna New Business (MI Preferred)	$2.14
Rate for Payer: Cash Price	$2.63
Rate for Payer: Cofinity Commercial	$2.30
Rate for Payer: Cofinity Commercial	$2.83
Rate for Payer: Healthscope Commercial	$2.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.80
Rate for Payer: PHP Commercial	$2.80
Rate for Payer: Priority Health Cigna Priority Health	$2.30
Rate for Payer: Priority Health SBD	$2.07

LEVOTHYROXINE 50 MCG TABLET

Facility

$313.50

Service Code	NDC 0904-6950-61
Hospital Charge Code	4421
Hospital Revenue Code	637
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$282.15
Rate for Payer: Aetna Commercial	$266.48
Rate for Payer: Aetna New Business (MI Preferred)	$203.78
Rate for Payer: Cash Price	$250.80
Rate for Payer: Cofinity Commercial	$219.45
Rate for Payer: Cofinity Commercial	$269.61
Rate for Payer: Healthscope Commercial	$282.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$266.48
Rate for Payer: PHP Commercial	$266.48
Rate for Payer: Priority Health Cigna Priority Health	$219.45
Rate for Payer: Priority Health SBD	$197.50

Know your out-of-pocket cost for care.

All Charges